Saturday, June 29, 2013

Chelation and Chronic Disease: A History

Chelation therapy is a treatment that is often surrounded by confusion and misunderstanding. So, in evaluating this treatment, any patient or doctor should look at the scientific evidence available—which, when it comes to chelation therapy, is considerable.

And, it's important to know why chelation should be considered in the first place. To do this, it is necessary to understand the nature of chronic diseases that can take a toll on your health.

An American Epidemic
Throughout history (and even today in the Third World), there have been a number of factors that can cut lives short: war, starvation, childbirth, infectious diseases, and human and animal predators, to name a few. Here in the United States, such dangers are of less concern, but that doesn't mean we don't have serious foes to battle.

Because quality of life and medical innovations have dramatically improved in the Western world, we're living longer. And with our aging population comes a rise in deadly or disabling chronic illnesses like cardiovascular disease and cancer.

Here are some recent statistics from the CDC that might give you pause:
  • One in every two patients has at least one chronic disease.
  •  One in 10 Americans suffer from major physical limitations due to a chronic illness.
  • Approximately 70 percent of all deaths in this country are now due to chronic diseases.
  • Each year, 1.7 million Americans die from chronic diseases.
  • Heart disease, stroke and cancer account for 50 percent of all deaths in the United States.
  • One American dies every minute from a coronary event.
  • There are 635,000 new heart attacks and 280,000 recurrent heart attacks each year.
  • There are 150,000 silent first heart attacks yearly and 325,000 sudden cardiac deaths each year.
These statistics show that chronic diseases are a clear and present danger in this country, causing significant suffering before death.

An Unexpected Troublemaker
We know the usual culprits that increase our risks of chronic disease: increasing age, sex, marital status, tobacco use, elevated blood sugar, high blood pressure, high cholesterol and other blood fats, excessive weight and larger waistlines, etc.

Recently recognized risk factors are elevated high sensitivity C-reactive protein (hs-CRP) and elevated serum ferritin. The former is a sensitive measure of chronic low-grade inflammation. The latter is a measure of iron in the body which causes oxidation and inflammation when elevated. We can even measure cytokines which are the molecules released by cells to signal to other cells that it’s time to rev up inflammation.

We now know that the common cause of all chronic illnesses is inflammation. The body’s cells lose the ability to turn off inflammation which is necessary to fight off infections and heal cuts. Once the infection is controlled and the cut is healed abdominal fat cells, trans-fats, low grade infections like gingivitis, excessive sugar, genetically modified food, chronic stress, and even lack of fish oil and sleep keep inflammation turned on.

Inflammation contributes to the development of hypertension, cardiovascular disease, abdominal obesity, type 2 diabetes, cancer, Alzheimer’s Disease and many other chronic illnesses. The triggering sources for inflammation are everywhere. And there is an unrecognized risk factor damaging the body. Toxic metals just like too much iron increase inflammation dramatically worsening chronic degenerative diseases.

 In 1999 a study led by Andrea Frustaci compared biopsies of patients’ heart muscle with idiopathic dilated cardiomyopathy (IDCM or congestive heart failure of undetermined cause) compared to those with normal hearts. They found 22,000 times the concentration of mercury in the IDCM hearts compared to normal hearts. They also found 12,000 times the concentration of antimony compared to controls. The authors suggested “The increased concentration of TE (trace elements) in patients with IDCM may adversely affect mitochondrial activity and myocardial metabolism and worsen cellular function.” Mitochondria are your cells powerhouses. With reduced power production, the health of the cell is compromised and this can lead to disease and early death.

Elevated iron levels can increase oxidative stress in the lining of the arteries. Oxidative stress, think of it as rusting, produces too many free radicals that then trigger additional inflammation.  Elevated ferritin doubles a person's risk of having a heart attack if it is over 200.

Chronic lead toxicity or plumbism has been associated with hypertension and kidney damage for decades. Cadmium found in cigarettes and conventionally raised spinach contributes to lung cancer, is an estrogenic carcinogen and damages the kidneys.

Not to discount concerns about cholesterol numbers, toxic metals are at work under the radar, posing a real risk of chronic illness. We all have higher levels of many toxic metals in the body now than we did in years past. We enter the world with 1000 times more lead in our bones than people did at the turn of the last century just before the industrial revolution got started.

Given the connection between toxic metals and inflammation, you can see where toxic metal chelation offers a different approach. It doesn’t replace conventional cardiac or chronic illness care; it adds another tool to the tool chest. It compliments conventional care. Chelation therapy uses medicines or natural products that chelate or wrap around or cuddle metals so that they are deactivated and eliminated from the body.

Toxic Metals in the Body
Physicians are trained to screen for metal toxicity using blood and urine tests. These tests are primarily useful for detecting recent poisonings. Unfortunately, 3-30 days after exposure to a toxic metal there is no longer a significant level of the toxic metal left in the blood. These tests only reflect what a person has been exposed to recently. It does not reflect the total body load of toxins. So, frequently, well-trained physicians miss chronic low-level metal overload resulting in toxicity.  

