Chelation: Therapy or
mercury, and arsenic serve no function in the human body. If
they accumulate in large enough amounts, they cause poisoning.
Other metals which are essential to human function can become
toxic if they accumulate in large amounts; examples include iron
and copper. Effects differ according to the metal involved,
whether it is introduced into the body by ingestion, inhalation,
or skin contact, and the age of the victim.
very high levels of these heavy metals are treated with drugs
called “chelators” [KEY-lay-ters]. These medicines bind to the
metals in the blood stream; this metal-chelator compound is then
eliminated in the urine. While chelators are valuable drugs,
they have side effects which limit their use to only a few
medical conditions involving heavy metal toxicity, especially
those due to lead, mercury, arsenic, and iron.(a)
there are limited approved indications for the use of chelators,
they are often advertised as treatments for numerous other
conditions. Many of these expensive, lengthy “treatments” are
administered directly into the bloodstream (intravenous, IV) in
an office setting. Others are advertised for use at home.
Purported uses include:
treating damaged arteries (atherosclerosis) by removing
calcium from arterial plaques, though there is little to no
evidence that this is possible or effective;
treating intermittent claudication (painful leg cramps due
to arteriosclerosis [narrowed arteries]), though there is no
evidence that this works;
or improving symptoms of autism, though there is no evidence
that metals are a cause of autism;
preventing or curing neurodegenerative conditions such as
Alzheimer’s disease, though there is no evidence that
currently-available chelators have any effect on these
uses of chelation therapy have resulted in harm, even death.
This is an unacceptable risk in the absence of proven benefit.
Several unapproved “chelators” are marketed for home use. The
U.S. Food and Drug Administration (FDA) recently warned several
companies that they are breaking the law by marketing such
“therapies”. FDA noted that all approved chelating drugs require
Chelating with drugs
is indicated primarily for acute poisonings by some metals,
especially lead, arsenic, mercury, and iron.1 Though
the drugs may have dangerous side effects, the risks are
considered worthwhile in the face of toxicity which may be fatal
or cause serious, even permanent injury. 
chelating drugs in the U.S. include succimer, dimercaprol (BAL),
edetate calcium disodium, deferoxamine, and penicillamine. They
are given only for diagnosed metal toxicity because 1) they may
have serious side effects, even when their use is needed; and 2)
they are non-specific and can bind even essential “trace” metals
in the body, for example copper and zinc. They can sometimes
bind calcium, too. Chelation of these substances can cause
symptoms related to their deficiency.
2,3-dimercaptosuccinic acid) is taken by mouth to treat
poisoning by lead, mercury and arsenic. Serious side effects
are uncommon. 
(British Anti-Lewisite, BAL) is given by injection to
treat severe lead poisoning (with edetate calcium disodium),
mercury poisoning, and arsenic poisoning. A variety of side
effects have been reported, usually dose-related; high doses
can cause coma and seizures. 
Edetate calcium disodium (CaNa2EDTA)
is given intravenously to
treat severe lead poisoning. This drug can be toxic to the
kidneys; doses and dosing schedules must be carefully
calculated and kidney function must be monitored during
given intravenously to treat iron poisoning. Possible side
effects include very low blood pressure, lung injury, and
sometimes used to treat bismuth, copper, lead, mercury, and
nickel toxicity. When used for acute poisoning, the primary
adverse effect is an allergic reaction in people who are
also allergic to penicillin. 
the National Center for Health Statistics reported that 111,000
adults said they used chelation therapy, along with 72,000
children under the age of 18.  It is highly unlikely that
183,000 US residents required chelation therapy for the limited
number of approved indications. It is much more likely that
therapies were received for conditions attributed to heavy
metals without scientific validation.
recently warned several companies that marketed chelation
products and tests for home use that they are violating federal
law.  These products purported to treat such serious
conditions as “autism spectrum disorder, cardiovascular
diseases, Parkinson’s disease, Alzheimer’s disease, macular
degeneration, and other serious conditions”. Related products
were advertised to detect the presence of heavy metals. FDA
strongly stated that chelating products are approved for
prescription use only.
therapy has been associated with fatalities. [9, 10] A
2-year-old girl with lead poisoning died after the wrong
chelation drug caused her blood calcium to drop too low. A
5-year-old boy with autism died after being inappropriately
treated in a doctor’s office with a chelating drug; autism is
not caused by heavy metals and is not an indication for
chelation. A 53-year-old woman without evident heavy metal
poisoning died during chelation therapy by a naturopath.
arsenic, and iron account for most cases of diagnosed heavy
metal poisoning in the United States. Laboratory studies are
required for diagnosis. Treatment includes removing the victim
from the source of the metal and treating the patient’s
symptoms, when that is possible. For very high levels or severe
symptoms, chelating drugs may be given.
