Complementary and alternative medicine Friday Woo Medicine Quackery Skepticism/critical thinking

Your Friday Dose of Woo: Gonna wash those (heavy metal) toxins right out of your blood!

After the last couple of weeks of Your Friday Dose of Woo, I was in a bind. You see, people were telling me that they really enjoyed the last couple of weeks, particularly last week. For some reason, they were amused by my discussion of various liver cleansing regimens, hot on the heals of having discussed colon cleansing regimens. (Must be the bathroom humor; it gets ’em every time.) Some of you were surprised at the real obsession that alties have with “purifying” their insides from various “poisons” or “toxins.” As I discussed, some of these folks seem to believe that their insides are vile, disgusting places, teeming with all manner of sewage, filth, and toxins that must be cleansed. That just isn’t true (unless, maybe of course, you’re Keith Richards, in which case it’s nothing that a little dialysis and plasma exchange wouldn’t cure). Heck, even Richards doesn’t seem to need any help–as long as he doesn’t climb coconut trees, that is). Yes, occasionally, a colon perforation or necrotic bowel will indeed fill your insides with truly disgusting things (“big brown on the loose,” as we surgeons call it), but when that happens the patient becomes incredibly sick and in danger of imminent death.

So, having covered how to cleanse one’s intestines and liver, what’s left? Is it enough just to root out all the “rotting” material in your intestines and colon, plus flush out all those liver and gallstones that you supposedly have?

I think you know the answer to that one. Think about it. Your colon’s clean as a whistle; your liver’s completely flushed out. What’s left?

There’s still your blood. Or hadn’t you noticed? It’s in dire need of a cleansing.

Yes, I thought I’d continue the whole “purging” and “cleansing” theme for at least one more Friday Woo. But what, pray tell, does your blood need to be “cleansed” of? Well, if you’ve been reading this blog for very long, you know exactly what horrific substances need to be removed, pronto, if you don’t want to suffer from heart disease, autism, Alzheimer’s disease, and a wide variety of other unrelated diseases. Can you guess?

Of course you can; it’s heavy metals, of course, particularly mercury. (No, not that kind of heavy metal.)

Yes, indeedy, it’s chelation time!

Now, before we look at chelation therapy, the responsible doc in me demands that I point out that heavy metal poisoning is indeed a known clinical entity. It is indeed possible to have toxic levels of lead, mercury, iron, or other metals in your blood if you’ve been exposed to high enough amounts of them. When that happens, chelation therapy is indeed the correct treatment in order to get rid of those metals. The problem is, real metal poisoning is almost never what we’re talking about when the woos go blood purifying, as evidenced by the contents of a flier that somehow got mailed to my office many months ago:

Chelation Therapy: The Secret for a Healthier, More Energized Life!
GHL, MD – Guest Speaker
XXX Nursing/Rehab Center

Chelation therapy may be the most successful method to extend maximum life span. It is a safe, effective therapy utilizing EDTA (natural preservative), which is administered intravenously in a doctor’s office. Often, angina pain goes away, an increase in energy is experienced, along with clarity of thought, and a reduction in pain.

To register for this free community program, call the XXX Education Foundation at (XXX) XXX-XXXX
Limited to the first 35 callers.

Chelation therapy has helped with:

Aches and pains
Hardened or blocked arteries
Elevated blood cholesterol
Leg cramp pain (claudication)
Angina pain
Poor circulation
Cold extremities
Elevated blood pressure
Skin ulcers
Kidney stones
Impaired memory or concentration

Egads! Is there nothing chelation therapy isn’t good for? Osteoporosis and even kidney stones? (Never mind that chelation therapy would be expected, if anything to make osteoporosis worse. Never mind that chelation therapy can actually damage the kidneys, rather than cure stones.)

So, what is this wondrous thing called chelation therapy? Chelating agents (like EDTA) are ring-shaped, water-soluble molecules that can bind a variety of metal ions like calcium, magnesium, manganese, mercury, aluminum, nickel, zinc, and iron. Their structure allows them to form a structure around these positively-charged ions like a ring or a sphere, preventing them from exercising their toxic effects and allowing them to be more easily excreted by the kidneys. The calcium salt of EDTA, for example, exchanges its calcium ion for ions for which EDTA has more affinity, like lead, and is used for lead poisoning; the sodium salt exchanges its sodium ions for calcium and is used to treat elevated calcium levels (which can be a complication of and advanced malignancy, for example). One particular purpose for which a chelation agent (deferoxamine) is very effective is for the treatment of iron overload from multiple transfusions.

