The Chelation Protocol

Before chelation infusion
therapy is started a detailed study should be made of the patient
to ensure that this is an appropriate approach to the problem(s)
of the individual.

A full medical case history
and examination is the first prerequisite, including a comprehensive
personal and family history detailing all aspects of previous
health problems and current status. Questions relating to diet,
habits, emotional status, exercise, stress levels and a detailed
listing of symptoms is part of this. A full physical examination
is also required, most notably of all aspects of the circulatory
and respiratory systems.

An electrocardiogram and chest
X­ray might be required as well as a number of blood tests.
Exercise tolerance tests may be used to see just how the functioning
of the heart, lungs and circulation responds to activity. A commonly
used procedure, before chelation therapy is started, and of major
importance in establishing a ‘before’ picture of circulatory efficiency,
is the use of what is known as bi­directional Doppler (sound
wave) examination.

This is a painless, non­invasive
use of sound waves (ultrasonic) which is used to investigate six
major arterial sites which relate to circulation to the brain,
as well as eight sites which relate to circulation to the legs.
The Doppler equipment gives readings which tell the doctor running
the tests three important pieces of information at each site:

1. It shows whether there is any turbulence which could relate to breakaway deposits of plaque,
etc., which could be involved in production of a stroke.



2. It checks for any signs of capillary hardening in the brain, often associated with memory
loss and age­related brain changes.



3. The major arteries are assessed for obstructions to normal flow of blood which could relate to over­burdened heart function or deficient circulation to the legs.

This sound­wave testing
takes about an hour and all findings are recorded on charts so
that later tests can be compared. This is also an excellent way
for the patient to appreciate visually the degree of current circulatory
difficulty.

Use of thermographically (heat)
sensitive film allows areas of the body which are not receiving
their full circulatory servicing to be photographed as a record
which can be compared with the same region after treatment.

Among other tests, an initial
one is performed (not for people with diabetes) after overnight
fasting (14 hours without food). This test is usually done around
mid­morning, the last food (or coffee or sugar) having been
consumed around 9 pm the previous night. The fasting blood test
gives an accurate idea of cholesterol levels as well as other
key markers. Periodic monitoring of blood levels of cholesterol
and other elements (giving evidence of levels of blood fats, carbohydrates,
whether or not there is anaemia, infection, immune system problems,
liver or kidney dysfunction, etc.) is made during the chelation
treatment which can last for some months, with two or three infusions
per week.

Depending upon the condition
of the patient a blood sample may be required before each treatment,
or periodically.

A 24­hour sample is required
for assessment of normal urinary output of creatinine, a key guide
as to kidney status. A periodic assessment is made of the creatinine
levels of the urine as the series of chelation treatments progress,
but this does not require collection of 24­hour samples.
As with blood testing, the frequency of urine testing during a
series of chelation infusions will vary, depending on the nature
of the problem being treated and the health of the patient.

If there is any evidence that
the kidneys could not be expected to deal efficiently with the
elimination of EDTA during infusion, then the treatment series
would be delayed or stopped until this factor had been dealt with
appropriately. As we will see in a description of important research
by Doctors McDonagh, Rudolph and Cheraskin later in this chapter,
kidney dysfunction is often capable of being normalized by EDTA
chelation therapy

A computerized dietary analysis
(based on the filling in of lengthy questionnaires) of what the
patient eats is often required so that comprehensive dietary and
supplementation advice can be given to the person being chelated,
to complement the treatment.

In addition, saliva, sweat
and faeces may need to be tested for a variety of reasons, including
assessment of what the patient’s current metabolic and nutrient
status is, how well foods are being digested and absorbed, etc.
Whether such tests are needed will depend upon the individual
problems being dealt with.

This non­invasive and
inexpensive method is also sometimes used to provide an accurate
indication of heavy metal toxicity as well as to give some idea
of the current mineral status of the body. The findings from this
and the other tests allow the doctor in charge to decide just
what balance of minerals should be added to the basic EDTA infusion
solution in order to obtain the best results.

Once it has been established
that there is a problem which could benefit from EDTA infusion,
a series of treatments are scheduled, either two or three times
per week. Most chelation centres treat patients in a group setting.

A large room with appropriate
seating (usually comfortable recliners) is all that is needed
(not unlike a hairdressing or beauty salon). There are several
advantages to this approach:

1. The mutual support of people
having the same procedure is reassuring and encouraging. There
will almost always be someone present who has had a number of
infusions and who can give a personal account of what to expect.



2. The costs can be reduced,
since fewer supervisory staff are required if patients are grouped
together in this way.



3. During the 3 1/2 hours of
the infusion the patient can read, doze, chat, watch TV, listen
to a pep talk on diet or exercise from a clinician (this is a
truly ‘captive audience’).