For example, lead stays in the blood for 35 days. Then it spends about 40 days in the soft tissue. After that, it lingers three or four years in the trabecular bone, the bone marrow, and 16-20 years in the cortical bone, the tough outer layer of the bone. Other toxic metals accumulate in different organs of the body, causing a variety of symptoms. Regardless, the more you are exposed to toxic metals throughout your life, the more may accumulate in your body.  And the longer they will stay in your body.

The gold standard test, among physicians trained in environmental medicine, to assess the total toxic metal load that a person has involves collecting a pre-provoked urine sample. This is followed by giving the person a dose of one or more chelating agents intravenously or by mouth. Then a second sample of urine is collected for six hours. Both urines are sent to a lab which uses inductively coupled plasma mass spectrometry, ICP-MS to determine the levels of toxic metals and/or essential minerals.

A physician then compares the pre and post-test results to estimate the total toxic metal load. This is only an estimate and it is a good estimate. Until we can assess the amount of metals in each different tissue in the body, this is the best test available.

While exposure to one toxic metal is worrisome, most of us are exposed to many toxic metals over our lifetime. This condition creates a synergistic effect that can be deadly. Consider the following research:

A study utilized the LD1 (Lethal Dose 1), the widely accepted measurement of the lethal dose of a toxin needed to kill one lab rat, mouse or human out of 100 test rats, mice or humans.  The LD1 for lead was determined and separately the LD1 for mercury was determined. Then the study team combined the two metals. When an LD1 of lead was combined with an LD1 of mercury, the combination was equivalent to an LD100, the lethal dose needed to kill all 100 rats.

100 rats died that day with very small exposures to two different toxic metals in extremely low doses. Small combinations of several metals are much more toxic than either metal alone, and this explains why toxic metals can be so harmful. Unfortunately, these days virtually every tissue in the body is subjected to a daily diet of toxic metals that come in easily, and linger and poison for years.

Imagine your body as a rain barrel which slowly fills up with various toxins over many years. One only starts experiencing symptoms when the rain barrel is full and starts to overflow. Up until then the body makes adjustments to tolerate the toxins. When the body finally retains more than it can tolerate, toxic symptoms begin to occur. This toxic level will vary from person to person.

Chelation to the Rescue
If toxic metals are found in abundance on a provoked urine test, chelation is the most effective way to remove them from the body. There are different drugs that can be used in this process. Some are given intravenously, others are taken by mouth.

In addition, there are natural binders of toxic metals that can be found in a grocery store or health food store. They include chlorella, cilantro and spirulina. These are not true chelators, but they do bind toxic metals. In clinical practice, whether a chemical is a true chelator or simply effective as a binder really has no real significance. The result is that they both reduce the toxic metal burden.

By removing toxic metals from the body, chelation reduces the damage from metal-mediated free radical attacks. Since free radicals contribute to inflammation, the key to all degenerative diseases, this therapy may be very helpful in reducing inflammation.

The next area to investigate, of course, is whether or not chelation can achieve such a goal. Medical studies suggest it can.

A Timeline of Chelation Research
Research into the link between chelation and chronic disease prevention goes back 60 years. The first person to observe that chelators helped reduce the risk of cardiovascular disease was Norman E. Clarke, MD, who was the father of chelation therapy in America. In the early 1950s, Dr. Clarke, a Detroit-based cardiologist provided chelation therapy for battery factory workers who had chronic lead poisoning or plumbism. Over the course of the treatments he noticed improvement in many of the patients' cardiovascular functions, including a reduction in angina intensity and frequency, and a resolution of various EKG abnormalities.

Dr. Clarke also found unparalleled safety in using the chelator ethylene diamine tetra-acetic acid (EDTA). He used over 4,000 infusions—sometimes high doses or frequently administered doses—and observed very infrequent and mild side effects. Meanwhile he witnessed dramatic cardiovascular improvements. As a result, Dr. Clarke published his findings in the American Journal of Medical Sciences in 1955.

Because of Dr. Clarke's success with chelation, other physicians tried chelation and published their results.. Early studies often had as few as 6-20 patients, but the physicians repeatedly recorded strikingly positive improvements among study participants.

Later larger observational studies confirmed early ones. Research showed virtually every organ improved over time—the heart, brain, arteries, kidneys, liver, lungs, skin, sugar and fat metabolism, and clotting parameters. with chelation.  

In 1964, a decade after Dr. Clarke's findings were published, Albert Soffer, MD published a monograph entitled Chelation Therapy, which described the various benefits possible with intravenous EDTA in the treatment of cardiovascular conditions, especially rhythm disturbances. Dr. Soffer later went on to become editor of CHEST Journal, the official publication of the American College of Chest Physicians.

Also in the 1960s, H. Ray Evers, MD, conducted research that showed 90 percent improvement in cardiovascular symptoms for study participants over several years. As a result, he later stated, "Every cardiovascular patient deserves a therapeutic trial (of chelation) before surgery."

