Chelation Therapy
Chelation
Detoxifying the Heart ------------------------------------------------------------------------
Progressive cardiologists have known for decades that intravenous chelation therapy can clear clogged arteries and help prevent heart disease—now chelation can be given orally. Is this the advent of angioplasty in a pill? By Richard leviton Angioplasty is a fairly brutal way of mechanically "scrubbing" the inside of clogged arteries with an inflated balloon catheter to flatten deposits of plaque that have thickened to the point of being dangerous to health. The balloon momentarily expands t he artery allowing more blood to pass. The goal is to prevent heart attacks and reduce the risk of heart disease, both of which abound today. Statistics tell us that throughout the 20th century the average American's heart has been growing progressively sicker. Nutritionally inadequate diets, toxins, pollutants, physical inactivity, smoking, and other factors have resulted in an estimated 57 m illion Americans currently suffering from life-threatening heart conditions. In the U.S., heart disease now accounts for ten out of every 24 deaths annually, or about 42% of all deaths. The data on heart disease, both its incidence and cost, is not only alarming, but should mobilize concerned individuals to look for effective alternatives to maintaining a healthy heart and preventing heart disease. Coronary artery bypass surgery, ballo o n angioplasty, even heart transplants, are now routinely performed for Americans with clogged arteries, but the costs are enormous, the risks are high, and the benefits are often short-lived, requiring yet more medical intervention, more money, and more risk. Surely there's another way. Since as early as 1948, forward-thinking American cardiologists have known about a minimally invasive, highly effective procedure called chelation therapy as a way of accomplishing what angioplasty does, and more. Chelation therapy, comprising a series o f intravenous infusions of substances that remove plaque deposits and other harmful materials, including heavy metals, from the arteries, has been performed on an estimated 700,000 individuals of whom between 75 and 90% have benefited with improved cardi ovascular health. Its proponents have championed intravenous chelation therapy, especially when coupled with nutritional supplementation and dietary changes, as foremost among alternative approaches in preventing heart disease. Now, according to some cardiologists, it may be possible to detoxify the circulatory system using oral chelation—pills you take every day just like vitamins. Scrubbing the Arteries Chelation is a bit like gently scrubbing the inside of approximately 60,000 miles of arteries, veins, and capillaries in the body to remove the deposits that have thickened and hardened the blood vessel walls, thereby obstructing blood flow. The analogy of scrubbing is apt because EDTA, the main chelating agent, was originally used by the U.S. Navy to remove calcium from pipes and boilers. It was also given orally to humans to safely and successfully treat lead poisoning. U.S. doctors noted that patient s treated with EDTA for lead poisoning also showed considerable improvement in cardiovascular disease symptoms. Developed in Germany in the 1930s, EDTA is a nontoxic amino acid (ethylene diamine tetra-acetic acid). Today, EDTA is the prime component in chelation therapy which, since the 1960s, has been given intravenously. EDTA, incidentally, is 31/2 times less t o xic than common aspirin and about 300 times safer than bypass surgery. Chelation therapists state that within 24 hours, 99% of the infused EDTA has been excreted from the body. The medical reasoning for using EDTA for cardiovascular purposes is that plaque, a fibrous, yellowish deposit on arterial walls, is made up largely of calcium, along with cholesterol, fats, and heavy metals. If EDTA removed calcium from pipes, and peopl e who took EDTA for lead poisoning enjoyed heart benefits, EDTA should be an effective way to unclog arteries and improve blood flow. Copious clinical research over the past 50 years has borne out this supposition. Researchers L. Terry Chappell, M.D., and John P. Stahl, Ph.D., recently reviewed the results of 19 studies evaluating the effectiveness of EDTA chelation therapy on 22,765 p atients. They found that 87% registered clinical improvement according to