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Formerly, Associate Professor of Pathology (adj.), College
and Surgeons of Columbia University, NY
Formerly, President of Staff and Chief Pathologist,
Holy Name Hospital, Teaneck, NJ
College of Surgeons of England -
American Board of Anatomic and Clinical Pathology
Diplomate, American Boards of Environmental Medicine
Past President Capital University of Integrative
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Journal of Integrative Medicine
Improved Myocardial Perfusion in Patients
with Advanced Ischemic Heart Disease with An Integrative Management Program Including
EDTA Chelation Therapy
Majid Ali, M.D., Omar Ali, M.D.,
Alfred Fayemi, M.D., Judy Juco, M.D.,
Carol Grieder-Brandenburger, R.N.
From the Departments of Medicine
of Capital University of Integrative Medicine, Washington, D.C., and Institute of
Preventive Medicine, New York (MA,OA,AF,JJ, CG), the Department of Pathology, College of
Physicians and Surgeons, Columbia University, New York (MA), and Department of Pathology,
Mount Sinai School of Medicine (AF). Send requests for reprints to MA at Suite 1-H, 140
West End Avenue, New York, N.Y. 10083. This outcome study was presented in part at the
1995 annual meeting of the American Academy of Preventive Medicine in New York.
To assess the clinical efficacy of an integrated management program
including nutritional and herbal therapies, nongoal-oriented exercise, self- regulation,
and EDTA chelation therapy for patients with advanced ischemic heart disease (IHD).
Twenty-six consecutive patients who presented with advanced ischemic
heart disease and who had fared poorly after one or more coronary bypass operations (5),
one or more angioplasty procedures (6), or who failed to respond adequately to multiple
drug therapies (15), and who had received a minimum number of 20 EDTA infusions. Duration
of follow-up ranged from 15 months to 9 years.
1. Clinical evaluation of patients before, during and after the integrated program used in
this study. 2. Assessment of myocardial perfusion by comparative study of thallium
perfusion scans performed before and after the IHD reversal program.
Clinical Outcome Measures
The following clinical outcome criteria were semiquantitatively defined: Excellent
outcome, absence of significant symptoms and discontinuance of previously prescribed drug
therapies; good, 75%+ relief of symptoms and reduction of drug dose; moderate, 50%+ relief
of symptoms and reduction of drug dose; and poor, 25% or less relief of symptoms and
reduction of drug dosage. Elements for follow-up included in the clinical outcome sheet
were as follows: angina, chest tightness and related discomfort, arrhythmia, other chest
symptoms, dyspnea, severity of stress, mood changes, anger, energy level, quality of
sleep, appetite, digestion and frequency of bowel movements (all clinical parameters that
determine the degree of AA oxidopathya state of chronic and insidious accelerated
oxidative molecular injury to all elements of the circulating blood which we consider to
be the core pathogenetic mechanism of IHD.1)
Clinical outcome data are as follows: excellent 61%, good 17%, moderate 13%, and poor 9%.
Comparative study of pre- and post-chelation myocardial perfusion scans showed clear,
objective evidence of significant improvement in myocardial perfusion in five of six
patients in whom such studies were performed. No patients during the study period suffered
an acute myocardial infarction or underwent angioplasty or coronary bypass operation.
Preliminary and limited outcome data in this study indicate significant potential for
reversing IHD in patients with advanced ischemic heart disease by an integrated management
plan with global emphasis on reducing oxidative stress on the circulating blood, cardiac
myocytes and the conducting system of the heart. The program included nutritional and
herbal therapies, self-regulation, nongoal- oriented exercise and EDTA chelation therapy.
Additional and larger studies are warranted to fully explore the clinical potential of
such an integrated management plan.
In the United States, advanced IHD is generally managed with one of the
following four approaches: (1) pharmacologic regimens comprising multiple drugs; (2)
mechanical approaches to segmental coronary arterial lesions, such as angioplasty and
coronary bypass surgery; (3) holistic nutritional, herbal, and stress-reduction therapies;
and (4) integrative programs that include EDTA chelation infusions in addition to
therapies included in the third category. In mainstream cardiology, patients who fail to
respond to multiple drug therapies, angioplasty, and bypass surgery generally continue to
be managed with ineffective trials of drugs in various combinations. The efficacy of
mechanical approaches to segmental coronary lesions in such patients is admittedly poor,
even for the staunchest supporters of such therapies. The reason for failure of such
therapies is that neither the pharmacologic nor the mechanical coronary approach addresses
any of the pathogenetic mechanisms involved in IHD.1,2 Not unexpectedly, there
is widespread disillusionment with such therapies.3-11
Patients with failed drug and mechanical therapies sometimes show dramatic
improvement when they are managed with integrative, holistic therapies. However, such
promising clinical outcomes are rarely, if ever, documented in mainstream literature.
There are three reasons for this. First, holistic practitioners are seldom funded to
undertake systematic clinical outcome studies. Second, such practitioners have seldom been
trained to write papers that meet publication criteria. Finally, on the rare occasions
that such reports are submitted by holistic practitioners, the editors of established
medical journals readilyand regrettablyreject those reports because of their
ingrained prejudice against the outcome being reported. As for the integrative management
plans that employ EDTA chelation, several reports show promising results12-25;
however, the data for patients with advanced IHD in such reports is often blended with
those for patients with milder forms of disease or those without clearly documented IHD.
In this report, we present outcome data for a series of patients
with advanced IHD who received little or no benefit with intensive and extended
pharmacologic therapies, angioplasty, or coronary bypass surgery, and who were managed
with an integrated management plan that focused on the following issues: adrenergic
hypervigilance; optimal hydration and food choices in the kitchen; empirical nutrient and
herbal therapies; nongoal-oriented slow, sustained exercise; and a series of intravenous
PATIENTS AND CLINICAL OUTCOME RECORDS
We established the following two criteria for entry of patients in the
study: (1) consecutive patients presenting with advanced IHD who were deemed failures of
angioplasty, coronary bypass operation, and extended multiple drug therapy; and (2)
completion of at least 20 EDTA infusions.
