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Detoxification
CHAPTER 106
Detoxification Luke Fortney, MD, FAAFP • Rian Podein, MD • Michael Hernke, PhD
WHAT IS DETOXIFICATION AND WHY DO IT? Detoxification, as reviewed here, is the constellation of physiological and psychological processes through which the body identifies, neutralizes, and eliminates toxic substances, metabolic byproducts, habits, and patterns. Alcohol and other narcotic withdrawal therapies are serious medical conditions requiring close supervision and are not discussed here. For an increasing number of people living in a more polluted and stressful world, body systems can become overburdened and strained by various contaminants that may lead to health problems.1 In general, these toxins can be identified within the following general categories:2 • Antinutrients such as high-fructose corn syrup, trans fats, caffeine, alcohol, and processed foods • Internal metabolic toxins such as nitrogen, carbon dioxide, bile, urea, free radicals, and stool • Medications used improperly, inappropriately, or too often • Heavy metals such as mercury, arsenic, lead, cadmium, tin, and aluminum • Chemicals such as pesticides, herbicides, cleaning products, solvents, and glues • Allergens such as food, mold, dust, pollen, and chemicals • Infectious organisms such as bacteria, viruses, yeast, and parasites Further, the following social, emotional, and spiritual challenges affect health and well-being:3,4 • Stress, such as lack of personal time, too much work, excessive worry, too little rest, and financial strain • Unhealthy mental states, such as addictions, overeating, and destructive mental patterns • Ambient distractions, such as pervasive noises, smells, lights, and images • Overstimulation from advertisements, radio, computers, television, smart phones, and pagers • Lack of spiritual connection, a loss of meaning and purpose • Isolation, the lack of social support and community • Nature deprivation, being disconnected from natural environments5 • Negative emotions and persistent self-defeating thoughts, such as anger, fear, guilt, and hopelessness Although too infrequently acknowledged, the body and mind already possess the capacity to handle these challenges. This process of maintaining biological and mental balance is called homeostasis. The major systems that work together synchronously to maintain health and balance include the following: 996
• • • • • • •
iver and gallbladder (Figs. 106.1–106.3) L Kidneys Gastrointestinal system Skin Lungs Lymphatic and circulatory systems Mind and brain Symptoms that may reflect an overtaxed or dysfunctional detoxification system are often vague and nonspecific, but when seen in constellation, they suggest a problem with the body’s ability to restore itself. When potentially serious medical conditions have been ruled out by a reasonable medical workup, symptoms that may be attributed to a detoxification problem with the body often include the following:1,6,7 • Fatigue with sleep disruption and brain-fog • Mood disturbance, especially depression, anxiety, fear, and anger • Muscle aches and joint pain • Sinus congestion, dark circles under the eyes, and postnasal drip • Headaches with neck and shoulder pain • Bloating and flatulence • Irritable bowel, foul-smelling stools, and dark urine • Weight changes and loss of muscle tone • Heartburn, recurrent colds, and persistent infections • Infertility and low libido • Premature aging and weakness • Fluid retention and excess weight • Rashes and canker sores • Bad breath and adverse body odor Although conclusive scientific data supporting detoxification therapies are largely lacking, the question for a patient suffering from any of these symptoms remains this: “What can I do to feel better?” Unfortunately, many gimmicky, expensive, unnecessary, and potentially harmful products and programs exist, and dubious practitioners may exaggerate their claims. In general, patients should avoid dramatic, expensive, and extreme approaches in favor of reasonable, safe, and health-promoting lifestyle changes that empower patients and avoid dependency and unrealistic expectations. The five basic components of any detoxification program should include the following: • Daily physical activity, such as yoga and walking (preferably in natural “outdoor” environments when possible)5 • Regular sweating, through physical activity, use of a sauna or steam room, or a hot-room yoga class • Healthy nutrition, rich in organic fruits and vegetables and filtered water (see Figs. 106.1–106.3) • Self-reflection, such as any contemplative practice (e.g., meditation), journaling, and breathing-focused relaxation techniques
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106 Detoxification Endotoxins * end products of metabolism * bacterial endotoxins Exotoxins * drugs (prescription, OTCs, recreational, etc.)
* chemicals
- agricultural - food additives - household - pollutants/contaminants * microbial
PHASE I [cytochrome P-450 enzymes]
PHASE II [conjugation pathw ays]
(
nonpolar lipid-soluble
excretory derivatives
intermediary metabolites
* toxins
(
Reactions oxidation reduction hydrolysis hydration dehalogenation
lipid-soluble (nonpolar) toxins stored in adipose (fat) tissue contribute to increased/mobilized toxin load with weight loss.
Enzymes, Cofactors & Other Nutrients Used
(
riboflavin (vit. B2 ) niacin (vit. B3 ) pyridoxine (vit. B6 ) folic acid vitamin B12 glutathione branched-chain amino acids flavonoids phospholipids
more polar more water-soluble
sulfation glucuronidation glutathione conjugation * acetylation amino acid conjugation glycine taurine glutamine ornithine arginine methylation
(
Reactive Oxygen Intermediates
polar ( water-soluble (
Serum Kidneys
* N-acetylcysteine, cysteine, methionine are precursors
Bile
Antioxidant/Protective Nutrients/Plant Derivatives
Superoxide
carotenes (vit. A) ascorbic acid (vit. C) tocopherols (vit. E) selenium copper zinc manganese coenzyme Q10 thiols (found in garlic, onions
Free Radicals
Urine
Feces/stools
Secondary tissue damage
& cruciferous vegetables)
bioflavonoids silymarin pycnogenol
FIG. 106.1 □ Liver detoxification: over-the-counter (OTC) drugs.
Phase 1 Detoxification Alcohol
Environmental Toxins
Phase 2 Detoxification Conjugation
Drugs
Neutralized Toxin P-450 System ~100 Enzymes Free Radicals
Neutralized Toxin
Antioxidants (Glutathione)
Phase II System Glutathione Amino Acid Methylation Sulfation Acetylation Glucuronidation
FIG. 106.2 □ Phase 1 detoxification: cytochrome P-450.
Required Nutrients Glutathione, B6 Glycine SAMe Cysteine, methionine molybdenum, Acetyl CoA Glucuronic Acid
Toxin Prepared for Excretion
Fat Soluble Cleared
Fat Soluble
Water Soluble Bile/Intestines
Urine/Kidneys
FIG. 106.3 □ Phase 2 detoxification: CoA, coenzyme A; SAMe, S-adenosylmethionine. (From Bland JS, Costarella L, Levin B, et al. Environment and toxicity. In: Clinical nutrition: a functional approach. Gig Harbor, WA: Institute for Functional Medicine; 1999:261.)
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• M anual therapies, such as massage and acupuncture • Regular supportive social time with friends, family, and community8
TESTING FOR TOXINS Although laboratory testing for various chemicals and toxins has the appeal of specifically identifying potential culprits to explain various symptoms in some cases, random screening testing remains largely unfounded with few exceptions, and evidence does not support regular or widespread use. The Centers for Disease Control and Prevention (CDC) conducts a National Biomonitoring Program that tests urine and serum samples from representative populations for industrial pollutants.9 Results continue to demonstrate the ubiquitous nature of industrial pollutants, or body burdens, across all demographic groups regardless of health status.10-13 Sadly, these findings indicate the widespread presence of societal chemicals and suggest that chemical body burden can be presumed for any presenting patient.14-19 Given the expense, variable quality, questionable validity, and unclear clinical significance of the majority of specific pollutant body burdens, routine testing is not recommended.13,20,21 Moreover, the health significance of specific chemical exposures—at what levels, during which times, and at what frequency—is poorly understood.22 Indiscriminate and unfounded causal statements about exposure, harm, and treatment efficacy should be approached cautiously and skeptically. Therefore the focus should be on reducing the amount of toxicity in our living environments (see Chapter 108).
CHELATION THERAPY Using safe and effective methods to prevent disease, treat symptoms, and achieve homeostasis is the primary goal of a good detoxification regimen. Appropriate, well-placed skepticism and concern exists over many detoxification therapies, including chelation for the removal of various heavy metals from the body.23 For example, a common but unfounded use for chelation therapy is autism spectrum disorder (ASD). However, a Cochrane Review found no evidence that chelation therapy was effective. The review went on to caution against its use because the risks of adverse effects far outweigh any potential benefits.24 The safety of widespread chelation therapy remains questionable. A study from the Emergency Department at Emory University in Atlanta, Georgia, found common adverse effects associated with intravenous chelation that included diaphoresis, hypotension, tachycardia, leukopenia, thrombocytopenia, electrocardiographic abnormalities, and increased serum creatinine.25 The clinical significance of chelation therapy is also uncertain. A Cochrane Review concluded that, at present, evidence of the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of patients with atherosclerotic cardiovascular disease is insufficient.26 However, the CDC did recommend that the calcium disodium edetate
(CaNa2EDTA) challenge test be considered for children who have blood lead levels of 1.21–2.12 mcmol/L (25–44 mcg/dL) to determine whether chelation is indicated.27 Another option could include use of a modified citrus pectin product (such as Pectasol), which may also have benefit in children whose test results reveal levels higher than those acceptable for lead and other heavy metals.28-32 The dose in one study was 5 g three times daily for 4 weeks.
