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Chelation: a treatment with a track record Published 3/10/2005 In a recent edition of IMN (29/8/05), there are three articles which touch on the subject of chelation. There is quite an amount of misinformation about this excellent treatment. Many agents referred to as chelating agents are in fact not chelating agents, but provide their benefits via their antioxidant properties. Irish Medical News A chelating agent is a substance that grasps heavy metals and removes them from the body via the kidneys. This can be demonstrated, and the toxic metals identified, by performing a urinary metals challenge test. The test is done by administering the chelating agent, collecting a timed urine sample, and measuring and identifying toxic metals excreted. In one of the articles, Dr Caroline Ward referred to lipoic acid and sulphur colloidal in chelating therapy. Neither of these are chelating agents. Lipoic acid is primarily an antioxidant with minimal chelating properties. It inhibits the oxidation of heavy metals, thereby preventing the formation of free radicals. It is these free radicals that damage cells and are believed to be a major factor in the chronic degenerative diseases. Colloidal silver, used by some in the treatment of autism, is a suspension of silver that kills almost all micro-intestinal organisms, but it also kills beneficial organisms. It is in itself a heavy metal, and as such is toxic. Generally, its use is not recommended. Likewise, many of the vitamins and trace elements are referred to as chelation agents which they are not. While vitamin C in large doses has some chelating properties, it mainly acts via its antioxidant effect. Certain herbs such as chlorella have very weak chelating properties. Vitamins A,C, E, and selenium together with N Acetyl cysteine and alpha-lipoic acid are essential for the manufacture of glutathione, the most abundant antioxidant in the body. These nutrients and antioxidants are used as adjuncts in the chelation process but of themselves are not chelating agents. The two most widely used and effective chelating agents are intravenous EDTA and oral DMSA. EDTA is used intravenously in the treatment of adults and is particularly effective in the treatment of heart disease, circulatory disorders and the chronic degenerative diseases. It was recently reported in the lay press that intravenous EDTA may have been responsible for the death of a five-year-old autistic child in Pittsburgh, US. While the cause of death has yet to be established, it is important to understand that intravenous EDTA has no role to play in the treatment of autism at this time. While intravenous EDTA is an excellent chelator of toxic metals such as aluminium, antimony, arsenic, cadmium, lead, uranium, silver, tin etc., as well as excess iron and copper, it is a weak chelator of mercury. In autism, mercury is believed to be the main offending agent. Concerns over rising levels of mercury are dealt with by Dr John Fleetwood in his excellent article, The impact of rising mercury levels (IMN, 29/8/05). In the case in Pittsburgh, the question must be asked: “Was EDTA given according to established protocol?” Neither of the main proponents of chelation therapy, ACAM (The American College for Advancement in Medicine) or the IBCT (International Board Of Chelation Therapists) would condone its use in the treatment of a fiveyear-old autistic child without following established guidelines. According to the recommended ACAM protocol, millions of chelations have been performed over the last 30 years with no recorded death. In western Canada,doctors are licensed to practise intravenous EDTA chelation since 1997, provided they prove themselves familiar with, and follow the protocol of, ACAM. Despite strict reporting guidelines, no serious adverse effects have been seen. The NIH in the US is presently conducting a $30 million, five-year clinical trial with intravenous EDTA using the ACAM protocol on 2,300 cardiac patients, with no serious adverse effects so far reported. The NIH also estimated that 800,000 intravenous EDTA chelations were performed in 1997 in the US alone, with no serious adverse effects. As it is only five per cent absorbed, EDTA is ineffective orally and in suppository form. The oral chelators of choice are DMPS and DMSA. Of these, the one most widely used is DMSA orally. While not as powerful as intravenous EDTA, it does chelate heavy metals and is effective in chelating mercury. Where mercury is shown to be the offending agent in adults, dental amalgams must be removed following a proper technique and a programme followed using DMSA to detoxify the tissues. Simply removing the dental amalgams by itself will not provide any benefit. A good dietary regime with nutritional supplementation is also essential. DMSA in oral form is the chelator of choice in autism, and forms part of an overall treatment programme. It is administered according to the DAN (Defeat Autism Now) protocol and does bring significant improvements in many cases. This is well documented by the Autism Research Institute in San Diego. While genetics undoubtably plays a role, were autism entirely genetic we would not be seeing the dramatic surge we see today. At least one expert using the same criteria for the diagnosis of autism for the past 30 years has found a tenfold increase in incidence. There is evidence that environmental issues and increasing mercury concentrations play a major role. That chronic, low-grade exposure to heavy metals is toxic can no longer be disputed. There is no doubt that chelation, properly administered, is both safe and effective, providing significant health benefits. It has a 30-year safety record . Were intravenous EDTA and DMSA still patentable today and of commercial interest, I have no doubt they would be widely used in conventional medicine. Dr T E Gabriel Stewart is a GP in Castleknock, Dublin The following article was published in the Irish Times on May 2nd, 2006, in response to the article "A Dose of Cynicism" by Paul O'Donoghue of The Irish