Since there was a story on NPR just yesterday about a study on the effectiveness of chelation therapy in cardiovascular disease and because cardiovascular disease is where chelation woo first got its start, before spreading and metastasizing to the treatment of practically every disease known, I thought it would be good to start there first. The vast majority of cardiovascular disease results from atherosclerotic plaques that result in the narrowing of the lumen of blood vessels, causing low blood flow to the heart when in the coronary vasculature and claudication or limb loss when in the peripheral vasculature of the leg. These deposits, after they’ve been around a while, often develop calcium deposits in them. Indeed, some atherosclerotic blood vessels can feel hard as a rock because of all the calcium. Back in the 1950’s some scientists postulated that that “hardened” arteries might be “softened” if the calcium were removed with a chelation agent. Sounds nice, neat, and logical, right?

Too bad it’s just plain wrong.

Over the years, there have been at least four mechanisms postulated to explain the supposed “efficacy” of chelation therapy. The very earliest one was the “roto-rooter” hypothesis, in which the removal of calcium from the plaques is said to cause the plaques to disintegrate. The problem is that plaque is made up of way more than just calcium. There are cells, debris, lipids, and a variety of other nastiness in there. Calcium is usually not deposited until fairly late in the process, and it is quite possible to suffer a fatal heart attack or a stroke from a calcium-free plaque. Worse, EDTA and most chelators can’t even penetrate the lipid-rich cell membranes and fatty deposits anyway, and the stoichiometry is impossible, with the maximum possible amount of calcium bound by the usual dose of EDTA being negligible, about 0.02% of total body calcium removed per dose, or 0.3% of by a full course. Big surprise, there has never been a study that shows a decrease in the amount of calcium in atherosclerotic plaques as a result of chelation therapy, nor has there ever been a study that has documented an objectively-measurable regression of atherosclerotic plaques. Consequently, even die-hard chelationists rarely mention this concept anymore.

But alties are resourceful; they soon came up with another idea, which was that lowering calcium in the blood, as chelation undeniably does, caused calcium to be removed from the bone, causing parathyroid hormone to be secreted and promote the remineralization of bone from calcium leeched from the atherosclerotic plaques. The problem is, the physiology doesn’t work that way, as is explained here. A third hypothetical mechanism proposed (and still used today) was that EDTA blocks production of free radicals by binding heavy metal ions, particularly iron. (Woos love to invoke free radicals as one purpose causes of disease almost as much as they love to invoke heavy metals.) Unfortunately, most iron is bound to proteins and unavailable to catalyze the generation of free radicals anyway. In the case of iron at least, EDTA does not decrease its oxidative capability and may actually increase it. The final hypothesis” I have recently heard of is that is winding its way through altieland; that is, that chelation somehow increases the generation of nitric oxide, a natural vasodilator. There is one study that suggests it might improve blood flow by this mechanism. This is the study all the chelationists tout. What the chelationists won’t tell you is that it was a small study with only 8 patients and that a more recent, randomized, double-blind, placebo-controlled study failed to show any benefit in terms of increased blood flow.

There have been several clinical studies that are described in detail here, here, here, and here. To this day, no properly randomized, double-blind study has ever shown any benefit from chelation therapy for symptoms of cardiac disease or peripheral vascular disease. For nearly any “conventional” medical therapy, the combined weight of the presently existing studies would have almost certainly been enough to put a final stake through its heart and then shine sunlight on it so that it explodes in flame. Not so for chelation therapy. So great is the clamor for chelation therapy by alties that the National Center for Complementary and Alternative Medicine decided to sponsor yet another clinical trial to test the efficacy of chelation therapy in cardiovascular disease. As Dr. R. W. recounts, the study is not particularly well-designed. For one thing, only 12 of the 110 study sites are in academic medical centers with the infrastructure, expertise, and experience necessary to carry out such a large trial. Many of the nonacademic sites have names like Integrated Healing Arts, Hyperbaric Medicine, Inc., M.T.O. Holistic Center, and the Magaziner Center for Wellness. Dr. R. W. promises to profile some of these centers in a little piece he plans on calling a Magical Mystery Tour of NCCAM Chelation Study Sites, but let me just mention one: The Chelation Centers of Texas. CCT offers chelation therapy for a variety of illnesses; IV hydrogen peroxide therapy for asthma, emphysema, and other diseases; and touts N-acetyl-cysteine as “reducing cancer by 90%. (That ought to tell you all you need to know about CCT.) Worse, as Dr. R.W. reports, the double-blinding of the study may not be adequate, allowing investigators to be able to figure out fairly easily who’s getting EDTA and who’s getting placebo, possibly without even trying to, thus potentially introducing observer bias into the study.