Unfortunately, pectin is a viscous fiber that is not absorbed into the bloodstream, and food sources (e.g., citrus, apples, legumes, and cabbage) do not help chelate heavy metals outside of the gut. However, modified citrus pectin is absorbed through the gastrointestinal tract and appears to reduce this burden via renal clearance and urinary elimination.
In general, what can or should be done to address the ubiquitous nature of chemical body burden is uncertain. Caution and skepticism in the use of chelation therapy are therefore recommended. Further information regarding chelation therapy can be found online (see the Key Web Resources and Chapter 107).
SAUNA THERAPY The body stores fat-soluble toxins such as pesticides in adipose tissue (also called lipophilic persistent organic pollutants, or POPs). One well-known example are the flame retardants polybrominated diphenyl ethers (PBDEs); some of the highest levels of these compounds throughout the world have been found in the breasts of lactating American women.33 These compounds were banned in Europe due to their association with reproductive, neurodevelopmental, and thyroid toxicities.33 Taking a relaxing sauna or steam bath is an effective therapy to help the body detoxify.34 The traditional sauna increases the air temperature to 160°F–200°F (approximately 70°C–90°C), with 25% humidity compared with a steam room, which is heated to 120°F–130°F at 100% humidity. The exogenous heat diverts blood to the skin, where sweating releases excess sodium, nitrogen, and toxins.35-37 In addition to its use in Scandinavia and many cultures around the world for hundreds of years, research since the 1960s has demonstrated the health-promoting effects of regular sauna use, including stress reduction, detoxification, lower blood pressure, and decreased pain.38 In fact, increased frequency of sauna use is actually associated with a reduced risk of sudden cardiac death, fatal cardiovascular disease, and all-cause mortality.39 Sauna cessation is advised for men attempting to conceive with their partners as heat-based therapies temporarily impair sperm count and motility.40 Although sauna use is safe for most people of all ages, caution should be used in people who have undergone recent surgery; have unstable cardiovascular conditions such as recent myocardial infarction or cerebrovascular accident; or have multiple sclerosis, acute lung infections,
106 Detoxification
or pregnancy complications.41 Even people with known heart disease can partake in sauna therapy. The greatest risk for all uses is hypotension and syncope, particularly if alcohol is used during sauna use (which is not recommended).39 Some evidence indicates that a lower-temperature infrared sauna may offer similar health benefits. Lowertemperature infrared saunas are typically heated to 120°F and are a good option for those who cannot tolerate the higher temperatures of a traditional sauna or steam room (e.g., individuals with multiple sclerosis). For further reading on the many health effects of sauna therapy, please refer to an excellent book entitled, The Holistic Handbook of Sauna Therapy, by Nenah Sylver.42
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TABLE 106.1 The Environmental Working Group’s List of the “Dirty Dozen” (Foods Highest in Pesticides Used) and the “Clean 15” (Foods Lowest in Pesticides Used) Dirty Dozen (Better to Buy Organic)
Clean 15 (Less Important to Buy Organic)
1. Celery
1. Onions
2. Peaches
2. Avocado
3. Strawberries
3. Sweet corn
4. Apples
4. Pineapple
5. Blueberries
5. Mangoes
6. Nectarines
6. Sweet peas
EXERCISE
7. Bell peppers
7. Asparagus
8. Spinach
8. Kiwi
Reasonable and safe approaches to body burden detoxification include increasing awareness and adherence to healthy lifestyle behaviors such as regular physical activity, healthy nutrition, stress reduction, mind-body practices, spiritual connection, and avoidance of harmful behaviors such as smoking. Exercise has been shown to enhance adipose tissue circulation and therefore increases the release of stored toxins.43 Cardiovascular exercise also supports detoxification through sweating. Starting with gentle, but regular, forms of exercise, such as walking or bicycling for 30 minutes or more per day, is best. Ideally, a person should set a goal of vigorous movement of any kind for 60 minutes or more on a daily basis. Hot room yoga is particularly beneficial for detoxification, but any and all forms of movement are encouraged.
9. Cherries
9. Cabbage
10. Kale and collard greens
10. Eggplant
11. Potatoes
11. Cantaloupe
12. Grapes (imported)
12. Watermelon
NUTRITION Nutrition is arguably the first and most important step in promoting health and supporting the body’s efforts to remove harmful substances. What a person avoids eating is equally important as what is included in a healthy diet. By avoiding artificial additives and unhealthy fats, reducing excess calories (including less salt, saturated fats, and sugars), and adhering to a diverse whole food organic diet, a person will be better able to support the body’s detoxification process, in large part, by avoiding overeating and ingestion of environmental pollutants44-46 (see Chapter 88). While annually millions of people worldwide take part in various forms of detoxification, little is mentioned about the role of the gut microbial microbiota. One study evaluated the effects of several 3-day dietary detox regimens and found that they do indeed change the microbial community, with some of them increasing a genus of bacteria thought to help prevent obesity and diabetes.47 However, with return to their prior standard American diet, the gut microbial changes returned to their predetox state at approximately 10 days. These findings are consistent with those of a prior research study that showed that dietary changes can rapidly and reproducibly alter the human gut microbiota but that short-term
13. Grapefruit 14. Sweet potato 15. Honeydew melon Data from the Environmental Working Group: http://www.ewg.org.
detox programs may be most effective as a jumpstart to an ongoing dietary lifestyle modification that supports an optimal gut microbiome48 as well as the many health benefits associated with probiotic supplementation for various medical conditions.49
Safe and Environmentally Friendly Fish and Seafood Choices Consuming fish and seafood a few times per week has many benefits;50 however, concerns exist about contaminants that may affect our health and the environmental impact of fishing practices. Resources that can be used to help guide safe fish and environmentally sustainable seafood choices are provided in the Key Web Resources.
Pesticides in Produce When deciding whether to invest in organic produce, it can be helpful to understand which conventional fruits and vegetables are highest and lowest in pesticide content. The Environmental Working Group publishes a helpful guide that lists the “Dirty Dozen” (foods highest in pesticides) and the “Clean 15” (foods lowest in pesticides), as shown in Table 106.1 (see also the Key Web Resources).
Fasting Occasional and sensible fasting may be helpful as well. Several variations of fasting exist, some involve drinking only water or juices or other nonsolid foods. During
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fasting, the main source of energy used by the body comes from hydrolyzing fatty acids from triglycerides stored in adipose tissue.51-54 Because many toxins are sequestered in adipose tissue, fasting may be helpful in eliminating these toxins from the body. Initially, a person may feel worse during a fast because of this mobilization process. Resting and drinking plenty of fluids are therefore helpful during a fast.
$20,000
100%
$18,000
90%
$16,000 $14,000
Personal income (in 1995 dollars)
Manual therapies such as massage may be helpful to mobilize and eliminate toxins from the body by mobilizing the lymphatic system, among other possible benefits. Together with exercise and sauna therapy, massage can greatly enhance the ability of the lymphatic, cardiopulmonary, and hepatorenal circulatory systems to eliminate toxins. For example, massage has been shown to reduce excessive fluid volume by 65% in patients with lymphedema.55,56 Other forms of body work such as acupuncture may be helpful as well, in part, by increasing the relaxation response as well as treating qi stagnation and myofascial restrictions.
Mind-Body Connection Finally, any detoxification review or program that ignores the mind-body connection is remiss. Stress is arguably the most significant toxin confronting patients on a daily
60%
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50% Percentage very happy
40%
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30%
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20%
$2,000
10%
$0
0% 1956 1963 1970 1977 1984 1991 1998
FIG. 106.4 □ U.S. Department of Commerce, Bureau of the Census.
and long-term basis. As measures of happiness decline in the United States (Fig. 106.4), various mind-body syndromes such as fibromyalgia, migraine, chronic fatigue, irritable bowel, multiple chemical sensitivity, and others continue to affect more people.57,58 Unfortunately, support and awareness are lacking for mind-body interventions that cultivate understanding, behavior changes, insight, and accountability for patients and health care workers.59 Various chapters in this text offer helpful tools to support a healthy mind and emotions.
Key Web Resources University of Wisconsin Department of Family Medicine: This website provides a regularly updated, self-guided 7-day detoxification plan. Environmental Working Group: This group offers excellent resources regarding information on harmful toxins in the environment with recommendations on how to avoid them, including information on toxins in fish and pesticides in produce. Environmental Defense Fund seafood selector: This organization offers ratings of the best (least contamination) and worst (most contamination) for seafood consumption, as well as a pocket guide for selecting seafood. Centers for Disease Control chemical exposure report: This report details the health effects of human exposure to environmental chemicals. Doctor’s Data, Inc.: This laboratory offers toxicology testing, as well as drinking water analysis. It also contains information on chelation therapy. Bioneers: This organization offers advice on sustainable living that supports wider social and ecological health. National Center for Complementary and Alternative Medicine: This National Institutes of Health website provides information on many topics, including chelation therapy.