The infusion itself involves
the insertion into a vein (usually in the hand or forearm, but
sometimes the lower leg) of a needle which is attached to the
container (hung on an adjustable stand), from which is drip­fed
around half a litre of fluid over the 3 1/2 hours’ duration of
each treatment. This liquid usually contains 2 to 3 grams of EDTA
and whatever additional minerals the doctor has decided will best
help achieve a balanced blood content.

EDTA mixture

Among the other substances
often placed in solution with the EDTA are a complex of B vitamins,
vitamin C, magnesium (extremely useful for cardiovascular health)
and heparin (an anti­coagulant, enough of which is sometimes
used just to prevent any clotting at the injection site). Cranton
suggests (Cranton and Frackelton, 1982) that since magnesium is
a natural calcium antagonist and also the ion least likely to
be removed by EDTA (see Chapter 4), and that it is relatively
deficient in many people with cardiovascular and circulatory problems,
it should be supplied with the chelation process. He suggests
that the best way to do this is to use magnesium­EDTA, which
would provide an efficient delivery system and thereby increase
magnesium stores in the body.

When the infusion is being
performed, the arm is kept stable as a rule by being taped to
a padded board which rests on a cushion for comfort. It is usually
quite possible (although it is not encouraged) for the patient
to move around freely during treatment (to visit the toilet, for
example) as long as the mobile infusion is wheeled alongside.

The rate at which the EDTA
solution is dripped into the bloodstream can be varied but usually
it is at a rate of one drop per second.

As a general rule, two, but
sometimes three, treatments are given each week, and a total of
anything from 20 (for relatively mild problems) to 30 infusions
in all comprise one complete series.

On a number of occasions (sometimes
at each visit) blood and urine testing (as well as other tests)
may be carried out to ensure that kidney and other functions are
operating sufficiently well to cope with the EDTA detoxification.
This is obviously more important in elderly patients or anyone
with compromised kidney function. In some instances where a great
deal of circulatory pathology exists, follow­up series of
chelation infusions might be encouraged, with many people showing
benefits after up to 100 infusions.

The EDTA is eliminated from
the body, 95 per cent via the kidneys and 5 per cent via the bile,
along with the toxic metals and free ionic calcium which it has
locked on to in its transit through the circulatory system.

In hospital settings, EDTA
infusions have in the past been given daily for up to five days,
followed by a two­day rest period for the kidneys. This protocol
is now discouraged by the American medical group with the most
experience of chelation, the American Academy of Medical Preventics.

General toxicity

Walker and Gordon (1982) inform
us that EDTA is far safer than aspirin, digoxin, tetracyclin,
ethyl alcohol or the nicotine from two cigarettes, in equivalent
therapeutic doses. EDTA is used in thousands of food products
(it is in most canned foods) and its toxicity is known to be extremely
low.

In assessing the relative
toxicity of a substance a therapeutic index is established. Firstly,
the amount of the substance which would prove lethal to half the
animals in an experimental setting is discovered by the gruesome
process of increasing their intake until half of them die. This
is the LD­50 measurement (LD for lethal dose). When this
amount is divided by the amount required for a therapeutic effect
we end with a number which is the therapeutic index.

The LD­50 of EDTA is
2000 milligrams per kilo of body weight, whether taken orally
or intravenously. In comparison aspirin has a toxicity equal to
558 milligrams per kilo of body weight. So in general there is
no need for concern as to general toxicity with
EDTA usage, whether by mouth (see Chapter 9) or directly into the blood.

Kidney toxicity

In the early 1950s several
deaths occurred from nephrotoxicity after EDTA treatment. At that
time the dosage used was around 10 grams per infusion, whereas
the recommended dose now adays is 3 grams.

Halstead (1979) states:

The problem in EDTA nephrotoxicity
is based upon two fundamental principles of toxicology: dosage and route of administration. Dosage is concerned with both the amount administered and the rate
of administration, or the time period in which the EDTA is given.

It appears that toxicity for
the kidneys may relate directly to too large a dose infused at
too fast a rate. In general, if no more than 3 grams is infused
in any 24­hour period (diluted with 500 ml sterile Lactated
Ringer’s solution or-except in the case of diabetes-5 per cent
dextrose solution), with a 24­hour rest period between chelation
infusions (2­3 per week) and if the infusion of these 3 grams (less than 50 milligrams per kilo of body weight) is timed to take around three hours, little if any danger exists of producing toxicity for the kidneys.

Indeed, research has shown
that in general chelation therapy improves kidney function, particularly
if any impairment to these vital organs relates to circulatory
problems.