Humans have been
poisoned by lead for thousands of years. Ancient Roman water
pipes were made of lead. Since lead must be mined, miners (and
often their families) have been exposed. Now, most cases of lead
poisoning are in children who swallow lead-based paint in homes
built before the 1970s. Among many other causes are water
carried through pipes made of lead or containing lead solder;
soil around homes painted with lead-based paint; toys, charms,
and amulets worn and/or mouthed by children; pica (eating
non-food items); old homes being renovated without proper safety
precautions (also a source of lead poisoning in pets); some
imported cosmetics, ceramics, candy, and spices; hobbies in
which lead is heated and breathed in without protection, e.g.
casting bullets and fishing weights; lead bullets retained in a
joint; firing ranges with inadequate ventilation; and industries
that use or re-claim lead, e.g. battery manufacturing and
removing paint from industrial sites. 
There is no
necessary or safe level of lead in human bodies. Children are
especially susceptible to the toxic effects of lead. Lead
affects the developing brain and nervous system, potentially
causing lower IQs, learning difficulties, hearing loss, and
behavior difficulties. Abdominal complaints are common. Anemia
is often found in children with lead poisoning. In adults, lead
poisoning can cause high blood pressure and kidney damage.
poisoning is diagnosed by a blood test.
children who may be exposed to lead on a regular basis, a
screening test is done with a finger-prick test. If that
level shows the possibility of lead poisoning, a blood
sample from a vein is tested. If that level is higher than
10 µg/dL (micrograms of lead per 100 milliliters of blood),
the child’s home and other places where the child spends
time are examined for a source of lead. Once identified,
that source must be removed from the child’s environment and
the child re-tested. If the lead level rises, further
investigation is required until the source is definitely
poisoning in adults is addressed by identifying the source
of the lead, taking necessary steps to stop the exposure,
monitoring levels, and treating with chelators if levels are
high enough. 
of 45 µg/dL and above, treatment with the oral chelating drug
succimer (DMSA) is given. At higher levels, and in children with
coma or seizures, IV drugs (dimercaprol/BAL, calcium disodium
EDTA) are given. These are selected carefully, with carefully
calculated doses, to derive maximum benefit with the fewest
possible side effects. Patients are monitored while the lead
Mercury is found in
Metallic mercury is an inorganic mercury compound also
called quicksilver. As a silver-colored liquid at room
temperature, it rarely causes poisoning, even if swallowed.
However, if it is heated and the fumes are breathed in,
poisoning readily occurs. Metallic mercury left open at room
temperature, for example in an open container or from a
broken thermometer, also can contaminate the air and cause
poisoning. Effects include lung injury and kidney damage.
Symptoms may include cough, fever, chills, headache, nausea,
vomiting and abdominal pain. (This
is the type of mercury found in silver dental fillings,
which have not been associated with human poisoning).
forms of inorganic mercury such as mercurous chloride and
mercuric chloride are used in industry, as fungicides and
pesticides, in batteries, and in preservatives for wood and
laboratory specimens. Inorganic mercury is sometimes found
in skin-whitening creams. After long exposure, symptoms may
include gastrointestinal effects, weight loss, and fatigue.
Children can develop a rash accompanied by weakness and
mercury, such as ethyl mercury and methyl mercury, can cause
central nervous system effects and kidney damage.