70%
$12,000
$8,000
MANUAL THERAPIES
80%
http://www.fammed.wisc.edu/integrative/modules http://www.ewg.org http://www.ewg.org/safefishlist
http://www.edf.org/page.cfm?tagID=1521
http://www.cdc.gov/exposurereport/ http://www.doctorsdata.com http://www.bioneers.org http://www.nccam.nih.gov
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Detoxification Program Patient Handout: Seven Day Detoxification Program Many detoxification programs are available, but caution is advised before doing one. Very often symptoms are a signal from the body that something is out of balance and needs to be addressed. However, before adding any treatments, it is often the case that something should be removed as the first step to healing (eg smoking cessation for coughing). This program is about jump-starting a healthy lifestyle, which is far more important than any short-term detox. Most importantly, be flexible and adapt this program to your specific needs. The following plan (found online at www.fammed.wisc.edu/integrative/modules) offers a general outline for a self-guided detox program. Getting Started • This regimen is not intended to be an exhaustive resource, nor is it a test of will and endurance. It is designed to be a safe, gentle, useful, empowering, and accessible health guide that takes into account personal variability. Adaptations should be made as necessary. However, this process does require planning and preparation, so read through it and make preparations ahead of time. • In addition to physiologic approaches, this plan equally emphasizes mind-body approaches that can aid the relaxation response and unravel negative and unconscious mental patterns that often result in pain and discomfort. • The most important part of going through a detox program is to first ask why you are doing it. Being clear about your intentions helps avoid inflated expectations and disappointment. Write-down the reason for going through a detox in your own words. • The five basic ingredients of this detox regimen are self-reflection, exercise, sauna, nutrition, and manual therapy. The program offered here is designed to support and enhance your body’s inherent ability to heal and be well. It is intended for most people with few exceptions. • The program has a strong emphasis on using organic, sustainable, local, responsible, gentle, natural, whole, and balanced ingredients that honor the global and spiritual aspect of health. Precautions and Expectations • Healing crises can occur during a detox. Common temporary symptoms can include general malaise, fatigue, headache, lightheadedness, diarrhea, cramps, bloating, body-aches, mood-changes, and generalized weakness. These symptoms are often caused by a combination of factors including the mobilization of toxins, low blood sugar, low fluids, electrolyte imbalance, withdrawal from habitual substances (such as alcohol, caffeine, sugar, nicotine), and even changes in your daily routine. • Most often the best approach is to continue with the detox. However, you may need to stop or alter the detox if you experience ongoing or worsening symptoms. • Dehydration is unnecessary during a detox. Make sure that you drink a lot of fluids. • Address your particular needs as you go along, such as more frequent snacks, larger meals, increase protein and healthy fats, less physical work, more rest, and less striving in general. • Continued use of prescription medications is advised and should be monitored by a physician. If needed, use “over-the-counter” medications sparingly for relief of headaches or other symptoms. • Communicate with your health care provider about any concerns that arise during the detox as needed. In the end, you will likely find that you feel better, have more energy, are healthier, and may require less medication. Below are three examples of different detoxification programs to consider. You can choose the one that best matches your needs and lifestyle. They progress from simple (#1) to more involved (#3). Version #1 (short) for 5 or more days: * Eat only fruits and vegetables in any combination, amount, and preparation using healthy oils and spices as needed. * Drink plenty of filtered water, juice, tea, and broth. * Move and exercise the body in any variety, intensity, and duration everyday. * Keep a daily journal and practice any form of self-reflection everyday (eg meditation). Use the “Mind/Body Awareness Writing Exercises” workbook at www.fammed.wisc.edu/integrative/modules as a guide for journaling. Version #2 (simplified) for 7 or more days (extend days 6 and 7 to a full 10 days if desired): * Days 1 and 2: Eliminate meat, eggs, dairy, wheat, alcohol, caffeine, chocolate, and refined sugars. Eat only organic vegan foods in any arrangement, preparation, and amount using cooking oils and seasonings. * Day 3: Further eliminate all grains, nuts, beans, and legumes. Eat only fruits and vegetables in any combination, amount, and preparation using oils and spices as needed. * Day 4: If possible avoid eating any solid food. Drink plenty of water, broth, juice, and tea. Rest during this day. * Day 5: (same as Day 3) * Days 6 and 7 (and optional extended days 8-10): (same as Days 1 and 2) * Throughout the detox, keep a daily journal and practice any form of self-reflection everyday (eg meditation). Use the “Mind/Body Awareness Writing Exercises” workbook at www.fammed.wisc.edu/integrative/modules as a guide for journaling. Version #3 (advanced) with added supplements and probiotic bowel regimen: Days 1 and 2: For the entire detox week, eliminate all meat (e.g., fish, beef, pork, lamb, poultry), refined sugars (white/brown sugar and especially high-fructose syrup), and especially artificial sweeteners such as saccharine, aspartame, and Splenda (natural sweeteners such as honey, maple syrup, molasses, Stevia, and erythritol, are okay to use in small amounts). Also avoid alcohol, tobacco, caffeine, cigarettes, chocolate, and recreational drugs for the entire week. It is advised to avoid dairy, wheat, and eggs during the detox week as well (instead try soy/almond/rice milk, soy cheese, soy yogurt, stanol/sterol spreads). Cooking should be guided by healthy recipes for soups, steaming, sautéing, and baking etc based on your preferences. Keep a daily journal and practice any form of self-reflection everyday (eg meditation). Use the “Mind/Body Awareness Writing Exercises” workbook at www.fammed.wisc.edu/integrative/modules as a guide for journaling. Encouraged foods for days 1 and 2 include fresh/frozen/dried vegetables, fruit, and mushrooms (maitake, shiitake, oyster, and/or enoki, etc). Healthy grains are also recommended for days 1 and 2 (brown/wild rice, quinoa, buckwheat, oatmeal, millet etc), as well as seeds, nuts, legumes, and flaxseed. Other suggestions for days 1 & 2 include the following: Cold-pressed organic extra virgin olive oil as guided by “detox appropriate” recipes. Spices and healthy seasonings as needed based on your preferences. Drink 8–10 glasses of filtered water, including “vitalizing beverage,” “detox broth,” smoothies, and diluted juices. Drink tea throughout the day, such as peppermint, decaf green, chamomile, licorice, ginger, rooibos, and digestive tea. For snacks eat mixed nuts, dried and fresh fruit, vegetables, and detox broth (see Table ***). Consider using the optional herbs and supplements at recommended dosages. Consider 15–30 minutes of sauna or steam-room therapy. Consider 30–60 minutes of light exercise such as walking, running, biking, skiing, jump rope, stretching, yoga, pilates. Practice any variety of self-reflection, including meditation and breathing exercises. Journaling is encouraged.
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Day 3: For day 3 also eliminate grains, nuts, seeds, legumes, beans, and mushrooms. Eat only fruit and vegetables fresh/frozen/dried in any combination and amount using detox appropriate recipes. Just like days 1 & 2 the following items are suggested: Olive oil Spices and seasonings Filtered water, tea, vitalizing-beverage, detox broth, smoothies, and diluted juice Optional herbs and supplements at recommended dosages Sauna or steam-room heat therapy Light exercise Journaling, self-reflection/meditation A new suggestion for today is to add a session of massage therapy to help mobilize toxins and stimulate the lymphatic circulation. Day 4 (Modified Fasting): Eliminate all solid food (i.e., using only water, tea, juices, and broth with adaptations as needed). Pay attention to the needs of your body! Sensitive, ill, weak, and thin people should avoid or modify this day of fasting if needed, such as drinking more juice and broth as needed. Other suggestions for this day include: Rest and relaxation—avoid exercise and sauna today. Do minimal or no work today. Stop all previous supplements for today. Drink plenty of fluids and keep up with bowel and bladder losses (tea with honey, vitalizing beverage, diluted fruit/vegetable juice, and detox broth). Use journaling, self-reflection, or meditation. A new suggestion for today only is to add an optional bowel cleansing regimen: Take 500–1000 mg of activated charcoal capsules (or bentonite clay)—toxin binders for the gut—by mouth three times per day with water. Drink 300 mL of magnesium citrate (typically one bottle) in the morning as a laxative for bowel elimination. Use 1 saline Probiotic Fleet Enema in the afternoon or evening (See Table *** below for instructions). Day 5 (Same as Day 3 except for added Energy Work session): For day 5, add back fruit and vegetables in any combination, preparation, and amount using detox appropriate recipes. Again, encouraged foods include fresh/frozen/dried vegetables and fruit (but no mushrooms, grains, seeds, beans, legumes, or nuts for this day). Just like day 3, the following items are suggested: Olive oil Spices and seasonings Filtered water, tea, vitalizing-beverage, detox broth, smoothies, and diluted juice Optional herbs and supplements re-started at recommended dosages Sauna or steam room therapy Light exercise Journaling, and self-reflection, or meditation A new suggestion for today is to add a session of Energy Work such as acupuncture, Reiki, Healing Touch etc to help balance your newly cleansed system. Days 6 and 7 (Same as Days 1 and 2, extend for days 8-10 if desired): In addition to fruits and vegetables, add back mushrooms, beans, legumes, seeds, nuts, and healthy grains (same as Days 1 & 2 above). The following suggestions continue to be encouraged: Olive oil Spices and seasonings Filtered water, tea, vitalizing-beverage, detox broth, smoothies, and diluted juice Optional herbs and supplements at recommended dosages Sauna or steam room heat therapy Light exercise Journaling, self-reflection, or meditation Detox Recipes and Supplements Detox broth recipe: Use fresh organic ingredients if possible. This is an excellent aid for fasting on Day 4. Ingredients can vary depending on availability. 