Improved kidney function
after EDTA

McDonagh, Rudolph and Cheraskin
(1982d) have investigated the alleged toxicity of EDTA in relation
to kidney function and their results are worth some consideration.

They examined the results
of treating 383 people with a variety of chronic degenerative
disorders (primarily occlusive arterial disease) with EDTA chelation
therapy (plus supportive multivitamin/mineral supplementation)
for 50 days.

The measurement of the levels
of creatinine in the blood is commonly used in medicine as a guide
to kidney efficiency.

Creatinine is the end breakdown
product of muscle activity which is cleared from the body by filtration
through the normal kidney. The levels found in the bloodstream
are known to correlate well with the rate and efficiency of clearance,
giving a simple way of judging kidney function. The researchers
made specific measurements of the levels of creatinine in the
blood of these patients at the first visit (fasting levels) and
then gave 10 infusions of 3 grams of EDTA in a solution of 1000
cc normal saline with an interval of five days between each infusion
(supplementation was also given). After this the serum creatinine
was again assessed.

They found that a very interesting
balancing effect could be seen when the overall picture was revealed,
very similar to that noted when cholesterol ratios were examined
(see Chapter 4). Those people who initially had low levels of
serum creatinine showed a very slight increase; those in the mid­range
(normal?) showed no change and those above the mid­range
of normal and actually with a creatinine excess (therefore indicating
poor clearance by the kidneys) showed a drop towards normal.

Overall the total measurement
showed an average decline in serum levels (indicating improved
kidney function), but far more significant, according to the judgement
of the researchers, is the homoeostatic effect in which ­
whether high or low to start with ­ a tendency towards the
mid­range (between 0.5 and 1.7 milligrams/decilitre) is observed.

It seems that EDTA therapy
may actually improve kidney function if it is applied slowly
with normal dosages.

One exception


These researchers make note
of one exceptional case amongst nearly 400 patients tested in
this way, and the progression of events is worth noting as an
example which highlights both the initial concerns which some
patients might produce and the long­term benefits of chelation
therapy.

This was an 86­year­old
female in whom the initial measurement of creatinine was 1.9 mg/dl,
which is regarded as abnormally high and therefore indicative
of poor kidney function. After starting chelation every five days,
a rise was seen in the creatinine levels by day 25 (fifth infusion)
to a very unhealthy 3.5 mg/dl. As treatment progressed, it dropped
to 2.8 mg/dl by day 60 and had dropped to 1.8 mg/dl by day 100,
some time after the course of chelation therapy had finished.

As the researchers point out:
‘this emphasizes the need to follow renal function during EDTA
therapy, and, one might add, for a while after, as the benefits
frequently are not fully manifest before about three months after
treatment is over.

Special considerations:
age, heavy metals or parathyroid deficiency

If the patient is very elderly,
or has low parathyroid activity or is suffering from heavy metal
toxicity which is damaging kidney tubules, treatment should be
modified to use less EDTA less frequently (once weekly perhaps).
Heavy metals damage the kidneys and too rapid infusion can overload
them. Heavy metals most likely to produce kidney damage during
infusion therapy (if this is done too rapidly, that is) are lead,
aluminium, cadmium, mercury, nickel, copper and arsenic.

Renal function tests should
always be performed before chelation therapy is started in which
serum nitrogen (BUN) and serum creatinine is examined. In any
case of significant renal impairment, lower dosage EDTA infusions
should be used with extreme caution with suitable periods of rest
between.

Too much calcium removed

If, through inexperience or
error, there is too rapid an infusion (or too much EDTA used),
levels of calcium in the blood can drop rapidly, resulting in
cramps, tetany, convulsions, etc. An injection of calcium gluconate
will swiftly control such abnormal reactions. This hypocalcaemia
reaction is almost unheard of where the guidelines given above
are followed as to dosage, speed of infusion and spread of treatments.

Inflammation of a vein

If an infusion into a vein
is performed too rapidly, inflammation may occur (thrombophlebitis).
This is unlikely in the extreme if guidelines as described above
are followed concerning dilution of EDTA with Ringers solution
or dextrose solution and slow infusion.

Should the needle carrying
the infusion slip, a local soft tissue irritation may develop.
This may best be treated with use of alternate hot and cold packs.
Supplementation with antioxidant nutrients such as vitamins C
and E (make sure of a good source) and the mineral selenium should
protect against such an incident.