objective tests. In one study, 58 out of 65 coronary artery bypass candidates and 24 of 27 people scheduled for limb amputation were able to cancel their surgery after chelation therapy. The analysis provides "very strong evidence that EDTA is effective in the treatment of cardiovascular disease," state Chappell and Stahl in Questions from the Heart (Hampton Roads Publishing, 1996). Efrain Olszewer, M.D., and James P. Carter, M.D., reviewed the cases of 2,870 patients with hardening of the arteries and other age-associated diseases who were treated with EDTA chelation therapy and vitamin/mineral supplementation between 1983 and 1985 at the Clinica Tuffik Mattar in Sao Paulo, Brazil. According to their results, published in the Journal of Advancement in Medicine (1989), marked improvement occurred in 76.9% of patients with ischemic heart disease and 91% of patients with peripheral vascular disease. In addition, 75% of all patients ha d reductions in vascular symptoms and, overall, 89% had benefits rated as "good." Chelation therapy can also relieve chest pain, according to a study involving 18 patients, age 45 to 73, with heart disease, conducted by H. Richard Casdorph, M.D. (Journal of Advancement in Medicine, 1989). After 20 chelation infusions, "all patients im proved clinically and in all but two there was a complete subsidence of angina during the course of chelation therapy," said Dr. Casdorph. How Chelation Therapy Works The growing body of clinical evidence supports the claim that chelation therapy is a safe and effective way to reduce the risk of heart disease. In the procedure, performed in a physician's office, EDTA is given as an intravenous infusion over a 11/2 to 31/2 hour period. Usually 20 to 30 treatments (at an average cost of about $100 each) are administered at the rate of one to three sessions per week. EDTA circulates through the blood vessels and binds to ("chelates") excess amounts of calcium, iron, copper, lead, or other heavy metals; the EDTA, with its mineral/metal load, is then eliminated quickly through the urine. Arterial walls become softer an d more pliable after chelation, allowing for greater blood flow. Calcium plaque is foremost among the targets of EDTA. Calcium floating freely in the bloodstream can build up in the tissues and joints and lead to the formation of plaque lesions. Atherosclero-sis, one of the most common types of heart disease, involves a buildup of plaque on the inner walls of the arteries, making them thick and hard. Calcium acts as part of the glue that holds the plaque lesions together. The plaque limits the amount of blood flow, reduces the supply of oxygen to body organs, and increases the risk of inappropriate blood clotting. The plaque lesions and the subsequen t reduced oxygen supply can lead to chest pain, coronary heart disease, and heart attacks. If you take an average 80-year-old man and examine his aorta, says Garry F. Gordon, M.D., D.O., a chelation pioneer and co-founder in 1973 of the American College for Advancement in Medicine, now in Laguna Hills, California, you will probably see evidenc e of up to 140 times more calcium on this arterial wall than he had at age ten. "The abdominal artery shows a 50-fold increase, and the coronary artery shows a 30-fold increase," continues Dr. Gordon. "This means you're gradually turning to stone in all your arteries. However, we can document that calcium accumulation in the arterie s is totally reversible by enough chelation." EDTA is chemically similar to vinegar, or ordinary acetic acid, says Dr. Gordon. "It's actually a weak acid; if you put an eggshell in vinegar, it will dissolve. In the same way, intravenous EDTA will take calcium off your arteries. Because EDTA ties up calcium so avidly, it was used by blood banks for 15 years to prevent blood from clotting. Once you tie up calcium, blood cannot clot." While it removes excess calcium, EDTA does not deplete the body of calcium. By a surprising biochemical mechanism, che lation therapy actually stimulates bone growth and can help prevent osteoporosis. People do not die from atherosclerosis, says Dr. Gordon, but from preventable complications of blood vessel spasm (preventable by adequate magnesium intake), irregular heart rhythms (preventable by sufficient mineral intake), or blood clots. Much of the long-term benefit of chelation therapy derives from its ability to slow down free-radical activity