Even so, my guess is still that the NCCAM trial will be negative too. Even in the unlikely event that it is not entirely negative, given the previous trials, I consider it unlikely that the this trial will show a large effect. Indeed, the NPR story seems to suggest that the results so far are disappointing (in other words, consistent with previous studies. Finding only a small effect would, in essence, disprove the extraordinary claims of chelationists, because the large effects claimed by chelationists should be mind-numbingly easy to spot in even small clinical trials. ) My further guess is that it won’t matter even if it is a negative trial that finds no effect due to chelation beyond that of a placebo. The NPR story confirms my suspicion in this. For example, check out the attitude of this particular “alternative medicine” practitioner:

Dr. Allan Magaziner, a former president of ACAM, is less certain. He’s treating patients in the NIH study at his clinic in New Jersey. But he says he’ll be skeptical if the results are negative.

“Sometimes statistics can be manipulated in certain ways in certain studies,” he says. “So we’d have to make sure that wasn’t the case here.”

Magaziner says it’s possible that a negative result might change the way he uses chelation. But he adds, “I don’t know if I’d stop completely because we’re seeing great results with it.”

Big surprise, eh? If the study is negative, chelationists won’t stop using chelation therapy to “treat” cardiovascular disease, and–oh, by the way–the statistics must have been cooked by big pharma to prevent the valiant chelationists from bringing their brand of woo to the clamoring masses–all for around $200 a treatment. (And, of course, most patients “require” around 30-40 treatments.) One also has to wonder what Dr. Magaziner considers “statistical manipulation” and what he might be doing to “make sure this concern isn’t the case.”

Of course, if you peruse altie websites, you will find chelation therapy touted for far more than just vascular disease, with mercury and other heavy metals blamed for autism, Alzheimer’s disease, cancer, heart disease, and a list of diseases so numerous that it is easier to list major diseases that alties haven’t blamed on mercury or other heavy metals.

So, where does all this mercury and metal come from? Well, if you answered “the environment,” “fish,” or (more specifically) “tuna,” you would be giving a fairly reasonable, evidence-based answer. (The government doesn’t recommend that pregnant women abstain from tuna and large fish for nothing.) It’s not woo to be concerned about environmental pollution finding its way into our food supply and to look for health effects from pollution. However, an evidence-based answer would also point out that for the vast majority of people living in this country, mercury “poisoning” is not a problem. And the chelators and anti-amalgam activists take it way beyond “reasonable” concerns into a realm of fear that is difficult for most reality-based people to comprehend and into the realm of woo.

In woo world, the two most dire threats to your health as far as “poisoning” you with mercury are vaccines (of course!) and dental amalgams. I’ve blogged extensively about how the evidence does not indicate that vaccines cause autism or many of the other disases blamed on them; so I won’t rehash all that, other than pointing out that the scientific evidence suggesting that vaccines don’t cause autism is becoming so strong that, as Kevin Leitch has pointed out, even the die-hard mercury militia is starting to move on to other causes to blame autism on, while others are descending into Hutton Gibson-worthy conspiracy-mongering.

Sadly, the whole topic of amalgam mania could easily make up an entire Friday Woo all by itself. (Heck, it could provide material for an entire series of Friday Woos until you, dear reader, became sick to death of the topic.) So, I’ll give you the ultra-brief version. The concept is that the mercury in your dental fillings is leeching into your body and slowly poisoning you. Naturally, the evil American Dental Association (and presumably the manufacturers of amalgams) are in a vast conspiracy to keep using amalgams for reasons that are clear only to woos. Of course, in actuality, it is the anti-amalgam dentists who are benefiting the most financially from this scare:

Anti-amalgam dentists typically use a mercury vapor analyzer to convince patients that “detoxification,” is needed. To use the device, the dentist asks the patient to chew vigorously for ten minutes, which may generate tiny amounts of mercury from the fillings. Although this exposure lasts for just a few seconds and most of the mercury will be exhaled rather than absorbed by the body, the machines give a falsely high readout, which the anti-amalgamists interpret as dangerous.

