From The March 1997 Issue of Nutrition Science News
Detox Therapies
by Jill E. Stansbury, N.D.
Our world is a toxic jungle. Most cities now steep in a plethora of poisons—exhaust fumes, dioxins, heavy metals, industrial solvents, volatile substances and other chemical compounds percolate in the surrounding air, soil and water. Plus, much of the food supply contains dyes, preservatives, pesticide residues, nitrates, hydrogenated oils and other agents known to have carcinogenic potential.
Then there are the many items in our homes and workplaces that contain toxic substances that can induce acute headaches, malaise and respiratory distress in some, and unknown long-term consequences for the rest of us.
Even the most dedicated among us who eat only organic, unprocessed foods and abstain from unhealthy lifestyles cannot entirely avoid environmental toxins. This toxic onslaught is a burden on everybody, but particularly on those individuals with a liver, gallbladder, pancreatic or bowel disease, because these organs clear toxins from the blood. People with poor diets face double the risk because they typically consume an increased amount of toxic substances and an insufficient amount of nutrients for liver and tissue detoxification.1
Frequent headaches, PMS, joint pain, fatigue, skin eruptions, digestive symptoms, halitosis (bad breath), recurrent infections and immune deficiency may indicate a need for detoxification. So what is detoxification therapy?
Toxemia And Disease
First, let's look at how the body processes toxins and what happens when we overtax this system. Philosophically, naturopathic medicine views acute disease as the body's attempt to purge itself of accumulated toxic substances. Therefore, most degenerative disease is the body's attempt to survive at a lowered state of health.2 Over time, the body is forced to accept toxins it is not capable of detoxifying and eliminating. Prolonged toxemia (a state of increased toxins in the blood), infection and tissue inflammation results in decreased vitality and function and, ultimately, in degeneration of tissues.
Acute diseases such as infections and inflammations can be seen as the body's recognition of a toxic state and its desire to heal. The formation of a pimple or abscess, for example, is the body's attempt to move toxins outward through the skin. An acute fever and runny nose may also be a healing effort whereby the body purges itself of a virus. With sufficient vitality, the body may choose to eliminate wastes and move toward healing with a purgative action. Such an action requires energy and temporary discomfort but may yield improved health. In creating fever, diarrhea or discharge, the body burns or expels toxic substances. By mounting an immune and inflammatory response, and generating some heat and metabolic momentum, the homeostatic mechanism within organizes itself back into a higher state of health. Call it a "healing crisis," as the body makes a wise and necessary move to restore vitality to the tissues.
In naturopathic medicine, a person who is undergoing a healing crisis is supported with immune-nourishing and tonifying therapies so the body can accomplish its natural detoxifying and revitalizing actions. Considered from this perspective, controlled fevers, localized infections, discharges and the like can be seen as positive purge processes.
A "disease crisis," on the other hand, is not detoxifying or vitalizing. The devitalizing disease crisis is the result of repetitive healing crises, such as chronic cystitis leading to degenerative changes in the bladder, or repeated kidney infections leading to renal damage. In these examples, the body has become too ill, or the organs too damaged and weak, to summon the vitality required to direct a healing crisis. In naturopathic medicine, the goal is to avoid disease crises by recognizing that repeated infections, skin eruptions, joint pain, fatigue and hormonal diseases are signs of systemic imbalance. Symptoms of such diseases should not simply be suppressed or opposed with pharmaceutical medicines, but treated as a warning. Patients should seek balance to prevent health-damaging infections, degenerative diseases and possibly cancers. Toxemia is the harbinger of aging, loss of tone and function, and permanent degeneration.
In the naturopathic tradition, the bowels are the soil of the body. Nutrient absorption, metabolism, and synthesis of many hormones and enzymes, as well as processing and elimination of waste products and toxins, all occur in the bowels. The enzymes, proteins, fats and hormones found in every cell of the body are largely the result of what the digestive organs absorb, metabolize, secrete and excrete. Like a chain reaction, intestinal constipation will lead to cellular constipation, and digestive inflammation will lead to cellular inflammation.