1 large soup pot or kettle 1 strainer 1 large bowl or container for straining the soup 3–4 quarts of filtered water (fill pot after all ingredients are in) 1 large chopped onion (white or yellow) 3–5 small bunches of various chopped greens (kale, parsley, cilantro, chard, or dandelion) 2 stalks of sliced celery 1 cup of fresh or dried seaweed (nori, dulse, wakame, kelp, or kombu) 1/2 small-medium head of chopped cabbage (any variety) 2 peeled carrots 2 stalks of peeled burdock root 1 large peeled daikon root 1 cup of squash (any variety) chopped into cubes 3 chopped root vegetables (turnip, parsnip, or rutabaga 2–3 cups fresh/dried mushrooms (maitake, shiitake, oyster, or enoki) Add all ingredients to the large pot at once and bring to a low boil for 40–60 minutes (add water to fill). Strain the stock to remove the solid material (keep the liquid broth and dispose the left over solid parts). Salt to taste. Store in the original soup pot or a tightly sealed container for use all week. Keep the remaining broth cooled in the refrigerator, and reheat for use. Enjoy as a sipping broth throughout the detox week, especially during the day of fasting on day 4. Smoothie recipe with optional supplements: Use organic ingredients when possible. This makes about 1 liter which is divided into 4 servings, or 2 days worth, a glass in the AM and PM. About 2 tablespoons (20 mL) of organic cold pressed extra virgin olive oil 1/2 avocado
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About 4 tablespoons (20 g) of whey protein powder (optional) About 4 tablespoons (20 g) of modified citrus pectin (Pectasol, optional) 1/2 cup of orange juice (or 100% organic juice of choice) 1/2 cup of vanilla flavored soy milk, rice milk, or almond milk About 4 tablespoons (40 g) of flaxseed (or psyllium) 8–10 ice cubes (or 1/2 cup of filtered water) 1 organic banana (sliced) 1 organic apple or pear with peel (sliced) 1/2 cup organic frozen or fresh blueberries (and/or seasonal berries of choice) Place ingredients in a blender and grind up until smooth, adding more water as needed. Store remaining mix in the refrigerator. Be creative; this can be varied according to taste and availability of various fruit. Enjoy 1 tall glass twice a day with or between meals. Digestive tea recipe: 1/2 teaspoon (t) of whole fennel seeds 1/2 t of whole coriander seeds 1/2 t of whole cumin seeds Add seeds to about one quart boiling water. Let the seeds steep for about 10 minutes. Enjoy after meals throughout the detox week. Other recommended teas include ginger, licorice, peppermint, chamomile, rooibos, and decaf green teas. Vitalizing beverage: This is an excellent aid for fasting on day 4. 1–2 tablespoons fresh lemon and/or lime juice (about 1/2 crushed or squeezed lemon/lime) 1–2 tablespoons of real maple syrup 1/10 teaspoon cayenne pepper (a small pinch) Purified, spring, or mineral water (carbonated water can also be used) In a tall glass combine the juice, syrup, and cayenne. Fill the glass with water and stir well. Add crushed ice as desired. Enjoy throughout the detox, especially during fasting on day 4. Diluted fruit juice of any variety (1/2 real juice and 1/2 water) is also recommended. Optional supplements list for advanced detox regimen: • Hydrolyzed whey protein powder 10 g powder two times per day mixed in smoothies or juice. Whey protein contains bonded cysteine that increases glutathione, a potent antioxidant, immune modulator, and detoxifier. • Pectasol powder (modified citrus pectin-MCP, NOT pectin fiber) 10 g powder two times per day mixed in smoothies. MCP is absorbed in the gut and chelates heavy metals in the body that flow to the kidneys and liver where they are eliminated. It may be easier to find online. • Milk thistle crude extract capsules 500–1000 mg three times per day with meals. This is a safe and beneficial herb used for 7 days for liver support. • Dandelion root capsules, 500–1000 mg three times per day with meals. This is a safe and beneficial herb for kidney and gallbladder support. It may increase urination. • Multivitamin tablet, one daily with a meal. • Turmeric capsules, 500–1000 mg three times per day with meals. This is a safe and beneficial herb used for 7 days for inflammation and gut support. • Probiotics, one capsule three times per day. This is a safe and beneficial supplement used for 7-10 days to colonize the gut with healthy supportive bacteria. • Fish Oil omega-3 essential fatty acids, 1000 mg total of EPA and DHA daily in liquid or capsule form. Vegetarian options include 2 tablespoons (T) daily of ground flaxseed or flax oil mixed in with smoothies. This supplement is used to reduce inflammation in the body. • Extra virgin, cold-pressed, organic olive oil, 2 tablespoons in smoothies twice a day (and used in any amount in food for cooking). This healthy oil is rich in essential fatty acids. • DAY OF FASTING ONLY: Activated charcoal or bentonite clay capsules, 500–1000 mg three times per day to bind gut toxins, but only taken during fasting. Always take 1-2 hours before or after anything else by mouth. Probiotic fleet enema regimen (this is should be done after a bowel movement) What you’ll need: * Over-the-counter saline Fleet Enema (4.5 oz, or 133 mL). * Unscrew the Fleet enema cap to access the saline solution. * Dissolve 2 probiotic capsules from 3 different probiotic brands/varieties and pour in the contents into the fleet enema solution (each of the 3 different probiotic brands should include a bacterial strain that is different from the other 2 brands for variety). * Laying on your LEFT side, insert the probiotic enema rectally, and squeeze the bottle firmly, and then remove. * Suggested body poses for use immediately after (rest in each pose for 20-30 seconds): LEFT side, BACK (bridge pose), RIGHT side, child-pose, hands-&-knees, then stand up. * Hold the enema as long as you can. From University of Wisconsin Integrative Medicine, “Detoxification” Patient Handouts, www.fammed.wisc.edu/integrative/modules
Patient Handout Detoxification Program. (From University of Wisconsin Integrative Medicine, “Detoxification” Patient Handouts, www. fammed.wisc.edu/integrative/modules.)
ACKNOWLEDGMENT Special thanks to Mandy Fortney for reviewing, testing, and improving this detox program. REFERENCES References are available online at ExpertConsult.com.
REFERENCES 1. Kokayi K, Altman CH, Callely RW, Harrison A: Findings of and treatment for high levels of mercury and lead toxicity in ground zero rescue and recovery workers and lower Manhattan residents, Explore (NY) 2:400–407, 2006. 2. Hyman M: The detox box, Louisville, CO, 2006, Sounds True. 3. Myers DG: The funds, friends, and faith of happy people, Am Psychol 55:56–67, 2000. 4. World Health Organization: Closing the gap in a generation: health equity through action on the social determinants of health, Final report of the Commission on Social Determinants of Health, Geneva, 2008, World Health Organization. 5. Kuo F: The impacts of parks and green environments on human health: http://www.medicalnewstoday.com/releases/222938.php. Accessed 11/13/15. 6. Miller CS: Medicine’s blind spot, Fam Med 31:280–282, 1999. 7. Green MM: Six trauma imprints treated with combination intervention: critical incident stress debriefing and thought field therapy, Traumatology 8:18–30, 2002. 8. Egolf B, Lasker J, Wolf S, et al.: The Roseto effect: a 50-year comparison of mortality rates, Am J Public Health 82(8):1089–1092, 1992. 9. CDC: National report on human exposure to environmental chemicals: http://www.cdc.gov/exposurereport/, Feb 2015. Accessed 11/13/2015. 10. Centers for Disease Control and Prevention: Third national report on human exposure to environmental chemicals, Atlanta, 2005, Centers for Disease Control and Prevention. 11. Thornton JW, McGally M, Houlihan J: Bio-monitoring of industrial pollutants: health and policy implications of the chemical body burden, Public Health Rep 117:315–323, 2002. 12. Centers for Disease Control and Prevention: National report on human exposure to environmental chemicals: 2009 and 2011: www.cdc.gov/exposurereport. Accessed 08.03.11. 13. Paustenbach D, Galbraith D: Biomonitoring and biomarkers: exposure assessment will never be the same, Environ Health Perspect 114:1143–1149, 2006. 14. Blount BC, Valentin-Blasini L, Osterloh JD: Perchlorate exposure of the U.S. population, 2001–2002, J Expo Sci Environ Epidemiol 17:400–407, 2007. 15. Blount BC, Pirkle JL, Osterloh JD: Urinary perchlorate and thyroid hormone levels in adolescent and adult men and women living in the United States, Environ Health Perspect 114:1865–1871, 2006. 16. Janssen S, Solomon G, Schettler T: Chemical contaminants and human disease: a summary of evidence, Sci Environ Health Netw, 2006. http://guamagentorange.info/yahoo_site_admin/assets/docs/ CHE_Toxicants_and_Disease_Database.160121218.pdf. Accessed 10.01.12. 17. Rogan WJ: Pollutants in breast milk, Arch Pediatr Adolesc Med 150:981–990, 1996. 18. Solomon GM, Weiss PM: Chemical contaminants in breast milk: time trends and regional variability, Environ Health Perspect 110:A339–A347, 2002. 19. Environmental Working Group: Pharmaceuticals pollute US tap water: http://www.ewg.org/node/26128, 2008. Accessed 11.03.11. 20. Frisch M, Schwartz BS: The pitfalls of hair analysis for toxicants in clinical practice: three case reports, Environ Health Perspect 110:433–436, 2002. 21. Eastern Research Group: Hair analysis panel discussion: exploring the state of the science, Atlanta, 2001, Agency for Toxic Substances and Disease Registry. 22. U.S. Government Accountability Office: Chemical regulation: options exist to improve EPA’s ability to assess health risks and manage its chemical review program. U.S. Government Accountability Office report to congressional requesters: GAO-05–458: http://www.gao.gov/new. items/d05458.pdf, 2005. Accessed 11.03.11. 23. Miller AL: Dimercaptosuccinic acid: a nontoxic water soluble treatment for heavy metal toxicity, Altern Med Rev 3:199–207, 1998. 24. James S, Stevenson SW, Silove N, et al.: Chelation for autism spectrum disorder, Cochrane Database Syst Rev, 2015. 25. Morgan BW, Kori S, Thomas JD: Adverse effects in 5 patients receiving EDTA at an outpatient chelation clinic, Vet Hum Toxicol 44:274–276, 2002.
