* Eat a Mediterranean diet, including lots of beans, peas, fish, fruit, vegetables, cereals and olive oil, and not so much meat, fat and eggs (Circulation, 1999; 99: 779-85). A high dairy intake can increase heart disease risk (Altern Med Rev, 1998; 4: 281-94)

* Avoid the standard heart-healthy low-fat, low-cholesterol diet. In one Indian study, those on a Mediterranean diet had half the heart symptoms and nearly one-third the deaths from heart attack as those on a low-fat diet (Lancet, 2002; 360: 1455-61)

* Avoid high-glycaemic, processed foods, linked to high cholesterol and other heart problems

* Stop smoking

* Eat nuts; they dramatically reduce the risk of heart disease (BMJ, 1998; 317: 1341-5)

* Avoid hydrogenated fats and trans fatty acids, found in most processed foods, particularly margarine (Lancet, 1993; 341: 581-5)

* Consume foods rich in flavonoid antioxidants – brightly coloured fresh fruits and vegetables, grape juice, green tea, red wine in moderation (J Nutr, 2000; 130: 53-6). Flavonoids contain proanthocyanidins and tannins, which strengthen blood vessels and blood flow

* Two-and-a-half servings of wholegrains a day can cut your heart disease risk by a third (Am J Clin Nutr, 1999; 70: 412-9)

* Exercise regularly – even just walking increases the levels of protective HDL (JAMA, 1991; 266: 3295-9). In those with CHF, regular exercise reduced mortality by 40 per cent, and 60 minutes of cycling three times a week significantly lowered death rates, and improved heart function and quality of life (BMJ, 2004; 328; 189; Circulation, 1999; 99: 1173-82)

* Supplement with coenzyme Q10 (10-30 mg/day for general prevention; 200-400 mg/day as therapy). In nearly 3000 people with CHF, 50-150 mg/day for three months reduced fluid retention by 80 per cent, heart palpitations by 75 per cent, and liver enlargement and shortness of breath by 50 per cent (Mol Aspects Med, 1997; 18: S159-68). Also, just 60 mg of CoQ10 twice a day reduced high systolic blood pressure by a massive 18 mmHg (South Med J, 2001; 94: 1112-7). Moreover, CoQ10 appears to help us live longer. Says Dr Lansjoen, ‘People who make it to the age of 90 tend to have high Q10 levels.’

In addition, supplement with:

* Vitamin E (400 IU/day) to neutralise ‘bad’ LDL cholesterol (Arterioscler Thromb, 1993; 13: 1779-89)

* Vitamin C (at least 1 g/day) to maintain healthy blood vessels (Am J Clin Nutr, 1974; 27: 866-76)

* A multivitamin rich in the other antioxidants (such as vitamin A and selenium, which may help with any statin-induced damage) plus an evening supplement of zinc

* L-Carnitine, a non-essential amino acid (1-4 g/day), which increases ‘good’ HDL cholesterol (Curr Ther Res, 1980; 27: 208-16) and helps improve tolerance to exercise (Jpn Heart J, 1984; 25: 587-97; Clin Terap [Ital], 1992; 140: 353-77)

* Magnesium, the heart mineral, which may reduce cardiovascular spasm (Magnesium, 1985; 4: 226-44)

* Chondroitin (1500 mg/day), which can ‘dramatically’ reduce the risk of heart attack (Angiology, 1973; 24: 269-87)

* Brewer’s yeast (2 tsp/day) contains chromium and lowers cholesterol (Nutr Res, 1989; 9: 989-98)

* Psyllium (5-10 g/day) lowers LDL by almost 10 per cent (J Nutr, 1997; 127: 1973-80)

* Fenugreek seed powder (25-50 g/day) can increase HDL (Phytother Res, 1991; 5: 145-7)

* Beware of environmental toxins, which have been linked to heart disease and heart inflammation (N Engl J Med, 1997; 337: 422-4).

In August 2001, the statin Baycol was withdrawn by its German manufacturer Bayer after 31 people died due to drug-induced rhabdomyolysis. From November 1997 to March 2000, 601 cases of statin-induced rhabdomyolysis – and 38 deaths – were voluntarily reported to the US Food and Drug Administration (Lancet, 2004; 363: 892-4).

Minor adverse effects include skin rash, constipation and headache.

Unofficial side-effects include cancer, nerve damage (peripheral neuropathy), memory loss and other cognitive problems. There’s also the strong possibility that statins may cause diabetes, as insulin sensitivity is significantly reduced by these drugs (JAMA, 2002; 287: 598-605). Statins also deplete antioxidants by 25 per cent, which may explain the possible cancer connection.

Despite claims that side-effects affect only a tiny percentage of patients, the evidence indicates that as much as 65 per cent of those taking statins experience adverse side-effects (Am J Cardiol, 2003; 92: 670-6).

A new finding is that statin side-effects resemble symptoms of a deficiency in the antioxidant selenium (Lancet, 2004; 363: 892-4). It’s believed that statins may somehow block selenoprotein synthesis. Selenoproteins are involved in the formation of the hormones thyroxine and glutathione peroxidase, and in muscle-cell regeneration. Interestingly, selenoprotein dysfunction is seen in diseases with symptoms similar to statin side-effects – namely, juvenile myopathy and muscular dystrophy.

This chronic disease tends to develop slowly, with symptoms of fatigue, shortness of breath and swelling in the legs. The underlying cause is a loss of pumping capacity by the heart, which may be due to persistent high blood pressure, irregular heartbeats, hardened arteries, a previous heart attack, lung disease or thyroid gland problems.

Early on, the body compensates by increasing the heart rate and even the size of the heart. However, as the heart weakens, fluid collects in the lungs (hence the word ‘congestive’) or is trapped in the circulatory system, causing swelling of the blood vessels and organs such as the liver.

