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METALS in MEDICINE Robert A Research Article METALS IN MEDICINE Robert A. Nash, MD The effects of toxicant metals on human health have been infarction patients in the Trial to Assess Chelation Therapy reported in peer-reviewed literature with increasing frequency. (TACT). This article’s author is on the NIH Data and Safety Toxicant metals are present in many diseases of aging, especial- Management Board of that study. He was asked to write this ly vascular diseases. Toxicant metals are a natural environmen- review article and include an update on the clinical, environ- tal phenomenon as well as a byproduct of industrialization. mental, historical, and scientific elements of this expanding The historical experience of toxicologists who treated individu- field. This article reviews toxicant metals in the environment als poisoned by acutely toxicant metals is waning; very few of and their potential health consequences. (Altern Ther Health these cases have been reported during the past 30 years in the Med. 2005;11(4):18-25.) US. Researchers with a special interest in clinical metal toxicol- ogy have noticed a clinical correlation between metal detoxifi- Author Disclosure: I have no special or vested interest in any cation by chelation therapy and clinical improvement of aspect of this article. I am the Chairman of the American Board of vascular diseases. Chelation therapy currently is being tested Clinical Metal Toxicology, which has a special interest in this field. by the National Institutes of Health (NIH) for post-myocardial No grant monies or other funding were received for this article. Robert A. Nash, MD, is Chairman of the American Board of healthcare delivery and consumer preference. Many baby Clinical Metal Toxicology. boomers are not content with the care given to their parents, and they are taking increasing responsibility for their he 2001 Institute of Medicine (IOM) report healthcare.7 They have become interested in prevention, healthy “Crossing the Quality Chasm: A New Health System lifestyles, and supplements. The disease care industry is boom- for the 21st Century,” exposed the current crisis in ing, and many hospitals are reaching their maximum capaci- medicine.1 Loosely translated, the report states that ties.8,9 Examination of the role of environmental pollutants of our current health system is in a terminal state and toxicant metals and persistent organic pollutants, their detoxifi- must be replaced. The IOM report states that the new health sys- cation, and preventive medicine and nutrition are evolving into Ttem will have to include complementary and alternative medi- proactive health approaches. cine, as well as preventive measures. In his editorial, “Paradigm The medical model of the US was developed before ade- Shift: The End of ‘Normal Science’ in Medicine, Understanding quate clinical texts were published and before the wide use of Function in Nutrition, Health and Disease,” Mark Hyman, MD, computers. Medical students are taught how to diagnose and explained the need for a change in the way medicine is practiced.2 treat diseases. Symptoms are often considered non-life-threaten- Jim Gordon’s Report on the White House Commission calls for ing and are treated with an appropriate medication. implementation of the Commission’s recommendations, includ- My personal estimate is that approximately 90% to 95% of ing expanding treatment options to include prevention and physicians have excellent memories and cumulative minds and complementary and alternative medicine.3 Furthermore, Gary compassionately practice what they learned in medical school. Null’s “Death By Medicine” states that the leading cause of death The other 5% to 10% of physicians have associative minds or in the US is a combination of pharmaceutical, iatrogenic, and good memories and the ability to look for nuances of disease hospital-based causes.4 Dr. Null’s work emphasizes the need to causation. They tend to do their own clinical observations, over scrutinize our current system. Improvement in perception, if not time, and share them with their colleagues. Although their meth- in fact, is needed. ods are not as scientifically rigorous academic methods, many of David M. Eisenberg, MD, brought consumers’ interest in these physicians make clinical observations that are later con- complementary and alternative medicine (CAM) and their use firmed scientifically. They tend to be problem solvers. This of CAM to our attention.5,6 Since the publication of his seminal group may be trained in physical science, mathematics, or engi- article on this topic in 1993, a virtual evolution has occurred in neering before they enter medicine. Many of these physicians are 18 ALTERNATIVE THERAPIES, July/aug 2005, VOL. 11, NO. 4 Metals in Medicine in private practice and often seek solutions to patients’ problems heart disease introduced by Michael Ellis DeBakey, MD. The that they might not have been taught in medical school. These AHA’s support led to the development of our current approach physicians, like most physicians, are contributing to evolving