26. Villarruz MV, Dans A, Tan F: Chelation therapy for atherosclerotic cardiovascular disease, Cochrane Database Syst Rev (4):CD002785, 2002. 27. Campbell JR, Schaffer SJ: Predicting the outcome of the CaNa2EDTA challenge test in children with moderately elevated blood lead levels, Environ Health Perspect 107:437–440, 1999. 28. Eliaz I, Hotchkiss AT, Fishman ML: The effect of modified citrus pectin on urinary excretion of toxic elements, Phytother Res 20:859– 864, 2006. 29. Eliaz I, Weil E, Wilk B: Integrative medicine and the role of modified citrus pectin/alginates in heavy metal chelation and detoxification: five case reports, Forsch Komplementmed 14:358–364, 2007. 30. Guess BW, Scholz MC, Strum SB, et al.: Modified citrus pectin (MCP) increases the prostate-specific antigen doubling time in men with prostate cancer, Prostate Cancer Prostatic Dis 6:301–304, 2003. 31. Wisner RM, Shields GM, Beckmann SL: Treatment of children with the detoxification method developed by Hubbard, Proc Am Public Heath Assoc, 1995. http://www.detoxacademy.org/pdfs/childtox.pdf. Accessed 11.03.11. 32. Zhao ZY, Liang L, Fan X, et al.: The role of modified citrus pectin as an effective chelator of lead in children hospitalized with toxic lead levels, Altern Ther Health Med 14:34–38, 2008. 33. Satori MA, LaKind JS, Naiman DQ, et al.: Improving infant exposure and health risk estimates: using serum data to predict polybrominated diphenyl ether concentrations in breast milk, Environ Sci Technol 47:87–95, 2013. 34. Gard ZR, Brown EJ: Literature review and comparison studies of sauna/hyperthermia in detoxification, Townsend Lett 76–86, 1999. 35. Lovejoy HB, Bell Jr ZG, Vizena TR: Mercury exposure evaluations and their correlation with urine mercury excretions, the elimination of mercury by sweating, J Occup Med 15:590–591, 1973. 36. Schnare DW, Ben M, Shields MG: Body burden reductions of PCBs, PBBs and chlorinated pesticides in human subjects, Ambio 13:378–380, 1984. 37. Schnare DW, Denk G, Shields M: Evaluation of a detoxification regimen for fat-stored xenobiotics, Med Hypotheses 9:265–282, 1982. 38. Hannuksela ML, Ellahham S: Benefits and risks of sauna bathing, Am J Med 110:118–126, 2001. 39. Laukkanen T, Khan H, Zaccardi F, et al.: Association between sauna bathing and fatal cardiovascular and all-cause mortality events, JAMA Intern Med 175(4):542–548, 2015. 40. Garolla A, Torino M, Sartini B, et al.: Seminal and molecular evidence that sauna exposure affects human spermatogenesis, Hum Reprod 28(4):877–885, 2013. 41. Crinnion W: Components of practical clinical detox programs: sauna as a therapeutic tool, Altern Ther Health Med 13:S154–S156, 2007. 42. Sylver N: The holistic handbook of sauna therapy, Stone Ridge, NY, 2004, Center for Frequency. 43. Bulow J: Adipose tissue blood flow during exercise, Dan Med Bull 30:85–100, 1983. 44. Lietzmann C: Nutrition ecology: the contribution of vegetarian diets, Am J Clin Nutr (Suppl 78):657S–659S, 2003. 45. McMichael AJ, Powles JW, Butler CD: Food, livestock production, energy, climate change, and health, Lancet 370:1253–1263, 2007. 46. Carlsson-Kanyama A, Ekstrom MP: Food and the life cycle energy inputs: consequences of diet and ways to increase efficiency, Ecol Econ 44:293–307, 2003. 47. American Gut Website: http://americangut.org/?page_id=258. Accessed September 6, 2015. 48. David LA, Maurice CF, Carmody RN, et al.: The gut microbiome can rapidly respond to altered diet, Nature 505:559–563, 2013. 49. Fortney L, Podein R: Updates and future direction on medical uses for probiotics, Prim Care Reports 20(12):141–150, 2014. 50. National Public Radio: Americans are on the hook for seafood consumption: http://www.npr.org/sections/thesalt/2015/08/06/ 430074111/americans-are-on-the-hook-for-seafood-consumption, Accessed 11/13/15. 51. Cahill GJ, Owen OE, Morgan AP: The consumption of fuels during prolonged starvation, Adv Enzyme Regul 6:143–150, 1968. 52. Sorrentino D, Stump DD, Zhou SL: The hepatocellular uptake of free fatty acids is selectively preserved during starvation, Gastroenterology 107:1415–1424, 1994.
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1003.e2 References 53. Saudek CD, Felig P: The metabolic events of starvation, Am J Med 60:117–126, 1976. 54. Toxicologic consequences of oral aluminum (editorial), Nutr Rev 45:72–74, 1987. 55. Little L, Porche DJ: Manual lymph drainage (MLD), J Assoc Nurses AIDS Care 9:78–81, 1998. 56. Badger C, Preston N, Seers K, Mortimer P: Physical therapies for reducing and controlling lymphedema of the limbs, Cochrane Database Syst Rev (4):CD003141, 2004. 57. Hsu MC, Schubiner H, Lumley MA: Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized trial, J Gen Intern Med 25:1064–1070, 2010.
58. Lumley MA, Stout RL, Cohen JL: An emotional exposure-based treatment of traumatic stress for people with chronic pain: preliminary results for fibromyalgia syndrome, Psychotherapy (Chic) 45:165–172, 2008. 59. Krasner MS, Epstein RM, Beckman H: Association of an educational program in mindful communication with burnout, empathy, and attitude among primary care physicians, JAMA 302:1284– 1293, 2009. 60. University of Wisconsin Integrative Medicine: Detoxification handouts: www.fammed.wisc.edu/integrative/modules. Accessed 11.03.11.
Detoxification Luke Fortney, MD, FAAFP • Rian Podein, MD • Michael Hernke, PhD
WHAT IS DETOXIFICATION AND WHY DO IT? Detoxification, as reviewed here, is the constellation of physiological and psychological processes through which the body identifies, neutralizes, and eliminates toxic substances, metabolic byproducts, habits, and patterns. Alcohol and other narcotic withdrawal therapies are serious medical conditions requiring close supervision and are not discussed here. For an increasing number of people living in a more polluted and stressful world, body systems can become overburdened and strained by various contaminants that may lead to health problems.1 In general, these toxins can be identified within the following general categories:2 • Antinutrients such as high-fructose corn syrup, trans fats, caffeine, alcohol, and processed foods • Internal metabolic toxins such as nitrogen, carbon dioxide, bile, urea, free radicals, and stool • Medications used improperly, inappropriately, or too often • Heavy metals such as mercury, arsenic, lead, cadmium, tin, and aluminum • Chemicals such as pesticides, herbicides, cleaning products, solvents, and glues • Allergens such as food, mold, dust, pollen, and chemicals • Infectious organisms such as bacteria, viruses, yeast, and parasites Further, the following social, emotional, and spiritual challenges affect health and well-being:3,4 • Stress, such as lack of personal time, too much work, excessive worry, too little rest, and financial strain • Unhealthy mental states, such as addictions, overeating, and destructive mental patterns • Ambient distractions, such as pervasive noises, smells, lights, and images • Overstimulation from advertisements, radio, computers, television, smart phones, and pagers • Lack of spiritual connection, a loss of meaning and purpose • Isolation, the lack of social support and community • Nature deprivation, being disconnected from natural environments5 • Negative emotions and persistent self-defeating thoughts, such as anger, fear, guilt, and hopelessness Although too infrequently acknowledged, the body and mind already possess the capacity to handle these challenges. This process of maintaining biological and mental balance is called homeostasis. The major systems that work together synchronously to maintain health and balance include the following: 996
• • • • • • •
iver and gallbladder (Figs. 106.1–106.3) L Kidneys Gastrointestinal system Skin Lungs Lymphatic and circulatory systems Mind and brain Symptoms that may reflect an overtaxed or dysfunctional detoxification system are often vague and nonspecific, but when seen in constellation, they suggest a problem with the body’s ability to restore itself. When potentially serious medical conditions have been ruled out by a reasonable medical workup, symptoms that may be attributed to a detoxification problem with the body often include the following:1,6,7 • Fatigue with sleep disruption and brain-fog • Mood disturbance, especially depression, anxiety, fear, and anger • Muscle aches and joint pain • Sinus congestion, dark circles under the eyes, and postnasal drip • Headaches with neck and shoulder pain • Bloating and flatulence • Irritable bowel, foul-smelling stools, and dark urine • Weight changes and loss of muscle tone • Heartburn, recurrent colds, and persistent infections • Infertility and low libido • Premature aging and weakness • Fluid retention and excess weight • Rashes and canker sores • Bad breath and adverse body odor Although conclusive scientific data supporting detoxification therapies are largely lacking, the question for a patient suffering from any of these symptoms remains this: “What can I do to feel better?” Unfortunately, many gimmicky, expensive, unnecessary, and potentially harmful products and programs exist, and dubious practitioners may exaggerate their claims. In general, patients should avoid dramatic, expensive, and extreme approaches in favor of reasonable, safe, and health-promoting lifestyle changes that empower patients and avoid dependency and unrealistic expectations. The five basic components of any detoxification program should include the following: • Daily physical activity, such as yoga and walking (preferably in natural “outdoor” environments when possible)5 • Regular sweating, through physical activity, use of a sauna or steam room, or a hot-room yoga class • Healthy nutrition, rich in organic fruits and vegetables and filtered water (see Figs. 106.1–106.3) • Self-reflection, such as any contemplative practice (e.g., meditation), journaling, and breathing-focused relaxation techniques
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106 Detoxification Endotoxins * end products of metabolism * bacterial endotoxins Exotoxins * drugs (prescription, OTCs, recreational, etc.)