Contaminated fish and industrial chemicals are the primary
sources of organic mercury exposure in humans. Symptoms of
poisoning can include tremors, blindness, nerve damage, and
coma, among many others. Thimerosal, a mercury-containing
preservative, is found in some vaccines in very small
in vaccines has not been associated with human poisonings).
be measured in the blood stream soon after someone is poisoned,
but it quickly moves to other body organs. After that, measuring
the amount of mercury eliminated in the urine during a 24-hour
period is the most accurate way to diagnose poisoning.
drugs used to treat mercury poisoning may include succimer,
edetate calcium disodium, BAL, or penicillamine. Whether a
chelator is indicated or not will depend on the form of mercury
involved, the person’s mercury level, and if the person is
Arsenic is a
naturally occurring substance. In some areas of the world,
low-level arsenic exposure occurs because of the continuing
presence of arsenic in ground water. Arsenic is found in some
fish and seafood and so can confuse laboratory findings in
people whose diets include seafood. At one time, arsenic was
common in weed killers. It has uses in laboratories and some
amounts of arsenic are swallowed, victims quickly develop
gastrointestinal symptoms including profuse vomiting and
diarrhea. Shock and coma can follow. People with lower levels of
arsenic exposure, especially over a long period of time, may
develop muscle weakness, numbness and tingling in their arms and
legs, skin changes, Mees lines (which look like horizontal white
stripes) on their nails, and cancer. (But note that most white
lines on nails aren’t related to arsenic.)
poisoning usually is diagnosed by measuring the amount of
arsenic excreted in the urine. Chelators used to treat arsenic
poisoning include dimercaprol, succimer, and penicillamine.
At one time, iron was
a leading cause of poisoning death in children. The source was
adult-strength iron supplements, toxic to children in small
amounts.  Many manufacturers changed the way the pills were
packaged and labels warn of the dangers of iron poisoning in
children. Fatalities are now uncommon but serious poisonings
poisoning initially causes damage to the gastrointestinal tract.
Someone who swallows an overdose may quickly develop bloody
vomiting and bloody diarrhea. As the iron is metabolized, or
broken down in the body, shock develops and liver damage occurs.
A few weeks later, scar tissue in the gastrointestinal tract may
develop and eventually require surgery to repair. The chelating
drug used to treat iron poisoning is deferoxamine.
Chelation “therapy”: unapproved uses of chelation
As noted above,
chelation therapy is approved for a limited number of
indications involving documented poisoning by heavy metals; it
is carried out under medical supervision with prescription
drugs. However, entering “chelation therapy” into an internet
search engine yields more than 500,000 hits. Alongside entries
relating to lead and iron poisoning are entries referring to
“veggie caps”, chelation “without chemicals”, “dissolve artery
blockages”, “chelation suppositories”, and “undesirable ionic
material”, plus many ads for over-the-counter chelating
substances. There is at least one entry offering chelation
therapy while traveling overseas; this destination also offers
“therapy” is offered for a number of conditions:
arteriosclerosis, angina, poor circulation to the legs and feet,
autism, Parkinson’s disease, Alzheimer’s disease, cancer,
diabetes, and many other conditions. Even when it is implausible
or impossible for chelation to be effective, it has been made to
sound rational to people unfamiliar with the causes of these
“diagnose” heavy metal poisoning as a cause of these conditions,
and therefore appropriate for chelation therapy, practitioners
will often administer a test or challenge dose of a chelator. In
a day or two, a urine test is done to measure metals. Since some
metals are found in all humans, these tests are always
“positive”, though they are not measured against established or
medically accepted standards. These results are then used to
market chelation therapy to the individuals. The American
College of Medical Toxicology warns that basing chelation
therapy on these types of tests is without benefit to patients
and may prove harmful. 
chelation regimes involve intravenous infusions of EDTA several
times weekly for months at a time, with “maintenance” doses at
regular intervals – sometimes hundreds of treatments in all.
Usually, the infusions contain vitamins and other proprietary
preparations. Other regimes involve the purchase of oral
proprietary formulations that supposedly will provide benefits
of chelation. Based on current research, there are risks to
patients without established benefits. These therapies are
expensive, with all charges paid by individual patients, as
insurance companies will not pay for inappropriate use of
Atherosclerosis (arterial plaques)
narrowing of arteries due to plaques; these are fatty deposits
on the inside walls of arteries. Because they narrow the
arteries, blood flow is limited to the heart, brain, and limbs.