There were 26 patients (21 males, 5 females) with an average age
of 65 years (range 42 to 76). Of those, 6 patients had undergone coronary artery bypass
procedures; 5 had undergone angioplasty; six patients had been advised angioplasty or
coronary bypass surgery but had declined; and the remaining 9 patients suffered
intractable coronary symptoms unrelieved by multiple drug therapies. Duration of treatment
ranged from 15 months to 9 years.
INTEGRATIVE PROGRAM FOR ADVANCED IHD
This study was designed as an open trial and no attempt was made to
narrowly define the management plans or to blind any member of the team providing the
care. Indeed, attempts to set limits on the integrative therapies that the managing
physician may include in the management of a given patient or to establish placebo
controls would not only have violated the spirit of integrative medicine, such attempts
would have been doomed to failure.
The integrated program for arresting and reversing advanced IHD
employed in this study comprised global strategies for controlling accelerated oxidative
stress on the circulating blood and had the following seven major components: (1)
education; (2) self-regulation; (3) food choices; (4) limbic exercise; (5) nutritional
therapies; (6) herbal protocols; and (7) EDTA infusions.
We recognized a special need to educate patients in the
study of three specific areas: (1) philosophy, principles and practice of integrative
medicine (focus on the whole person rather than his diagnostic category); (2) the
scientific basis of the oxidative phenomena that cause IHD (oxidative coagulopathy and AA
oxidopathy occurring in the blood rather than the tissue damage in the coronary arterial
walls)1; and (3) the integrative management plans that arrest oxidative
coagulopathy and AA oxidopathy, and set the stage for reversal of IHD. As discussed at
length in the companion article in this issue of the Journal,1 our concept of the etiology
of IHD, and the management approach to advanced IHD based on it, is radically different
from the prevailing opinions in mainstream cardiology, to which the patients in the study
were exposed before seeking care at the Institute. We recognized that the patients could
not give us informed consent for entry into the study unless they were well informed about
all such issues. Under ordinary circumstances, this would have been a daunting task of
patient education for any institution. However, for over a decade the Institute staff has
focused heavily on issues of patient education and has prepared an extensive library of
audio and videotapes as well as books discussing at length the issues of
health-dis-ease-disease continuum, nutrition, metabolism, and the energetic- molecular
basis of degenerative disease. Specifically, books were written, and videotapes and
audiotapes were prepared, to explain in simple language scientific concepts of the
following: spontaneity of oxidation in nature26-27; molecular duality of
oxygen, iron, nitric oxide and other redox-active molecular species28-29;
evidence of oxidative damage to circulating blood seen with high-resolution,
phase-contrast and darkfield microscopy30,31; electrophysiologic patterns of
myocardial activity and pulse pressure in states of adrenergic hypervigilence32-33;
changes in such patterns caused by meditative methods including
Other books and tapes addressed the issues of optimal choices in the kitchen36;proper
hydration37; need for avoiding rapid hyperglycemic-hypoglycemic shifts and
hyperinsulinemia,38 slow, sustained, noncompetitive and nongoal- directed
limbic exercise39,40; and effective methods of self-regulation.41-43
Special lecture-seminars were organized to further facilitate understanding of the
principles and practice of integrative medicine as well as reversal of advanced IHD.
Additional detailed information was provided in the form of easy-to-read booklets covering
subject matters of optimal food choices in the kitchen for reversing IHD,44
limbic exercise, and accelerated oxidative molecular stress.
The clinical experience at the Institute made it
abundantly evident to us that chronic, insidious adrenergic hyperactivity plays a critical
role in the cause of clinical syndromes associated with IHD. In a companion article in
this issue of the Journal,1 we have discussed at length the effects of anger,
stress, and other lifestyle elements on the clinical course of IHD. In recognition of
that, our program relied heavily on meditative methods for abating adrenergic
hypervigilance, for stress control, and for addressing issues of anger, hostility, fear,
and anxiety. In The Cortical Monkey and Healing32 and
What Do Lions Know About Stress?,45 we have described
meditative methods, as well as the spiritual work, used in our program. Specifically, we
emphasized the practice of Directed Pulses46 and Limbic Breathing34
for slowing the heart and respirations rates and for lowering blood pressure. The training
was given in self-regulation seminars held at the Institute and with audiotapes given for
use at home.
3. Food Choices
Detailed discussions of the principles and practice of
clinical nutrition as employed in our program have been described in
The Butterfly and Life Span Nutrition
.47 Briefly, the essentials of our
recommendations for food choices are the following: (1) diligent avoidance of foods that
generate sudden hyperglycemic- hypoglycemic shifts and cause rapid surges of insulin and
catecholamines; (2) partially-hydrolyzed protein formulations containing 85-90% amino
acids used to further relieve stress on glucose-insulin dynamics; (3) ample supplies of
essential oils (cold-pressed olive, flaxseed, sesame and pumpkin oils taken cold with
salad, uncooked vegetables or other cold foods); (4) avoidance of foods with oxidized,
denatured fats; (5) frequent consumption of foods items such as ginger, onions, garlic and
others that are empirically known to improve rheologic characteristics of blood; (6)
liberal nutrient supplementation of antioxidant vitamins, minerals that support
antioxidant enzyme systems and miscellaneous items. Table 1 shows the general range of
dosage of nutrient supplementation and herbal protocols employed in the program. It is
important to emphasize that nutrient and herbal protocols were prescribed and food choices
recommended for individual patients on the basis of evaluation of the specific needs of
individual patients, and participating physicians were asked not to limit themselves to
any algorithm. Again, this is totally consistent with the principles and practice of
integrative medicine. The complete listings of the individual nutrient and herbal
protocols have been previously published.48 The advice concerning
focused on issues of: (1) overhydration from morning to early afternoon hours; (2)
avoidance of carbohydrate overload (and hence, glucose-insulin-adrenaline roller
coasters); and (3) avoidance of oxidized and denatured fats.