to cardiac intervention and to the decline of chelation therapy. medicine in the 21st century by expanding our perceptions and Some physicians who personally saw the benefits of chelation interests regarding what it means to be a medical doctor. One therapy formed societies to further its use, and a protocol was such area is the role that toxicant metals have in the seeming established.13 In the more than 30 years the protocol has been in causation of diseases. This article outlines the history of metal use, there have been no deaths or events of renal shutdown due detoxification and bring us through the past 50 years to our cur- solely to chelation therapy administered by properly trained rent state of knowledge. It is an attempt to show how our envi- physicians. Because many patients were paying out of pocket for ronment affects us. this treatment, and rigorous double-blinded tests had not been performed, in 2002, the National Institutes of Health (NIH) HISTORY funded a five-year, $30 million, double-blinded prospective In 1893, Alfred Werner, PhD, a Swiss chemist, proposed the study called the Trial to Assess Chelation Therapy (TACT). theory of metal-ligand binding as a ring formation that provided Gervasio Lamas, MD, a cardiologist and researcher from Mount the foundation for modern coordination chemistry. He discov- Sinai Hospital in Miami, is the principal investigator. ered that the divalent cation of metals bound with the divalent anion of other chemicals to form a neutral substance. He CHRONIC TOXICANT METALS EXPOSURE? received the Nobel Prize for Chemistry in 1913 for complexion During the past five years, the understanding of vascular chemistry, which describes the process by which metal-ligand disease has changed. Vulnerable plaque has replaced stenotic complexes form. In 1920, two Americans, Morgan and Drew, lesion as the main cause of vascular problems.16 Questions about defined chelation as a metal ion incorporated into an hetero- the long-term benefits of coronary artery bypass grafting cyclic ring.10 The Greek word chelai, meaning a bird’s talon, (CABG) surgery have been raised.17 Metals have been implicated wolf ’s claw, or crab’s claw, was adopted to illustrate the grabbing in many of the diseases of aging as well as in neurodevelopmen- of the metal cation, rendering it inactive. Chelation therapy has tal diseases and autism spectrum disorders.18-24 The American been used in industry and manufacturing ever since. Board of Chelation Therapy (ABCT) has formally changed its As World War II approached, Germany began to prepare name to the American Board of Clinical Metal Toxicology for battle by inventing chemicals to replace those in short sup- (ABCMT) because of the new scientific association of toxicant ply. Citric acid was used in German industry to precipitate met- metals with multiple diseases.25 The most authoritative informa- als. Franz Munz synthesized nitro triacetic acid (NTA) to be used tion on the early work on metals in medicine is A Textbook on in the printing and textile industries as a substitute for citric EDTA Chelation Therapy.13 This textbook presents the clinical acid, which was in short supply. This was called Trilon-A.10 A sub- observations of the early pioneers in this field along with the sequent improvement, ethylene diamine tetraacedic acid evolving science of the time. Their clinical observations during (EDTA), was called Trilon-B.10p8 After World War II began, a the past 30 years have set the stage for the integration of new sci- search for antidotes to arsenic and other nerve toxins began. entific observations of toxicant metals in recent scientific litera- This led to the development of British Anti Lewisite (BAL) as the ture. The remainder of this article updates readers on the science first chelating compound to be used in medicine. EDTA was of toxicant metals, their place in diseases, and their diagnosis brought to the US in 1947, when Martin Rubin of Georgetown and treatment. The continuing unofficial outcomes research of explored its use to chelate calcium from blood, leading to the chelating doctors, now clinical metal toxicologists, is being development of the lavender top tube for hematological tests. understood better each year as scientific journals publish articles His research led to the use of EDTA in humans to chelate lead on toxicant metals and their effects. and other metals.11,12 As lead poisoning was relatively common in Toxicologists are experts in acute poisoning from metals. some industries, EDTA chelation therapy was used frequently. Their protocols, methods of diagnosis, and treatments are valid Some patients with lead poisoning had co-morbid conditions for acute poisoning only, which has become rare in American such as hypertension, angina, peripheral arterial disease, and medicine during the past 25 to 30 years. The new experts for memory problems. Many of the co-morbid conditions improved the low-dose, accumulated toxicant metals and their health con- as the lead was detoxified.13pp211-214 sequences are the clinical metal toxicologists.
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