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October 2008

Chelation therapy attacked
Healthy lifestyle lowers strokes
Diverticulitis: seeds, nuts, corn, and popcorn are OK
Dietary pattern and diabetes risk
Combined exercise helps heart failure

Chelation therapy attacked

Chelation therapy, as most frequently practiced for the treatment of vascular disease, consists of the intravenous administration of a synthetic amino acid called EDTA (ethylene diamine tetraacetic acid). It has been used since the 1950s by thousands of doctors on hundreds of thousands of patients. Early research on its benefits was highly positive, with few side effects.

In the early days of chelation, the safe dose of EDTA was not clear, and the high doses that were administered led to a few deaths from kidney disease. They were administering up to 10 grams of EDTA in each IV treatment with no monitoring of kidney function. We have since learned that a very safe dose of EDTA is approximately three grams administered over three hours.

Also, kidney function is closely monitored and the treatment is adjusted accordingly. When EDTA has been administered according to this safe protocol, no deaths or serious side effects have occurred. As a result of the safety and apparent usefulness of the treatment, as well as the controversy surrounding it, the National Institutes of Health has funded a study led by a respected cardiologist to determine more clearly whether EDTA is effective in a large, blinded trial (Trial to Assess Chelation Therapy, or TACT).

Now, a collection of antagonists to any integrative medicine, including some who have been discredited in court, and who have a specific distaste for chelation therapy, have complained that the study, based on decades of safe use and prior research, should be stopped. They say it is an unsafe treatment, which is untrue – the FDA did not even require further safety studies before approving the TACT protocol. They also make unfounded ad hominem attacks on the investigators in general because one was found to have a criminal background (when you have 100-200 investigators in private practice, it is hard to completely screen for distant histories of wrongdoing). This does not mean that all the researchers are tainted.

The critics make numerous unfounded allegations; one is that the disodium EDTA used in the study is dangerous, which is not true with the current dose and rate of administration. The study’s principal investigator (Gervasio Lamas, MD) is clearly well credentialed and an honorable cardiologist. The patients in the study all have vascular disease, so it would not be surprising if there were some deaths among them during the course of the study. While inappropriate administration of EDTA has risks (and has led to at least one recent death in a pediatric case), it is unlikely that any physician following the proper protocol has had a patient death as a result of the treatment for vascular disease.

Overall, the critics of chelation therapy have used misinformation and selective reporting to tarnish a therapy that has a long history of safe use and to attempt to block a study that has the potential to show how well chelation works. The small budget for this study must come from the government, as no drug company has an interest in evaluating the use of EDTA because it is no longer patentable. The American College for Advancement in Medicine (ACAM) has supported the suspension of the TACT until allegations of impropriety can be proved false. Their president has said that these “allegations are political in nature.”

I have treated patients with chelation therapy for 25 years, and have never seen a serious side effect. Most patients have seen clear benefits that are sometimes dramatic. I have also reviewed most of the research since the 1950s, and most of the studies are positive. The few that are reported as negative actually had positive results if you look at the data, rather than just the authors’ conclusions. I look forward to the results of the TACT.

Healthy lifestyle lowers strokes

A healthy lifestyle can reduce your risk of stroke, although this may hardly seem like news. Not smoking, maintaining a normal body mass index (BMI), moderating alcohol consumption, exercising 30 minutes per day, and eating a healthier diet all have benefits related to strokes. This study combined data from the Health Professionals Follow-up Study (43,685 men) and the Nurses’ Health Study (71,243 women). (Chiuve SE, et al., Primary prevention of stroke by healthy lifestyle. Circulation. 2008 Aug 26;118(9):947-54.)

Participants who followed the healthiest lifestyles had a 70 to 80 percent reduction in their stroke risks. The most benefit was in the reduction of strokes due to hardening of the arteries and thrombosis, but the risk of hemorrhagic stroke was also lowered.

Diverticulitis: seeds, nuts, corn, and popcorn are OK

Diverticulosis is a condition of the colon with pockets forming on the intestinal wall due to increased pressure, most likely from constipation. Sometimes food collects in these pockets (like bubbles on a tire inner tube when the outer tire is weak), and this can lead to infection and inflammation, a condition called diverticulitis.

For many years, patients with diverticulosis have been told to avoid certain fibrous foods, such as nuts, seeds, and corn, particularly popcorn. However, this was a theoretical concern, as it “seemed logical” that these foods could get trapped in the diverticula and lead to problems. It now turns out that the scientific data does not support these restrictions (most fibrous foods are not irritating, and indeed can help move things through the bowel and reduce constipation).

Researchers followed 47,228 men over 18 years and compared those with high nut, seed, corn, and popcorn consumption with those who consumed the least. (Strate LL, et al., Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008 Aug 27;300(8):907-14.) For the most part they found no association between these foods and diverticular disease. However, contrary to “popular” medical opinion, high intake of nuts and popcorn actually significantly reduced the incidence of diverticulitis, by 20 percent in the case of nuts, and by 28 percent for popcorn. In general, high fiber foods are associated with less diverticulosis, and now it appears that they can help prevent the inflammatory consequences that sometimes occur.

Dietary pattern and diabetes risk

Dietary patterns play a role in the risk of diabetes more than any one food. In a new study, a diet rich in whole grains, leafy green vegetables, fruits, nuts, seeds, and low-fat dairy products reduced the risk of diabetes by 15 percent. (Nettleton JA, et al., Dietary patterns and risk of incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2008 Sep;31(9):1777-82.)

Another dietary pattern was associated with an 18 percent increased risk of diabetes. This included refined grains, high-fat dairy products, tomatoes, and red meat (sounds like a pepperoni pizza to me) as well as beans. Why beans would be a problem is unclear, as most other research has shown them to be among the foods that lower diabetes risks, and the same could be said of tomatoes, unless you count the ketchup on French fries as part of the tomato group. Also, beans and tomatoes are often part of high-fat, cheesy, fast-food tacos that reflect poor dietary habits in general.

The research was done on 5011 participants from 45 to 84 years old, and they were followed for five to seven years. They included white, black, Hispanic, and Chinese subjects without diabetes or heart disease at the initial evaluation. It is interesting that the results were independent of race or ethnicity. People often like to blame genetics for such health problems, but it is clear from this research and other studies that the common health problems and obesity are lifestyle related rather than genetic.

Dietary pattern studies can be difficult to evaluate when disparate foods are included in one group. Most research shows that a diet high whole grains, vegetables (including tomatoes), fruits, beans, seeds, and nuts is beneficial for reducing the risks of diabetes, heart disease, cancer, and other illnesses.

Combined exercise helps heart failure

Aerobic exercise (endurance training) has many benefits, among them improvement in functioning in patients with congestive heart failure (to be clear, heart failure is not a complete failure of the heart to function, but a diminished functional capacity of varying severity). However, it now appears that including resistance training with workouts (lifting weights, resistance bands, or other exercise that builds muscle strength and bulk) provides even more benefits than endurance training alone. (Beckers PJ, et al., Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: a prospective randomized study. Eur Heart J. 2008 Aug;29(15):1858-66.)

Researchers evaluated 58 subjects with class II and class III heart failure and put half on and endurance training program and half on a combined program with endurance and resistance exercises. Of those in the endurance group 28 percent had significant improvement in symptoms, while among those on combined exercise 60 percent showed improvement. Muscle strength, exercise, and quality of life were better in the combined exercise group, and neither group had any negative effects on the heart muscle. In heart failure patients it has been a concern that muscle workouts might strain the heart muscle, but this was not evident in either exercise group.

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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.

Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.