Skeptics Society: Mainstream medicine hostage to vested interests Irish Times Dr Gabriel Stewart replies to a recent Health Supplement article deriding alternative treatments and puts forward his arguments for why conventional medicine deserves its share of scepticism In his article A dose of cynicism Paul O'Donoghue again takes a wide swipe at all alternative treatments that fall out of the realm of conventional medicine. He purports to understand why mainstream practitioners get involved in these treatments. While many alternative treatments are rather bizarre, and patently do not work, there are many well-trained and experienced physicians who integrate beneficial treatments into their practices that are not part of mainstream medicine. The main reason that these are not accepted is that they have not been proven by the Randomised Clinical Trials so rigorously demanded by mainstream medicine. Yet more than 80 per cent of conventional treatments have not been subject to trials. Publish Many of the treatments which become part of medical dogma do so as a result of clinical trails, many of which are fatally flawed. The following are some of the problems which have been documented by experts in the field of clinical trials such as Elmer Cranton, author JS Cohen, MD, who wrote a book entitled Overdose: The case against drug companies and James P Carter MD, a professor of nutrition in the US and author of Racketeering in Medicine: 1. Key findings in the body of these trials do not appear in the abstract or summaries of the studies, which is all the physicians, reporters, insurers and others may ever read. 2. References are selected to include only ones that support the papers' conclusions. 3. Side effects which cause drop outs are often omitted. 4. Adverse effects are usually deprecated. 5. Trials are run only as long as the outcome favours treatment. 6. Unfavourable trials are not published. 7. The use of ghost writers and figurehead authors in papers on drug research has been well documented, along with directions from sponsors to authors about what key pages to include and what findings to de-emphasise. This point has been made by a number of medical experts on the issue. 8. Only studies with the most favourable results are published. 9. More importantly, drug research gives details of relative risks, rather than absolute risk. Research findings usually also give details of the reduction of the death rate in specific categories, rather than the overall death rate which should be given in clinical trials. This last point paints a rosy, but inaccurate picture of many trials. Doctors who incorporate effective treatments in their practices that are not recommended by mainstream authorities, risk losing their licences and all that it entails. The benefits of these treatments can often be demonstrated by clinical observation and further verified by clinical tests. Pharmaceutical firms are not interested in this particular approach as there is no money to be made from these treatments. Drug manufacturers also have a serious conflict of interest in trying to balance the interests of employees and shareholders against the interest of patients. A drug can cost up to €800 million to put on the market. Nor is the National Institute of Health (NIH), in the US, nor the US Food and Drug Administration (FDA) free from the pharmaceutical industry's influence. It wasn't until last June the US House of Representatives voted to prohibit doctors and scientists who work for drug companies from sitting on FDA panels. It remains to be seen if this is confirmed by the US Senate or if the drug companies can use their enormous influence to derail it. Clinical observation is the most important vehicle for a physician to assess any treatment. However, with the advent of ever more stringent audits of doctors, the art of medicine will be further eroded. Doctors will be forced to follow treatments, many of which are based on poor science and flawed clinical trials. The cosy relationship that exists between the medical powers that be, and the powerful pharmaceutical industry will be further solidified. O'Donoghue comments on treatments that do not have a scientific base. He states: "Try wishing away appendicitis." Yet this is apparently what happens in 20 per cent of cases. Twenty per cent of appendectomies reveal appendices that are perfectly normal. While these procedures are entirely justifiable it demonstrates that surgical procedures are subject to the "mind over matter" placebo effect which science cannot explain. How many other procedures are placebo effect with no scientific basis as demanded by O'Donoghue? It is believed that on average 30 per cent of successful treatments are placebo effects. For a drug treatment to be ratified, it barely has to exceed this. O'Donoghue states that many naturally occurring materials are highly toxic. While deaths from alternative practices are rare and when happen get headline-grabbing attention, the same does not apply to conventional treatments. He fails to mention that non error, adverse effects of drugs is the fourth leading cause of death in the US each year. To put this into perspective, more people die from taking drugs correctly, as prescribed by their doctor, every year in the US than are killed in road accidents. Some of the suggestions of experts to prevent perversion of trials include the following: to prevent "manipulation" all government employees at NIH, FDA or investigating bodies should be barred from any consulting agreements, or any form of compensation or gifts. All clinical trials of devices, tests, surgeries, drugs supplements should be registered with a totally independent NIH or some other investigative body. Independent observers should be assigned to each study to ensure it was not perverted or buried. Only if these and other measurements are put in place can the public feel assured in following any treatment either mainstream or alternative. Dr Gabriel Stewart is a practising GP who uses both complementary and conventional treatments. He has a clinic in Dublin. © The Irish Times