4. Limbic Exercise
According to the Centers for Disease Control of Disease (CDC),
lack of physical exercise contributes to more than a third of approximately 500,000 annual
cardiac deaths.49 In recognition of such statistics, cardiac rehabilitation
programs have sprouted everywhere in the United States. However, almost all such programs
emphasize mechanical aspects of exercise with focus on changes in the heart rate,
ventilatory parameters, metabolic rates, and duration and intensity of exercise. Extensive
empirical experience in the care of severely ill patients led us to challenge this view.39,40
We are convinced that for physical fitness, the Eastern methods of physical fitness
that emphasize energy dynamics, fluidity and spontaneity of motion offer far superior
results. Thus, our program focused on meditative, slow, sustained, noncompetitive and
nongoal-oriented exercise which we designate limbic exercise.39,40
Specifically, our purpose was to help our patients free their bodies from the performance
demands of their analytical mind. Training was given using exercise workshops and a
specially prepared limbic exercise video. In limbic exercise, frequency of limbic
stretching and exercise is considered important and fixation on matters of intensity and
duration of exercise is regarded as counterproductive. Once understood and practiced, most
of the patients in the study group expressed clear preference for limbic exercise over the
traditional cardiac rehabilitation programs. The details of those methods have been
published previously in The Ghoraa and Limbic Exercise.39
It is noteworthy that a panel of exercise researchers convened recently by the CDC and the
American College of Sports Medicine reported that people need not engage in vigorous
exercise to improve their health.49 We also wish to point out that the issue of
meditative limbic exercise is especially critical in the management of patients with
advanced refractory IHD.
5. Nutrient Therapies
In accordance with the core principle of integration of safe and
empirically-effective therapies, we made no attempt in this study to isolate the clinical
benefits of individual nutrient or herbal therapies in our program. Rather, our focus was
on integrating as many empirically effective components as could safely be done. Again,
the choice of nutrient therapies was made in order to avoid: (1) dehydration; (2)
and simple carbohydrate overload; (3) sugar- insulin-adrenaline roller coasters; (4) food
sensitivity reactions; (5) prolonged bowel transit time (desired goal: two to three
odorless, effortless bowel movements a day); and (6) avoidance of meals that interfere
with sound sleep. The table 1 shows the amounts of the main agents we used. The scientific
basis and/or rationale of our use of nutrient and herbal protocols have been described in RDA: Rats, Drugs and Assumptions.50,51
6. Herbal Protocols
Herbs have been prescribed by herbologists to improve
the rheologic characteristics of blood for centuries. They prescribe some herbs for the
empirical "blood thinning" effectsthe direct prevention of oxidative
coagulopathy in the context of AA oxidopathywhile they employ other herbs for the
empirical cleansing effects on the colonthe indirect prevention of oxidative
coagulopathy by restoring altered states of bowel ecology and correction of increased
bowel permeability. For this study, we used the following herbs and plant-derived
substances for the former category: hawthorn berry tincture, ginger, garlic, onions,
cayenne, turmeric, and some others included in table 1. The elements used in the latter
category included the following: echinacea, astragalus, burdock root, goldenseal, pau
d'arco, alfalfa, cat's claw, Devil's claw and some others shown in Table 1. The
compositions of such protocols have been detailed elsewhere.52
7. EDTA Infusions
Extensive experience with clinical states characterized by accelerated
oxidative stress has convinced us of the value of a series of EDTA infusions for arresting
AA oxidopathy and for reversing cellular and tissue damage caused by microclots and
microplaques circulating in the bloodstream. As for the clinical efficacy of EDTA therapy
for managing and reversing coronary ischemic heart disease, the published studies
generally have lacked objective evidence of improved myocardial perfusion. The details of
EDTA infusions employed in this study have been published.53
Diagnosis and Management of
In the companion article of this issue of the Journal1, we
present direct morphologic evidence for the role played by fungemiaand, by
implication, mycotoxicosisin pathogenesis of oxidative coagulopathy and AA
oxidopathy. We consider it important to address this issue in the management of patients
with advanced IHD when the existence of
yeast overgrowth in the blood can be proven with
high-resolution, phase-contrast microscopy.1 For patients with clinical history
of allergy, we performed micro-elisa assays for Ig-E antibodies with specificity for mold
as described previously.54,55 When high levels of mold- specific IgE was found,
patients were administered antigen immunotherapy according to previously published
Standard Cardiac Care and Reduction and Discontinuance of Drug Therapies
All patients in the study were required to continue drug regimens begun
by their primary care physicians and/or cardiologists since the Institute staff does not
provide in-hospital care. Specifically, they were asked not to delay standard cardiac care
if symptoms persisted or acute symptoms developed. As their conditions stabilized on our
program, their pharmacologic therapies were reviewed and suggestions were made to
gradually decrease the drug dosage. Initially, we expected this to pose a problem of how
to integrate our cardiac care program with the care of the patients' cardiologists who,
with rare exceptions, were evidently hostile to our efforts. In actual experiences the
task of decreasing the dose of drugsand, when safely possible, discontinuing drug
use altogether proved not too difficult. We waited until patients showed clear
clinical and laboratory evidence of stabilization of their cardiac status. Only
thenand in most cases only after several months of beginning our integrative program
when patients could see for themselves evidence of stabilizationdid we begin the
closely-monitored, slow process of reducing the amounts and frequencies of their drug
COMPOSITION AND ADMINISTRATION OF EDTA
1. NUTRIENT AND HERBAL PROTOCOLS
|Nutrient & Herbal
||Vitamins C, 4-6 gm; A 10,000 IU; E,
||Thiamine, riboflavin and pyridoxine,
30 mg each; Niacinamide, 150 mg; Pantothenic acid, 220 mg; Biotin, 100 mg; Folic acid, 400
mcg; Choline and inositol, 50 mg each; Zinc, 4 mg; and others51
||Magnesium oxide 250 mg; Taurine, 300
mg; Choline bitartrate, 50 mg; Carnitine, 20 mg; Bromelaine, 25 mg; and others51
||Taurine, 500 mg; Magnesium sulfate,
300 mg, Potassium citrate, 100 mg
||Chromium, 100 mcg; Selenium, 400
mcg; Molybdenum, 1,000 mcg; Copper, 1 mg; Manganese, 5 mg
|Lipid (lipotropic factors and
||Choline, 100 mg; Inositol, 100 mg;
Methionine, 100 mg; lecithin, 200 mg
||Echinacea, Astragalus, Burdock root,
Goldenseal, Pau d'arco, Artemisia, Alfalfa and others in doses of 350 to 750 mg.
