Chelation Therapy

***Disclaimer: This blog is not meant to be used as legal or medical advice.  It is written as my person perspective on how medical professionals could blend western medicine with other modalities***

Welcome to another exciting episode of The Integrated Pharmacist Podcast!  Today's topic is chelation therapy.  Chelation is the process of binding heavy metals in order to flush them out of a system.  This was originally performed in pipes.  This is the traditional method of water softening created in 1930.  During World War II, the University of Oxford used the chemical ethylene-di-amine-tetra-acetic acid (or EDTA) to combat lewisite - a chemical weapon that uses arsenic.  Since then, the same chemical has been used to treat lead and mercury poisoning.  In the 1950's, it was used on a large group of battery factory workers, again for lead poisoning.  However, the doctor discovered that patients who had previously experienced angina no longer suffered from this health issue after treatment.  Since then, the complementary and alternative medical community has continued to use this and other chelating agents to treat atherosclerosis and other diseases.  However, there has been governmental push back that there is not enough clinical evidence yet to support this indication, and the FDA does not recognize any OTC medication for this indication.

This leads us to the TACT trial.  This is a double-blind, placebo-controlled, multicenter randomized trial that began in 2003 and concluded in 2011 and included 1708 patients who had experienced a myocardial infarction.  Although critics of the therapy point out the lack of proper evidence from phase I and II trials, this trial was supported by the American College of Cardiology.  Results indicated a moderate improvement in composite cardiovascular outcomes.  In a post hoc analysis, there was evidence to further investigate this therapy in diabetic patients specifically.  This trial faced several challenges.  First, the composite endpoint made this relatively large study underpowered to detect significance.  The original design accounted for over 2300 patients, but was adjusted due to lack of ability to acquire patients within the allotted time.  Also, there was no clear understanding of the mechanism of action within the human body.  Theories of extracting calcium from calcified arterial walls had no evidence.  Others theorize that removing heavy metals like lead have a positive effect on cardiovascular outcomes that might explain the historical benefits seen.  Without the necessary underlying studies, the TACT trial has unfortunately low merit.
The reality of chelation therapy is rather burdensome as well.  A single infusion can cost $75 to $125, but standard treatment can be 30 or more infusions.  Also, an infusion can be over 3 hours long at least weekly and often 2 or 3 times a week.  If improperly administered, this therapy could be fatal.  These burdens outweigh the meager evidence.  There is still hope that chelation for cardiovascular disease could be successful for diabetic patients.  Researchers are currently investigating the TACT II trial which looks specifically at patients with a history of a heart attack and diabetes.
Of course, we should remember that this therapy already rests firmly within the bounds of western medicine for lead, mercury, and iron toxicities.  There is little evidence that it works for other diseases such as Alzheimer's or Autism, and only weak evidence that it works for atherosclerosis.  I would advise patients against this therapy for these indications.  That being said, heavy metals can cause toxicity which may exhibit as various diseases.  According to research published by the NIH, cadmium exposure can cause pulmonary and GI irritation; chromium can damage the kidneys and liver, and lead to cancer; lead poisoning can cause diminished intelligence, behavioral changes, infertility, angina, and poor vitamin D absorption; and mercury and arsenic both cause DNA damage leading to a multitude of symptoms.  If a patient were to experience heavy metal toxicity, it is possible to be misdiagnosed with other diseases.  I can see why some doctors theorize that heavy metal detoxification could be so highly curative.  It could potentially treat many different symptoms - if they're caused by heavy metal exposure.  This is an appropriate use of chelation therapy.

I would also advise caution with over-the-counter products as these have usually not been tested for efficacy.  As always, patients should counsel with their healthcare providers when looking into these kinds of therapies.  Be aware that some practitioners of chelation therapy have been known to administer false tests for heavy metal toxicity such as hair sampling.  This is an unproven method meant to trick patients into thinking they need the therapy.  It may be possible to have your blood tested for heavy metal toxicity with your primary care provider.  Results can be taken to a specialist.  If you or your patients would like to learn more about chelation therapy or to find a practitioner, a good place to start would be the American College for Advancement in Medicine at www.acam.org.  This organization provides training and certification to licensed health practitioners and education on chelation to the general public.
I would like to thank you listeners for following this podcast.  I hope you found value in this episode.  If you did, please subscribe, rate and review this podcast and tell a friend!  If you'd like to reach me for comments, concerns, questions, or suggestions, email me at integratedpharmacist@gmail.com.  To read the transcript and see references from this show, visit the associated blog at www.integratedpharmacist.blogspot.com.
References:
Lamas GA, Goertz C, Boineau R, et al. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA. 2013;309(12):1241–1250. doi:10.1001/jama.2013.2107

Tchounwou PB, Yedjou CG, Patlolla AK, Sutton DJ. Heavy metal toxicity and the environment. Exp Suppl. 2012;101:133–164. doi:10.1007/978-3-7643-8340-4_6