* chemicals
- agricultural - food additives - household - pollutants/contaminants * microbial
PHASE I [cytochrome P-450 enzymes]
PHASE II [conjugation pathw ays]
(
nonpolar lipid-soluble
excretory derivatives
intermediary metabolites
* toxins
(
Reactions oxidation reduction hydrolysis hydration dehalogenation
lipid-soluble (nonpolar) toxins stored in adipose (fat) tissue contribute to increased/mobilized toxin load with weight loss.
Enzymes, Cofactors & Other Nutrients Used
(
riboflavin (vit. B2 ) niacin (vit. B3 ) pyridoxine (vit. B6 ) folic acid vitamin B12 glutathione branched-chain amino acids flavonoids phospholipids
more polar more water-soluble
sulfation glucuronidation glutathione conjugation * acetylation amino acid conjugation glycine taurine glutamine ornithine arginine methylation
(
Reactive Oxygen Intermediates
polar ( water-soluble (
Serum Kidneys
* N-acetylcysteine, cysteine, methionine are precursors
Bile
Antioxidant/Protective Nutrients/Plant Derivatives
Superoxide
carotenes (vit. A) ascorbic acid (vit. C) tocopherols (vit. E) selenium copper zinc manganese coenzyme Q10 thiols (found in garlic, onions
Free Radicals
Urine
Feces/stools
Secondary tissue damage
& cruciferous vegetables)
bioflavonoids silymarin pycnogenol
FIG. 106.1 □ Liver detoxification: over-the-counter (OTC) drugs.
Phase 1 Detoxification Alcohol
Environmental Toxins
Phase 2 Detoxification Conjugation
Drugs
Neutralized Toxin P-450 System ~100 Enzymes Free Radicals
Neutralized Toxin
Antioxidants (Glutathione)
Phase II System Glutathione Amino Acid Methylation Sulfation Acetylation Glucuronidation
FIG. 106.2 □ Phase 1 detoxification: cytochrome P-450.
Required Nutrients Glutathione, B6 Glycine SAMe Cysteine, methionine molybdenum, Acetyl CoA Glucuronic Acid
Toxin Prepared for Excretion
Fat Soluble Cleared
Fat Soluble
Water Soluble Bile/Intestines
Urine/Kidneys
FIG. 106.3 □ Phase 2 detoxification: CoA, coenzyme A; SAMe, S-adenosylmethionine. (From Bland JS, Costarella L, Levin B, et al. Environment and toxicity. In: Clinical nutrition: a functional approach. Gig Harbor, WA: Institute for Functional Medicine; 1999:261.)
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• M anual therapies, such as massage and acupuncture • Regular supportive social time with friends, family, and community8
TESTING FOR TOXINS Although laboratory testing for various chemicals and toxins has the appeal of specifically identifying potential culprits to explain various symptoms in some cases, random screening testing remains largely unfounded with few exceptions, and evidence does not support regular or widespread use. The Centers for Disease Control and Prevention (CDC) conducts a National Biomonitoring Program that tests urine and serum samples from representative populations for industrial pollutants.9 Results continue to demonstrate the ubiquitous nature of industrial pollutants, or body burdens, across all demographic groups regardless of health status.10-13 Sadly, these findings indicate the widespread presence of societal chemicals and suggest that chemical body burden can be presumed for any presenting patient.14-19 Given the expense, variable quality, questionable validity, and unclear clinical significance of the majority of specific pollutant body burdens, routine testing is not recommended.13,20,21 Moreover, the health significance of specific chemical exposures—at what levels, during which times, and at what frequency—is poorly understood.22 Indiscriminate and unfounded causal statements about exposure, harm, and treatment efficacy should be approached cautiously and skeptically. Therefore the focus should be on reducing the amount of toxicity in our living environments (see Chapter 108).
CHELATION THERAPY Using safe and effective methods to prevent disease, treat symptoms, and achieve homeostasis is the primary goal of a good detoxification regimen. Appropriate, well-placed skepticism and concern exists over many detoxification therapies, including chelation for the removal of various heavy metals from the body.23 For example, a common but unfounded use for chelation therapy is autism spectrum disorder (ASD). However, a Cochrane Review found no evidence that chelation therapy was effective. The review went on to caution against its use because the risks of adverse effects far outweigh any potential benefits.24 The safety of widespread chelation therapy remains questionable. A study from the Emergency Department at Emory University in Atlanta, Georgia, found common adverse effects associated with intravenous chelation that included diaphoresis, hypotension, tachycardia, leukopenia, thrombocytopenia, electrocardiographic abnormalities, and increased serum creatinine.25 The clinical significance of chelation therapy is also uncertain. A Cochrane Review concluded that, at present, evidence of the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of patients with atherosclerotic cardiovascular disease is insufficient.26 However, the CDC did recommend that the calcium disodium edetate
(CaNa2EDTA) challenge test be considered for children who have blood lead levels of 1.21–2.12 mcmol/L (25–44 mcg/dL) to determine whether chelation is indicated.27 Another option could include use of a modified citrus pectin product (such as Pectasol), which may also have benefit in children whose test results reveal levels higher than those acceptable for lead and other heavy metals.28-32 The dose in one study was 5 g three times daily for 4 weeks.
Unfortunately, pectin is a viscous fiber that is not absorbed into the bloodstream, and food sources (e.g., citrus, apples, legumes, and cabbage) do not help chelate heavy metals outside of the gut. However, modified citrus pectin is absorbed through the gastrointestinal tract and appears to reduce this burden via renal clearance and urinary elimination.
In general, what can or should be done to address the ubiquitous nature of chemical body burden is uncertain. Caution and skepticism in the use of chelation therapy are therefore recommended. Further information regarding chelation therapy can be found online (see the Key Web Resources and Chapter 107).
SAUNA THERAPY The body stores fat-soluble toxins such as pesticides in adipose tissue (also called lipophilic persistent organic pollutants, or POPs). One well-known example are the flame retardants polybrominated diphenyl ethers (PBDEs); some of the highest levels of these compounds throughout the world have been found in the breasts of lactating American women.33 These compounds were banned in Europe due to their association with reproductive, neurodevelopmental, and thyroid toxicities.33 Taking a relaxing sauna or steam bath is an effective therapy to help the body detoxify.34 The traditional sauna increases the air temperature to 160°F–200°F (approximately 70°C–90°C), with 25% humidity compared with a steam room, which is heated to 120°F–130°F at 100% humidity. The exogenous heat diverts blood to the skin, where sweating releases excess sodium, nitrogen, and toxins.35-37 In addition to its use in Scandinavia and many cultures around the world for hundreds of years, research since the 1960s has demonstrated the health-promoting effects of regular sauna use, including stress reduction, detoxification, lower blood pressure, and decreased pain.38 In fact, increased frequency of sauna use is actually associated with a reduced risk of sudden cardiac death, fatal cardiovascular disease, and all-cause mortality.39 Sauna cessation is advised for men attempting to conceive with their partners as heat-based therapies temporarily impair sperm count and motility.40 Although sauna use is safe for most people of all ages, caution should be used in people who have undergone recent surgery; have unstable cardiovascular conditions such as recent myocardial infarction or cerebrovascular accident; or have multiple sclerosis, acute lung infections,
106 Detoxification
or pregnancy complications.41 Even people with known heart disease can partake in sauna therapy. The greatest risk for all uses is hypotension and syncope, particularly if alcohol is used during sauna use (which is not recommended).39 Some evidence indicates that a lower-temperature infrared sauna may offer similar health benefits. Lowertemperature infrared saunas are typically heated to 120°F and are a good option for those who cannot tolerate the higher temperatures of a traditional sauna or steam room (e.g., individuals with multiple sclerosis). For further reading on the many health effects of sauna therapy, please refer to an excellent book entitled, The Holistic Handbook of Sauna Therapy, by Nenah Sylver.42
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TABLE 106.1 The Environmental Working Group’s List of the “Dirty Dozen” (Foods Highest in Pesticides Used) and the “Clean 15” (Foods Lowest in Pesticides Used) Dirty Dozen (Better to Buy Organic)
Clean 15 (Less Important to Buy Organic)
1. Celery
1. Onions
2. Peaches
2. Avocado
3. Strawberries
3. Sweet corn
4. Apples
4. Pineapple
5. Blueberries
5. Mangoes
6. Nectarines
6. Sweet peas
EXERCISE
7. Bell peppers
7. Asparagus
8. Spinach
8. Kiwi
Reasonable and safe approaches to body burden detoxification include increasing awareness and adherence to healthy lifestyle behaviors such as regular physical activity, healthy nutrition, stress reduction, mind-body practices, spiritual connection, and avoidance of harmful behaviors such as smoking. Exercise has been shown to enhance adipose tissue circulation and therefore increases the release of stored toxins.43 Cardiovascular exercise also supports detoxification through sweating. Starting with gentle, but regular, forms of exercise, such as walking or bicycling for 30 minutes or more per day, is best. Ideally, a person should set a goal of vigorous movement of any kind for 60 minutes or more on a daily basis. Hot room yoga is particularly beneficial for detoxification, but any and all forms of movement are encouraged.