and undo the underlying cause of arterial blockage, says Dr. Gordon. "The number of damaging free radicals is increased by the presence of heav y metals and acts as a chronic irritant to blood vessel walls and cell membranes." This free-radical activity is stimulated by excess heavy metals and minerals in the blood and plays a major role in the development of heart disease. "EDTA removes those m etallic irritants, allowing leaky and damaged cell walls to heal." According to Stephen F. Edelson, M.D., a progressive alternative physician who uses chelation therapy in his practice in Atlanta, Georgia, EDTA's ability to bind with and remove metals, such as iron, copper, lead, and cadmium, may be a more important fac tor in reducing heart disease than its effect on calcium plaque. These metals are powerful triggers of excessive free-radical reactions, Dr. Edelson explains. "Free-radical pathology, it is now believed, is the underlying process triggering the developme nt of most age-related ailments." The Oral Chelation Alternative The intriguing question is whether you can reap the same benefits from chelation when you take EDTA or other substances orally. According to John R. Alm, M.D., a physician practicing in Vista, California, oral chelation is a viable way of "roto-rootering " the cardiovascular system and of detoxifying the liver and kidneys, the system's main filters. Dr. Alm works with the new Cardio-Care line of oral chelation products including Buffer-pH+, TriCardia+, and Systemex. This is a three-step, three-month program designed by Växa International, a maker of homeopathic formulas, based in San Diego, Californ ia. The concept here is to detoxify, balance, and nourish the cardiovascular system, says Dr. Alm, who is a member of Växa's medical advisory board. First, Buffer-pH+ helps to restore a more alkaline pH in the body. An acid pH is regarded as the "seed-bed of degenerative disease" including most forms of heart disease. The majority of people in the U.S. are in a constant state of acidosis, in which th eir system is overly acidified, primarily from a faulty diet, explains Dr. Alm. This, in turn, leads to a kind of "corrosion" of the blood vessel linings; in a curious way, hardening of the arteries may emerge as the "body's protective reaction" to this acidic state, Dr. Alm speculates. "In an acid environment, heavy metals tend to bind with cholesterol which then adheres to vessel linings and attracts fibrin [blood-clotting protein] and other debris, building layer upon layer, eventually becoming a cement of plaque, blocking arteries." This decreases blood flow which further acidifies the body's tissues. However, when the pH is balanced again, heavy metals remain free and unbonded, while those that were previously bonded are easier to remove with EDTA in the program's second element, TriCardia+, says Dr. Alm. TriCardia+ contains homeopathic ingredients as well as 1.5 g of EDTA and 2.5 g of 31 other free-form chelating amino acids. The product also contains: substances (essential methyl donors) that will help reduce levels of homocysteine (see accompanying sid ebar, page 69); fats and minerals that together help repair the damaged inner lining of the cardiovascular system; and enzymes and herbs that will help thin the blood and reduce the possibility of clotting, says Växa president, Gregory C.D. Young, Ph.D. Systemex, the third element in Växa's Cardio-Care program, is a liquid meal replacement formula designed to nutritionally support the cardiovascular system. The formula is fat free and lactose free and contains proteins, complex carbohydrates, essential fatty acids, amino acids, and 36 vitamins and minerals. A reasonable question often raised is whether oral EDTA is absorbed as well as that taken intravenously. According to Dr. Young, "Assimilation of EDTA is effective when it is taken either intravenously or orally." Dr. Young states that EDTA, even though it is a synthetic amino acid, "in free form it biochemically behaves and is absorbed in exactly the same way as other free-form (or unbound) amino acids." It bypasses the digestive system entirely and, owing to its small molecular size, enters the bloodstream through the first segment of the small intestine, says Dr. Young. He estimates that just as with other free-form amino acids, about 80% of oral EDTA is assimilated by the body in the first 20 minutes, the rest following within 90 