Return to Treatments Available Page Chelation Therapy
YouTube Audio-Visual Presentations:
EDTA Chelation Therapy in Cardiovascular Disease (2007)
Chelation Therapy in Cardiovascular and Renal Disease - Fall 2017 ACIM Meeting
Chelation Therapy - Dr. Roberts has been providing his patients with chelation therapy (CT), in all of its forms, for 25 years. He passed the written exam of the American Board of Chelation Therapy in 1996 and has participated in the training of other physicians in this technique. Dr. Roberts was a Principal Investigator in TACT (Trial to Assess ChelationTherapy) which demonstrated the benefits of CT in patients with chronic coronary disease (in heart attack survivors adding EDTA to standard drug/interventional therapy decreased 5-year adverse event rate by 18-50%). Ten years ago there was only one approach to CT, the three hour infusion of Mg-EDTA. Today we have multiple chelating agents, many of which can be administered in more than one way. It will be Dr. Roberts' job to evaluated your need for CT and then to recommend a treatment program tailored to your individual health needs.
Chelation Therapy - The Basic Concept:
Heavy metals, such as lead, cadmium, arsenic, and mercury, poison key enzyme systems and play a key, causative role in the degenerative, age related disease states that plaque Western society. Our bodies were not designed to deal with these toxins (neither evolution or our maker anticipated the toxic metal exposure experienced by mankind today). We do a poor job of removing them, such that these toxins accumulate over our lifetime. When we are young and healthy we can handle this toxic stress, sequestering the toxins in intracellular dust bins (unless we are genetically predisposed to heavy metal toxicity, such as in the situation of Autism), but eventually our intracellular dump sites overflow, our enzymes systems begin to fail, and then we get sick. This starts with age-related conditions such as hypertension and hyperlipidemia, or we may feel tired for no good reason. In later years metal toxicity may show itself in disease states that end our lives, including heart disease, cancer, or the neurodegenerative diseases associated with advancing age. CT involves the administration of agents that will bind to the heavy metals stored within our body and then escort them out, via the kidneys or GI tract. The goal of CT is to "de-poison" you. While patients typically become interested in CT only when they suffer from an advanced disease state and no other options are available to them (basically because insurers will not cover the cost of CT), the best time to begin CT is well before your get sick. To us, CT is a no-brainer. We feel that CT is one of the most important thing that we can offer you. Standard medicine offers you drugs and surgery, as do we, but it just doesn't make sense to us to drug you and operate on you without at least attempting to detoxify you.
Chelation Therapy - Which approach is best for you?
Good question - the answer will depend on:
A. The types of metals you have on board.
B. Their tissue levels; stated otherwise your toxic burden.
C. Your concomitant medical conditions.
D. Your preference as to route of administration, how quickly you wish to be detoxified, and cost factors.
Our best measure of tissue or body metal burden is the provocative challenge study. It would be neat if your blood level of a specific toxic metal reflected your body burden of that metal, but this is not the case. The correlation between blood and tissue metal levels is limited. We also know that "normal" blood levels of toxic metals are associated with disease states The average or mean blood lead level in American adults is 3.6 ug/dl, and anything below 10 is considered to be "normal". But if you compare American adults with blood lead levels in the upper tercile (top 1/3rd), with levels above 3.6 ug/dl, against those whose levels are in the lower tercile, with levels below 1.9, and follow their course over 12 years, you find that the high normal lead individuals are 25% more likely to die than are their lower lead colleagues. Their 12 year relative risk for death due to heart attack, stroke, or cardiovascular disease in general, in comparison to the lower lead group, are 1.9, 2.5, and 1.5. That's a lot of disease and death associated with blood lead levels well within the normal range. Our conclusion is that there is no normal range for lead; we want to get lead, and any other toxic metals that are in you, our of you. Kids with a blood lead level of 10 have IQs 7 points lower than kids with levels of 0-1. Lead and Cadmium are discussed in the Medical Topics section, and within the YouTube presentations listed above; we have a four-hour YouTube presentation on Mercury and Mercury chelation).