9. Cherries
9. Cabbage
10. Kale and collard greens
10. Eggplant
11. Potatoes
11. Cantaloupe
12. Grapes (imported)
12. Watermelon
NUTRITION Nutrition is arguably the first and most important step in promoting health and supporting the body’s efforts to remove harmful substances. What a person avoids eating is equally important as what is included in a healthy diet. By avoiding artificial additives and unhealthy fats, reducing excess calories (including less salt, saturated fats, and sugars), and adhering to a diverse whole food organic diet, a person will be better able to support the body’s detoxification process, in large part, by avoiding overeating and ingestion of environmental pollutants44-46 (see Chapter 88). While annually millions of people worldwide take part in various forms of detoxification, little is mentioned about the role of the gut microbial microbiota. One study evaluated the effects of several 3-day dietary detox regimens and found that they do indeed change the microbial community, with some of them increasing a genus of bacteria thought to help prevent obesity and diabetes.47 However, with return to their prior standard American diet, the gut microbial changes returned to their predetox state at approximately 10 days. These findings are consistent with those of a prior research study that showed that dietary changes can rapidly and reproducibly alter the human gut microbiota but that short-term
13. Grapefruit 14. Sweet potato 15. Honeydew melon Data from the Environmental Working Group: http://www.ewg.org.
detox programs may be most effective as a jumpstart to an ongoing dietary lifestyle modification that supports an optimal gut microbiome48 as well as the many health benefits associated with probiotic supplementation for various medical conditions.49
Safe and Environmentally Friendly Fish and Seafood Choices Consuming fish and seafood a few times per week has many benefits;50 however, concerns exist about contaminants that may affect our health and the environmental impact of fishing practices. Resources that can be used to help guide safe fish and environmentally sustainable seafood choices are provided in the Key Web Resources.
Pesticides in Produce When deciding whether to invest in organic produce, it can be helpful to understand which conventional fruits and vegetables are highest and lowest in pesticide content. The Environmental Working Group publishes a helpful guide that lists the “Dirty Dozen” (foods highest in pesticides) and the “Clean 15” (foods lowest in pesticides), as shown in Table 106.1 (see also the Key Web Resources).
Fasting Occasional and sensible fasting may be helpful as well. Several variations of fasting exist, some involve drinking only water or juices or other nonsolid foods. During
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fasting, the main source of energy used by the body comes from hydrolyzing fatty acids from triglycerides stored in adipose tissue.51-54 Because many toxins are sequestered in adipose tissue, fasting may be helpful in eliminating these toxins from the body. Initially, a person may feel worse during a fast because of this mobilization process. Resting and drinking plenty of fluids are therefore helpful during a fast.
$20,000
100%
$18,000
90%
$16,000 $14,000
Personal income (in 1995 dollars)
Manual therapies such as massage may be helpful to mobilize and eliminate toxins from the body by mobilizing the lymphatic system, among other possible benefits. Together with exercise and sauna therapy, massage can greatly enhance the ability of the lymphatic, cardiopulmonary, and hepatorenal circulatory systems to eliminate toxins. For example, massage has been shown to reduce excessive fluid volume by 65% in patients with lymphedema.55,56 Other forms of body work such as acupuncture may be helpful as well, in part, by increasing the relaxation response as well as treating qi stagnation and myofascial restrictions.
Mind-Body Connection Finally, any detoxification review or program that ignores the mind-body connection is remiss. Stress is arguably the most significant toxin confronting patients on a daily
60%
$10,000
50% Percentage very happy
40%
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30%
$4,000
20%
$2,000
10%
$0
0% 1956 1963 1970 1977 1984 1991 1998
FIG. 106.4 □ U.S. Department of Commerce, Bureau of the Census.
and long-term basis. As measures of happiness decline in the United States (Fig. 106.4), various mind-body syndromes such as fibromyalgia, migraine, chronic fatigue, irritable bowel, multiple chemical sensitivity, and others continue to affect more people.57,58 Unfortunately, support and awareness are lacking for mind-body interventions that cultivate understanding, behavior changes, insight, and accountability for patients and health care workers.59 Various chapters in this text offer helpful tools to support a healthy mind and emotions.
Key Web Resources University of Wisconsin Department of Family Medicine: This website provides a regularly updated, self-guided 7-day detoxification plan. Environmental Working Group: This group offers excellent resources regarding information on harmful toxins in the environment with recommendations on how to avoid them, including information on toxins in fish and pesticides in produce. Environmental Defense Fund seafood selector: This organization offers ratings of the best (least contamination) and worst (most contamination) for seafood consumption, as well as a pocket guide for selecting seafood. Centers for Disease Control chemical exposure report: This report details the health effects of human exposure to environmental chemicals. Doctor’s Data, Inc.: This laboratory offers toxicology testing, as well as drinking water analysis. It also contains information on chelation therapy. Bioneers: This organization offers advice on sustainable living that supports wider social and ecological health. National Center for Complementary and Alternative Medicine: This National Institutes of Health website provides information on many topics, including chelation therapy.
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http://www.fammed.wisc.edu/integrative/modules http://www.ewg.org http://www.ewg.org/safefishlist
http://www.edf.org/page.cfm?tagID=1521
http://www.cdc.gov/exposurereport/ http://www.doctorsdata.com http://www.bioneers.org http://www.nccam.nih.gov
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Detoxification Program Patient Handout: Seven Day Detoxification Program Many detoxification programs are available, but caution is advised before doing one. Very often symptoms are a signal from the body that something is out of balance and needs to be addressed. However, before adding any treatments, it is often the case that something should be removed as the first step to healing (eg smoking cessation for coughing). This program is about jump-starting a healthy lifestyle, which is far more important than any short-term detox. Most importantly, be flexible and adapt this program to your specific needs. The following plan (found online at www.fammed.wisc.edu/integrative/modules) offers a general outline for a self-guided detox program. Getting Started • This regimen is not intended to be an exhaustive resource, nor is it a test of will and endurance. It is designed to be a safe, gentle, useful, empowering, and accessible health guide that takes into account personal variability. Adaptations should be made as necessary. However, this process does require planning and preparation, so read through it and make preparations ahead of time. • In addition to physiologic approaches, this plan equally emphasizes mind-body approaches that can aid the relaxation response and unravel negative and unconscious mental patterns that often result in pain and discomfort. • The most important part of going through a detox program is to first ask why you are doing it. Being clear about your intentions helps avoid inflated expectations and disappointment. Write-down the reason for going through a detox in your own words. • The five basic ingredients of this detox regimen are self-reflection, exercise, sauna, nutrition, and manual therapy. The program offered here is designed to support and enhance your body’s inherent ability to heal and be well. It is intended for most people with few exceptions. • The program has a strong emphasis on using organic, sustainable, local, responsible, gentle, natural, whole, and balanced ingredients that honor the global and spiritual aspect of health. Precautions and Expectations • Healing crises can occur during a detox. Common temporary symptoms can include general malaise, fatigue, headache, lightheadedness, diarrhea, cramps, bloating, body-aches, mood-changes, and generalized weakness. These symptoms are often caused by a combination of factors including the mobilization of toxins, low blood sugar, low fluids, electrolyte imbalance, withdrawal from habitual substances (such as alcohol, caffeine, sugar, nicotine), and even changes in your daily routine. • Most often the best approach is to continue with the detox. However, you may need to stop or alter the detox if you experience ongoing or worsening symptoms. • Dehydration is unnecessary during a detox. Make sure that you drink a lot of fluids. • Address your particular needs as you go along, such as more frequent snacks, larger meals, increase protein and healthy fats, less physical work, more rest, and less striving in general. • Continued use of prescription medications is advised and should be monitored by a physician. If needed, use “over-the-counter” medications sparingly for relief of headaches or other symptoms. • Communicate with your health care provider about any concerns that arise during the detox as needed. In the end, you will likely find that you feel better, have more energy, are healthier, and may