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Ali M, Ali O, Fayemi A, Juco J, et al.   Improved Myocardial Perfusion in Patients with Advanced Ischemic Heart Disease with An Integrative Management Program Including EDTA Chelation Therapy
J Integrative Medicine 1997;1:113-142

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.

Objective
    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).

Patients
    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.

Methods
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 oxidopathy—a 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)

Results
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.

Conclusion
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.

INTRODUCTION
    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 readily—and regrettably—reject 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 results^12-25; 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 EDTA infusions.

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.

1. Education
    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 nature^26-27; molecular duality of oxygen, iron, nitric oxide and other redox-active molecular species^28-29; evidence of oxidative damage to circulating blood seen with high-resolution, phase-contrast and darkfield microscopy^30,31; electrophysiologic patterns of myocardial activity and pulse pressure in states of adrenergic hypervigilence^32-33; changes in such patterns caused by meditative methods including limbic breathing.^34-35 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 exercise^39,40; 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.

Article Segments 1 l 2 l 3 l 4 l 5 l 6

 

Index of Article Authors
Majid Ali, MD
Omar Ali, MD
Mary Ann Carroll, RN
Alfred Fayemi, MD
C.Grieder-Brandenburger, RN
Judy Juco, MD
Tsuneo Kobayashi MD
Jean A. Monro, MB, BS
(This index is incomplete and will be completed shortly)

Past and
Current Editors
Omar Ali, M.D.
Robert Atkins, M.D.
Robert Bradford, D.Sc
Paul Cheney, M.D., Ph.D.
Steven Davies, M.D.
Alfred O. Fayemi, M.D.
Claus Hanke, M.D.
Doug Hutto, N.D.
Judy Juco, M.D.
Paris Kidd, Ph.D.
Oscar Kruesi, M.D.
Derrick Lonsdale, M.D.
D. Vijen Poleszynski, B.S.
Christine Radulescu, Ph.D.
Ray Russamono, M.D.
Susan Test, Ph.D.
Lowell Weiner, D.D.S.
John C. Williams, M.D.

The Journal of Integrative Medicine shall not be held responsible for statements of the contributing authors. The views and opinions expressed are those of the submitting authors and do not necessarily reflect those of The Journal of Integrative Medicine, The American Academy of Integrative Medicine,
The American Academy of Preventive Medicine, any advertisers or staff members of The Journal of Integrative Medicine
 

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The Journal of Integrative Medicine shall not be held responsible for statements of the contributing authors. The views and opinions expressed are those of the submitting authors and do not necessarily reflect those of The Journal of Integrative Medicine, The American Academy of Integrative Medicine, The American Academy of Preventive Medicine, any advertisers or staff members of The Journal of Integrative Medicine