The most accurate means of assessing your body burden of a given toxic metal would be to biopsy your brain, heart, kidneys, and liver - obviously not practical. Instead we carry out a "biochemical biopsy" or Provocative Challenge - we administer to you a chelating agent, a drug or nutritional agent that binds to, and then removes via the kidneys, the toxic metal in question from your system, and then measure its concentration in a subsequent six-hour urine sample. The amount of metal that we see in the urine sample, your "metal spill", will be a function of your body burden of this metal, the integrity of your excretory routes, the specific chelating agent that we administer, and its dose. EDTA binds avidly to lead within your system, but not to Mercury. If we are interested only in lead, we would carry out an EDTA challenge. We would administer 3,000 mg of IV EDTA, then measure the amount of lead excreted over the next six hours. We would see lead, cadmium, a few other metals, but negligible amounts of mercury. We would not see much mercury, no matter your body burden of this agent, because EDTA does not bind to mercury. If we were interested only in mercury, we would carry out a DMPS challenge. Here you would receive 3 mg/kg of DMPS, which binds tightly to mercury, and less avidly to lead. Your urine sample would likely demonstrate an appreciable amount of mercury, and not much lead. If we administered only 1.5 mg/kg of DMPS, we would see a smaller mercury spill, just as we would see less lead if we gave you 1,000 mg as apposed to the usual 3,000 mg of EDTA. DMSA, an orally administered agent, will bind to lead, cadmium, and mercury, but less avidly than would EDTA or DMPS. Comparing metal levels in a post-EDTA urine specimen to the metal spill following EDTA or DMPS would be inappropriate, really an apples to oranges comparison. Previously we would carry out a "triple challenge", administering to you IV EDTA and IV DMPS and oral DMSA. IV DMPS is not currently available, so we are carrying out a "Double Challenge", as outlined in the Provocative Challenge section. The level of toxic metals in a subsequently collected 6 hour urine specimen serves as our best measure of your soft tissue (where the biochemical processes poisoned by metals are located) body burden of these agents, and will shape the chelation program that we design for you. We will repeat the challenge study periodically, using the results to make adjustments in your program, such as when to switch from one chelator to another or whether to switch from active therapy to maintenance chelation, always using the same protocol, allowing for an apples to apples comparison. This is our best methodology but it's not a perfect methodology. Some people with high body metal burdens spill little metal on their initial challenge study. The problem is that they are so poisoned by metal, or so sick in general, that the enzymes involved in basic detoxification and excretion are shot. If we chelate these people for a period of time, and/or take other measures to improve their health, we will typically see a greater spill of metals with subsequent testing. Thus it is not unusual for your challenge report to look worse after a period of chelation. Your metal burden has not increased; what has increased is the functional integrity of your enzyme systems and excretory routs. The determination of your toxic metal body burden is the most important factor in determining our chelation prescription for you, but we will also take in to consideration your specific health care needs, your preferences, and cost factors. Representative challenge findings are presented at challenge results. Now lets examine the individual chelating agents in common use.
IV EDTA, short for ethylene diamine tetraacetic acid, binds avidly to lead and cadmium, less tightly to aluminum and arsenic, and only weakly to mercury. EDTA administered orally is poorly absorbed; only 2-4% of a given dose will enter the bloodstream. Oral EDTA works by binding to metals dumped into the GI tract by the liver, blocking their reabsorption from the gut back into the circulation (more on this later). EDTA given orally is thus a relatively inefficient approach to chelation therapy; oral EDTA works - it will decrease your body burden of lead, cadmium, and other metals that EDTA can bind to - but it works only slowly. Oral EDTA is used as an adjunct to IV chelation therapy, or as a preventive. Oral EDTA alone is not an appropriate mono-therapy for a sick patient with a heavy body metal burden. On the other hand, EDTA administered IV is an extremely efficient metal chelator. Standard chelation therapy, as it has been practice over the past 50 years, involves a 3 hour infusion of EDTA bound to magnesium (Mg-EDTA). Included in the IV bag will be 5,000 mg of vitamin C, B vitamins, and folic acid. Mg-EDTA removes toxic metals, provides anti-oxidant protection, addresses homocysteine, and provides vitamin C (see vitamin C literature review in the medical topics section) and magnesium, two key nutritionals lacking in