||Butcher's broom, hawthorne, mother's
wort, St. John's wort, bilberry, cayenne, turmeric, ginger, dandelion and garlic.
||Ginger, garlic, celery and others.
||Broccoli, burdock, celery, daikon,
flaxseed, garlic, ginger, grapefruit, klongi, soybean, squashes and green leafy
The composition of ethylenediaminetetraacetic acid (EDTA) infusion
protocol used in this study is shown in Table 2. EDTA has a greater affinity for magnesium
than for sodium; hence, magnesium readily displaces sodium in the EDTA salt. The
components heparin and sodium bicarbonate are used as rheologic agents. The frequency of
infusions was weekly except in cases of persistent symptomatology and a high risk of
recurrent infarction, in which case EDTA was administered on a twice-weekly basis for the
first two to three weeks. The issues of informed consent, clinical and laboratory
evaluation, vein access, maintenance of the infusion, protocols for detection of adverse
effects during EDTA infusion, and supplemental nutrition have been described previously.59
2. COMPOSITION OF EDTA PROTOCOL
|EDTA (sodium salt)
* Multivitamin protocol includes the following: thiamine,
25 mg; riboflavin, 5 mg; niacin, 50 mg; niacinamide, 50 mg, pantothenic acid, 12.5;
pyridoxin, 7.5 mg; ascorbic acid, 500 mg; vitamin A, 5,000 IU; vitamin D, 500 IU; vitamin
E, 2.5 IU.
None of the 26 patients in the study underwent angioplasty or
coronary bypass during the study period. Two patients required hospitalization for chest
symptoms: the admission of the first patient was precipitated by extreme stress resulting
from vandalism and violence. No evidence of myocardial ischemia was found after the
workup. In the second patient, an electrocardiogram showed evidence of acute myocardial
The clinical outcome data are shown in Table 3. The clinical response
in seventy-eight percent of patients was deemed excellent according to outcome criteria
indicated in the section dealing with clinical outcome measures. Only 9% of patients
failed to respond satisfactorily.
CLINICAL OUTCOME DATA
An Illustrative Case
A 67-year-old man underwent coronary bypass surgery in 1987. When
first seen at the Institute in 1989, he experienced daily angina attacks and periods of
arrhythmia. His symptoms persisted in spite of daily use of Inderal, Vasotec, Ativan,
sublingual nitroglycerine, and aspirin. He was homebound due to angina at rest and cardiac
arrhythmia. A second coronary bypass was recommended, but prognosis after surgery was
considered guarded. The patient refused surgery. The integrated program as outlined above
was instituted, including initial weekly EDTA infusions. After 21 months and 45 EDTA
infusions, his daily episodes of angina at rest had largely subsided and his clinical
condition stabilized enough to permit discontinuance of Inderal and Ativan. About three
years after beginning the program, he was walking one mile a day without any chest
symptoms. He experienced occasional episodes of chest pain, which he effectively
controlled with limbic breathing. All pharmacologic therapies were discontinued at 52
months. The patient declined a repeat thallium scan to assess myocardial perfusion. In
1995, six years after beginning the program, he was hospitalized for chest pain following
vandalism of his property and physical violence. A cardiac work-up did not disclose any
evidence of myocardial infarction. Now in 1997, he is drug-free and symptom-free.
Comparison of Pre- and
Postchelation Myocardial Perfusion Thallium Scans
Comparative studies of pre- and posttreatment thallium myocardial
perfusion scans were conducted by radiologists. They reported objective evidence of
improved myocardial perfusion in 5 of 6 patients. The essentials of the radiologist's
report in one of those cases are shown in Table 4.
We quote below excerpts from the radiologists' reports of the
comparative study of pre- and posttreatment thallium myocardial perfusion scans for three
Case 1: 67-year-old male with history of acute myocardial infarction.
"Partial redistribution to the inferior wall seen on delayed images of pre-chelation
scans not observed on post-chelation study...no inferior wall scarring seen. Triple bypass
at 65; 36 chelation infusions. Today's (post-chelation) images demonstrate that the
intensity of activity in the inferior wall is greater than noted on the prior
(pre-chelation) redistribution images."
Case 2: 56-year-old woman. Coronary bypass recommended but declined. 29
chelations. Activity increased from walking less than a block to being able to walk three
miles. Radiologist's report: "Pre-chelation perfusion scans showed "diminished
activity in the inferolateral segment which is fixed on the delayed films and most likely
represents infarct." Post-chelation showed "diminished activity without any
Case 3: 71-year-old male; S/P angioplasty; 34 EDTA infusions.
