Objective: To discuss the use and hazards of ethylene diamine tetra-acetic acid (EDTA) in current alternative and complementary medicine practice. Methods: A review of three databases, Medline 1966-2006, Google Scholar, and Lexis-Nexis 1997-2007, was undertaken to retrieve pertinent articles regarding the practice of using EDTA in alternative medicine practice and the risks of such treatment. Results: In recent years, there has been a resurgence in the use of alternative medicines. In the U.S. alone, visits to alternative medicine providers account for 629 million clinic visits costing over $20 billion. Alternative approaches that have been advocated include routine heavy metal screening with provocative challenges, and chela-tion therapy for a variety of non-traditional indications. Alternative and complementary medicine professional associations include the American College of for the Advancement of Medicine, International Society for Orthomolecular Medicine, International Board of Clinical Metal Toxicology, and the American Board of Chelation Therapy advocate these approaches. In particular, EDTA has been touted for the treatment of cardiovascular disorders. Although sometimes not well appreciated, there are two different types of EDTA approved by the U.S. FDA. In 1953, Edetate calcium disodium also known as Calcium EDTA (marketed under the trade name Calcium Disodium Versenate registered ) was approved for the treatment of lead poisoning. Three years later in 1956 a related EDTA compound, Edetate disodium, was also approved for clinical use. This compound, also known as Disodium EDTA, has been marketed under the trade names Disotate registered and Endrate registered . The essential difference between these two compounds is that Calcium EDTA's structure has an incorporated Ca super(2+) moiety while Disodium EDTA does not. The use of the latter compound Disodium EDTA has been associated with life threatening and fatal hypocalcemia. It has been estimated that between $400 million and $3 billion have been spent annually in the U.S. for the use of EDTA in the treatment of cardiovascular diseases. Proponents have argued that this is safe therapy citing the safety record of Calcium EDTA in the treatment of lead poisoning, despite the fact that it is Disodium EDTA that is used in the treatment of cardiovascular diseases. Advocates have cited several small non-controlled studies that suggested that EDTA provided benefit. Proposed mechanisms to explain an advantageous effect include liberating calcium plaque, free radical scavenging function, inhibition of lipid oxidation, arterial dilation to by possible calcium channel blocking actions, stimulation of prostacyclin production and improvement in arterial wall elasticity, and increased production of nitric oxide. However, in 2002, a Canadian RCT study failed to find a benefit for EDTA. When its finding were not accepted by chelation proponents, the U.S National Institutes of Health decided to fund a much larger $30 million study in attempt to settle the question of EDTA efficacy in the treatment of cardiovascular disease. This study is currently ongoing. Conclusions: Medical toxicologists should recognize that the alternative and complementary medicine community accounts for an increasing and very significant component of the health care delivery system and that the continued use of EDTA, particularly Disodium EDTA for non-approved indications requires vigilance and education.
Article Subject Terms: Calcium; Calcium channels; Cardiovascular; diseases; Chelation; Databases; Edetic acid; Education; Ethylene; FDA; Free radicals; Hazards; Health care; Heavy metals; Herbal medicines; Hypocalcemia; International trade; Lead; Lipid peroxidation; Lipids; Metals; Nitric oxide; Oxidation; Plaques; Poisoning; Reviews; Vigilance; heavy metals; professional associations; prostacyclin; Article Geographic Terms: USA; H 14000 Toxicology; X 24330 Agrochemicals