the patient with cardiovascular disease and hypertension. We favor IV Mg-EDTA over IV Ca-EDTA for the metal overloaded patient whose primary problems are vascular insufficiency and/or hypertension. While Mg-EDTA requires a 1.5 - 3 hour infusion, Ca-EDTA can be administered over 10-20 minutes. Ca-EDTA does not provide magnesium, vitamin C, or B vitamins; all it provides is EDTA for metal detoxification, but here it is a little more efficient than is Mg-EDTA. We favor Ca-EDTA over Mg-EDTA when hypertension or atherosclerotic vascular disease are not major problems, or for the patients who cannot give up 3 hours for the Mg-EDTA infusions. We typically carry out 20 to 30 IV Mg or Ca-EDTA treatments, and then repeat the metal challenge study to monitor progress. IV EDTA is typically administered once a week, but if we are not in a hurry then every two- four week dosing is OK. We will always recommend oral EDTA as an adjunctive treatment when we treat you with IV EDTA - here's why - I will use lead as an example but the principle applies to all toxic metals. While our body does not, on its own, do a good job of clearing lead, we do try. The liver will filter lead from the circulation and from the food that we ingest. The filtered lead is secreted by the liver cells into bile, which is excreted by the liver into the GI tract, from there expelled into the stool. Lead itself is not water soluble, so the liver cells bind it to a glutathione, so it is actually the water soluble lead-glutathione complex that is excreted into the bile. The problem with this process is that the bond between glutathione and lead is not very tight. If our GI tract is functioning smoothly, the lead is excreted in the stool, but if our GI tract is sluggish, the typical situation in American adults, the lead-glutathione bond breaks before the lead can be excreted. When this happens, the lead is reabsorbed into the bloodstream, while the glutathione molecule is lost in the stool. The reabsorbed lead can be re-filtered by the liver, re-bound to a new glutathione molecule, dumped into the gut, and then reabsorbed. This process accomplishes nothing except for depletion of the liver's glutathione stores. This is a disaster, as glutathione is not only a detoxifier, it is also the primary antioxidant in our system (this is why metal toxicity is so dangerous - the metals poison us and at the same time our futile attempt to remove them weaken us further). However, if we happen to have EDTA in the gut (and 96% of the EDTA that we take in orally will remain in the gut), any lead dumped into the gut by the liver (glutathione-bound or free because the glutathione-lead bond broke) will be immediately scarfed up by the EDTA, and taken out with the stool. Oral EDTA thus converts our innate, relatively inept and self-injurious lead detoxification system into an efficient and effective lead detoxification system. Oral EDTA will also bind up any lead that you take in with your food and water. Concomitant oral EDTA greatly enhances the efficacy of the EDTA that we administer IV, be in Mg or Ca-EDTA. Our standard recommendation is that you take Med Five (Enteric coated EDTA) twice day two days pre through 2-days post each IV EDTA treatment. In this fashion we get more metal out, and we improve your tolerance to the EDTA administered IV (When we administer EDTA IV, it binds to lead and most of the EDTA-lead created is excreted via the kidneys into the urine, but some goes out via the liver, from there to re reabsorbed into the circulation, making you feel poorly the day after you receive IV EDTA. However, if you also receive oral EDTA, the lead will not be reabsorbed into the circulation.).
IV EDTA can be administered in one of three forms:
A. IV Mg-EDTA administered over three hours (ACAM Protocol). The American College for Advancement in Medicine (ACAM) has for decades been teaching practioners this safe and effective IV approach to metal detoxification. The ACAM protocol was utilized in the Trial to Assess Chelation Therapy, which demonstrated efficacy and safety (even when the protocol was provided by inexperienced practioners). I took this course, under the supervision of Dr. Ted Roczema (the guiding force and a lead author of the TACT study), 25 years ago, periodically help teach it today, and was a Principal Investigator in TACT. The upside of this approach is documented safety and efficacy and the co-administration of Mg, Vitamin C, and B Vitamins; the down side is your 3-hour time commitment.
twenty-minute infusion. European practioners used Ca-EDTA,
administered as a slow IV push or short infusion. Dr. Gary Gordon, a
co-founder of ACAM, brought this approach to the US 15 years ago. Ca-EDTA
alone is infused over 15-20 minutes, without Mg or B Vitamins, and then you
leave. We do not have clinical trials to tell us which approach is best, but
my feeling is that:
1. If the only goal is to remove metals, either approach can be used.
2. If the goal is to remove metals in patients with arterial disease or compromised kidney function, then Mg-EDTA is preferred.