Radiologist's report: "The degree of perfusion deficits in the thallium scans not
quantified by the first radiologist. A pattern of increased perfusion in the
post-chelation scans recognized by the reviewing radiologist."
Untoward effects were encountered in seven patients. Two patients
developed headaches lasting one to five hours. One patient suffered an episode of
dizziness lasting less than three hours. Two patients complained of occasional leg cramps,
which responded satisfactorily to additional calcium supplementation. Muscular twitching
or clinical signs of tetany were not observed in any patient. No evidence of fluid
overload, congestive heart failure or phlebitis was encountered in any of the patients.
In a companion article in this issue of the Journal, it is proposed
that ischemic heart disease (IHD) is caused by AA oxidopathy. The dysregulation of redox
dynamics of plasma and blood corpuscles results in congealing of plasma and agglutination
of cells, leading to the formation of microclots and microplaques in the circulating
blood, a process designated as oxidative coagulopathy.1 The term microclot
refers to loosely formed clots composed of congealed plasma with entrapped damaged
erythrocytes, platelets, and leukocytes that are readily discerned in freshly prepared,
unstained peripheral blood smears with high-resolution (x 15,000) phase-contrast
microscopy. Microclots are sticky and grow in size by a snow-balling effect as they
circulate in the bloodstream (illustrated on page 36 of this issue of the Journal). The
term microplaque indicates a later stage of microclots when their cellular and plasma
components degenerate and they are compacted into plaque- like structures. Such
microplaques usually display layers of clotted blood elements and necrotic debris and are
also readily observed in freshly prepared peripheral blood smears (see page 37). Such
clots and plaques adhere to the arterial intima and initiate atherogenesis.
According to the AA oxidopathy hypothesis, oxidatively damaged
molecules, microclots, and microplaques formed in the circulating blood cause IHD by three
principal mechanisms: (1) their accretion on the endothelial surface inflict vascular wall
damage and initiate atherogenesis; (2) coronary artery spasms triggered by them result in
myocardial ischemia and necrosis without atheromatous occlusion of coronary arteries; and
(3) products of oxidative coagulopathy and AA oxidopathy inflict direct oxidative injury
to cell and plasma membranes of cardiac myocytes and those of the conducting system of the
heart, and lead to cell membrane permeability dysfunctions with consequent membrane
depolarization derangements. The term leaky-cell membrane dysfunction has been used to
discuss the pathogenesis and clinical implications of such cell and plasma membrane
injury.2 The AA oxidopathy hypothesis seeks to establish clotting-unclotting
dysequilibrium in the circulating blood as the core pathogenetic element of IHD and
regards atherogenic cellular and tissue changes involving the vessel wall as
consequential. This hypothesis also calls for a wholly new clinical approach to IHD that
is based on global strategies for arresting oxidative coagulopathy and AA oxidopathy and
for reducing insidious and accelerated oxidative stress on the circulating blood. It also
raises new and serious questions about the appropriateness of
therapies and mechanical coronary interventions in most cases.
Clinical Value and Appropriateness of Coronary Angioplasty
The growth of invasive cardiology has been staggering, with the number
of coronary angioplasty procedures worldwide approaching 900,000 in 1995. Not
unexpectedly, U.S. cardiologists took the lion's share.60 This has happened
despite the recognition that the pathologic processes involved in IHD are insidious and
diffuse while mechanical approaches to coronary artery disease, of necessity, can address
only discrete segments of the arteries. The estimated direct cost of coronary
angioplasties and coronary bypass procedures is more than $150 billion.60 In
addition, there are substantial indirect costs of managing unsuccessful procedures and
their complications, which remain unaccounted for and may exceed direct costs. Despite
such enormous expenditure, there is little consensus that these procedures prolong life.61-69
We cite one specific example. In a recent report, coronary angioplasty and bypass
operations were performed 7.7 and 7.8 times respectively as often for the elderly in the
U.S. as in Canada. And yet the clinical outcome was deemed "virtually
identical."70 In 1988, two panels of doctors, one in the UK and the other in the
U.S.A, judged the appropriateness of the procedure as performed in the two countries.4
That report showed that 17% and 27% of the investigations had been inappropriate by the
standards of the U.S.A panel, whereas 42% and 60% were inappropriate by the UK panel
Coronary angioplasty, though of some clear short-term benefit in terms
of symptom relief, has not been proven to significantly extend life. The incidence of
periprocedural death ranges from 1 to 4 percent.60 The incidence of failed
angioplasty necessitating repeat angioplasty or coronary bypass operations ranges from 25
to 35 percent. Angiographic restenosis within 6 months occurs in up to 42 percent of
cases.60 Some studies report combined rates of repeat angioplasty and coronary
bypass operations of over 50 percent.71 The failure rate increases with longer-term
follow-up. Stent angioplasty is being hailed as a valid answer to this dilemma. But it
also suffers from a severe limitation: Subacute thrombotic occlusion occurs in up to 4
percent of patients within 2 to 14 days and is almost always followed by myocardial
infarction or death. Such high rates of poor clinical outcome are not unexpected since
angioplasty, even its staunchest supporters concede, addresses none of the underlying
causes of IHD. Indeed, angioplasty denudes the endothelium and predictably increases the
risk of thrombosis.
