Chelation

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Chelation

Introduction

Chelation, also known as detoxification, is a highly controversial

and potentially dangerous intervention which involves using one or

more chemicals to correct the chemical balance in the bodies of

individuals with autism.

Opinion

There is currently no scientifically valid and reliable evidence to

show that chelation is effective in the treatment of people with

autism.

The National Institute for Mental Health in the USA is currently

running a major clinical trial into chelation and people with

autistic spectrum disorders but there is, as yet, no evidence from

this trial.

Some chelating agents can have significant and very harmful side

effects.

For these reasons, we do not believe that chelation is an appropriate

intervention for the treatment of people with autism.

Trials

Bradstreet J. et al. (2003). A case-control study of mercury burden

in children with autistic spectrum disorders. Journal of American

Physicians and Surgeons, 8(3), pp. 76-79. Read Full item

National Institute of Mental Health (NIMH). (Commenced 2006). An

Investigation of the Efficacy of Mercury Chelation as a Treatment for

Autism Spectrum Disorder. Ref. NCT00376194

Audience

The proponents of chelation claim that it is suitable for most

children with autism and other autistic spectrum disorders

because `most children with autism suffer from mercury/metal

toxicity.' (DAN!, 1999).

However this claim is not accepted by the majority of academic

researchers.

Aims

To reduce the causes and/or symptoms of autism by

removing excess levels of toxic metals from the body and/or

improving the sulphur amino acid balance in individuals with autism

and/or

increasing the anti-oxidant properties of people with autism

Claims

There have been various claims for chelation. For example, Defeat

Autism Now (2001) stated that

` Many DAN! physicians have reported good improvements with DMSA,

although the improvements are sometimes accompanied by gut problems.

Reported benefits include rapid progression of language ability,

improved social interaction, improved eye contact, and decreased self-

stimulatory behaviors ( " stimming " ). Children with motor problems have

experienced significant improvement in both strength and

coordination.'

Detail

Chelating agents

There is a wide range of different chelating agents, each of which

has different properties – such as effectiveness and side effects.

They include

Alpha lipoic acid

Cysteine, aka Cystin

DMSA, aka succimer or Chemet

DMPS, aka 2,3-Dimercapto-1-propanesulfonic acid

EDTA, aka ethylene-diamine-tetra-acetic acid

NAC, aka N-Acetyl-L-Cysteine

NDF, aka Nannocolloidal Detox Factors

TTFD, aka Thiamine Tetrahydrofurfuryl Disulfide

However not all chelating practitioners agree as to which of these

chelating agents is appropriate to use. For example, Defeat Autism

Now! states that cysteine/cystine should not be used because they may

worsen mercury intoxication by spreading it to other tissues. They

may also promote or worsen intestinal candidiasis.

Process

Different practitioners of chelation follow different processes. The

following processes are those recommended by Defeat Autism Now! in

its Mercury Detoxification Consensus Group position paper of 2001.

First stage: Provocation Test

The purpose of the provocation test is to find out if a toxic metal

is present in the body, and if the given chelating agent can remove

it.

This is done by using a small dose of a given chemical, such as DMSA,

followed by a collection of urine or stool depending on the mode of

excretion.

Second stage Pre-Detoxification Treatment

All sources of the metal are removed from the immediate environment

of the child e.g. mercury or lead based paint, flame retardant

materials, water which contains uranium.

Existing nutritional problems are corrected e.g. the practitioner

checks that the child has sufficient vitamins, minerals and amino

acids, especially zinc.

Glutathione, an anti-oxidant peptide, levels are normalised – usually

by giving the child glutathione supplements.

Any existing gastro-intestinal problems, such as constipation,

diarrohea, bacterial and yeast infections, are corrected. If this is

not done, the adverse side effects of the therapy may be made worse

e.g. explosive growth of abnormal or pathogenic bacteria or fungi.

Liver, kidney and Complete Blood Count are monitored before and

during detoxification. Some chelating agents can adversely affect

liver/kidney function, platelet count, and lymphocytes.

Third stage – Treatment

The third and last stage of treatment is to give full doses of the

chelating agent, along with supplements of minerals and vitamins.

Depending on the chelating agent, it may be given orally, by

intravenous infusion, or in the form of nasal sprays, suppositories

or creams.

The dosage is determined by the individual's reaction to the initial

testing and to subsequent doses of the chelating agent.

Time

Different authorities suggest different amounts of time required to

undertake chelation. The clinical trial currently being run by the

National Institute for Mental Health in the USA is providing

chelation 3 times daily for 12 weeks.

Involvement

Five or ten minutes a day.

Costs

We have not yet been able to identify the costs of chelation.

Credentials

Some chelating agents, such as DMSA, are only available from

qualified medical practitioners.

Other chelating agents, such as NDF, are available without a

prescription in chemists and health food stores.

Therefore some providers will have professional credentials and

qualifications, while others will not.

Many of the chemicals and nutritional supplements discussed in this

section are not approved by the National Institute for Health and

Clinical Excellence (NICE) or by the United States Food and Drug

Administration (USFDA).

The UK and the US governments do not strictly regulate herbs and

supplements. Because of this there is no guarantee of strength,

purity or safety of some chelating agents and their effects may vary.

Availability

Most of these chelating agents are widely available within Europe and

the US.

Hazards

Different chelating agents have different adverse effects but some

can

-remove essential minerals and vitamins from the body e.g. zinc and

magnesium.

-may worsen mercury poisoning by spreading it to other tissues.