The advantage here is time (one hour vs. half a day), and less stress on your veins.
C. IV Mg-EDTA given over 90 minutes (the “half bag” approach). Your EDTA dose is calculated in relation to your height, weight, age, and kidney status. The half bag approach provides ˝ of your ACAM dose, delivered over 90 minutes, with ˝ of the Mg and Vitamin C, and a full complement of B Vitamins. Experienced chelation physicians, including Dr. Terry Chappell (past president of ACAM and ICIM – the International College of Integrative Medicine, a Principal Investigator in TACT, and one of my mentors), feel that this approach is non-inferior or possibly superior to full dose EDTA given over 3 hours. While “less is better” is counterintuitive, it may be that “˝ is enough”, or that full dose Vitamin C is causing transient oxidative stress. We don’t know for sure, but there is no increased safety concern with the half bag approach, and it is easier on your back, bladder, and veins. If you wish to received IV Mg-EDTA in this fashion than we will provide it to you.
DeToxMax and Lipohos EDTA - DeToxMax and Lipophos EDTA both contains EDTA, magnesium, and lipoic acid admixed with microencapsulated Phosphatidylcholine. These preparations provide an effective oral delivery system for EDTA and Phosphatidylcholine, the two most important molecules in nutritional cardiology. For more information and case studies please click on DeToxMax and Lipophos EDTA. Med Five, which Dr. Roberts helped design, can also be used as an oral chelator.
Chelation Safety Issues - Chelation therapy is safe. Remember, we are taking poisons out of you, not putting poisons in (which in a sense we are doing with drug therapy). Still, there are issues of patient safety and treatment tolerance that we should address. The chelating agents that we administer to you do not stay in your body. They bind their target metals, and then the metal-chelator complex exits the body via the kidneys or GI tract. It is possible to overwhelm the body's excretory routes with too much metal. Let's say that you are loaded to the gills with lead, and you already have some pre-existent kidney damage. If we gave you a large dose of IV EDTA, we could mobilize far more lead than the already dysfunctional kidneys be handled. Some of the lead could get "biochemically stuck" within the kidneys and kidney function could be compromised. If we did this over and over, without checking on kidney function, we could damage the kidneys. On the other hand, studies have shown that EDTA chelation actually slows down the rate of kidney deterioration in chronic kidney disease (see Lead discussion in the Medical Topics section of this website), and this has been our experience as well (see Case Study - Kidney function improves with chelation). The key point here is to administer the EDTA in a slow and steady fashion, at a dose that the kidneys can handle. We will determine your dose of EDTA as a function of you body size and your baseline kidney function, and we will monitor your kidney function with periodic lab studies, and then adjust your EDTA dose accordingly. If we add a new drug that might affect kidney function (say a diuretic, ACEI, or spironolactone for heart failure), then we will recheck your kidney function to determine if a change in your EDTA dose is appropriate. If another Doctor changes your drug regimen, please let us know, as this may influence our decision making as well. We may recommend that you take nutritional agents that seem to help kidney function, such as asparagus extract or N-Acetyl Cysteine. While chelation therapy with EDTA does not affect liver function, some of the EDTA-metal is removed via the liver; to support liver function we may recommend Mild Thistle Extract (Silymarin) and N-Acetyl Cysteine.
Detox Reactions and Patient Tolerance - Some people are so toxic that when we mobilize the offending metals they experience a "detox reaction". They feel poorly, with muscle aching, fatigue, and nausea. Mercury overloaded individuals may experience a rash or irritability. While you certainly are not enjoying your detox reaction, it does mean that we are barking up the right tree. These metals do need to come out, but of course we do not want to torture you in the process. What we do here is to slow down the process, decreasing the dose of your chelator, and/or increasing the time interval between treatments. We may administer 1 or 2 IVs containing vitamin C, minerals, and glutathione, without a chelator. Symptoms occurring the day after chelation are typically related to GI re-uptake of metal-chelator complexes cleared by the liver into the gut (see discussion above). Here we increase the oral component of your program to help trap the toxin within the GI tract. Muscle aching and muscle spasms typically reflect mineral deficiency. The chelators bind preferentially with toxic metals, but they can bind to and remove from your body nutritional minerals as well. All patients receiving chelation should be on a 6-a-day vitamin and mineral supplement (or an alternate program guided by lab testing). We ask you to "divorce" the minerals from your chelation. Take your minerals as far apart from your chelator as is feasible. Do not take oral minerals on the morning of IV EDTA; take them that night instead. If you do take your minerals and your chelator at the same time, nothing will go wrong, but the chelator may bind up the nutritional mineral that you just took. You won't get the benefit of the mineral, and you won't get the benefit of the chelator. If you do experience muscle aching, the first thing to do is to increase your mineral supplementation.