minutes. "The notion that EDTA is not absorbed, is in some way destroyed, or suffers from diminished potency when given orally, is unfounded and contradicts the experience of the U.S. Navy in the late 1940s," says Dr. Young. "At that time thousands of sailors ben efited from simple oral administration of EDTA for lead toxicity." "The notion that EDTA is not absorbed, is in some way destroyed, or suffers from diminished potency when given orally, is unfounded and contradicts the experience of the U.S. Navy in the late 1940s," says Dr. Young. "At that time thousands of sailors ben efited from simple oral administration of EDTA for lead toxicity." Växa's Cardio-Care program has not been on the market long enough—it was introduced in late 1996—for there to be much clinical evidence supporting its claims. However, Dr. Alm offers the following case report showing good results using this approach. Colin, age 74, had chronic high blood pressure and a 20-year history of arrhythmia, and had suffered a series of strokes after being put on a blood-thinning drug. The strokes produced a partial paralysis and considerable weakness in his right arm and leg , says Dr. Alm. Six weeks after starting the TriCardia+ program, Colin's heart "spontaneously converted to a normal rhythm and has stayed that way for three months," Dr. Alm reports. Obviously a great deal more clinical evidence will be required before it is known for certain if the persuasive theory behind Växa's oral chelation program is borne out. In any case, according to Dr. Gordon, the proper role of oral EDTA chelation may be preventive rather than restorative. An Insurance Policy for the Heart "Oral chelation is an insurance policy to guarantee that you stay alive long enough to take intravenous chelation when and if you choose to," comments Dr. Gordon, who recently introduced his own oral chelation product called Garlic-EDTA Chelator™ (each c apsule contains 400 mg garlic and 100 mg EDTA). In other words, the oral route is advisable for those people with potential heart problems but whose condition does not yet require rapid action. For those with serious cardiovascular problems, oral EDTA can be helpful as a maintenance program after or i n conjunction with intravenous chelation, says Dr. Gordon. The advantages of oral chelation are that it does not require a physician's supervision or expensive blood tests to monitor and is sufficiently low in cost to be useful as a self-care maintenance program. Its primary shortcoming is that for most patients it will take longer and require much more in quantity to get the same benefits as intravenous chelation. Dr. Gordon notes that for years he has given his cardiac patients 800 mg daily of oral EDTA, of which he estimates, taking exception to Dr. Young's more generous estimate of 80%, that only 3 to 8% is absorbed compared to 100% of intravenous EDTA. This me ans, says Dr. Gordon, it could take five to eight weeks of daily oral EDTA chelation to get the same effects of a single four-hour intravenous chelation. Until further definitive research is performed, absorption rates for oral EDTA will have to be place d somewhere between Dr. Gordon's 3 to 8% and Dr. Young's 80 to 100%. However, in Dr. Gordon's view, EDTA-based oral chelation can provide "automatic protection against the clotting process as well as lower a patient's lead level, so that they will have a higher functioning immune system, higher IQ, and better coordination ." When platelets, the factors in blood that produce clotting, become "sticky," they tend to clump together, or aggregate, and this sets up conditions for excessive and unwanted blood clotting, explains Dr. Gordon. This, in turn, promotes the formation of v essel-thickening plaque and an increased risk of heart attack and stroke. While conventional drugs such as aspirin and coumadin are given to circumvent this problem, Dr. Gordon notes, these approaches are "dangerous and far less effective" than a compreh ensive oral chelation approach. Dr. Gordon also notes that intravenous chelation cannot provide 24-hour-a-day protection against the main causes of sudden death from heart problems, and that this is where oral chelation finds its niche. "Continuous protection is afforded by an oral che lation program," Dr. Gordon says. He claims that "in the last 14 years new heart attacks and/or strokes have been virtually nonexistent in my patients on this oral