When present, they can cause chest pain (angina), leg pain due
to decreased circulation (intermittent claudication), and
compromised circulation to the brain (strokes).
a component of these plaques. It is known that chelators can
remove calcium from the blood stream. Some chelation
practitioners state that their treatments will dissolve arterial
plaques by removing calcium from them, thus eliminating the need
for drug therapy and coronary bypass grafts. On the surface,
this may appear plausible, but it is not; there is little if any
evidence that circulating chelators actually reach the calcium
in arterial plaques.  Other purported benefits of using EDTA
chelation therapy in patients with coronary artery disease
include decreasing the ability of platelets to clot, reducing
free radicals which cause cell damage, and lowering iron and
cholesterol in the blood stream. 
therapy for heart disease was first described in the 1950s. A
trial of chelation for intermittent claudication was published
in 1994; the authors found chelation to be no better than
placebo.  In 2000, Ernst summarized clinical studies of
chelation for cardiovascular disease published between 1955 and
1993.  He found 22 studies and case reports without control
groups, most reporting symptomatic improvement but without
documentation of improvement. There were two case reports with
objective measurements of results; neither documented benefit.
There were two controlled clinical studies, one with nine
patients and one with sixteen. Neither documented benefit. The
author attributes symptomatic improvement without measurable
clinical improvement to “a powerful placebo effect”. He states
that “The most striking finding is the almost total lack of
convincing evidence for efficacy” and further states that “this
treatment should now be considered obsolete.”
editorial in the same journal challenged Ernst’s conclusions.
 The authors stated that Ernst drew his conclusions from
insufficient data, that it seems plausible that chelation
therapy could work because of proposed antioxidant effects of
chelating drugs plus the vitamins and minerals typically
co-administered, and recommended that a definitive trial be
carried out to determine if chelation therapy helped people with
the National Institutes of Health (NIH) announced a large
clinical trial to assess the safety and effectiveness of
chelation therapy for coronary artery disease. The Trial to
Assess Chelation Therapy (TACT) was intended to study more than
2,300 patients who had evidence of coronary artery disease,
including a history of heart attack. The press release
announcing the study focused on the fact that chelation therapy
is widely administered, though it has never been proved safe and
effective. TACT was designed to provide answers: Is chelation
for coronary artery disease safe? Does it work? Do specific
vitamins and minerals make a difference in how patients do? Is
it cost-effective? 
was hailed by many chelation practitioners, including the
American College for Advancement in Medicine (www.acamnet.org),
which promotes chelation therapy and provided a protocol. There
was also vigorous dissent, as illustrated by an article
concluding that “TACT is unethical, dangerous, pointless, and
the Cochrane Collaborative concluded that available evidence was
insufficient to determine whether or not chelation therapy is
effective for atherosclerosis. The authors noted the need for
randomized clinical trials.  In its current statement about
chelation therapy, the American Heart Association finds “no
scientific evidence to demonstrate any benefit from this form of
the NIH chelation trial stopped enrolling patients,
approximately two years early; there were allegations that the
consent forms were improper. NIH is, however, continuing with
data analysis of the patients who were treated. Data analysis is
scheduled to be completed by the end of 2011, with results to be
announced in 2012.  (Update: The trial determined that IV
chelation with disodium EDTA slightly reduced the risk of
“adverse cardiovascular outcomes” and that the results could
guide further research but do not support the routine use of
chelation for patients who had a myocardial infarction. [25A])
Chelation therapy as
a treatment for autism is based on the erroneous belief that
mercury in childhood vaccines is a cause of autism. This belief
arose when it was noted that 1) the number of cases of autism
was growing and 2) the number of recommended childhood vaccines
was increasing. Some correlated the two and attributed the link
to thimerosal, a mercury-containing preservative in some
vaccines. The theory that thimerosal is responsible for autism
has been scientifically refuted. [26, 27. Also, see article
further discussion of this topic, with references]
is not caused by mercury in vaccines, chelating children for
mercury “toxicity” cannot help them. Despite this, chelation
therapy is widely promoted as a treatment for autistic children.
Practitioners administer succimer, vitamins, minerals, oral
chelation products, and IV chelation drugs, exposing children to
side effects for no clear benefit. In fact, IV chelation therapy
resulted in the death of a five-year-old boy; he went into
cardiac arrest during his third chelation treatment. The authors
who reported this death state that “The use of chelation therapy
in autistic children has not been validated and can have tragic
sometimes used to chelate mercury, from environmental sources if
not from vaccines, in an attempt to treat autism. There is no
evidence that this works. Cao and colleagues studied mercury
elimination in children who needed chelation with succimer for
lead poisoning; they found “limited efficacy”. 
alternate belief is that removing an excess body burden of heavy
metals can improve autism symptoms. In a pilot study, Soden and
colleagues gave DMSA (succimer) to children with and without
autism. Then, they compared the amounts of arsenic, cadmium,
lead, and mercury excreted in their urine before and after
chelation. They reported that the results did NOT demonstrate
an excess body burden of any of these metals and that “there is
no evidence that any of the 15 autistic participants would
benefit from chelation therapy.” 
