Hello Doc,

Chelation is a chemical process in which a substance is used to bind metals or minerals so they can be excreted from the body.

Chelation therapy is a procedure in which EDTA { Ethyline Diamaine tetra acetic acid } is injected through a saline bottle. This EDTA is a chelating agent. A chemical that binds certain metal ions, such as calcium, magnesium, lead, and iron. It is used in pathology labs to prevent blood samples from clotting and to remove calcium and lead from the body.

Though this agent is used in pathology labs to prevent clotting, when injected in blood it has high chances to lead to platelet agglutination and thrombocytopenia also.

Can Chelation therapy have adverse effects?

• Yes. The most important serious side effects are hypocalcemia (abnormally low blood calcium levels) and damage to the kidneys.
• In the TACT study, which had extensive safety monitoring, 16 percent of people receiving chelation and 15 percent of people receiving the placebo stopped their infusions because of an adverse event. Four of those events were serious; two were in the chelation group (one death) and two were in the placebo group (one death).

Does Chelation therapy improve Ischemia?

Click on the below link to read the RCT research which says that improvement post 27 weeks of 27 sittings of Chelation in IHD patients improved the ischemia time by 63 seconds only, while placebo improved by 54 seconds.

RCT to assess effect of Chelation therapy on IHD

Does Chelation therapy help in reversing blockages?

Some health professionals also suspect that EDTA may act as an antioxidant by removing metals that combine with LDL which can damage arteries. The theory is that when you remove metals that flow freely through arteries (such as copper or calcium), you may slow down diseases such as atherosclerosis. Research has not proved this theory. Some experts believe that EDTA could remove calcium from healthy bones, muscles, and other tissues, as well as from diseased arteries. If you ask about reversal of plaque by this therapy, answer is NO. Average Coronary artery calcium reduction by this therapy is about 14%.

If the patient wants to simultaneously continue Chelation therapy along with your therapy, you can allow the patient for the same.

Hello Dr. Archana,

First of all I will like to congratulate you for your confidence in tapering medications of a Low BMI DM patient keeping his sugar levels in control. Helping such a  patient to maintain his HbA1C levels in control without Insulin and OHA is a great task.

I would like to clarify one point here that GTT is not the target for such patients. You should consider Hba1C as the parameter of reversal in such patients.

As you rightly said, to grow the muscle mass you have advised your patient for strength training and you should be aware that growing muscle bulk is a time consuming process.

According to me, you should conduct his GTT after a year of maintaining his HbA1C under 6 and growing his muscle bulk considerably so that the consumed sugars can be well utilized by his muscles.

Hello Doc,

Statins have a specific mode of action of inhibiting HMG co A reductase enzyme. This enzyme is known to halt the process of cholesterol biosynthesis in the liver. Thus in simple words, it shuts down the manufacturing factory of Cholesterol. As a result, LDL which transports the Cholesterol molecules from Liver to the target organ also reduces down as there is no cholesterol to be transported.

Inspite of this, many patients do present with elevated LDL and Cholesterol levels because Cholesterol is not only manufactured in the Liver, but it is manufactured in almost all cells of the body, brain and intestine also.

Statins are normally branded by certain pharma companies to halt the progress of Atherosclerosis, but that is not completely true. They change the plaque composition to a certain extent instead of reducing down the plaque size considerably. As per Asteroid trial, Statins could reduce the atheroma by 6.8 cu mm only even after intensive statin therapy for 24 months.

Visit this research paper to know more about it.

Asteroid Trial

https://www.ahajournals.org/doi/full/10.1161/hc2901.093188

Secondly, Statins are marketed to reduce down the mortality rate by reducing down the incidence of heart attack. If possible, click the following link to understand things better.

The above trial says that if 217 patients consume Statins for 5 years, only 1 patient can avoid a Heart attack.

In such a scenario, one should not fear to taper Statins for your patients. Having said this, we need to follow a specific guideline to taper Statins.

Taper statins as per the protocol in a compliant patient under your regular monitoring if,

1. Total Cholesterol is below 200 mg/dl
2. LDL is below 100 mg/dl
3. TG is below 100 mg/ dl

Along with tapering, every clinician has to regularly monitor for lipid profile, Vit D3 and relevant vitals at specific frequency. Guide the patient for the diet restrictions and regular exercises with cessation of smoking and control on alcohol intake.

Few patients who are non compliant to above guidelines, its advisable to refrain from tapering Statins and antioxidant medicines or supplements.

For more details about tapering medications talk to your ZMH for specific protocols.

Yes Doc!

We can use Framingham risk score for initial screening. No doubt.

It is calculated on the basis of whether the patient is Diabetic, HTN, Smoker and his Lipid levels. As an initial screening, we can use this as a home based questionnaire. Infact, the branding and lead generation team in our organization screens the patients on the same criteria before sending the patients to the clinic. Limitations of the score lies in it being a very preliminary screening process, nothing else.

When it comes to screening inside the clinic by a doctor, further investigations like ECG, Stress test and ECHO can be better tools to diagnose the patient better.

Hello Doc,

This 28 year old patient with Type 1 DM needs to be treated in a different format as compared to Type 2 DM.

Type 2 DM is generally considered very similar to Kaphaj Diabetes, while right opposite could be Type 1 DM and this patient thus can be considered in Vataj Diabetes.

This patient should be treated with Bruhan concept. We have developed a preliminary guideline to treat such patients which is showing good improvement in initial few patients.

The treatment consist of a Diet plan of > 1400 Cal of food along with Snehan, Swedan and A special bruhan Anuvasan basti of 240 ml. Kindly reach out to your ZMH to enroll this patient for this treatment and make the related treatment kit available in your clinic.

Parameters to be assessed regularly will be

1. Weight gain : 3 days
2. FBS and PLBS : 3 days
3. Serum Insulin PP: 30 days
4. C peptide : 30 days
5. HbA1C : 30 days

Weight gain will be considered as a good sign in this patient along with control of his BSL during simultaneous reduction of insulin doses.