chelation program." Garlic, taken alone, is an excellent chelator of metals such as lead and mercury, says Dr. Gordon. "Now, if you add EDTA to it, you get more removal of lead, but you also enhance the garlic's anti-platelet [anti-blood-clotting] activity. Through this com bined action, since EDTA binds with the calcium that is required for blood to clot, you can protect yourself far more effectively against a blood clot, even more so than any aspirin dose you might take." As a supplement to oral chelation with EDTA, Dr. Gordon recommends OC Packs, a heart nutrient program he originally customized for his patients in the early 1980s. These nutrients represent an "important part of the insurance policy" to prevent death fro m heart disease, says Dr. Gordon. Chelating Brandon With Diet and Nutritional Substances Cardiologist W. Lee Cowden, M.D., of the Conservative Medicine Institute in Richardson, Texas, contends that oral EDTA is not "particularly effective" in removing arterial plaque. But Dr. Cowden argues that a precise combination of nutritional substances and dietary factors can "cause the body to spontaneously, naturally break down the plaque and pull it off the arterial walls, producing an effect that is equivalent to the chelation process." As evidence, Dr. Cowden cites the case of Brandon, age 57, who had severe disease in three coronary arteries. His physicians were strongly urging him to undergo angioplasty and even Dr. Cowden, a long-time advocate of progressive alternatives in medicine , regarded Brandon's condition as dangerous. "I've never had anyone in my office so close to having a heart attack without yet having one," he comments. An electrocardiogram showed evidence of an impending heart attack. About 60% of the heart's chamber wall was immobilized, and the rest was working poorly. Despite the risk, Brandon refused to be hospitalized and asked Dr. Cowden for home-care strategies. Dr. Cowden put Brandon on a strict vegetarian diet, emphasizing mostly raw fresh foods, whole grains, and beans. Brandon avoided dairy products, red meats, chicken, and turkey, and only occasionally ate fish. Research demonstrates that fresh fruits and v egetables reduce the risk of heart disease. According to Dr. Cowden, the living enzymes in raw foods may help to remove arterial plaque. Brandon's dietary changes were complemented with key supplements (see sidebar, page 68). In addition, Dr. Cowden had Brandon wear the negative pole of a small 1,000 gauss magnet against his left chest during all his waking hours. "The magnet dilates blood vessels and increases the blood flow to the coronary arteries," Dr. Cowden says. He emp hasizes the importance of using only the negative pole; the positive pole, when placed against the chest, could restrict blood supply and provoke a heart attack, he said. Brandon followed the program faithfully for nine days, then came to Dr. Cowden for another evaluation. "He climbed up the stairs to my office without any chest discomfort," reports Dr. Cowden. "On the heart stress test performed on a treadmill, Brandon w ent over 11 minutes, which is probably as far as I could have gone that day. He showed no abnormalities on his electrocardiogram. This means that after nine days his advanced triple-vessel coronary disease was essentially reversed. He returned to work th e next day and has remained healthy since." Dr. Cowden cites another case from his practice illustrating how nutritional substances can reverse the symptoms of heart disease. Louisa, age 60, had a 75% blockage in the carotid artery in her neck and was told that unless she had surgery to correct it , she was likely to have a stroke. Dr. Cowden put her on Brandon's nutritional program and after three months a new ultrasound scan of her carotid artery revealed it was only 22% blocked with plaque. The Dental Factor in Heart Disease Often in a case of coronary disease, Dr. Cowden recommends that patients have all the mercury amalgams removed from their teeth. Aside from the documented effect that mercury can leach from dental fillings and be distributed throughout the body, it can a lso leak into specific nerve ganglia (stellate, vagus, or cardiac) which regulate heart function, as Dr. Cowden has observed in some of his heart disease patients. "Because the mercury was poisoning those ganglia, or nerve bundles, the patient's heart started having problems, such as impaired blood