The intestines house an extremely complex, symbiotic microbial environment that is akin to a delicate ecosystem providing the soil of life. Just as life on the planet depends on nitrogen-fixing bacteria and related microorganisms in the soil, the life of higher animals depends on the microbial milieu of the intestinal mucosa. There are more microbes in our intestinal lining than there are cells in our body.3 We have a symbiotic relationship with our intestinal microbes: We provide an environment conducive to their growth and proliferation; they synthesize vitamins, absorb nutrients, detoxify poisons such as mercury, and prevent invasion by pathogenic bacterial and fungal strains such as yeast, salmonella and toxic strains of E. coli. Undesirable bacterial strains gain a foothold when intestines lose beneficial bacterial strains because of antibiotic use, bowel disease, unsupportive diet and inundation with toxins that they must both absorb and eliminate. Pathogenic bacteria are known to produce toxic substances of their own, such as ptomaines and proteases. At the same time, they fail to detoxify wastes, metabolize hormones, manufacture vitamins, or properly nourish and support the intestinal lining. Such mucosal imbalances may promote inflammatory bowel disease.4 By the same token, inflammatory joint diseases are often induced or aggravated by aberrant microbial flora.5
Bowel Toxemia
Typically, the intestinal lining and its microenvironment delicately maintain the metabolic activities and integrity of the cells lining the gut wall. These mucosal cells have the important dual role of excluding certain substances while admitting others. When toxins accumulate, the cells are more easily inflamed and infected. This inflammation can result in increased permeability or "leakiness," which allows toxic, improperly digested and unmetabolized substances to be absorbed into the internal tissues and beyond into the body.6
It is suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) increase intestinal permeability in an undesirable way.7 The intestinal mucosal cells ordinarily produce prostaglandins--local hormone messengers--that help stabilize permeability, but they are inhibited by the presence of NSAIDs, including aspirin. Ironically, NSAIDs are typically used for arthritis, bowel diseases and migraines. Research suggests these very diseases may be caused or exacerbated by increased permeability and bowel toxemia. Thus pharmaceutical use may establish a vicious cycle.8,9
Modern medicine is beginning to recognize this pathology and is increasingly diagnosing intestinal dysbiosis and leaky gut syndrome. The increased absorption of antigenic foreign substances may trigger autoimmune and inflammatory diseases10 including rheumatoid arthritis,11 psoriasis,12 diabetes,13 multiple sclerosis, myasthenia gravis 14 and thyroiditis.15
Surrounding the intestinal border like sentries are a variety of immune cells such as Kupffer's cells, mast cells and phagocytes. In a state of toxemia, these cells must metabolize legions of endotoxins, antigens and inflaming compounds. The energy and nutrient expenditure required to maintain the optimal biochemical environment comes at a significant metabolic cost. The process is expensive in terms of antioxidant nutrients, cell membranes, immune cells, enzymes and cofactors. Free radicals and inflammatory debris also are generated. Immunoglobulins and detoxifying substances such as glutathione,16 cysteine, zinc, glycine, taurine and other nutrients are depleted and must be replaced.
Eliminating Toxins
The body's main routes of eliminating wastes and poisons are via the lymphatic, digestive and urinary systems. Secondary routes of elimination are via the skin and lungs. Bad breath or recurrent skin eruptions may be evidence of the lungs' and skin's attempt to assist overworked or weakened primary organs of elimination.
All of the digestive organs play a crucial role in detoxification. The liver, in particular, is responsible for oxidizing, conjugating or otherwise processing toxins. Several biochemical pathways exist to manage toxins including the family of enzymes called cytochrome P450s, which process many toxins so they can be further metabolized. One process is glutathione conjugation, wherein the molecule glutathione attaches itself to a toxin and thus facilitates its excretion into the bile or urine. The liver filters a liter of blood per minute, straining out endotoxins, bacteria and poisons. Some are deposited into the bile, which is squirted into the intestines by the gallbladder so the filtered impurities can be moved out of the body. Prescription drugs, birth control pills and other hormonal medications, high fat diets, gallbladder disease and a variety of other factors can reduce the quantity and the quality of the bile produced. Hepatitis, cirrhosis, biliary disease and nutrient deficiency can all hamper the liver's ability to effectively purify blood.17
The kidneys receive toxins and the glomeruli, a specialized apparatus within the kidneys, filters the blood and metabolizes water, electrolytes and nitrogen-based wastes. Heavy metals, long-term aspirin consumption, and numerous pharmaceuticals can damage the kidneys and hamper their ability to detoxify these substances.18
Poisons that have not been properly detoxified can end up in other organs and tissues. Additionally, every cell in the body produces waste products that can be toxic if not properly disposed. Lymphatic channels filter toxins and destroy immune cells that have died while combating invasive chemicals. With the help of phagocytic lymphocytes and specialized housekeeping nodes, the lymph system helps drain the tissues of toxins and debris. Enlarged tender lymph nodes are an indication of an infection or immune disease. Some toxins such as dioxin, THC (tetrahydrocannabinol) and PCB (polychlorinated biphenyl) are stored in fat cells, much like putting unwanted items in out-of-the-way cupboards where they won't clutter metabolic business. The skin also purges wastes via perspiration and sebaceous secretions.