Heart failure is now the leading cause of hospitalisation in those over 65 – and the problem is getting worse by the year. Experts tell of a ‘growing epidemic of CHF’ (Cardiol Clin, 2001; 19: 547-55), particularly over the last 20 years. In the US, nearly five million people suffer from heart failure; in the UK, it is believed to affect 1 per cent of the population – or around 500,000 people – at any given time. Some experts find this CHF epidemic puzzling, given the fall-off in other heart diseases (MMWR, 1994; 43: 77-81). Others warn that CHF is ‘highly lethal’, killing over 80 per cent of men within six years of diagnosis (Am Heart J, 1991; 121: 951-7).

Mortality rates like these have been one of the reasons why health authorities are prepared to spend huge amounts of money on statins, the so-called miracle drugs that are meant to prevent heart disease.

The miracle of statins
With most of the world’s major pharmaceutical companies offering a statin, this is now the biggest drug sector – worth a staggering $20 billion each year. Introduced less than 20 years ago, they have become the most profitable drugs in the history of medicine.

Statins don’t cure; they reduce cholesterol levels in blood to below the figure thought to cause heart disease. As such, statins are primarily prescribed as preventative medications and often given in perpetuity. But these ‘patients’ don’t have a true illness; they are simply those who have a particular lab-test reading – and may have no symptoms whatsoever.

Moreover, the cholesterol-heart disease connection is still largely only theoretical, and not always borne out in practice: for example, 50 per cent of people who die from heart attacks don’t have high cholesterol.

So, according to the best analysis, statins may only prevent some heart conditions – and that’s assuming they work. Nevertheless, cardiologists – especially those in the US – recommend that at least half of the adult population should be permanently taking statins. Even in the cash-strapped NHS, British GPs are urged by drug companies to give statins to anyone whose cholesterol levels fall outside of the recommended ‘target’ values.

But statins are now increasingly coming under fire. First, although marketed as safe, bitter experience has revealed serious side-effects (see box, p 2). But the major concern is that, although statins may lower cholesterol by as much as 30 per cent, this does not translate into any significant prolongation of life – which is why they are given in the first place.

Statins unmasked
The evidence that statins don’t deliver the goods has been steadily accumulating over the past decade. Keen-eyed medical statisticians have pored over the data from drug company-sponsored clinical trials, and found some interesting facts hidden behind the headlines.

Last year, for example, researchers at the University of British Columbia concluded that statins may harm as many people as they help. Pooling the data from five separate large-scale trials, the UBC team found that statins indeed reduced heart attacks and strokes – but only by a meagre 1.4 per cent. This means that 71 people with high cholesterol would have to be treated with statins for up to five years to prevent just one heart attack or stroke.

Furthermore, setting this modest gain against a 1.8 per cent increase in the serious side-effects caused by the drugs effectively cancels the benefit, concluded the UBC team leader Dr James Wright, (Therapeutics Initiative, April-June 2003, University of British Columbia).

British researchers arrived at an even starker conclusion – that statins can kill. The University of Sheffield’s Department of Clinical Pharmacology looked at the risk-to-reward ratio of statins, comparing the mortality rates of people taking statins with their underlying risk of death. The figures suggest that statin use ‘could be associated with an increase in mortality of 1 per cent in 10 years’ (Br J Clin Pharmacol, 2001; 52: 439-46).

Heart failure
A small band of doctors are now beginning to ask: could there be a connection between the huge rise in statin use and the current epidemic of CHF?

One of the doctors leading this heresy is Texas cardiologist Dr Peter Langsjoen. ‘In my practice of 17 years, I have seen a frightening increase in heart failure secondary to statin usage – I call it ‘statin cardiomyopathy’,’ he says. ‘Are we causing this epidemic through our zealous use of statins? In large part, yes.’

But how can a drug meant to prevent heart failure possibly cause it? The answer has been unfolding since 1985, when a team led by University of Texas biochemist Dr Karl Folkers found that those suffering from heart failure had a deficiency of the enzyme ubiquinone in their heart tissue – the less ubiquinone, the worse the heart failure (Proc Natl Acad Sci USA, 1985; 82: 901-4).

Ubiquinone got its name because it is found everywhere in the body – it’s ubiquitous. Later recognised as necessary for glucose production, its name was changed to ‘coenzyme Q10’ (CoQ10). It was soon found to be at its greatest concentrations in the heart, where it is now known also to act as a powerful antioxidant.

Folkers immediately set about testing oral supplements of CoQ10 on patients with CHF. His reported results were spectacular. ‘These patients, steadily worsening and expected to die within two years under conventional therapy, generally showed an extraordinary clinical improvement,’ he wrote (Proc Natl Acad Sci USA, 1985; 82: 4240-4).

These results, together with his earlier discovery, strongly suggested that CoQ10 is an important contributory factor in CHF.

The CoQ10-statins connection
During the next five years, Folker teamed up with fellow Texan Langsjoen, the cardiologist who had expressed such concerns about statins causing heart failure. Combining Folker’s biochemical evidence with Langsjoen’s clinical experience, they asked: could statins be depleting CoQ10?

This possibility had never been investigated in any of the official trials of statins, so it was virgin scientific territory.

Folker’s biochemists set about testing their hunch in the laboratory by feeding rats lovastatin, the most widely prescribed statin drug.

What they found was a bombshell: lovastatin depleted as much as 20 per cent of the CoQ10 in the rats’ blood, and about 10 per cent from their heart tissue (Proc Natl Acad Sci USA, 1990; 87: 8928-30). Folker and Langsjoen then went on to test their findings on human volunteers and confirmed the animal findings – lovastatin destroys CoQ10 (Proc Natl Acad Sci USA, 1990; 87: 8931-4).

