Chelation therapy- Chelation therapy is the administration of chelating agents to remove heavy

metals from the body. For the most common forms of heavy metal intoxicationthose involving lead,
arsenic or mercurythe standard of care in the USA dictates the use of Dimercaptosuccinic acid
(DSA!. "ther chelating agents, such as #,$%dimercapto%&%propanesulfonic acid (D'S! and alpha
lipoic acid (A(A!, are used in conventional and alternative medicine.
Discovery and history in medicine
)helating agents *ere introduced into medicine as a result of the use of poison gas in +orld +ar ,.
-he .rst *idely used chelating agentthe organic dithiol compound dimercaprol, also named /ritish
Anti%(e*isite or /A(*as used as an antidote to the arsenic%based poison gas, (e*isite. ,t binds the
arsenic in (e*isite *ith t*o strong chemical bonds *ith the S0 groups (1mercaptans1!, forming a
*ater soluble compound that entered the bloodstream, allo*ing it to be removed from the body by
the 2idneys and liver. /A( had severe side%e3ects.
After +orld +ar ,,, a large number of navy personnel su3ered from lead poisoning as a result of their
4obs repainting the hulls of ships. -he medical use of 5D-A as a lead chelating agent *as introduced.
Unli2e /A(, it is a synthetic amino acid6 it contains no mercaptans. +hile 5D-A had some
uncomfortable side e3ects, they *ere not as severe as /A(.
,n the &789s, /A( *as modi.ed into DSA, a related dithiol *ith far fe*er side e3ects. DSA :uic2ly
replaced both /A( and 5D-A, becoming the US standard of care for the treatment of lead, arsenic
and mercury poisoning, *hich it remains today.
;esearch in the former Soviet Union led to the introduction of D'S, another dithiol, as a mercury
chelating agent. -he Soviets also introduced A(A, *hich is transformed by the body into the dithiol
dihydrolipoic acid, a mercury and arsenic chelating agent. D'S has experimental status in the US
FDA, *hile A(A is a common nutritional supplement.
"ther chelating agents have been discovered. -hey all function by ma2ing several chemical bonds
*ith metal ions, thus rendering them much less chemically reactive. -he resulting complex is *ater
soluble, allo*ing it to enter the bloodstream and be excreted harmlessly.
5D-A chelation is approved by the U.S. Food and Drug Administration (FDA! for treating lead
poisoning and heavy metal toxicity.<&=
Medical use
)helation therapy is used as a treatment for acute mercury, iron (including in cases of thalassemia!,
arsenic, lead, uranium, plutonium and other forms of toxic metal poisoning. -he chelating agent may
be administered intravenously, intramuscularly, or orally, depending on the agent and the type of
poisoning.
"ne example of successful chelation therapy is the case of 0arold c)lus2ey, a nuclear *or2er *ho
became badly contaminated *ith americium in &7>8. 0e *as treated *ith diethylene triamine
pentaacetic acid (D-'A! over many years, removing ?& /: (&.& m)i! of americium from his body.
0is death, && years later, *as from unrelated causes.
Several chelating agents are available, having di3erent a@nities for di3erent metals. )ommon
chelating agents includeA
Alpha lipoic acid (A(A!
Aminophenoxyethane%tetraacetic acid (/A'-A!
Defarasirox
Deferoxamine
Diethylene triamine pentaacetic acid (D-'A!
Dimercaprol (/A(!
Dimercapto%propane sulfonate (D'S!
Dimercaptosuccinic acid (DSA!
5thylenediamine tetraacetic acid (calcium disodium versante! ()aBa#%5D-A!
5thylene glycol tetraacetic acid (5C-A!
D%penicillamine
Use in alternative medicine
Cilantro
)ilantro (coriander! has been tested in mice,<$= and is present in numerous alternative medications.
Although cilantro *as *idely described as a chelator of lead, mercury or other heavy metals in
internet literature,<?= <D= and is often used as such, there is little research about such claims.<8=
Heart disease
Some alternative practitioners use chelation to treat hardening of the arteries. -he use of 5D-A
chelation therapy as a treatment for coronary artery disease is currently being studied by the
Bational )enter for )omplementary and Alternative edicine, but no claims or .ndings are expected
before #997. <>= <&=
Autism
/ased on the speculation that heavy metal poisoning may trigger the symptoms of autism, some
parents have turned to alternative medicine practitioners *ho provide chelation therapy. 0o*ever,
the only evidence to support this belief is anecdotal. -here is strong epidemiological evidence that
refutes lin2s bet*een environmental triggers, in particular thimerosal%containing vaccines, and the
onset of autistic symptoms. Bo scienti.c data supports the claim that the mercury in the vaccine
preservative thiomersal causes autism<E= or its symptoms,<7= and there is no scienti.c support for
chelation therapy as a treatment for autism.<&9= <&&=
Controversy
-he e@cacy, safety, and much of the theory behind these alternative practices are disputed by the
medical community. ,n #99&, researchers at the University of )algary reported that cardiac patients
receiving chelation therapy fared no better than those *ho received placebo treatment.<&#=
,n #99$, the Supreme )ourt of issouri, in State Board of Registration for the Healing Arts v.
McDonagh, &#$ S.+.$d &?8, overturned a decision of the State /oard of ;egistration sanctioning a
doctor *ho used chelation therapy for the treatment of heart disease. -he )ourt held that the
therapy *as not harming patients, and the standard for determining repeated negligence in using an
alternative therapy such as chelation is not *hether it is popular or commonly accepted by the
medical community, but rather *hether heart specialists *ould consider its use to be reasonable.
,n &77E, the U.S. Federal -rade )ommission (F-)! charged that the *eb site of the American )ollege
for Advancement in edicine (A)A! and a brochure they published had made false or
unsubstantiated claims. ,n December &77E, the F-) announced that it had secured a consent
agreement barring A)A from ma2ing unsubstantiated advertising claims that chelation therapy is
e3ective against atherosclerosis or any other disease of the circulatory system.<&$= <&?=
Prevalence
-he American )ollege for Advancement in edicine (A)A!, a not%for%pro.t D9&(c!(8! organiFation
*hich promotes chelation therapy, claims that E99,999 patient visits for chelation therapy, *ith an
average of ?9 visits per patient, *ere made in the United States in &77>.<&D=
Side efects and safety concerns
-here is a lo* occurrence of side e3ects *hen chelation is used at the dose and infusion rates
approved by the U.S. FDA. A burning sensation at the site of delivery into the vein is common. ;arer
side e3ects include fever, headache, nausea, stomach upset, vomiting, a drop in blood pressure and
hypocalcemia. Gidney toxicity is a safety concern, but a rare occurrence. +hen 5D-A is not
administered correctly, more serious side e3ects can occur.<&=
)helation therapy can be haFardous. ,n August #99D, botched chelation therapy 2illed a D%year%old
autistic boy, a nonautistic child died in February #99D and a nonautistic adult died in August #99$.
-hese deaths *ere due to cardiac arrest caused by hypocalcemia during chelation therapy.<&8=