Understanding the body's detoxification process and realizing how much stress we place on these systems may prompt us to implement periodic purification regimens.
Detox Therapies
The desire to clean and purge the body is age old. Throughout history, people have practiced cleansing therapies such as periodic purification fasts and spiritual quests. Hot baths, steams, saunas and sweat lodges have all been used for purification and to treat infections and disease.
Detoxification therapies first take a load off the system by reducing exposure to toxins, irritants and synthetic substances. A nourishing diet and nutritional supplements assist detoxification. Exercise, saunas and sweating therapies facilitate waste elimination through the skin and circulatory system. Herbs that help the liver, lymphatic, hormonal and metabolic systems clear toxins from the body are valuable additions. Depending on the severity of the toxic load and the overall health of an individual, improving the vitality of the tissues can take from several months to several years. Following are the important steps in any detox regimen.
* Restore Bowel Health: Restoring intestinal health is a good place to start the detox process. Lighten the workload on the digestive organs. Avoid chemical-laden food and drink. Cut back on foods that are difficult to digest and that inflame or support undesirable bacterial strains. These include high-fat foods, dairy products and meats, as well as processed and fiber-depleted foods. Avoid unnecessary antibiotics and anti-inflammatory drugs. Restore favorable intestinal microbes by supplementing with probiotics--bacteria such as Lactobacillus acidophilus and other strains are crucial to biological waste detoxification and intestinal cell nourishment.19 Yogurt, sauerkraut and supplements all supply helpful microbes. Nondigestable starch compounds, known as fructo-oligosaccharides (FOS), favor the growth of desirable bacteria. These favorable bacteria are also supported by a high-fiber diet and an intestinal transit time that is neither too short (diarrhea) nor too long (constipation). Constipation allows toxins to irritate the colon and substances that should be excreted to be reabsorbed.20 Alternatively, diarrhea may prevent nutrients from being assimilated.
* Avoid Ingesting Toxins: Obviously, environmental and dietary toxins should be avoided whenever possible. Adopt a diet of organic, unprocessed foods. Avoid using soaps, shampoos, cosmetics, pharmaceuticals, household cleansers and aerosols that increase the toxic load on the body. Drink pure water and avoid toxic environments.
* Ensure Adequate Nutrition: Supplying nutrients--especially antioxidants--during the detoxification process is beneficial. As a group, the antioxidant nutrients protect body cells and membranes from toxins and oxidizing agents.21 Eat plenty of fresh vegetables (especially cabbage, garlic and onions), legumes and brightly pigmented foods. Supplement with antioxidant vitamins including C (2-4 g/day), E (400-600 IU/day), zinc (15-30 mg two or three times/ day) and beta-carotene (30,000-75,000 IU/day or more), and take a high-quality multivitamin for several months if not long term.
Following are other supplements to consider for a well-rounded detox program. Customers shouldn't feel they have to take all the supplements on the list; rather, recommend they adjust their regimen to serve their personal health needs.
Glutamine is synthesized from the amino acids arginine, ornithine and proline and has many functions in the body, including being a component of the neurotransmitter GABA and a noted anti-ulcer agent.22 Cabbage juice, once a folk remedy for digestive ulcers, is now known to be high in glutamine. Glutamine is the amino acid that nourishes the gastrointestinal mucosal cells. It reduces abnormal permeability, and enhances the health of the intestinal villi. Supplement with 1 g/day.
Glutathione is a sulfur-containing antioxidant that is depleted by toxemia, alcoholism and a diet lacking in sulfur or zinc.23 It can be synthesized from the sulfur-containing amino acids cysteine and methionine, which are commonly supplemented to raise glutathione levels. Milk thistle (Silybum marianum),24 cruciferous vegetables and bioflavonoids support glutathione levels and prevent its depletion. Supplements of cysteine, zinc and methionine can help increase glutathione levels.25 Supplement with 250 mg glutathione twice daily if available, or substitute 500 mg to 1 g/day cysteine or methionine.
Methionine is a sulfur-containing essential amino acid that improves cholestasis,26 a condition of slow-moving or stagnant bile flow, and helps the liver metabolize estrogens,27 toxins28 and bilirubin.29 Methionine prevents glutathione from being depleted. The amino acids cysteine and taurine are synthesized from methionine. Supplement with 1 g/day.