Since then, confirmation of their results has come in thick and fast, strongly implicating most of the statins in CoQ10 depletion. Italian physicians found that simvastatin caused a 20 per cent reduction in blood CoQ10 levels (Int J Clin Lab Res, 1994; 24: 171-6), and similar results were obtained by Russian doctors using cerivastatin (Bull Exp Biol Med, 2002; 134: 39-42). French physicians achieved the same results with all the statins they prescribed (Br J Clin Pharmacol, 1996; 42: 333-7).

So, all of this suggests that Langsjoen’s once heretical idea that statins cause heart failure may well be on its way towards becoming established fact. The logic seems clear: if statins deplete CoQ10, and low levels of CoQ10 are associated with CHF, then statins may be a causal factor in CHF.

In a crowning irony, Merck (which manufactures simvastatin, marketed as Zocor) has filed a patent proposing to add CoQ10 to its formulation – a tacit acknowledgement of the core problem with these drugs.

Nevertheless, the widespread use of statins increases unabatedly, with over a million prescriptions a month in the UK alone – a 10-fold increase in less than a decade.

Nearly three years ago, 14 experts from across the globe, most of them professors of medicine, signed an open letter (dated 5 September, 2001) to the US Food and Drug Administration, the supreme American health authority. In this communication, they pointed out the dangers of statins and pleaded: ‘It is urgently incumbent upon the scientific community . . . and the regulatory bodies to be certain that we are not inadvertently creating a life-threatening deficiency . . . in many millions of patients.’

Since then, however, regulatory bodies have done nothing. The silence has been deafening.

The mercury connection
Besides statins, what other factors might lie behind the CHF epidemic? Groundbreaking research from Italy says one major environmental cause could be dental amalgam fillings. Researchers at the Catholic University in Rome have tested patients with advanced CHF and found a ‘marked elevation’ of mercury in the heart tissue – in the order of a massive 22,000 times higher than normal. None of these patients worked or lived in areas that would have exposed them to mercury, so the source of this toxin in their bodies must have been the silver-mercury amalgam fillings in their mouths.

Interestingly, most of the mercury was concentrated in the heart, with very little found elsewhere in the body. Quite why this happens is not known, but the researchers speculate that the mercury can ‘adversely affect . . . heart metabolism and worsen cellular function’ (J Am Coll Cardiol, 1999; 33: 1578-83).

That mercury is a major poison has been known for more than a century, but dentists have always claimed that, when chemically amalgamated with silver, it becomes harmless. But, in the last 20 years, this view has been seriously called into question as study after study has shown that amalgam fillings leach mercury into the body, mainly through mercury vaporisation while chewing.

Dentists have been forced to retreat to a fall-back position in which they now admit that fillings do give off mercury, but at such low levels that they’re non-toxic. However, this convenient side-step appears to have been scuppered by the new Italian research demonstrating that mercury is not harmlessly distributed throughout the body, but accumulates into potential killer loads in the heart.

The Italian findings tie in with older US research that found that people with amalgam fillings had significantly more heart-related problems than those with healthy teeth. Amalgam-filled patients also had more irregular heartbeats and fatigue – typical of CHF (Sci Total Environ, 1990; 99: 23-35).

Similarly, when Soviet doctors studied workers exposed to mercury, they found that the heavy metal had a profound effect on the heart, interfering with its normal contractions, electrical conductivity and overall regulation. Like the Italians, they too found that mercury accumulated in the heart tissue and valves (Cardiotoxic Effects of Mercury, DHEW (NIH) Publication No 74-473, 1974: 109-34, 199-210).

So, with mercury accumulating in the heart, could it be affecting levels of CoQ10, which is also primarily found in the heart? Nobody knows for sure because the research hasn’t been done, but such a mechanism seems plausible.

Tony Edwards

A study from the Netherlands involving 10,519 patients aged over 55, who were taking both drugs, found their chances of landing up in hospital with congestive heart failure were more than twice as great as those on just diuretics.

Surprisingly, the greatest risk was in the younger age group patients aged between 54 and 64 possibly because the NSAIDs seemed to bring on heart failure within 20 days of the treatment starting if diuretics were already being taken.

The risk of a hospital stay increased to three times if diuretics were mixed with potassium sparing drugs, and the risk was also higher if loop diuretics were used with NSAIDs (Arch Internal Med, 1998; 158: 1108-12).

One statin, Baycol, was withdrawn after 31 people died while on the drug. Other documented side-effects include cancer, nerve damage, memory loss and other cognitive problems. There’s also the strong possibility that statins may cause diabetes, and that they deplete the body’s natural store of antioxidants.

So with that track record, it’s not surprising that the UK drug watchdog last month made them available at every pharmacy without the need of a prescription.

Better yet, one pharmacy group is taking full advantage of the relaxation of controls by touting statins around Britain’s pubs, where they think the drinkers and smokers are most likely to be potential customers.

The Co-Op Pharmacy will be offering on-the-spot health checks for high cholesterol to regulars at pubs and clubs before offering them some statins. The Co-Op will set up stalls in clubs, pubs and community centres in trial areas as a first stage.

At least we’re keeping a tight rein on vitamins.

* If statins are a health risk, what else can you do to reduce cholesterol? Find out in the WDDTY guide Your Healthy Heart. Your copy is just a click away, so click here: http://www.wddty.co.uk/shop/details.asp?product=110

I am still awaiting the results from the diagnostic tests – an oesophageal echocardiogram and coronary angiography – but my doctors believe surgery is inevitable to have my mitral valve either repaired or replaced.

Are there any alternatives to surgery? If there are none, what are the risks and drawbacks of this operation? I am 55 years old, and both my parents also suffered from cardiac problems – my father had a slow heartbeat and needed two pacemakers, while my mother died from a heart condition. – Malcolm Linchis, London

A MVP is a common heart condition in which the two flaps of tissue (mitral valves) controlling the flow of blood from the upper to the lower left heart chambers stop working properly. As a result, blood is ‘regurgitated’ back into the upper chamber, causing a ‘heart murmur’.