Two large recent studies of registry data cast doubt over the
superiority of angioplasty over thrombolytic therapies.72-73 Recent strategies
for preventing acute ischemic events during and after coronary angioplasty have been
directed at inhibition of platelet surface-membrane glycoprotein Iib/IIIa receptors.74,75
(Epic and Topol 94).The core tenet of AA oxidopathy holds that oxidative injury to blood
components can be caused by several non-platelet factors, and would predict that therapies
directed at platelet receptors alone are not likely to yield long-term good results. Even
in discussions of the atherogenic roles of platelets, we must recognize that the current
therapies that seek to modulate platelet dynamics do not address all known platelet
dynamics that are involved in IHD. As pointed out by Fuster et al.76 all
current antiplatelet and anti-coagulant therapies fail to address all known mechanisms of
platelet/coagulation activation. Indeed, those theoretical considerations are validated by
extended experience with antiplatelet therapies that failed to show their benefit in
reducing the need for subsequent revascularization procedures.77
Why are the above critical issues not addressed seriously by the
cardiology world? Are there viable options to angioplasty and coronary bypass? Why are
those options not explored earnestly? We believe those questions cannot be answered
without a clear understanding of the financial and political aspects of interventional
Clinical Value and Appropriateness of Coronary Bypass Surgery
Coronary bypass surgery has emerged as one of the most commonly
performed surgical procedures in the United States at this time. This is undoubtedly due
to proliferation of cardiac surgery centers in community hospitals across the nation. The
growth of cardiac surgery is all the more remarkable in view of many reports of its
inappropriate use. First, coronary bypass surgery evidently does not address any of the
systemic causes of IHD.1 Angiography is used to determine the need for bypass
surgery despite well-recognized dissociation between the severity of stenosis and the risk
of ischemic complications and infarction.78,79 Angiograms are used as road maps
for bypass surgery, and yet such studies are widely unsuitable and inadequate.79,80
It is recognized that angiographically mild lesions not usually targeted for treatment are
inherently more likely than severe lesions to cause myocardial infarction.81,82
Gross abuses of this coronary bypass operation have been documented. Specifically, in one
survey of coronary bypass surgery, the percentage of appropriate operations was reported
to range from 37 to 78% (thus making 63 to 22% of bypasses inappropriate) in some
reports.5 We may add here that in the study by Brook et al.4 cited above, 13%
of the CBG operations evaluated were deemed inappropriate by the USA and 35% by the UK
Coronary Bypass Surgery for Advanced IHD
For patients with advanced IHD, the reported perioperative mortality is
high (up to 8.4 percent) and long-term survival poor (mortality at three years as high as
one-third), and this subject has been reviewed recently by Khan et al.83 Again,
this should not come as a surprise since coronary bypass graft (CABG) procedure cannot be
expected to address any of the underlying causes of IHD any more than it can in patients
with advanced IHD than those with less advanced disease. Lansman et al.84
reported a 30-day mortality after CABG surgery of 4.8% and a perioperative myocardial
infarction (MI) rate of 4.8 percent. One- third of their patients did not survive the
third anniversary of the operation. A yet higher rate (8.4 percent) of overall hospital
mortality was reported in 83 patients who underwent CABG, with a left ventricular ejection
fraction of 30% or less by Elefteriades et al.85
Enhanced Quality of Life After Coronary Bypass Surgery
Most U.S. reports on the clinical usefulness of such interventions seem
to be positive and emphasize quality-of-life issues, even when survival advantages of
revascularization procedures are meager. This is clearly self-serving since such
procedures "generate billions of dollars in revenue."86 We believe a
clearer and more reliable picture emerges when data for clinical outcomes in the U.S. is
compared with data from other countries. Not unexpectedly, the authors of papers
supporting CABG, while recognizing lack of survival benefits for Americans, strived to
justify their excess of invasive procedures on the quality-of-life issue. And yet, they
neither accounted for the expected perioperative morbidity and mortality of the procedures
nor did they address the high incidence of cognitive disorders after bypass surgery. The
reported incidence of neuropsychological dysfunction during the perioperative period of
coronary bypass surgery varies over a wide range, extending from 25 to 79%.87-91
Even though the incidence of cerebral dysfunction reported from well established cardiac
centers with highly experienced staff is often lower, it must be recognized that a growing
number of procedures are performed in community hospitals lacking the depth of perspective
of university centers, and such data usually goes unreported.
The justification that the procedures improve the quality of life is
not valid in view of the documented high incidence of stroke, recurrent ischemic events,
cognitive disorders, and other adverse effects, as well as death caused by
procedure-related causes.87-91 As regards angioplasty, the restenosis rate
within 6 months of the procedure is reportedly over 40%,56,86 and the mortality
of this procedure in some studies is over 8%.85 The generally poor results
obtained with mechanical, segmental approaches to coronary artery disease are not
unpredictable, since neither angioplasty nor coronary bypass surgery addresses any of the
underlying pathogenetic mechanisms of IHD. Those and other considerations have led some
investigators to call for innovative research in the cause and management of IHD.92
The enthusiasts of bypass surgery often report extremely high rates of
quality-of-life improvement after CABG. Krumholtz et al.93 claimed that CABG
improved the quality of life for 89 percent of their patients (compared with only 44
percent for those on medical therapy alone); however, they deemed the performance of CABG
in terms of survival as of borderline significance. How can an absence of any survival
advantage of an operationwith mortality and morbidity rates as high as those cited
abovebe reconciled with claims of improved quality of life? How can the claimed
improved quality of life in 89 percent of CABG patients be accepted in view of the
reported incidence of neurological and cognitive dysfunctions in CABG patients of 75
percent or more? Perhaps the answer lies in a common observation of clinicians: Patients
recovering from any life-threatening surgery may be expected to be thrilled just to
recover from anesthesia and relish the attention paid to them by the surgical team.
Furthermore, accepting any major surgery is a substantial physical and emotional
investment for the patient, and those with life-threatening cardiac procedures are not
less likely to be persuaded of the putative gains of their investment than those who
undergo other types of surgical operations. Of course, all such benefits are short-lived,
as demonstrated by long-term CABG outcome studies.
