With the exception of using laetrile to treat cancer, few treatment modalities instill greater skepticism and outright condemnation than chelation for treating cardiovascular disease. Chelation has more recently been denigrated for its employment in treating autism. Critics point to a handful of studies done in the last 20 years that failed to demonstrate benefit in treating circulatory disorders. Of course, these critics ignore hundreds of "smaller" studies that did demonstrate effectiveness and safety of chelation for treating cardiovascular conditions. Hence, the National Institutes of Health thought that a well-organized study of chelation carried out through conventional medical channels, with the input of chelating and nonchelating doctors working together, would be an appropriate way to settle the controversy. While there were high hopes when the study was organized in 2004 that a completion date of 2009 or 2010 would be in the offing, the study organizers have predicted that it will continue for at least three more years.
Chelation therapy continues to be administered for cardiovascular disease in clinics around the US and internationally. However, treatment is not reimbursed by Medicare or private insurance. It is a rare circumstance when a controversial therapy is openly practiced in the US without the imprimatur of a medical society sanctioned by the AMA. Some practitioners administering chelation have undergone investigation by their medical boards; however, most state boards maintain a hands-off policy regarding chelation. Of course, in the event of a patient death or malpractice, physicians using chelation are invariably investigated.
In the January issue of Forbes magazine, chelation therapy came under an ad hominen attack. The premise for the article was the complaint of an individual who apparently was promised vague treatment benefits for undertaking chelation. The practitioner, who was not an MD, collected more than a $100,000 for treatment over a year. The premise of the Forbes article falls apart immediately – chelation does not cost this much. It appears that an unlicensed individual claimed to be administering chelation and was grossly overcharging the client. The Forbes article also made assertions that are utterly distorted. Chelation therapy, properly administered, is not toxic to the liver, kidneys, and other body tissues. The claim that chelation is a major threat to the kidneys has been under study for the past 50 years. Patients who have normal kidney function prior to initiating chelation have normal kidney function after its administration. Yes, patients who have abnormally functioning kidneys are at risk for worsening their kidney function if they undertake chelation. That would be the reason to assess the kidney function prior to starting chelation and prohibit patients with abnormal kidney function from receiving it. Forbes assumes that chelation does not have any benefit and makes the case that all patients are being defrauded. The author chose not to offer any positive comments about chelation – and even included a negative comment from a chelation practitioner.
Chelation is Not a 'Roto-Rooter'
In this issue of the Townsend Letter, John Parks Trowbridge, MD, makes the case for treating cardiovascular disease using intravenous EDTA chelation therapy. Trowbridge reviews the chelation literature carefully and presents the information that goes untold in Forbes and much of other critics' writing. Trowbridge has extensive experience administering chelation to patients. His treatment response is comparable to what other practitioners have seen using chelation. A majority of patients have significant improvement in their cardiovascular functioning. However, the treatment response of chelation is not based on a dissolution of plaque from the arteries. Chelation does not dissolve plaque buildup like a drain-cleaning product. Arterial plaque undergoes change with the administration of chelation in very slow fashion, generally with microscopic changes rather than gross dissolution. Following chelation, there is minimal but demonstrable increase in the diameter of the arterial channels where plaque was obstructing the circulation. A very small change in the diameter enables a significant increase in circulatory blood flow. Chelation treatment leads to functional improvements in cardiovascular physiology that are observed before anatomic changes in plaque composition are seen. The difficulty for proving chelation effectiveness has been the standard that plaque changes are required to demonstrate benefit. If the studies are restricted to assessing plaque composition, chelation treatment invariably shows limited efficacy. If the study assesses cardiovascular functioning, improvement can be shown.
Trowbridge reminds us that chelation is an effective and proven treatment to remove toxic elements from the body. The critics dismiss this role of chelation, asserting for the most part that heavy metal toxicity is not a common problem. Part of the controversy involves diagnostics, part lies with the treatment. Toxicologists set a high level for proving heavy metal toxicity and generally do not accept "increased toxic element burden." Normal and toxic levels are assigned for levels of serum lead, mercury, and arsenic – if that toxic level is not exceeded, it is assumed that the individual does not have a toxic element problem. Environmental medicine physicians think that the threshold needs to be set lower for establishing toxic element burden. Screening with hair generally reveals increased levels of these toxic elements; however, toxicologists generally deny hair measurements as being unsatisfactory for diagnosis. Chelation doctors usually assess toxic element burden by challenging the patient with a chelator such as EDTA or a sulfur-bond chelator such as DMSA or DMPS. After the person is administered the chelator by intravenous infusion or orally, urine is collected for six to eight hours. The postchelation urine specimen is evaluated for toxic elements. Generally speaking, there is a significant increase in urine toxic element levels in the postchelation sample compared with the prechelation specimen. When that increase is dramatic, chelation physicians diagnose increased toxic element burden. Unfortunately, toxicologists do not accept this postchelation challenge as a basis to diagnose heavy metal toxicity.
Chelation treatment is an effective therapy to remove toxic element burden. Uniformly, patients who undergo chelation therapy demonstrate a significant decrease in toxic elements as measured by postchelation toxic element challenge and other testing procedures. Trowbridge asserts that the lowering of toxic elements plays an important role in treating cardiovascular disease. Whether the toxic element played a direct role in the pathology or whether the removal of toxic elements indirectly improves circulation is not clear. The criticism that chelation has no clinical benefit is dismissed by theory and clinical measurement of toxic elements pre- and posttreatment. Trowbridge's article provides not only a good review of chelation's role in removing toxic elements but also the argument that it is an effective mechanism for removing these elements throughout the body.
We are pleased to present in this issue other physicians who also have evaluated the role of chelation therapy in health. Terry Chappell, MD, finds that chelation is pivotal in supporting patients with ischemic heart disease. Dr. Garry Gordon reports that chelation is critical in preventing progressive heart disease. We invite you to report your observations using chelation in the treatment of cardiovascular disease and other disorders.
Jonathan Collin, MD