While the symptoms of MVP are usually benign, with the majority of those affected continuing to lead normal lives, about a quarter of cases worsen with age. Progressive deterioration of the valves leads to more severe regurgitation, with the blood not only pushed back into the upper chamber, but also into the lungs. Symptoms such as breathlessness, fatigue and chest pain become more pronounced, as you’ve experienced and, in the worst-case scenario, congestive heart failure can ensue.

To prevent reaching such a dangerous stage, doctors recommend repairing your mitral valve or replacing it with a prosthesis, depending on the amount of damage. This essentially means open-heart surgery, and the risks are as high as you would expect for such an invasive procedure.

It is important that you consider very carefully if the benefits from surgery will outweigh the risks of the procedure. Once you have the results of your echo and angiographic tests, make sure the doctor explains to you as clearly as possible the severity of your condition and whether you really do need the surgery. Do not allow your doctor to wave away your questions and decide for you. Also, ask if there are any alternatives to surgery (see box on right).

If you do decide to opt for surgery, there seems to be a slight disparity between the success of mitral-valve repair vs replacement. Those who have undergone repair rather than replacement appear to have a slightly better chance of survival, and are less likely to need further surgery (J Cardiovasc Surg [Torino], 1999; 40: 93-9).

Congestive heart failure describes a problem where the heart is functioning inadequately as a
pump. This leads to a range of problems but most of the symptoms result from the congestion that develops in the lungs or backup pressure of blood in the veins of the body. Thus dyspnoea and edema will result. Orthodox medicine’s approach to heart failure is based upon the successful use of cardiac glycosides remedies such as Foxglove.

It would be inappropriate in a correspondence course format to explore
the use of cardio-active remedies in practice. As dramatically effective as they are, the key to safe and successful usage is skilled diagnosis and interpretation. Without this skill (unteachable in this format) these plants are potentially extremely poisonous. The non-cardioactive approach described here will prove effective in a number of situations:

• to support the work of the medication the patient may be on, but notreplace it.

• for patients with mild heart failure that does not warrant the use of stronger medication. This is especially the case in the elderly who have chronic CHF.
  

Actions indicated for the processes behind this disease

Cardio-actives will be the core for the treatment of such problems butare best prescribed by skilled diagnosticians who can follow
the changes brought about in the heart & its functioning.

Cardiac Tonics will aid any allopathically prescribed cardiacglycosides.

Peripheral Vaso-dilators may be indicated and will help generalized circulation in the face of the heart disease.

Hypotensives are often appropriate because of associated hypertension.

Diuretics ease the water retention problems. Cardio-actives diuretics
are often used. Replacement of flushed out potassium is essential.

Nervines will ease the stress component, either causal or a result of the heart disease.

System support

As this all too common malady is usually a result of degenerative processes, it may be accompanied by any of the plethora of conditions that may manifest the aging process. Tonic support is called for the CV and respiratory systems,
but beyond that the specifics will depend upon the individual concerned.

Specific Remedies

As the primary cardio-actives are often out of the range of what can be safely used by the herbalist can do in practice, we shall not used Lily of the Valley or its equivalents in this suggested prescription. Our aim is to either strengthen the heart muscle or support the work of all opathically prescribed cardiac glycosides.
Hawthorn, Linden Blossom and Garlic are essential.

One possible prescription:

Hawthorn — 3 parts

Ginkgo — 1 part

Linden Blossom — 1 part

Dandelion leaf — 1 part

Motherwort — 1 part

Cramp Bark — 1 part

Valerian — 1 part

to 2.5ml of tincture combination 3 times a day

Garlic should be used as a dietary supplement.

The dietary and life-style issues already discussed in this chapter on the cardiovascular system all apply for congestive heart failure. Please refer to Hypertension, Arteriosclerosis and the opening sections.

Breathing problems also affect people who are very allergic to some types of shellfish, nuts, medications and insect bites. These people can suffer an allergic reaction called anaphylactic shock. This reaction begins within minutes of exposure to the substance causing the allergy. During this type of allergic reaction, the airways narrow, making it difficult to breathe. Soon, the heartbeat races and blood pressure drops. Anaphylactic shock can be fatal if a person is not treated within 15 minutes.

Breathing problems from some things may require emergency care.

In children they include:

• Wheezing (see page 263)
  
• Croup, a virus with a “barking cough” common in young children (see page 255)
  
• Diphtheria, which is a very contagious throat infection
  
• Heart defects children are born with
  

• Severe allergic reactions
  
• A face, head, nose or lung injury
  
• Carbon monoxide poisoning
  
• Harsh chemical burns in the air passages
  
• Epiglottitis, which is inflammation of the flap of tissue at the back of the throat that can close off the windpipe
  
• Choking (see page 298)
  
• Drug overdose
  
• Poisoning (see page 322)
  
• Asthma (see page 76)
  
• Bronchitis (see page 81)
  
• Pneumonia (see page 369)
  

• Emphysema (see page 348)
  
• Congestive heart failure
  
• Heart attack (see “Chest Pains” on page 150 and “Coronary Heart Disease” on page 343)
  
• Blood clot in a lung
  
• Collapse of a lung
  

• Avoid allergic substances or agents that induce asthma, if you have it.
  
• Do not walk, run or jog on roads with heavy automobile traffic.
  
• If you have a gas furnace, install a carbon monoxide detector.
  
• Never leave your car running in a closed garage.
  
• Make sure immunizations against childhood diseases, especially diphtheria, are up-to-date. This is part of the Diphtheria, Tetanus, Pertussis (DTP) vaccination. (See “Immunization Schedule” on page 18.)
  
• If you smoke, quit.
  