Care regarding insulin
shock and hypoglycaemia

During EDTA infusion it is
possible for blood glucose to drop, leading to insulin shock.
This is more likely amongst diabetics in whom no dextrose solution
should be used. Patients having EDTA infusions are advised to
have a snack before or during the three hours plus treatment period.
Walker and Gordon (1982) recommend the following strategy:

You should eat something before
the three to four hour infusions, but not high­calcium­containing
foods such as dairy products. Rather, eat adequate unrefined complex
carbohydrates and avoid most sugars, including overripe bananas.

During an infusion they recommend
eating fruit.

In diabetic individuals, using
zinc­bound insulin involves a risk of too rapid a release
of insulin, leading to hypoglycaemia and shock. A rapid introduction
of sugar is needed in such an instance and a change in the form
of insulin used before further EDTA infusions are tried. Most
people with known diabetes find that with chelation therapy their
requirement for insulin declines.

Congestive heart failure

If the heart is already unable
to cope adequately with movement of fluids, and there is evidence
of congestive heart failure (extreme shortness of breath, swollen
ankles) and/or if digitalis­like medication is being taken,
extreme care is needed over chelation infusions, since EDTA prevents
digitalis working adequately. Sodium EDTA would appear to be undesirable
in such people as it could increase the fluid retention tendency.
However, Halstead is adamant that:

Na2 EDTA does not appear to
have any significant deleterious effects in congestive heart patients
since the sodium (Na2) is apparently excreted intact with the
metal chelate. However, the use of 5 per cent dextrose and water
is recommended in such cases.

Short­term side­effects

A number of variable side­effects
have been observed with use of intravenous EDTA infusion, including
the following:

• Headaches ­
  which often relate
  to the same phenomenon discussed above, of low blood sugar. Eating
  before treatment, or during it, will usually prevent this possibility.
  It is reported that a common recommendation which prevents ‘EDTA­headaches’
  is that a banana, not overripe, be eaten during the first hour
  of infusion.
  
• Diarrhoca ­ this
  unusual side­effect should be treated with rest and a bland
  diet with plenty of liquids for a day or so. Urinary frequency is common
  as kidney efficiency improves and a weight loss (from fluid excretion)
  of 3­5 pounds (1.3­2.2 kg) is common after an infusion
  if fluid retention was previously evident.
  
• Local skin irritation
  may result and
  is usually associated with a reduction in zinc and vitamin B6
  (pyridoxine). For this reason supplementation of these nutrients
  is usually suggested during chelation therapy.
  
• Nausea or stomach upset
  may also be related
  to vitamin B6 deficiency in the less than one patient in 100 receiving
  chelation therapy who feels this side­effect. It is best
  treated by B6 supplementation, although short­term relief
  (up to eight hours) from nausea can be achieved by applying thumb
  pressure to a point two thumb­widths above the wrist crease
  on either forearm (acupuncture point P6) for a minute or so whenever
  the symptom is felt.
  
• Feeling faint may
  relate to a drop in blood pressure. It is common for those who
  start treatment with high blood pressure to see a return to more
  normal levels. If it were normal to start with, it could drop
  slightly as well as leading to feelings of faintness on standing
  after sitting or lying. Treatment is to rest for an hour or so
  when this happens, ideally with the feet slightly higher than
  the head. The amino acid tyrosine can safely be supplemented to
  help restore normal pressure levels if this symptom persists.
  
  
• Fever may
  develop in a very few people during the day after chelation therapy
  sessions (approximately one in 5000). Whoever is in charge of
  the treatment should be told, although the condition normally
  resolves on its own.
  
• Extreme fatigue may be felt in some people and this is usually the result of a general
  nutrient deficiency in minerals such as magnesium, zinc or potassium.
  Taking a potassium­rich supplement and/or the regular eating
  of potassium­rich foods is suggested before and during chelation
  (grapes, bananas, peaches, potato skins), as this mineral may
  be removed by the process itself.
  
• Pains in the joints
  are more likely
  where infusions are frequent (three weekly). An immediate reduction
  to once weekly is suggested, and also possibly a reduction in
  dosage of EDTA being used, if strong flu­like aches develop.
  The symptoms should pass fairly soon if these strategies are adopted.
  
  
• Cramps in
  the legs are not uncommon (one patient in 20), usually at night.
  The supplementation of magnesium (either by mouth or in the El)TA
  infusions)
  will usually prevent this happening. If it is added to the infusion
  this could be in the form of magnesium chloride or magnesium sulphate.
  Such additions also reduce the chance of local skin irritation
  at the site of the infusion.
  

Other minor side­effects
have been reported in the many millions of chelation infusions
already given, but all seem to vanish when the therapy is reduced
or stopped. As Bruce Halstead states: ‘The number of significant
untoward reactions is probably less than in any other major therapeutic
modality’