Costs and Politics - Your insurer will not cover chelation therapy; neither will Medicare (even thought yours truly helped demonstrate cost-effective efficacy; » $5,000 for 40 EDTA treatments and mutinutritional supplementation decreased 5-year death rate in diabetic heart attack survivors by 50%). Many will say they do, and they may even put this in print in their brochures, but they will not cove the cost of your chelation. When pushed they will say that your chelation was "medically unnecessary". You can appeal, and a doctor who knows nothing about chelation therapy, a doctor who works for the insurance company, will review the records and tests that we send in and conclude that it was "medically unnecessary". There is nothing that we can do about this and the insurance companies know this. They may insist on an elevated blood lead level to confirm the diagnosis of lead or mercury overload. Anyone with even a passing knowledge of the scientific literature will tell you that blood levels do not correlate well with body metal burden in adults but your insurance company will still insist on a blood lead level. I will not bill your insurer for chelation therapy administered in my office. I do not care what they say in their literature. If you want to undergo chelation therapy and have it billed to your insurer, please have your chelation therapy done elsewhere. In addition, Medicare will not cover the cost of a creatinine level, if it is being measured only for the purpose of monitoring your EDTA dose. For this reason we must put "medically unnecessary" on the lab slip, such that the lab will not bill Medicare.
I was taught by my professors that chelation therapy was ineffective and that its practitioners were "quacks". I believed this and as a young doctor I parroted this nonsense. It wasn't that I was stupid. It wasn't because I was arrogant (well maybe a little). It was because going in to medical school/residency training, we soon-to-be physicians know nothing, and we believe what we are told by our teachers. It really takes being out in the real world for 10 years to see that not everything that we were taught is correct. My "awakening" to the benefits of chelation therapy in cardiovascular disease is discussed in Reverse Heart Disease Now. Briefly, a number of my personal patients underwent chelation therapy behind my back (this was back in my "admitting king" days) and got better. They got a lot better. It was embarrassing. So I learned how to do it so more of my patients could get better. Some inoperable patients got better. My then colleagues did not appreciate my new skill, or the direction I took back then to bring my practice to where it is now. I lost the friendship and respect of everyone (doctors, nurses, hospital administrators) who I had worked closely with for a decade. Patients left my practice, because they were told that I was a "bad doctor". Social friends learned that I was a "dirty doctor". Old friends began to shy away from me at our kids little league games. Lies and juicy half truths were sent in to the Medical Board. I stuck to my position as I was doing nothing wrong. It turns out that I was right. While I was hassled and threatened by state and federal agencies, no actions were taken against me. The NIH (National Institute of Health) later paid me to participate in TACT. I have new physician and personal friends (much better than the old crowd). I am 66 years old and have never been sued and have never been sanctioned for a patient care action (I was an Eagle Boy Scout so what do you expect!). I weathered the storm and am now stronger and smarter than I was back then (and in Med School I topped the class in the Cardiology section). So please do not expect me to defer to the wishes of practitioners who have not had a new thought in their head over the past decade. Do not expect me to put politics ahead of science. Do not expect me to compromise my judgment just to get along. In addition, if you want to pick a fight with your other doctors or with your insurance company, do not try to drag me in. I will not provide you with chelation therapy if I feel that this might compromise another, ongoing treatment, nor will we chelate you "on the sly", without the knowledge of your other doctors. I will be up front with you and you must be upfront with me - basically we all have to follow correct principles (really a great way to go through life).
James C. Roberts MD FACC FAARFM 9/3/21