• Keep small objects a child could choke on out of reach and do not give gum, (especially bubble gum), nuts, hard candy, or popcorn to children under 5 years old.
  
• Lock up all medications and poisonous substances so small children can’t get to them.
  

Has breathing stopped and is there no pulse?
Has breathing stopped, but there is a pulse?
Has breathing stopped due to choking on an inhaled object?
Are there signs of anaphylactic shock? Difficulty breathing Swollen tongue, eyes, or face Unconsciousness Difficulty in swallowing Dizziness, weakness Pounding heart Itching, hives
Are any of these problems present with difficulty in breathing? Signs of a heart attack such as chest pain, pressure, or tightness; pain that spreads to the arm, neck or jaw; irregular pulse. Serious injury to the face, head, or chest Signs of a stroke such as blurred or double vision, slurred speech, one-side body weakness or paralysis Signs of drug overdose such as drunkenlike behavior, slurred speech, slow or rapid pulse, heavy sweating, enlarged or very small eye pupils
Is it so hard to breathe that the person can’t talk (say 4 or 5 words between breaths) and/or is there wheezing that doesn’t go away?
Is blood being coughed up?
Does the difficulty in breathing occur with a cough in a baby and does it make the baby unable to eat or take a bottle?
Are any of these signs present? Breathlessness at night or at rest Pink or frothy phlegm being coughed up and/or A high fever along with rapid and labored breathing
Is a green, yellow, or gray mucus being coughed up?

• Wear a face mask that covers the nose and mouth, when outdoors. Most hardware stores carry inexpensive ones.
  
• Don’t smoke. Avoid secondhand smoke. This applies to anyone with breathing difficulties.
  
• Install an electronic air filtering system or use an air purifier in your home, especially in the bedroom. Tests show that air filters help clear the air of allergy-causing agents.
  

Breathing problems can be avoided or lessened if you:

• Do not rake leaves that have been on the ground for awhile. Molds and mildew grow on leaves after they’ve been on the ground for a few days.
  
• Keep your basement dry, well ventilated, and well lit. Use dehumidifiers and exhaust fans to reduce moisture in the air.
  
• Get rid of house plants.
  
• Avoid barns, chicken coops, damp basements, and attics.
  

See also: “Asthma” on page 76, “Bronchitis” on page 81, “Common Cold” on page 83, “Coughs” on page 85, and “Flu” on page 87.

A full medical case history
and examination is the first prerequisite, including a comprehensive
personal and family history detailing all aspects of previous
health problems and current status. Questions relating to diet,
habits, emotional status, exercise, stress levels and a detailed
listing of symptoms is part of this. A full physical examination
is also required, most notably of all aspects of the circulatory
and respiratory systems.

An electrocardiogram and chest
X­ray might be required as well as a number of blood tests.
Exercise tolerance tests may be used to see just how the functioning
of the heart, lungs and circulation responds to activity. A commonly
used procedure, before chelation therapy is started, and of major
importance in establishing a ‘before’ picture of circulatory efficiency,
is the use of what is known as bi­directional Doppler (sound
wave) examination.

This is a painless, non­invasive
use of sound waves (ultrasonic) which is used to investigate six
major arterial sites which relate to circulation to the brain,
as well as eight sites which relate to circulation to the legs.
The Doppler equipment gives readings which tell the doctor running
the tests three important pieces of information at each site:

1. It shows whether there is any turbulence which could relate to breakaway deposits of plaque,
etc., which could be involved in production of a stroke.



2. It checks for any signs of capillary hardening in the brain, often associated with memory
loss and age­related brain changes.



3. The major arteries are assessed for obstructions to normal flow of blood which could relate to over­burdened heart function or deficient circulation to the legs.

This sound­wave testing
takes about an hour and all findings are recorded on charts so
that later tests can be compared. This is also an excellent way
for the patient to appreciate visually the degree of current circulatory
difficulty.

Use of thermographically (heat)
sensitive film allows areas of the body which are not receiving
their full circulatory servicing to be photographed as a record
which can be compared with the same region after treatment.

Among other tests, an initial
one is performed (not for people with diabetes) after overnight
fasting (14 hours without food). This test is usually done around
mid­morning, the last food (or coffee or sugar) having been
consumed around 9 pm the previous night. The fasting blood test
gives an accurate idea of cholesterol levels as well as other
key markers. Periodic monitoring of blood levels of cholesterol
and other elements (giving evidence of levels of blood fats, carbohydrates,
whether or not there is anaemia, infection, immune system problems,
liver or kidney dysfunction, etc.) is made during the chelation
treatment which can last for some months, with two or three infusions
per week.

Depending upon the condition
of the patient a blood sample may be required before each treatment,
or periodically.

A 24­hour sample is required
for assessment of normal urinary output of creatinine, a key guide
as to kidney status. A periodic assessment is made of the creatinine
levels of the urine as the series of chelation treatments progress,
but this does not require collection of 24­hour samples.
As with blood testing, the frequency of urine testing during a
series of chelation infusions will vary, depending on the nature
of the problem being treated and the health of the patient.

If there is any evidence that
the kidneys could not be expected to deal efficiently with the
elimination of EDTA during infusion, then the treatment series
would be delayed or stopped until this factor had been dealt with
appropriately. As we will see in a description of important research
by Doctors McDonagh, Rudolph and Cheraskin later in this chapter,
kidney dysfunction is often capable of being normalized by EDTA
chelation therapy

A computerized dietary analysis
(based on the filling in of lengthy questionnaires) of what the
patient eats is often required so that comprehensive dietary and
supplementation advice can be given to the person being chelated,
to complement the treatment.

In addition, saliva, sweat
and faeces may need to be tested for a variety of reasons, including
assessment of what the patient’s current metabolic and nutrient
status is, how well foods are being digested and absorbed, etc.
Whether such tests are needed will depend upon the individual
problems being dealt with.