supply or disturbed heart rhythm," says Dr. Cowden. "When we got the mercury out of their teeth, then used chelating a gents such as DMPS to get the mercury out of their body tissues, the heart problems cleared up and they were able to discontinue their heart medications for arrhythmia and angina." Dr. Cowden speculates that some people who are helped by EDTA benefit because it pulls heavy metals from the nerve ganglia serving the heart. The dental factor, which Brandon could not afford to address at the time, probably accounted for the remaining 1 0% improvement that he failed to achieve, Dr. Cowden adds. Dr. Cowden also urges heart disease patients to eliminate all chronic infections from the teeth (such as within the jawbone or associated with root canals), intestines, and elsewhere in the body. "These infections usually cause an inflammatory response t hat speeds up the process of artery hardening," Dr. Cowden notes. One patient he treated with a heart rhythm disturbance had considerable mercury distributed in his body, but it was especially concentrated in the submandibular nerve ganglion (below the mandible in the jaw). In addition, an infection in the patient's ja w at the site of a previous wisdom tooth extraction was also contributing to the heart problem. Through the body energy lines called meridians in acupuncture, this site was energetically linked with his heart and the jaw infection was harming that organ. When the infection and mercury leakage and poisoning were corrected (including mercury amalgam removal), the man's heart arrhythmia resolved, recounts Dr. Cowden. How Arteries Thicken In atherosclerosis, or hardening of the arteries, as pH becomes more acid, cholesterol plaque (made from cholesterol, fibrin, heavy metals, wastes and toxins) builds up in arteries and veins over time and may dangerously block blood flow, subsequently ca using heart attack and stroke. 1.A normal, healthy artery with open and clear passages. 2.The beginning of cholesterol plaque build up within the artery. The inner artery wall is also beginning to weaken and bulge with cholesterol and toxic deposits. 3.Severely restricted artery with cholesterol plaque filling the majority of an artery. Note further breakdown and ballooning of inner artery wall. The Alarming Facts About Heart Disease Cardiovascular disease (CVD) has been the leading killer of Americans nearly every year since 1900. CVD includes coronary heart disease (decreased blood flow to the heart), heart attack, stroke, chest pain (angina pectoris), high blood pressure, arrhythm ia (irregular heartbeat), rheumatic heart disease, and hardening of the arteries (arteriosclerosis, with atherosclerosis, involving fatty arterial wall deposits, being the most common). According to the American Heart Association (AHA), every 33 seconds an American dies of CVD—that's about 954,000 deaths annually or about 42% of all mortalities. Every 20 seconds, an American suffers a heart attack, and every 60 seconds, somebody dies fr om one, says AHA. At present, an estimated 57.4 million Americans have one or more types of heart disease and, among deaths attributed to CVD, 52.3% are women and 47.7% are men. African Americans suffer CVD at much higher rates than whites: the rate of death from CVD amon g black males is 47.4% higher and, among black females, it's 69.1% higher. In 1994, an estimated 501,000 coronary bypass surgeries at $44,000 each were performed on Americans; 47% of these were done on men and women under age 65. In the same year, 404,000 angioplasties at $21,000 each were performed (65% on men, 53% on people u nder age 65). Total costs of CVD for 1994, both direct (hospitalization, procedures, and drugs) and indirect (lost working time), were an estimated $259 billion. Homocysteine: The Main Cause of Heart Disease? In 1969, heart researcher Kilmer S. McCully, M.D., published an unorthodox conclusion in the American Journal of Pathology regarding a new possible cause of heart disease. This move soon cost him his job at Harvard University, he says. Dr. McCully proposed that a substance called homocysteine could, when allowed to accumulate to toxic levels, degenerate arteries and produce heart disease. Homocysteine, an amino acid, is a normal by-product of protein metabolism (specifically, of the am ino acid methionine) which does not create a problem when present in small amounts. However, Dr. McCully observed that