-cause an explosion of bacteria and pathological fungal growth

-cause nausea, diarrhoea, anorexia, flatulence, fatigue,

irritability, sleep disturbances, macular-papular skin rash, allergic

reactions

-make autistic symptoms worse in some people e.g. leading to a

regression in language and behaviour

More seriously some chelating agents can also

-cause bone-marrow suppression, which can lead to neutropenia and

thrombocytopenia, which in turn can affect blood clotting and blood

immune response to infections and other toxins.

-cause liver and kidney damage

-cause toxic epidermal necrolysis or erythema multiforme

Some chelating agents, such as some commercially available brands of

chlorella, may already have high levels of mercury in them when

bought because of the way in which they are produced.

One five year old child reportedly died from hypocalcaemia after

receiving edetate disodium instead of edetate calcium disodium.

Contraindications

Chelation should not be used with people who have liver or kidney

problems.

History

Synthetic chelating agents have been available for nearly a century.

They were initially used by the military for treating acute exposure

to heavy metals and other toxic substances. They have since been

developed for use in other medical conditions, including

cardiovascular disease, Alzheimer's disease and cancer.

At the end of the 20th century various researchers suggested that

chelating agents could be used to remove heavy metals, especially

mercury, from people with autistic spectrum disorders.

Accounts

`Chelation with DMSA/ALA -went from not being able to use language

functionally, only having 6 words that he kept losing to 15 words in

two weeks, 50 words in a month, to limitless vocabulary in a year. He

never lost any words after starting chleation [sic]. He continued to

progress in a `fast forward' pace. Unfortunately he was still really

literal. He could answer what, who and where questions but the how,

why and when were still too hard for him to comprehend. Basically

improved his language, social skills (went from NONE to some )

digestion, bowel movements, and cognitive skills.' (TamiW, posted on

the AutismWeb.com forum 2007.)

`Chelation with NDF Plus- increases his focus, decreases negative

behaviors, increases abstract thought as well as enabled him to ask,

answer the why, how and when questions, improved expressive

language.' (TamiW, posted on the AutismWeb.com forum, 2007.)

Research

We have identified two scientific trials of chelation for people with

autistic spectrum disorders. One of them has been published in a peer-

reviewed journal, the other is currently underway.

The study by Bradstreet et al. (2003) included a total of 221

individuals aged 3-15. It stated that DMSA treatment appears to be a

useful way of determining mercury levels in individuals with autism.

However It did not claim that chelation could actually be used to

alleviate any of the problems faced by people with autism.

Status

There are some issues with the single study identified. For example

it was a retrospective study, the control group was very small and

clearly unusual in some way – for example, there were religious

objections to immunisation in half the group.

Trials

Bradstreet J. et al. (2003). A case-control study of mercury burden

in children with autistic spectrum disorders. Journal of American

Physicians and Surgeons, 8(3), pp. 76-79.

National Institute of Mental Health (NIMH). (Commenced 2006). An

Investigation of the Efficacy of Mercury Chelation as a Treatment for

Autism Spectrum Disorder. Ref. NCT00376194

Summary

There is no generally accepted, scientifically valid evidence to show

that chelation alters the outcome for children with autistic spectrum

disorders.

However this lack of evidence does not prove or disprove the

effectiveness of chelation for people with autistic spectrum

disorders. It simply shows how little research has been conducted to

date.

Reading

JB et al. (2006). Analyses of toxic metals and essential

minerals in the hair of Arizona children with autism and associated

conditions, and their mothers. Biol Trace Elem Res, 110(3), pp. 193-

209.

JB et al. (2007). Mercury, lead, and zinc in baby teeth of

children with autism versus controls. J Toxicol Environ Health A, 70

(12), pp. 1046-1051.

Brown MJ et al. (2006). Deaths resulting from hypocalcemia after

administration of edetate disodium: 2003-2005. Pediatrics.118(2):e534-

6.

son P. W. Myers G. J. Weiss B. (2004). Mercury exposure and

child development outcomes. Pediatrics, 113(4 Suppl.), pp. 1023-1029.

Defeat Autism Now! (2001). Mercury Detoxification Consensus Group

Position Paper. ARI. Read Full item (PDF document.)

Fido A. and Al-Saad S. (2005). Toxic trace elements in the hair of

children with autism. Autism, 9(3), pp. 290-298.

Holmes A. S. Blaxhill M. F. Haley B. E. (2003). Reduced levels of

mercury in first baby haircuts of autistic children. International

Journal of Toxicology, 22(4), pp. 277-278.

Ip P. et al. (2004). Mercury exposure in children with autistic

spectrum disorder: case-control study. Journal of Child Neurology, 19

(6), pp. 431-434.

Kern JK et al. (2007). Sulfhydryl-reactive metals in autism. J

Toxicol Environ Health A, 70(8), pp. 715-721.

National Autistic Society. (2006). Briefing on mercury and autism.

London: NAS.

Simpson R.L. et al In: Simpson R.L. et al (2005). Other

interventions, treatments, and related agents Autism spectrum

disorders: interventions and treatments for children and youth.

California, Corwin Press, pp. 207-229.

Sinha Y, Silove N, K. (2006). Chelation therapy and autism

BMJ, 333(7571), p. 756.

Soden SE et al. (2007). 24-hour provoked urine excretion test for

heavy metals in children with autism and typically developing

controls, a pilot study. Clin Toxicol (Phila), 45(5), pp. 476-481.

U.S. National Library of Medicine. (1999 ). Succimer. Bethseda, MD:

US NLM.

Problems:

Problems

Some of the problems which some people claim this intervention will

help to resolve.

Communication

Impaired immunity

Restricted and repetitive behaviours

Social difficulties