This non­invasive and
inexpensive method is also sometimes used to provide an accurate
indication of heavy metal toxicity as well as to give some idea
of the current mineral status of the body. The findings from this
and the other tests allow the doctor in charge to decide just
what balance of minerals should be added to the basic EDTA infusion
solution in order to obtain the best results.

Once it has been established
that there is a problem which could benefit from EDTA infusion,
a series of treatments are scheduled, either two or three times
per week. Most chelation centres treat patients in a group setting.

A large room with appropriate
seating (usually comfortable recliners) is all that is needed
(not unlike a hairdressing or beauty salon). There are several
advantages to this approach:

1. The mutual support of people
having the same procedure is reassuring and encouraging. There
will almost always be someone present who has had a number of
infusions and who can give a personal account of what to expect.



2. The costs can be reduced,
since fewer supervisory staff are required if patients are grouped
together in this way.



3. During the 3 1/2 hours of
the infusion the patient can read, doze, chat, watch TV, listen
to a pep talk on diet or exercise from a clinician (this is a
truly ‘captive audience’).

The infusion itself involves
the insertion into a vein (usually in the hand or forearm, but
sometimes the lower leg) of a needle which is attached to the
container (hung on an adjustable stand), from which is drip­fed
around half a litre of fluid over the 3 1/2 hours’ duration of
each treatment. This liquid usually contains 2 to 3 grams of EDTA
and whatever additional minerals the doctor has decided will best
help achieve a balanced blood content.

EDTA mixture

Among the other substances
often placed in solution with the EDTA are a complex of B vitamins,
vitamin C, magnesium (extremely useful for cardiovascular health)
and heparin (an anti­coagulant, enough of which is sometimes
used just to prevent any clotting at the injection site). Cranton
suggests (Cranton and Frackelton, 1982) that since magnesium is
a natural calcium antagonist and also the ion least likely to
be removed by EDTA (see Chapter 4), and that it is relatively
deficient in many people with cardiovascular and circulatory problems,
it should be supplied with the chelation process. He suggests
that the best way to do this is to use magnesium­EDTA, which
would provide an efficient delivery system and thereby increase
magnesium stores in the body.

When the infusion is being
performed, the arm is kept stable as a rule by being taped to
a padded board which rests on a cushion for comfort. It is usually
quite possible (although it is not encouraged) for the patient
to move around freely during treatment (to visit the toilet, for
example) as long as the mobile infusion is wheeled alongside.

The rate at which the EDTA
solution is dripped into the bloodstream can be varied but usually
it is at a rate of one drop per second.

As a general rule, two, but
sometimes three, treatments are given each week, and a total of
anything from 20 (for relatively mild problems) to 30 infusions
in all comprise one complete series.

On a number of occasions (sometimes
at each visit) blood and urine testing (as well as other tests)
may be carried out to ensure that kidney and other functions are
operating sufficiently well to cope with the EDTA detoxification.
This is obviously more important in elderly patients or anyone
with compromised kidney function. In some instances where a great
deal of circulatory pathology exists, follow­up series of
chelation infusions might be encouraged, with many people showing
benefits after up to 100 infusions.

The EDTA is eliminated from
the body, 95 per cent via the kidneys and 5 per cent via the bile,
along with the toxic metals and free ionic calcium which it has
locked on to in its transit through the circulatory system.

In hospital settings, EDTA
infusions have in the past been given daily for up to five days,
followed by a two­day rest period for the kidneys. This protocol
is now discouraged by the American medical group with the most
experience of chelation, the American Academy of Medical Preventics.

General toxicity

Walker and Gordon (1982) inform
us that EDTA is far safer than aspirin, digoxin, tetracyclin,
ethyl alcohol or the nicotine from two cigarettes, in equivalent
therapeutic doses. EDTA is used in thousands of food products
(it is in most canned foods) and its toxicity is known to be extremely
low.

In assessing the relative
toxicity of a substance a therapeutic index is established. Firstly,
the amount of the substance which would prove lethal to half the
animals in an experimental setting is discovered by the gruesome
process of increasing their intake until half of them die. This
is the LD­50 measurement (LD for lethal dose). When this
amount is divided by the amount required for a therapeutic effect
we end with a number which is the therapeutic index.

The LD­50 of EDTA is
2000 milligrams per kilo of body weight, whether taken orally
or intravenously. In comparison aspirin has a toxicity equal to
558 milligrams per kilo of body weight. So in general there is
no need for concern as to general toxicity with
EDTA usage, whether by mouth (see Chapter 9) or directly into the blood.

Kidney toxicity

In the early 1950s several
deaths occurred from nephrotoxicity after EDTA treatment. At that
time the dosage used was around 10 grams per infusion, whereas
the recommended dose now adays is 3 grams.

Halstead (1979) states:

The problem in EDTA nephrotoxicity
is based upon two fundamental principles of toxicology: dosage and route of administration. Dosage is concerned with both the amount administered and the rate
of administration, or the time period in which the EDTA is given.

It appears that toxicity for
the kidneys may relate directly to too large a dose infused at
too fast a rate. In general, if no more than 3 grams is infused
in any 24­hour period (diluted with 500 ml sterile Lactated
Ringer’s solution or-except in the case of diabetes-5 per cent
dextrose solution), with a 24­hour rest period between chelation
infusions (2­3 per week) and if the infusion of these 3 grams (less than 50 milligrams per kilo of body weight) is timed to take around three hours, little if any danger exists of producing toxicity for the kidneys.

Indeed, research has shown
that in general chelation therapy improves kidney function, particularly
if any impairment to these vital organs relates to circulatory
problems.

Improved kidney function
after EDTA

McDonagh, Rudolph and Cheraskin
(1982d) have investigated the alleged toxicity of EDTA in relation
to kidney function and their results are worth some consideration.

