Let’s Talk About…Chelation!

What is chelation?
Chelation is a medical intervention where an agent that attracts heavy metals is given in some form or another with the intent to remove heavy metals from the body.  Chelation therapy is offered to patients who have laboratory demonstrated elevations of heavy metals including lead, mercury, and arsenic.

Where do these metals come from?
I have the privilege of seeing patients from all around the world.  Different areas have different environmental pollutants.  Some cultures have a diet which includes a lot of seafood and people from that culture tend to have high levels of mercury because there is a large amount of mercury in some of the species of fish they consume, some people live in a very polluted environment like Kuwait when the oil fields were set on fire, others live near heavily sprayed agriculture (or golf courses), and the list goes on and on.

In a recent article, Body Burden – The Pollution of Newborns (you can read the article here) the umbilical cord blood of 10 infants were tested.   Tests revealed a total of 287 chemicals in the group. The umbilical cord blood of these 10 children, collected by Red Cross after the cord was cut, harbored pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage.  Mercury was found in the cord blood too!  We live in a toxic environment and susceptible individuals can inadvertently be poisoned by one means or another, starting from the womb.

Why don’t these metals come out naturally?
We have natural pathways that are designed to clear toxic metals from our body.  We are all born with different capacities to accomplish this task.  Some of our population is more easily “poisoned” than others.  We know the very young and the very old are especially sensitive to poisonings and heavy metal exposures.  In these cases, heavy metals can accumulate faster than they can be removed.  When they do accumulate, they can poison enzyme systems that are necessary for normal metabolic function.  Then there is a cascade of multiple metabolic dysfunctions that result in the child not being able to live at his or her full potential.

How do we test for heavy metals?
The science of detection of heavy metals is evolving nicely, but we have a long way to go.  You see, when someone is exposed to heavy metals, the heavy metals are picked up by blood and transported quickly to the metal’s tissue of choice.  This is like being in a taxi cab, you want to get to your destination and get out of the cab.  Let’s take lead for example.  Lead prefers to be bound to bone tissue.  Thus when the body is exposed to lead, the blood stream transports it to bone, and the lead then deposits there.  That’s why when a parent tells me that “they” tested the blood for lead and it was negative, all that tells me, is that the “taxi” is empty, currently (which is good because it means there is no on-going lead exposure), but tells me NOTHING about what happened 3 months ago or longer. There could have been a significant lead exposure, but today’s test won’t tell you that.  One of the most sensitive tests available at most labs (like Lab Corp) is called a Porphyrin Profile.   How this measures the total body burden of heavy metals as well as potentially pointing to a single agent is beyond the scope of today’s discussion.  Suffice it to say that this test can be serially followed while doing chelation and you can actually watch the numbers improve.  Another test, though less sensitive but a lot more gratifying is the urine toxic metal challenge.  In this test, a pre-chelation urine is obtained and evaluated for several specific heavy metals, which are ascribed a value.  When a chelating agent is then given, a follow up urine is obtained and if one or more of the heavy metals  is increased, you can see quickly (they are usually bar graphs) what is coming out (i.e. lead or mercury) and “how much” more than without the chelator.  There are some other ways to follow heavy metals, and your practitioner will certainly be well versed in one or more of these laboratory studies.

The Chelators

Calcium disodium EDTA (the only form of EDTA that I use)
This is an amino acid that attracts lead, other heavy metals, and some minerals from the bloodstream and expels the toxic elements in the urine.  EDTA works to remove excess lead from the body, but is not specific to mercury or methyl mercury like DMSA or DMPS.  It can be taken orally, rectal suppository, or given IV (intravenous).

DMSA
This is a FDA approved drug can be used in children when lead toxicity is suspected, but can remove other heavy metals including mercury and arsenic.  It can be taken orally, transdermally, or given as a suppository.

DMPS (not FDA approved)
DMPS is given with the intent to remove mercury from the body. It can be given IV, intramuscularly, subcutaneously, transdermally, or by suppository.

The Procedure
Clinicians who include chelation therapy in their practice will have their “favorite” approach to both diagnosis and treatment and monitoring.  They will often prescribe additional supplements because it is common for certain minerals to be removed during the process.  Chelation can certainly be augmented with many different approaches, such as the addition of glutathione, vitamin B12, etc.

Clinical outcomes
Yes, I have seen everywhere from marked improvement to no improvement.  There are so many variables here: age of exposure (like in the womb, 1 day old, etc), amount of exposure, type of exposure (which metals/toxins), genetic ability to handle the exposure, route of exposure, and more.  Regardless of the specifics on the variables, we know that we are trying to eliminate, to the best of our ability and as safely as possible, heavy metals.  Two current obstacles remain in our way.  One is that many of the metals’ preferred sites to “land” is the fatty tissues of the body, including the brain.  Current chelators are water soluble and reaching into the fat can be very difficult.  The second obstacle is having the chelators cross the blood-brain barrier.  That is, actually getting the chelating agent into the brain to remove heavy metals there.  With that said, there is no denying that many children improve with chelation, somehow in some manner that we just may not fully understand.

Beware!
There are many companies producing products that claim they chelate.  I would like you to ask these four simple words, “HOW DO YOU KNOW?”  They will tell you how the water changes color, the EEG changes, etc, but how do you know what you are doing is actually chelating?  There needs to be some way to monitor what we are doing.  Chelation should really be done with an experienced physician!