Letter from Publisher

Jonathan Collin, MD

Chelation Therapy for Cardiovascular Disease Gains Respect

When I was “introduced” to alternative medicine in February 1977, in Baton Rouge, Louisiana, by a district manager of Standard Process Vitamins, I was told to visit Ray Evers, MD, in Cottonwood, Alabama. Evers operated a clinic that provided intensive intravenous chelation therapy. He converted a barn into a treatment center with more than 60 beds. Patients received IV chelation daily—some received it on a continuous basis overnight. Evers didn’t limit his use of chelation to patients with cardiovascular disease. He felt it was an appropriate treatment for most degenerative conditions: heart and peripheral vascular disease, cerebrovascular disease, degenerative arthritis, neurologic disorders, diabetes, cancer, and more. Evers did rounds on his patients twice daily—early in the morning and late in the afternoon operating his facility more like a hospital than a clinic. I regret that I never made the trip to Cottonwood and did not get to observe Evers in action. Treating so many patients who were on their last legs would lead not infrequently to their passing and their relatives making a big fuss. Ultimately, the medical board in Alabama harassed Evers to the point where he had to move his operation to Mexico. Evers was never able to persuade the powers-to-be that chelation was sound medicine, efficacious, and safe.

In fact, despite a myriad of small studies that demonstrated effectiveness of chelation in treating cardiovascular disease, several larger studies done through the 1970s-1990s failed to confirm IV chelation’s treatment benefit. Various medical journals seized upon the negative outcomes of these latter studies editorializing that chelation was unproven for the treatment of atherosclerotic conditions and unsafe (!) and should not be covered by Medicare or insurance. Quackbusters included chelation in their list of quack therapies. Practitioners who focused on chelation found themselves frequently under investigation by their local boards and were often forced to justify their care but still were sanctioned and occasionally delicensed. Without public or private funding, chelation practitioners continued to document chelation effectiveness in clinical studies that the mainstream journals ignored.

All of this changed with the completion of the National Institutes of Health TACT trial completed in 2012 and published in JAMA in 2013. As reviewed by Terry Chappell, MD, in the May 2017 issue of the Townsend Letter, TACT demonstrated significant benefit of intravenous EDTA chelation therapy in patients with atherosclerotic coronary artery disease. TACT revealed that chelation was an important treatment to prevent recurrence of cardiac events in patients with heart disease. Furthermore, it demonstrated even greater prevention in diabetic patients with atherosclerotic disease. Contrary to the editorials of the past, chelation was demonstrated to be safe, period. The American College of Cardiology and American Heart Association upgraded the evidence of chelation therapy to its classification of IIb. Such a classification matches the evidence for many therapies used in the treatment of heart disease. Despite the aforementioned, some critics remain unconvinced and attempt to dismiss the findings of the TACT trial trivializing its outcome with objections to methodology. Never mind that it was a ten-year study involving multiple institutions, randomized, and double-blinded. In fact, those chelation patients who concurrently received high potency multiple vitamin supplementation as part of their chelation protocol had the best outcomes.

When I initiated chelation therapy administration in the late 1970s, my patients were informed that chelation was worthless or worse. The insurance companies balked at covering my services and Medicare challenged any billings for chelation. If I brought up chelation to a cardiologist, the immediate response was that it is unproven. What a difference 30 years makes. Now cardiologists know that chelation is an effective and safe treatment, and patients who inform their cardiologist of their chelation treatment are acknowledged positively.

It is a shame that Evers died years before the TACT trial was completed. His work would have at last received the respect it deserved.

Terry Chappell, MD, Reviews Conventional and Alternative Treatments for Hypertension

As Dr. Chappell explains in his review of hypertensive therapies in this issue, the standards for defining hypertension dramatically changed on November 13, 2017. The American Heart Association and the American College of Cardiology set new guidelines for high blood pressure; instead of 140/90, cardiologists agreed that 130/80 should be the lower limit for hypertension. The lower reading meant that there would be an immediate 12% increase of hypertensive patients in the US. The AHA and ACC did not choose to seek consensus with family doctors who opted to retain the 140/90 limit. As noted by the Stanford Prevention Research Center, 29 million additional patients would require treatment, meaning addition prescription medication. Of course, integrative and naturopathic practitioners would argue that high blood pressure should not be managed with medication, but by lifestyle changes, exercise, herbal supplements, and other approaches. Chappell comprehensively reviews what should be done.