Chelation studies increased in the 1990s and 2000s. In 1992, Martin Rubin, PhD, wrote a chapter in the textbook Cardiovascular Drug Therapy, describing his observations of the reduction in calcium scores in coronary vessels as seen on ultrafast CT scans.

In 1993, Terry Chappell, MD, conducted a meta-analysis of 19 qualifying studies of intravenous EDTA chelation that reviewed the outcomes of 22,765 patients, and found that, overall, there was an 87 percent improvement in all participants studied.

Also in 1993 a pair of Danish physicians, Hancke and Flytlie, published a study on EDTA chelation in 470 patients over six years. 58/65 patients on the waiting list for cardiac bypass and 24/27 peripheral vascular patients on a surgical waiting list were able to cancel their surgeries after receiving EDTA chelation therapy. This saved an estimated three million dollars of insurance money. They saw no severe side effects or deaths arising from the treatment. They concluded that EDTA chelation therapy was safe, effective and cost saving.

In the mid-1990s, researchers in Brazil under the direction of Olszewer demonstrated that intravenous EDTA lead to marked improvement in 76 of 80 patients with peripheral artery disease (PAD)—a 95 percent success rate.

In 2000, Peter van der Schaar, a Dutch cardiovascular surgeon reported significant treadmill improvement in 111 patients with occlusive vascular disease after only 25 chelation treatments.

When it comes to research specifically related to chelation and cardiovascular disease, the list goes on and on. And virtually every early study was overwhelmingly successful, with patients showing marked improvement in carotid blood flow, coronary artery circulation, and peripheral arterial disease.

The most recent chelation study, sponsored by the National Institutes of Health (NIH), was the TACT study. This was a placebo controlled double blind study. This was different from the previous observational studies. Instead of the researchers observing a response to preselected patients who received chelation, this time neither the patients nor the physicians knew who was getting EDTA or a placebo. The complete results of the Trial to Assess Chelation Therapy were published in JAMA, the Journal of the American Medical Association, on March 27, 2013. The trial demonstrated an 18 percent reduction in overall risk of new cardiovascular events in people over age 50 that had already had a heart attack.

Interestingly, it demonstrated an even better response among sicker patients. A subgroup of diabetic patients had a 38% reduction in new cardiovascular events. There was a similar reduction in new events of those who had a previous anterior myocardial infarction that is more damaging to the heart than other heart attacks. Importantly, this trial not only demonstrated that chelation worked, but confirmed that EDTA chelation was safe.

What about other diseases?
What about cancer? Studies have shown that chelation has been helpful as well. In 1980, a 10-year study conducted by Joseph Bloomer, MD, showed a 90 percent reduction in the instances of cancer among patients treated with EDTA chelation. He did a follow-up study in 1989 reporting a 90 percent reduction in cancer deaths. Incidentally the population of patients studied also suffered few myocardial infarctions.

What about kidney disease? In 2003, Ja-Liang Lin, MD, published research in the New England Journal of Medicine showing that individuals with renal insufficiency who received chelation, did not progress to dialysis over a two-year period, even though the placebo group did progress to dialysis at a much higher rate. Lin has published many other studies using EDTA to slow progression in renal disease.

What about neurological illness? Many physicians have utilized chelation and the removal toxic metals in the treatment of Autism, multiple sclerosis, and mild to moderate memory loss. Advanced Alzheimer’s does not respond to chelation. Most published studies are observational studies focusing on Autism Spectrum Disorder.

Chelation Utilized around the World
There was a World Chelation Summit in Washington, DC, in March 2013. Physicians who have used chelation in their practices for 30 to 40 years were present. These physicians were from all over the world, including Ecuador, Brazil, Denmark, Belgium, Germany, Canada, Jakarta, and the United States. Some have published that chelation consistently slows down the progression of cardiovascular diseases such as coronary artery disease, PAD, and carotid artery disease in close to 90% of those treated..  And, they have noticed the positive role chelation plays in a whole range of other organ systems.

Many more have not published their results but have experienced good to excellent results in many more patients.

Next Steps
Now, especially following the TACT study, physicians who perform chelation are trying to determine which direction new research will take. These decisions are still being made, but more studies will be conducted. Even without additional studies, TACT demonstrated that chelation works and is safe. And there are 60 years of published studies and clinical observations that demonstrate the benefits of this therapy—especially for patients who are at risk of cardiovascular disease or have already-established cardiovascular disease, and for those who are concerned about reducing their chances of chronic disease.

We live in a polluted world and we are polluted too.  The only real question is whether the load of toxins, including toxic metals, is enough to contribute to illness.  A review of one’s past medical history including a careful history of personal exposures, a review of family history, a thorough physical exam and performing a provoked urine test using chelating drugs and comparing it to a baseline pre-provoked urine test can all be helpful in determining if chelation may be helpful to an individual.

If you are interested in obtaining more information about chelation which removes toxic metals from the body to slow the progression of chronic diseases, the following websites may be of help.