They examined the results
of treating 383 people with a variety of chronic degenerative
disorders (primarily occlusive arterial disease) with EDTA chelation
therapy (plus supportive multivitamin/mineral supplementation)
for 50 days.

The measurement of the levels
of creatinine in the blood is commonly used in medicine as a guide
to kidney efficiency.

Creatinine is the end breakdown
product of muscle activity which is cleared from the body by filtration
through the normal kidney. The levels found in the bloodstream
are known to correlate well with the rate and efficiency of clearance,
giving a simple way of judging kidney function. The researchers
made specific measurements of the levels of creatinine in the
blood of these patients at the first visit (fasting levels) and
then gave 10 infusions of 3 grams of EDTA in a solution of 1000
cc normal saline with an interval of five days between each infusion
(supplementation was also given). After this the serum creatinine
was again assessed.

They found that a very interesting
balancing effect could be seen when the overall picture was revealed,
very similar to that noted when cholesterol ratios were examined
(see Chapter 4). Those people who initially had low levels of
serum creatinine showed a very slight increase; those in the mid­range
(normal?) showed no change and those above the mid­range
of normal and actually with a creatinine excess (therefore indicating
poor clearance by the kidneys) showed a drop towards normal.

Overall the total measurement
showed an average decline in serum levels (indicating improved
kidney function), but far more significant, according to the judgement
of the researchers, is the homoeostatic effect in which ­
whether high or low to start with ­ a tendency towards the
mid­range (between 0.5 and 1.7 milligrams/decilitre) is observed.

It seems that EDTA therapy
may actually improve kidney function if it is applied slowly
with normal dosages.

One exception


These researchers make note
of one exceptional case amongst nearly 400 patients tested in
this way, and the progression of events is worth noting as an
example which highlights both the initial concerns which some
patients might produce and the long­term benefits of chelation
therapy.

This was an 86­year­old
female in whom the initial measurement of creatinine was 1.9 mg/dl,
which is regarded as abnormally high and therefore indicative
of poor kidney function. After starting chelation every five days,
a rise was seen in the creatinine levels by day 25 (fifth infusion)
to a very unhealthy 3.5 mg/dl. As treatment progressed, it dropped
to 2.8 mg/dl by day 60 and had dropped to 1.8 mg/dl by day 100,
some time after the course of chelation therapy had finished.

As the researchers point out:
‘this emphasizes the need to follow renal function during EDTA
therapy, and, one might add, for a while after, as the benefits
frequently are not fully manifest before about three months after
treatment is over.

Special considerations:
age, heavy metals or parathyroid deficiency

If the patient is very elderly,
or has low parathyroid activity or is suffering from heavy metal
toxicity which is damaging kidney tubules, treatment should be
modified to use less EDTA less frequently (once weekly perhaps).
Heavy metals damage the kidneys and too rapid infusion can overload
them. Heavy metals most likely to produce kidney damage during
infusion therapy (if this is done too rapidly, that is) are lead,
aluminium, cadmium, mercury, nickel, copper and arsenic.

Renal function tests should
always be performed before chelation therapy is started in which
serum nitrogen (BUN) and serum creatinine is examined. In any
case of significant renal impairment, lower dosage EDTA infusions
should be used with extreme caution with suitable periods of rest
between.

Too much calcium removed

If, through inexperience or
error, there is too rapid an infusion (or too much EDTA used),
levels of calcium in the blood can drop rapidly, resulting in
cramps, tetany, convulsions, etc. An injection of calcium gluconate
will swiftly control such abnormal reactions. This hypocalcaemia
reaction is almost unheard of where the guidelines given above
are followed as to dosage, speed of infusion and spread of treatments.

Inflammation of a vein

If an infusion into a vein
is performed too rapidly, inflammation may occur (thrombophlebitis).
This is unlikely in the extreme if guidelines as described above
are followed concerning dilution of EDTA with Ringers solution
or dextrose solution and slow infusion.

Should the needle carrying
the infusion slip, a local soft tissue irritation may develop.
This may best be treated with use of alternate hot and cold packs.
Supplementation with antioxidant nutrients such as vitamins C
and E (make sure of a good source) and the mineral selenium should
protect against such an incident.

Care regarding insulin
shock and hypoglycaemia

During EDTA infusion it is
possible for blood glucose to drop, leading to insulin shock.
This is more likely amongst diabetics in whom no dextrose solution
should be used. Patients having EDTA infusions are advised to
have a snack before or during the three hours plus treatment period.
Walker and Gordon (1982) recommend the following strategy:

You should eat something before
the three to four hour infusions, but not high­calcium­containing
foods such as dairy products. Rather, eat adequate unrefined complex
carbohydrates and avoid most sugars, including overripe bananas.

During an infusion they recommend
eating fruit.

In diabetic individuals, using
zinc­bound insulin involves a risk of too rapid a release
of insulin, leading to hypoglycaemia and shock. A rapid introduction
of sugar is needed in such an instance and a change in the form
of insulin used before further EDTA infusions are tried. Most
people with known diabetes find that with chelation therapy their
requirement for insulin declines.

Congestive heart failure

If the heart is already unable
to cope adequately with movement of fluids, and there is evidence
of congestive heart failure (extreme shortness of breath, swollen
ankles) and/or if digitalis­like medication is being taken,
extreme care is needed over chelation infusions, since EDTA prevents
digitalis working adequately. Sodium EDTA would appear to be undesirable
in such people as it could increase the fluid retention tendency.
However, Halstead is adamant that:

Na2 EDTA does not appear to
have any significant deleterious effects in congestive heart patients
since the sodium (Na2) is apparently excreted intact with the
metal chelate. However, the use of 5 per cent dextrose and water
is recommended in such cases.