By and large high blood pressure can be managed with diet, salt reduction, mineral supplementation, stress reduction, and, if need be, a prescription drug. But sometimes these are not sufficient—the blood pressure remains elevated. The AMA approach is that if one drug is not completely effective, then a second drug is added. And if the two together are unsatisfactory, then a third drug is added, or a fourth, or more yet! Of course, such a strategy is likely to lead to one or more adverse effects. In fact, it is not infrequent for a patient to be switched from one cocktail of anti-hypertensive drugs to another. Integrative physicians disdain such a strategy; in fact, a common goal for the practitioner and patient is to eliminate anti-hypertensive medications. But what if all these efforts fail and the patient continues to maintain an elevated blood pressure, especially in seeking this idealized limit of 130/80? Chappell offers a myriad of additional modalities that should be implemented in achieving normal blood pressure rather than stacking up medications.

Gary Huber, DO, Examines Testosterone’s Role in Cardiovascular Health

Despite the fact that many patients are being screened with the Berkley Lipoprotein analysis, ultimately treatment is based on total cholesterol and LDL. When these are high, a statin drug is prescribed and, depending on the elevation of the triglyceride level, another drug or drugs are advised. However, as Gary Huber, DO, has written in March 2016,¹ elevated LDL cholesterol due to excessive fat in the diet is not the primary, much less, the sole cause of atherosclerotic heart disease. Yet this paradigm continues to be the chief consideration in treating the heart patient; failing to treat a diabetic with a statin to reduce their elevated LDL is considered malpractice. Huber emphasizes that it is not the LDL itself but its oxidation that causes the atherosclerosis. His explanation is that the oxidized LDL is captured by the blood vessel macrophages that transform into foam cells creating the plaque. Huber explains that the oxidized LDL creates an autoimmune process creating antibodies that hasten plaque formation. An elevation of these autoantibodies is predictive of major atherosclerotic events.

In 2015, Basaria and colleagues published a paper that raised alarms about the use of testosterone in patients who have atherosclerotic disease.² Basaria’s work suggested that testosterone use posed a significant risk in men having heart disease. The paper was criticized by some for faulty methodology and statistical analysis. Nevertheless, there remains considerable concern in the conventional medical community about ad lib use of testosterone for “Low-T” not only because of cardiovascular concerns but also disputed worries about testosterone’s role in initiating prostate cancer. Furthermore, the well documented benefits of testosterone in lessening the adverse effect of lipids in the atherosclerotic process, benefitting cardiovascular health, is being ignored.

Huber and Andrew Comb, RPh examine the truths and controversies in the medical literature and argue that testosterone definitely plays a role in cardiovascular health.

Our Cover Story: Chris Meletis, ND, Introduces Us to Certification for CBD Prescribing

While many states are legalizing the purchase of marijuana in retail stores and medical dispensaries, hemp oil cannabinoid (CBD) preparations with minimal THC content is being sold widely throughout the US. CBD hemp oil is touted to have significant medical benefit in many medical conditions including seizure disorders, pain management, anxiety and depression, musculoskeletal inflammation, and cancer. Unfortunately, hemp oil products are not regulated currently, and concentrations of CBD and THC may be mislabeled. It is not infrequent that the content of CBD is minimal compared to what is specified on the label. Furthermore, products may be adulterated with heavy metals, chemicals, and pesticides. An educational and regulatory group, the International Center for Cannabis Therapy (ICCT), is seeking to certify manufacturers and products to ensure proper labeling and safety of products.

Chris Meletis, ND, has been named the Chief Medical Officer-USA of the ICCT, a role he will execute while continuing his naturopathic practice in Oregon. One of the main concerns for health practitioners is the lack of sufficient education for appropriate prescribing of CBD hemp oil. The ICCT will be offering an educational program by webinar modules leading to certification in CBD prescribing. The ICCT program will have a faculty of ICCT scientists and physicians who have researched the clinical use of cannabis and CBD. Practitioners will not only learn effective use of integrating CBD in a patient’s medical program but also will be trained about legal regulations and marketing strategies.

Jonathan Collin, MD

Publisher

1. Huber G, Bankemper B. An integrative medical approach to reversing cardiovascular disease: Practicing beyond the standard of care. March 2016. Available at www.huperpm.com.

2. Basaria S, Harman S, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels; a randomized clinical trial. JAMA, 2015. 314(6) 570-581.