American Academy of Pediatrics issued a policy statement saying
that “…unless there is clear evidence of current heavy metal
toxicity, chelation by any method is not indicated outside of
monitored clinical trials.”  This policy was reaffirmed in
the U.S. National Institute of Mental Health (NIMH) had
announced that it had begun three clinical studies of autism.
One was of chelation therapy for children with autism, in part
because chelation was already being administered to large
numbers of children with no proof of efficacy or safety.  In
late 2006, a study in rodents cast doubt on the safety of
succimer as it would have been used in this study. Treatment
with succimer improved cognitive outcomes in rats with lead
poisoning, but actually caused lasting impairment in animals
without lead poisoning.  NIMH re-evaluated the proposed
study in light of these findings and determined that children
would be put at disproportionate risk. In 2008, NIMH announced
that the study was cancelled. It was also noted that there were
other, more promising areas of research. 
is a leading cause of memory impairment in older adults. The
Alzheimer’s Association estimates that 5.2 million Americans
have Alzheimer’s disease, most of them over 65. In addition to
difficulty with memory, victims may suffer from depression,
confusion, impaired judgment, and difficulty managing everyday
activities. In its later stages, trouble speaking, walking, and
eating may develop. Being immobilized can lead to pneumonia,
other infections, and death. 
or causes, of Alzheimer’s disease are not yet known. Nothing has
been shown to prevent the development of Alzheimer’s disease.
There are drugs that can delay the symptoms of the disease in
some people, but there are no treatments. 
It is known
that abnormal deposits called amyloid plaques are present in the
brain of many Alzheimer’s victims. (These can only be found
after death, if an autopsy is conducted on the brain.) It is
thought that iron, aluminum, copper, and zinc in the brain may
be involved with these plaques in some way, but it is not yet
known how. Perhaps there is a problem with how the brain uses
metals that are normally present; perhaps exposure to metals is
a cause; or there may be other explanations. Science doesn’t yet
have the answers. 
the metal which has received the most attention in the popular
press.  Ever since aluminum was identified in the brains of
patients with Alzheimer’s disease, it was proposed that people
absorbed aluminum from food, drinking water, aluminum pots and
pans, and underarm deodorant. But as early as 1992, some
researchers disputed that hypothesis, finding that aluminum was
a contaminant of the materials used to study brain tissue rather
than a component of plaques. 
A review of
several studies of occupational exposure to aluminum found no
association with Alzheimer’s disease.  A study of 89 people
with Alzheimer’s disease concluded that lifetime workplace
exposures to solvents and to aluminum were “not likely to be
important risk factors for Alzheimer’s disease”.  One study
found that high concentrations of aluminum in drinking water may
be a risk factor for Alzheimer’s disease , while another
found “little association between Alzheimer’s disease and higher
aluminum…concentrations in drinking water”. 
metals being studied include iron [43, 44], copper, and zinc.
researchers believe that metals are involved in some way with
the development of Alzheimer’s disease, some chelation
practitioners recommend courses of chelation therapy for these
patients. This may sound intuitive, but the reality is that
available chelators cannot work in the brain. The protective
“blood-brain barrier” will allow only the smallest of particles
to leave the bloodstream and enter brain tissue.
Currently-available chelating drugs circulate in the bloodstream
but they are unable to cross the blood-brain barrier, making
them useless for decreasing the amount of metals in the brain.
There is a
great deal of research being conducted on nanoparticles, agents
small enough to enter brain tissue to chelate metals. [46, 47]
For now, though, there is no indication for exposing patients
with dementia to the risks of chelation therapy because current
chelators cannot help them.(b)
Chelation therapy is
an approved treatment for poisonings caused by such heavy metals
as iron, mercury, arsenic, and lead. Based on erroneous theories
of disease causation, some practitioners advocate chelation
therapy for such conditions as cardiovascular disease, autism,
and Alzheimer’s disease. There is no scientific basis for these
expensive treatments, which expose patients to risks without
benefit. One condition, cardiovascular disease, is the subject
of a large clinical trial to assess possible benefits of
chelation therapy; the results are not expected until 2012.
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