Physician Practice Versus Patient Outcome Issues
There are other disturbing aspects of the utilization of angioplasty
and coronary bypass operations in the United States. It is well recognized that such
procedures have the best chance of yielding a good outcome when performed for the most
critically sick persons, i.e., the elderly with left ventricular failure and those with
coexisting serious illnesses.94 Predictably, the mortality associated with such
cases is also the highest. Regrettably, in our fee-for-service model, the procedural
outcomes that assure financial and career rewards for physicians often influence
therapeutic decisions made by clinicians. If this were not so, and if financial and
personal career issues were not to determine who receives the procedures and who doesn't,
cardiologists and cardiac surgeons would favor doing procedures for patients who are most
likely to benefit from such procedures (even though those patients are most likely to
succumb to such procedures). As shown by Pilote et al.94 critically ill
patients who might benefit most are least likely to be offered high-risk procedures.
Care of IHD Within the Context of the Chronically Ill
It generally goes unrecognized that chronic illness replaced infectious
diseases as the dominant public health issue in the 1920s, long before antibiotics
appeared on the scenea global pattern evidently related to nutritional and
environmental factors.95 The first National Health Survey conducted in 1935
reported that 22% of Americans lived with a chronic condition.96 In 1987,
nearly 30% of the population (90 million Americans) suffered from one or more chronic
conditions.97 Based on trends during the preceding decades, nearly 50% of the
population (148 million) may be expectedly to become chronically ill. These considerations
are evidently pertinent to our discussion of medical options for IHD since it accounts for
the major part of the chronically illness population. In the Medicare program, 10% of
beneficiaries consumed 70% of medical resources.98
As the U.S. population ages and the demand for cardiac care by elderly
citizens leapfrogs, the issue of the cost of delivering care assumes critical importance.
The fact that optimal therapy must focus on utilization of health care resources is
becoming increasingly apparent. Consider the following quote from a recent issue of The
New England Journal of Medicine:
Thirty-seven patients would need to be treated for four years (at a
cost of about $438,672 for lovastatin alone) to prevent one patient from undergoing
For this report, we did not attempt to precisely compare the cost of
our entire integrative program for arresting and reversing IHD with the cost of
traditional treatment plans that include multiple drug therapies, hospitalizations for
angioplasty and coronary bypass surgery, and expensive cardiac rehabilitation programs.
However, our estimated cost of the total integrative program for a period of six months is
less than $4,000 (including the cost of 20 EDTA infusions [$95.00 per infusion], cost of
periodic blood testing, nutrient and herbal supplementation, fees for seminars and the
cost of books and tapes). This cost is far less than even the most conservative estimates
of mechanical interventional programs in which hospital charges for even one day may
exceed the cost of our entire program for a full six months. Cost accounting for
in-hospital care is an area a great uncertainty, with estimates of coronary surgery
varying over such a broad range as to be worthless. We include another quote from a recent
issue of The New England Journal of Medicine to illustrate the magnitude of this problem:
[For complications of coronary artery surgery] True
in-hospital costs, including charges for personnel and in-hospital services, if added to
the expense of an array of long-term out-of-hospital medical and rehabilitative services,
probably result in an additional expenditure ranging from 5 to 10 times the narrowly
defined in-hospital costs.100
In discussions of cost-benefit ratio, a critical issue is how much
benefit an integrative program like the one described in this article offers to the
patient in terms of prevention of nutritional, autoimmune and degenerative disorders that
the patient may suffer concurrently with heart disease or may develop during subsequent
years. Evidently, mechanical coronary interventions do not address any of the vascular
lesions in other locations such as the brain, limbs, kidneys and other body organs. Nor do
drug therapies for IHD offer any preventive advantages to the patient as is done by
integrative programs. Indeed, the issue of long-term chemical consequences of
pharmacologic regimens employing concurrent use of multiple drugs should loom large in all
Proposed and Putative Mechanical and Genetic Advances in Cardiology
A recent special report on heart disease published in a business
magazine advises us that about 1 million Americans die of heart disease each year,
including about 300,000 who die of cardiac arrest before reaching a hospital.101
This report was primarily intended for the business and investment community and included
the following recent or imminent advances: (1) the use of a gene-spliced version of
apo-A-1 Milano gene as a drug to increase blood HDL levels; (2) a "biobypass"
approach to coronary artery disease that hopes to use genetically engineered viruses to
transfer VEG-F gene to the heart which is projected to promote angiogenesis in the heart;
(3) the use of a gene-spliced form of VEG-F gene to be used as a drug with the intended
benefit of angiogenesis; (4) the use of total heart replacement implants; (5) the use of
an assist pump called "Streamliner," which will whirl like a turbine and pump
blood in a continuous stream (the patients will no longer have a pulse); (6) the use of
genetically engineered pig hearts, which will carry human immune system proteins; 7) the
use of transplantable hearts developed and cloned in animals, following the lead of Dolly,
the Scottish covergirl sheep. (How transfer of animal viruses to human recipients will be
prevented in such transplants is not obvious); and 8) the use of irradiated filigreed
metal stents that will supposedly prevent the formation of occlusive clots in coronary
Notwithstanding its value to the business and investment communities,
this report prompts us to raise four questions concerning the putative advances in
cardiology: (1) How relevant are the proposed advances to patients with advanced IHD at
present? (2) How relevant are the proposed advances likely to be for the majority of
Americans with advanced IHD in five years? (3) What long- term benefits may be expected
from the proposed advances? (4) What costs can we project for such high-tech answers to
IHD when the number of potential recipients of such therapies grows into millions in the
aging population? The answer to the first question is clear: The proposed advances are of
no value. The answer to the second question is also similar: none most likely. As for the
third question, we discuss at length in this article as well as in the companion article,
AA Oxidopathy, in this issue of the Journal the reasons why mechanical approaches to
segmental lesions of the coronary arteries cannot be expected to provide good long-term
benefits for a disorder that is essentially an oxidative-metabolic disorder of the
circulating blood. The fourth question concerns projected costs of proposed therapies if
they were applied to all those who develop IHD. We are unable to answer that question with
any precise computer models. However, if the past is any indicationboth in terms of
frequency of interventional procedures and failure ratesit seems safe to predict
that the country simply will not be able to fund such high-tech therapies for all patients
with IHD, even if all available health-care dollars were exclusively committed to this
EDTA Chelation for Advanced IHD
The use of ethylenediaminetetraacetic acid (EDTA) infusions as a
chelating agent to "leach" calcium out of atheromatous plaques and so reverse
atherosclerosis was first attempted in the 1950s12,13. The early experience,
which was reported as promising, was followed by decades of controversy, which regrettably
was fueled less by reason and search for effective therapies than by a turf battle among
those who favored bypass surgery and those who were branded as "chelating
quacks." Clinical outcome reports of a large number of physicians who described
positive results were dismissed as unscientific. Even more regrettable was the gross abuse
by the powerful bypass industry of medical licensing boards, which revoked or threatened
to revoke the licenses of clinicians who used EDTA chelation therapy.