Short­term side­effects

A number of variable side­effects
have been observed with use of intravenous EDTA infusion, including
the following:

• Headaches ­
  which often relate
  to the same phenomenon discussed above, of low blood sugar. Eating
  before treatment, or during it, will usually prevent this possibility.
  It is reported that a common recommendation which prevents ‘EDTA­headaches’
  is that a banana, not overripe, be eaten during the first hour
  of infusion.
  
• Diarrhoca ­ this
  unusual side­effect should be treated with rest and a bland
  diet with plenty of liquids for a day or so. Urinary frequency is common
  as kidney efficiency improves and a weight loss (from fluid excretion)
  of 3­5 pounds (1.3­2.2 kg) is common after an infusion
  if fluid retention was previously evident.
  
• Local skin irritation
  may result and
  is usually associated with a reduction in zinc and vitamin B6
  (pyridoxine). For this reason supplementation of these nutrients
  is usually suggested during chelation therapy.
  
• Nausea or stomach upset
  may also be related
  to vitamin B6 deficiency in the less than one patient in 100 receiving
  chelation therapy who feels this side­effect. It is best
  treated by B6 supplementation, although short­term relief
  (up to eight hours) from nausea can be achieved by applying thumb
  pressure to a point two thumb­widths above the wrist crease
  on either forearm (acupuncture point P6) for a minute or so whenever
  the symptom is felt.
  
• Feeling faint may
  relate to a drop in blood pressure. It is common for those who
  start treatment with high blood pressure to see a return to more
  normal levels. If it were normal to start with, it could drop
  slightly as well as leading to feelings of faintness on standing
  after sitting or lying. Treatment is to rest for an hour or so
  when this happens, ideally with the feet slightly higher than
  the head. The amino acid tyrosine can safely be supplemented to
  help restore normal pressure levels if this symptom persists.
  
  
• Fever may
  develop in a very few people during the day after chelation therapy
  sessions (approximately one in 5000). Whoever is in charge of
  the treatment should be told, although the condition normally
  resolves on its own.
  
• Extreme fatigue may be felt in some people and this is usually the result of a general
  nutrient deficiency in minerals such as magnesium, zinc or potassium.
  Taking a potassium­rich supplement and/or the regular eating
  of potassium­rich foods is suggested before and during chelation
  (grapes, bananas, peaches, potato skins), as this mineral may
  be removed by the process itself.
  
• Pains in the joints
  are more likely
  where infusions are frequent (three weekly). An immediate reduction
  to once weekly is suggested, and also possibly a reduction in
  dosage of EDTA being used, if strong flu­like aches develop.
  The symptoms should pass fairly soon if these strategies are adopted.
  
  
• Cramps in
  the legs are not uncommon (one patient in 20), usually at night.
  The supplementation of magnesium (either by mouth or in the El)TA
  infusions)
  will usually prevent this happening. If it is added to the infusion
  this could be in the form of magnesium chloride or magnesium sulphate.
  Such additions also reduce the chance of local skin irritation
  at the site of the infusion.
  

Other minor side­effects
have been reported in the many millions of chelation infusions
already given, but all seem to vanish when the therapy is reduced
or stopped. As Bruce Halstead states: ‘The number of significant
untoward reactions is probably less than in any other major therapeutic
modality’

Usually, they have many treatment alternatives but they have no information about their choices. One example of effective alternatives is the reduction in blood pressure that meditation produces. Others are the dietary changes and exercise programs that lead to lowered cholesterol. Since the medical treatments for these two conditions are often more dangerous than the problems, it is worth seeking safer alternatives.

Dr. Dean Ornish has shown that patients with heart disease can often avoid surgery and reverse their heart disease with a combination of a low-fat diet, meditation, and exercise. Norman Cousins healed his ankylosing spondylitis (a form of arthritis of the spine) with laughter and high doses of vitamin C. He wrote about his experience in the New England Journal of Medicine, and followed this article with a book, The Anatomy of an Illness. Many patients have cured their digestive disturbances simply by avoiding certain foods.

Over and over, we are seeing the results of lifestyle changes in health care. A recent scientific medical conference put on by the American College for Advancement in Medicine was entitled: Lifestyle Medicine—Medicine for the Nineties. Researchers and physicians both attended and taught at this scientific meeting. Much of it related to the role of dietary supplements in medical therapy.

Dietary supplements are among the safest and most effective choices in health care. They are almost free of side effects, they are easy to take, they are relatively inexpensive, and they usually enhance many life functions besides the specific condition for which they are being given. Following is an example of how nutritionally oriented physicians might use supplements as part of the treatment for a specific health problem. This is a suggestion that is supported in the medical literature and in the experience of many physicians.

Remember this is an example, not a prescription for you, and the supplement list is in addition to many other health practices. Other supplements may be helpful, and you may not need all of these to get results. For more information on any one supplement, look for its description in Dietary Supplements. No one program is appropriate for everybody, but these suggestions are good starting points from which individual programs can be modified.

The inability of the heart muscle to pump out all of the blood that is returned through the veins is called congestive heart failure. Fluid is forced out of the blood vessels into the surrounding tissues by the back pressure. The symptoms are shortness of breath, fatigue, and other signs of heart problems.

Swelling of the legs occurs when the smaller right chamber (ventricle) of the heart is involved, but both the right and left ventricles may be involved at the same time. It is important to avoid salt in the diet to reduce excess fluid accumulation. There are several dietary supplements that can help heart failure, but it is important to have a proper diagnosis and medical management, since this can be a serious situation. Helpful supplements include:

	AM	PM
Basic Multiple Formula	3	3
Vitamin C 1000 mg	3	3
Magnesium aspartate 200 mg	1	1
Vitamin E 400 IU natural mixed	1	1
Coenzyme Q10 200 mg	1
Taurine 500 mg	3	3
Hawthorne berry 250 mg	2	1

Again, other supplements are helpful with conditions that either cause or accompany heart failure, and they should be considered based on individual needs.