What is Chelation?
The term “chelation” is derived from the Greek work “chele” which refers to the claw of a crab or lobster. It implies the firm pincher-like binding action of an organic compound to a metal ion. Chelation was first developed during WWI as an antidote to arsenic-based chemical warfare.  It was then used again after WWII for lead poisoning in navy personnel from exposure on ships. The first clinical use of chelation therapy was in 1956 to treat lead poisoned patients with severe angina.  Its efficacy for metal poisoning is well established, but there has been limited information about its use in other conditions.  Currently the Trial to Assess Chelation Therapy 2 (TACT 2) trial is in its final stages of follow-up to assess chelation use for reduction of cardiovascular events.

Chelating Agents
In chelation therapy, a chelating agent is given through an IV drip or oral pill.  Once it enters the bloodstream, the agent binds certain molecules such as metals or minerals and eliminates them from the body through the urine.  Certain chelating agents bind certain metals better than others. The most common chelating agent is EDTA (Ethylene Diamine Tetra Acetic acid).  It is known to remove substances such as lead, iron, copper and calcium and is the most extensively studied chelating agent.  Other chelating agents include DMPS, DMSA, and penicillamine.  The best way to know what agent to use is to have a urine toxic element test done to know what toxic element needs to be excreted from the body.

Testing for Heavy Metals

Current Exposure
The best method for testing for toxic elements is to do a urine provocation test.  A first morning urine test collection is done to test for current exposure to an element.  If this test shows up positive, then it shows that you are currently being exposed to some toxic element.  Testing strips can be purchased at home improvement stores to test objects in your home.  Water tests can also be done to see if exposure is through lead pipes or your well.

Hair tests are available, but are limited in their ability to test for exposure beyond a few months out since hair is constantly being shed and replaced.

Past Exposure
For the best measurement of past exposure, treatment with a chelating agent is done followed by a 6-hour urine collection.  Heavy metals from past exposure store most commonly in the bone and organs.  This post chelation urine test shows what metals are stored and have been drawn out of the bones and organs from the chelating agent.  If the post urine test shows up positive, a series of chelation treatments (usually 10-20) are done on a weekly basis.  Urine testing is then done again to see if levels have come down to the normal range.

How am I getting exposed?
The most common heavy metal toxicity comes from lead, mercury, and arsenic.  Anyone born prior to 1979 has been exposed to lead through leaded gas.  It was also around this time that lead pipes started to be replaced in homes.  Living in an older home is a risk factor from not only pipes but from lead-based paint.  Other potential sources include lead crystal, jewelry, lipstick, purses, vinyl mini-blinds, herbal medications especially from China, and candle wicks. In 1929, 30 million pounds of arsenic based pesticides were sprayed on fields in the Midwest. It is commonly found in elevated concentration in underground aquifers within Indiana that feed wells. The most common sources of mercury exposure are through dental fillings, consumption of contaminated fish, vaccines containing thimerosal, mercury thermometers, and fluorescent light bulbs.

Chelation Process

Heavy metals

1. Pre-treatment urine test, 1 treatment with EDTA, then 6-hour urine collection.
2. After results received, treatment of choice determined based on toxic elements found.
3. 10-20 treatments done once weekly with duration based upon levels found.
4. Re-testing done to determine if toxic element cleared or more treatments needed.

Atherosclerotic Plaques

1. Pre-treatment urine test, 1 treatment with EDTA, then 6-hour urine collection.
2. 40 total treatments of EDTA. The first 30 are done once weekly with the remaining 10 done every 2 weeks.

Some people choose to do additional chelation treatments once monthly or once quarterly to prevent plaque buildup from reoccurring if the diet has not been altered or if continual exposure to a heavy metal is occurring.  Oral EDTA is available, but it should be noted that best estimates put 1-month oral treatment equivalent to just 1 IV treatment.

Side Effects
Chelation therapy is fairly well tolerated by most people. Kidney function needs to be known before treatment is started. The most common side effect of chelation therapy is mineral element depletion such as zinc and magnesium.  It is recommended that one take a multivitamin and mineral supplement while the chelation protocol is being done. An infusion of vitamins and minerals can also be done once monthly during the course of treatment if needed. Hypocalcemia can also occur if the dose is infused too rapidly or is too high. Irritation at the infusion site is also possible 

Conditions Treated
Once again, chelation is well established for its use in metal toxicity. The FDA has only approved chelation therapy for metal poisoning, but there is evidence chelation can used to treat other conditions.

TACT Trial
The TACT trial was completed in 2012 enrolling 1708 patients and showed that a combination of 40 infusions with EDTA along with oral vitamins & minerals led to a significant reduction in time to first recurrent cardiovascular event in patients with prior heart attacks. The evidence in the diabetic population showed a 51% reduction in cardiac events and reduced mortality by 43%.

TACT 2 Trial
The TACT 2 Trial enrolled 1,000 patients who completed their infusions in December 2021. Subjects are followed for 2.5 to 5 years. The primary endpoint is time to first occurrence of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina.  Results are expected to be released sometime in 2024.

Other Conditions
Other conditions that show evidence of benefits from chelation therapy include:

• Diabetes
• Alzheimer’s Disease
• Collagen Vascular Disease
• Rheumatoid arthritis
• Multiple Sclerosis
• Scleroderma

Link between Heavy Metals and Vascular Disease

In the past, it was thought that heavy metals and vascular disease were 2 separate issues.  Now we understand that heavy metals can cause vascular disease. Lead interferes with nitric oxide production by the blood vessels.  Nitric oxide has many responsibilities including dilating the blood vessels, reducing platelet stickiness, reducing monocyte stickiness (prevents plaque formation), reduces multiplication of smooth muscle cells of the artery wall, reduces release of superoxide radicals, and reduces oxidation of LDL cholesterol (component of plaque).

Arsenic affects nitric oxide production like lead.  Evidence indicates that chronic arsenic exposure is associated with vasospasm and peripheral vascular insufficiency.  Blackfoot disease is a vascular disease caused by high levels of arsenic in drinking water.

Mercury toxicity causes a wide array of affects on the body including oxidative stress, inflammation, thrombosis, vascular smooth muscle proliferation and migration, endothelial dysfunction and reduced NO, dyslipidemia, immune dysfunction, and mitochondrial dysfunction.