A critically important element in any discussion of management of
cardiovascular disorders is how a given therapy for a segmental lesion in one location
affects those in other areas. This is where the clinical benefits of integrated management
plans including EDTA chelation far outweigh those of coronary angioplasty and bypass
surgery. A systemic and non-segmental approach may be expected to improve tissue perfusion
and provide clinical benefit in non-cardiac lesions. This, indeed, happens. We report we
our preliminary and positive experience with a similar program including EDTA infusions
for arresting or reversing peripheral arterial insufficiency.102 Our data is
consistent with that reported by others.103,104 In another report we report our
experience in arresting or reversing renal failure with a similar program.105
This study was conducted as an open clinical outcome trial. In
integrative medicine, the emphasis clearly is on the integration of all measures and
therapies that can enhance the outcome. Indeed, we hold that the prevailing model of
double-blind studies is irrelevant to integrative medicine. There are other important
issues. What can be the moral or ethical basis for denying effective therapies to patients
with life-threatening advanced IHD? How does one justify giving starch pills to such
patients? How can an integrative physician ignore the patient's need for exercise,
meditation, choices in the kitchen, and nutrient and herbal therapies? How can he blind
himself or his patient to such therapies? Indeed, we believe the double-blind cross-over
model of drug research is singularly inappropriate for patients with serious chronic
illness. (In our view the use of a placebo group for patients with acute illness is just
as inappropriate as it for serious chronic illness.)
Some adverse effects reported by others but not encountered in the
present study are listed in Table 6. Such reactions may be expected and should be looked
for in any EDTA chelation program.
Ischemic heart disease (IHD) is an
insidious disorder of redox regulation in which accelerated oxidative molecular injury
occurs to all elements of the circulating blood. It is a diffuse disorder that cannot be
effectively addressed with mechanical interventional approaches directed at segmental
coronary lesions. Nor can the use of pharmacologic therapies that block cell membrane
channels or receptors, as essential as such drugs are for controlling acute illness, be
expected to yield good long-term results. The growth of interventional cardiology in
recent years has been staggering, indisputably fueled by a surfeit of invasive
cardiologists and the generation of billions of dollars in revenue for hospitals as well
as surgeons. Most physicians know of hospitals, whose very existence was threatened by low
occupancy rate, that not only survived but thrived after an invasive cardiology unit was
organized. In 1995, almost 900,000 coronary angioplasties were performed, the U.S. being
the clear leader in the field. Since over 1.5 million Americans are expected to suffer
myocardial infarction annually, it is safe to assume that the useunwarranted in our
viewof angioplasty and coronary bypass will continue to rise unchecked unless
serious efforts to educate people about the true state of affairs are undertaken.
Two simple questions may be asked in this context: First, in the face
of such rapid increases in the incidence of chronic illness, how long can the American
society sustain the leaping growth in the invasive cardiology industry? Second, how long
will the invasive cardiology industry use spurious statistics to sustain itself in the
face of growing recognition of its fundamentally flawed "plumbing" approach to a
clearly oxidative-metabolic disorder? Our preliminary data are consistent with several
previous reports of efficacy of the integrated programs for reversal of IHD employing EDTA
chelation therapy, and offer an alternative to ineffective pharmacologic therapies,
coronary angioplasty and coronary bypass surgery. In this report, our clinical outcome
data shows an extraordinarily safe and effective alternative to the prevailing, and
ineffective, therapies for advanced IHD. Our findings of pre- and post-treatment thallium
myocardial scans show clear evidence of improved perfusion.
REVERSAL OF CORONARY DISEASE:
DEFECTS IN BLOOD SUPPLY BEFORE AND
FOUR MONTHS AFTER BEGINNING A HEART DISEASE REVERSAL PROGRAM
|Area of Heart
In Table 5, we list the
mechanisms of action of EDTA when administered intravenously.
* Central Nervous System:
Coronary vasodilatation with improved myocardial perfusion, relief
of ischemic pain, improved contractile and conducting functions of the heart.
Clarity of thinking, improved memory, warmth, flushing, relief of
Improved night vision
* Peripheral Arterial Perfusion:
Improved perfusion with relief of ischemic claudication
Fall in BUN and creatinine levels
Improved perfusion with skin warmth, healing of chronic ischemic
Improvements in other body organ functions
TABLE 6. POTENTIAL ADVERSE EFFECTS OF EDTA
Hypocalcemia (with or without leg cramps)
Systemic responses in chronic fatigue states
Systemic reactions in chemical sensitivities
Systemic responses in multiple sclerosis and other autoimmune disorders
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