Carnitine helps the liver metabolize fats and is helpful in preventing alcohol-induced fatty liver.30 The recommended dosage is 500 mg twice a day. Naturopathic physicians and nutritionists are using carnitine for numerous conditions that require increased fat metabolism. The Physician's Desk Reference recommends 600-1,200 mg carnitine twice daily for patients with high levels of fat in the blood or who have heart disease.
Dietary fiber acts as a detoxifier in several ways. Because of a purely mechanical effect, fiber improves bowel transit time. Fiber also reduces aberrant intestinal permeability. It prevents conjugated estrogens (deactivated estrogens the body intends to excrete) from being reactivated and reabsorbed.31 Fiber traps some toxins and assists in the elimination of heavy metals and other wastes.32 Microbial flora act on cellulose in fiber, producing short-chain fatty acids that are used as energy sources for the liver and intestines.33 Try to eat 100-180 g of fiber per day.
* Consider A Fast: Periodic fasting causes the body to use fat for energy because dietary fats and carbohydrates are unavailable. Because many toxins are stored in adipose tissue, fasting liberates poisons. Although this has a detoxifying effect in most healthy individuals, it is a challenge to the body and not appropriate for the weak, hypoglycemic or malnourished. Begin with a simple 24-hour fast. From there you may opt for a one-day fast every week or a three-day fast every month.
* Sweat Toxins Away: Therapies that promote perspiration help the skin move waste out of the body. Hot baths, exercise, saunas, hydrotherapy, epsom salt soaks and any activity that enhances circulation in the skin and lymphatic channels can have a cleansing and stimulating effect. Make sure you sweat for 15 to 30 minutes several times per week, or even daily if you can.
* Enlist Herbal Help: Many herbs support detoxification, but herbs that promote liver and bowel function, lymphatic drainage and urine formation are particularly useful. Generally, herbs can be taken as a tea (2 to 4 cups daily), in capsule form (three to six per day) or as a tincture (1 to 2 teaspoons per day). This regimen can be followed for two to six months depending on individual needs. A naturopathic doctor or herbalist can personalize recommendations, which often produce the best results.
Bitter herbs that stimulate bile flow and liver activity can enhance the removal of wastes from the body. Alterative herbs that act as liver and digestive tonics include dandelion root (Taraxicum officinale), burdock root (Arctium lappa), milk thistle (Silybum marianum) and many others. Milk thistle has been shown to prevent toxin-induced glutathione depletion and liver inflammation.34,35 Turmeric (Curcuma longa) has also been noted to protect the liver.36 The alterative herb Oregon grape (Berberis aquifolium) has been shown to inhibit undesirable intestinal flora.37 Other antimicrobial and anti-inflammatory herbs such as garlic (Allium sativa),38 onions (Allium cepa), turmeric,39 citrus seed extracts 40 and ginger (Zingiber officinale)41 also have been shown to support desirable and inhibit undesirable microbial flora.
Herbs that stimulate the lymph nodes and channels to filter impurities from the tissue fluids support detoxification. Cleavers, an annual bedstraw (Galium aparine), pokeroot (Phytolacca decandra), and wild iris (Iris versicolor) all promote lymphatic drainage. Pokeroot and iris are potentially toxic and professional guidance is advised.
Urinary tonic herbs help the kidneys remove wastes from the body. Included in this category are stinging nettles (Urtica urens) and dandelion leaf.
Antioxidant and tissue-protective herbs such as turmeric are also valuable. Garlic and onions are high in antioxidant quercitins and antimicrobial sulfur compounds that help support bowel health.
Tonifying super-green foods like alfalfa, chlorella,42 spirulina and kelp are all extremely nourishing plants and can help rebuild and revitalize weakened individuals. They are best taken regularly for several months.
Plants that are known to enhance white blood cell activity against offending substances are helpful in detoxifying the body. Garlic,43 aloe vera juice,44 sarsaparilla (Smilax species), milk vetch (Astragalus membranosus)45 and Asian ginseng (Panax ginseng)46 are among the many herbs considered immune stimulating.
Our world contains many sources of toxicity, but there are also many natural resources for achieving detoxification. The suggestions here are safe and provide an excellent starting point for a self-guided detox program. However, for best results, consult a naturopathic physician or other expert.
Jill E. Stansbury, N.D., maintains a private practice in rural southwestern Washington state where she specializes in botanical and natural therapies. She heads the botanical medicine department at the National College of Naturopathic Medicine in Portland, Ore., and recently published a brief materia medica, Herbs for Health and Healing (Publications International, 1997). |