The most commonly used analyzer is the Jerome mercury detector, an industrial device which multiplies the amount of mercury it detects in a small sample of air by a factor of 8,000. This gives a reading for a cubic meter, a volume far larger than the human mouth. The proper way to determine mercury exposure is to measure urine levels, which indicate how much the body has absorbed and then excreted. Scientific testing has shown that the amount of mercury absorbed from fillings is too small to be significant.

Some antiamalgamists administer a “patch test” with a dilute solution of mercuric chloride. Redness of the skin or any of a large number of other symptoms are then misinterpreted as signs of “mercury poisoning,” and the patient is advised to have all amalgam fillings removed.

Never mind that there is no evidence that the minuscule amount of mercury released from amalgams causes any harm and that two large recent studies have shown that amalgams are safe in children. They must be poisoning you. You have…Toxic Teeth! (Roll scary music.) And don’t forget, amalgams are “medical genocide“! And never mind that the removal of these amalgams involves invasive dental procedures that can on occasion lead to tooth loss. Whatever the cost, those nasty amalgams must go!

But enough heavy metal. (Sorry Mr. Nugent.) It’s not just metals that are poisoning you. Oh, no, it’s much worse than that:

Toxicity can be caused by chemical irritants, those that are ingested, inhaled, or absorbed through the skin; it can also become elevated by die off of the tumor and/or other morbid cells. The primary symptoms of toxicity are itchiness and irritability. We might say that toxicity is red. When the normal eliminatory organs are overburdened by toxicity, the skin becomes a major organ of elimination. It will then tend to exhibit patches of red and sometimes “appearances” that may be either flat or elevated. These may also blister, ulcerate, and exude various substances.

Of course, conveniently the exact identities of these “toxins” is rarely, if ever, specified. It doesn’t matter anyway. The cure is the same:

There are stages of toxicity. When the heat is repressed, people are usually gray. They feel the blahs and their skins are dull or decidedly ashen (as happens to many who have chemotherapy.) Not everyone goes from gray to red and a few people start with the red and never experience the gray. Interestingly, the treatment is essentially the same for both types. They need detoxifying herbal bitters. The difference is that those with redness need to be more careful of foods that aggravate what is called in Ayurveda the pitta dosha. As many people know, both Ayurveda and traditional Oriental systems of medicine use a system of three main pulses. In Ayurvedic and Tibetan medicine, these translate to wind, bile, and phlegm. Bile is a “derangement” of the fire energy. It is not healthy. It means that the body is not properly pH balanced and that it favors acidity that in turn will lead to tissue breakdown.

And, of course, there are many herbaldetoxifyingblood cleansers to help you with this “purification” (although exactly how these concoctions “cleanse the blood” is usually unexplained or left quite vague).

Once again, I remain mystified by this altie obsession with the “filth” in their bodies and with “cleansing,” “purging,” and “purifying.” Some of these guys seem more obsessed with their “purity of essence” than General Jack T. Ripper. It goes way beyond a reasonable concern about one’s diet and environment and how they can affect one’s health. To combat these “toxins” in their blood and liver, to purge the “sewage” from their bowels, they’ll flush out their colons, try to flush their livers by fasting and drinking combinations of fruit juice and olive oil, and flush out their blood with chelation therapy and herbs, even at the risk of death. It’s more religious than rational.


And, I have to ask, once you’ve cleansed your colon, your liver, and your blood, what organ system is there left to purge?

I would say the brain, but for all too many of the the “toxin”-obsessed, it’s too late. It’s already been purged.

[Note added in proof: Dr. R.W. has discussed the first of the NCCAM chelation study centers in his series, Tequesta Family Practice, which promotes “heavy metal analysis for chronic fatigue, intravenous infusion of vitamins and minerals for chronic fatigue, evaluation and treatment of “dysbiosis”, evaluation of colonic ‘ecology’ by various culturing techniques, intravenous colchicine infusion for spinal disk herniation and, of course, chelation therapy.” I also note that it promotes “liver detoxification,” as well.]

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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