children with elevated levels of homocysteine showed signs of blood vessel degeneration similar to these observed in middle-aged adults with heart disease. He next demonstrated that when rabbits were injected with homoc ysteine, they developed arterial plaques within three to eight weeks. Homocysteine apparently curtails the ability of blood vessels to expand, keeping them restricted and narrow. It accomplishes this by increasing connective tissue growth and by degenera ting the elastic tissue in the arterial walls, says Dr. McCully. Dr. McCully argued that high-protein diets, more than fats and cholesterol, seem to be a prime cause of heart disease. After publication of his novel theory, subsequently backed by considerable clinical support, Harvard denied him tenure, and effectively fired him. The evidence continues to mount in support of Dr. McCully's homocysteine theory. In 1992, researchers at Harvard University School of Public Health showed that men with homocysteine levels only 12% higher than average had 3.4 times greater risk of heart attack than those with normal levels. Also that year, the European Journal of Clinical Investigation showed that 40% of stroke victims have elevated homocysteine levels compared to only 6% of controls. The Journal of the American Medical Association (1995) reviewed 209 studies linking homocysteine with heart disease and concluded that homocysteine represents a strong independent risk factor. In 1996, The Lancet stated that homocysteine was to be consid ered an independent risk factor for stroke even after adjustment for other risk factors. According to Dr. McCully, heart disease is attributed to "abnormal processing of protein in the body because of deficiencies of B vitamins in the diet." It is this B-vitamin deficiency which allows homocysteine, normally converted to a harmless substance , to accumulate to dangerous levels. "Protein intoxication," characterized by excess homocysteine, then starts damaging the cells and tissues of arteries, "setting in motion the many processes that lead to loss of elasticity, hardening and calcification, narrowing of the lumen [arterial passageway], and formation of blood clots within arteries." Elevated homocysteine has the potential of displacing high cholesterol levels as the major dietary factor in heart disease. A German study (1991) looked at the coronary arteries of 163 males with chest pain and concluded that the arterial narrowing was d ue more to blood levels of homocysteine than to cholesterol. In 1997, Dr. McCully declared: "Elevated blood homocysteine is estimated to account for at least 10% of the risk of coronary heart disease in the U.S. population." An effective way to lower homocysteine is through vitamin B6, often combined with folic acid and vitamin B12, Dr. McCully further discovered. Dr. McCully generally recommends 3-3.5 mg of vitamin B6, 350-400 mcg daily of folic acid, and at least 3 mcg dai ly of vitamin B12. According to Mark Nehler, M.D., and colleagues at Oregon Health Sciences University in Portland, at least 50,000 annual deaths from coronary disease could be prevented yearly by supplementation with oral folate (folic acid), based on h is analysis of the patient outcomes (and mortalities) of other published studies. SOURCES—Kilmer S. McCully, M.D., The Homocysteine Revolution: Medicine for the New Millennium, Keats Publishing, Inc. (1997), 27 Pine Street, Box 876, New Canaan, CT 06840; tel: 800-858-7014. To reach Kilmer McCully, M.D., contact: Veterans' Affairs Medi cal Center, 830 Chalkstone Avenue, PL & M (113), Providence, RI 02908; fax: 401-457-3069. Mark Nehler, M.D. et al., "Homocysteinemia as a Risk Factor for Atherosclerosis: A Review," Cardiovascular Pathology 6 (1997), 1-9. For more information about chelation therapy, contact: American College for Advancement in Medicine, 23121 Verdugo Drive, Suite 204, Laguna Hills, CA 92653; tel: 714-583-7666 or 800-532-3688. For Buffer-pH+, TriCardia+, and Systemex, contact: Växa Intern ational, Inc., 10307 Pacific Center Court, San Diego, CA 92121; tel: 800-248-8292 (reference RS# 30181-3) or 619-625-8292; fax: 619-625-8272; website: http://www.vaxa.com. For John R. Alm, M.D., contact: Pacific Immediate Care, 1900 Hacienda Drive, Vista , CA 92083; tel: 760-940-2011; fax: 760-940-0359. For Garry F. Gordon, M.D., D.O.: Get Healthy, 901 Anasazi Road, Payson, AR 85541; tel: 520-472-9086; fax: 520-474-1297;