require less medication. Below are three examples of different detoxification programs to consider. You can choose the one that best matches your needs and lifestyle. They progress from simple (#1) to more involved (#3). Version #1 (short) for 5 or more days: * Eat only fruits and vegetables in any combination, amount, and preparation using healthy oils and spices as needed. * Drink plenty of filtered water, juice, tea, and broth. * Move and exercise the body in any variety, intensity, and duration everyday. * Keep a daily journal and practice any form of self-reflection everyday (eg meditation). Use the “Mind/Body Awareness Writing Exercises” workbook at www.fammed.wisc.edu/integrative/modules as a guide for journaling. Version #2 (simplified) for 7 or more days (extend days 6 and 7 to a full 10 days if desired): * Days 1 and 2: Eliminate meat, eggs, dairy, wheat, alcohol, caffeine, chocolate, and refined sugars. Eat only organic vegan foods in any arrangement, preparation, and amount using cooking oils and seasonings. * Day 3: Further eliminate all grains, nuts, beans, and legumes. Eat only fruits and vegetables in any combination, amount, and preparation using oils and spices as needed. * Day 4: If possible avoid eating any solid food. Drink plenty of water, broth, juice, and tea. Rest during this day. * Day 5: (same as Day 3) * Days 6 and 7 (and optional extended days 8-10): (same as Days 1 and 2) * Throughout the detox, keep a daily journal and practice any form of self-reflection everyday (eg meditation). Use the “Mind/Body Awareness Writing Exercises” workbook at www.fammed.wisc.edu/integrative/modules as a guide for journaling. Version #3 (advanced) with added supplements and probiotic bowel regimen: Days 1 and 2: For the entire detox week, eliminate all meat (e.g., fish, beef, pork, lamb, poultry), refined sugars (white/brown sugar and especially high-fructose syrup), and especially artificial sweeteners such as saccharine, aspartame, and Splenda (natural sweeteners such as honey, maple syrup, molasses, Stevia, and erythritol, are okay to use in small amounts). Also avoid alcohol, tobacco, caffeine, cigarettes, chocolate, and recreational drugs for the entire week. It is advised to avoid dairy, wheat, and eggs during the detox week as well (instead try soy/almond/rice milk, soy cheese, soy yogurt, stanol/sterol spreads). Cooking should be guided by healthy recipes for soups, steaming, sautéing, and baking etc based on your preferences. Keep a daily journal and practice any form of self-reflection everyday (eg meditation). Use the “Mind/Body Awareness Writing Exercises” workbook at www.fammed.wisc.edu/integrative/modules as a guide for journaling. Encouraged foods for days 1 and 2 include fresh/frozen/dried vegetables, fruit, and mushrooms (maitake, shiitake, oyster, and/or enoki, etc). Healthy grains are also recommended for days 1 and 2 (brown/wild rice, quinoa, buckwheat, oatmeal, millet etc), as well as seeds, nuts, legumes, and flaxseed. Other suggestions for days 1 & 2 include the following: Cold-pressed organic extra virgin olive oil as guided by “detox appropriate” recipes. Spices and healthy seasonings as needed based on your preferences. Drink 8–10 glasses of filtered water, including “vitalizing beverage,” “detox broth,” smoothies, and diluted juices. Drink tea throughout the day, such as peppermint, decaf green, chamomile, licorice, ginger, rooibos, and digestive tea. For snacks eat mixed nuts, dried and fresh fruit, vegetables, and detox broth (see Table ***). Consider using the optional herbs and supplements at recommended dosages. Consider 15–30 minutes of sauna or steam-room therapy. Consider 30–60 minutes of light exercise such as walking, running, biking, skiing, jump rope, stretching, yoga, pilates. Practice any variety of self-reflection, including meditation and breathing exercises. Journaling is encouraged.
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Day 3: For day 3 also eliminate grains, nuts, seeds, legumes, beans, and mushrooms. Eat only fruit and vegetables fresh/frozen/dried in any combination and amount using detox appropriate recipes. Just like days 1 & 2 the following items are suggested: Olive oil Spices and seasonings Filtered water, tea, vitalizing-beverage, detox broth, smoothies, and diluted juice Optional herbs and supplements at recommended dosages Sauna or steam-room heat therapy Light exercise Journaling, self-reflection/meditation A new suggestion for today is to add a session of massage therapy to help mobilize toxins and stimulate the lymphatic circulation. Day 4 (Modified Fasting): Eliminate all solid food (i.e., using only water, tea, juices, and broth with adaptations as needed). Pay attention to the needs of your body! Sensitive, ill, weak, and thin people should avoid or modify this day of fasting if needed, such as drinking more juice and broth as needed. Other suggestions for this day include: Rest and relaxation—avoid exercise and sauna today. Do minimal or no work today. Stop all previous supplements for today. Drink plenty of fluids and keep up with bowel and bladder losses (tea with honey, vitalizing beverage, diluted fruit/vegetable juice, and detox broth). Use journaling, self-reflection, or meditation. A new suggestion for today only is to add an optional bowel cleansing regimen: Take 500–1000 mg of activated charcoal capsules (or bentonite clay)—toxin binders for the gut—by mouth three times per day with water. Drink 300 mL of magnesium citrate (typically one bottle) in the morning as a laxative for bowel elimination. Use 1 saline Probiotic Fleet Enema in the afternoon or evening (See Table *** below for instructions). Day 5 (Same as Day 3 except for added Energy Work session): For day 5, add back fruit and vegetables in any combination, preparation, and amount using detox appropriate recipes. Again, encouraged foods include fresh/frozen/dried vegetables and fruit (but no mushrooms, grains, seeds, beans, legumes, or nuts for this day). Just like day 3, the following items are suggested: Olive oil Spices and seasonings Filtered water, tea, vitalizing-beverage, detox broth, smoothies, and diluted juice Optional herbs and supplements re-started at recommended dosages Sauna or steam room therapy Light exercise Journaling, and self-reflection, or meditation A new suggestion for today is to add a session of Energy Work such as acupuncture, Reiki, Healing Touch etc to help balance your newly cleansed system. Days 6 and 7 (Same as Days 1 and 2, extend for days 8-10 if desired): In addition to fruits and vegetables, add back mushrooms, beans, legumes, seeds, nuts, and healthy grains (same as Days 1 & 2 above). The following suggestions continue to be encouraged: Olive oil Spices and seasonings Filtered water, tea, vitalizing-beverage, detox broth, smoothies, and diluted juice Optional herbs and supplements at recommended dosages Sauna or steam room heat therapy Light exercise Journaling, self-reflection, or meditation Detox Recipes and Supplements Detox broth recipe: Use fresh organic ingredients if possible. This is an excellent aid for fasting on Day 4. Ingredients can vary depending on availability. 1 large soup pot or kettle 1 strainer 1 large bowl or container for straining the soup 3–4 quarts of filtered water (fill pot after all ingredients are in) 1 large chopped onion (white or yellow) 3–5 small bunches of various chopped greens (kale, parsley, cilantro, chard, or dandelion) 2 stalks of sliced celery 1 cup of fresh or dried seaweed (nori, dulse, wakame, kelp, or kombu) 1/2 small-medium head of chopped cabbage (any variety) 2 peeled carrots 2 stalks of peeled burdock root 1 large peeled daikon root 1 cup of squash (any variety) chopped into cubes 3 chopped root vegetables (turnip, parsnip, or rutabaga 2–3 cups fresh/dried mushrooms (maitake, shiitake, oyster, or enoki) Add all ingredients to the large pot at once and bring to a low boil for 40–60 minutes (add water to fill). Strain the stock to remove the solid material (keep the liquid broth and dispose the left over solid parts). Salt to taste. Store in the original soup pot or a tightly sealed container for use all week. Keep the remaining broth cooled in the refrigerator, and reheat for use. Enjoy as a sipping broth throughout the detox week, especially during the day of fasting on day 4. Smoothie recipe with optional supplements: Use organic ingredients when possible. This makes about 1 liter which is divided into 4 servings, or 2 days worth, a glass in the AM and PM. About 2 tablespoons (20 mL) of organic cold pressed extra virgin olive oil 1/2 avocado
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About 4 tablespoons (20 g) of whey protein powder (optional) About 4 tablespoons (20 g) of modified citrus pectin (Pectasol, optional) 1/2 cup of orange juice (or 100% organic juice of choice) 1/2 cup of vanilla flavored soy milk, rice milk, or almond milk About 4 tablespoons (40 g) of flaxseed (or psyllium) 8–10 ice cubes (or 1/2 cup of filtered water) 1 organic banana (sliced) 1 organic apple or pear with peel (sliced) 1/2 cup organic frozen or fresh blueberries (and/or seasonal berries of choice) Place ingredients in a blender and grind up until smooth, adding more water as needed. Store remaining mix in the refrigerator. Be creative; this can be varied according to taste and availability of various fruit. Enjoy 1 tall glass twice a day with or between meals. Digestive tea recipe: 1/2 teaspoon (t) of whole fennel seeds 1/2 t of whole coriander seeds 1/2 t of whole cumin seeds Add seeds to about one quart boiling water. Let the seeds steep for about 10 minutes. Enjoy after meals throughout the detox week. Other recommended teas include ginger, licorice, peppermint, chamomile, rooibos, and decaf green teas. Vitalizing beverage: This is an excellent aid for fasting on day 4. 1–2 tablespoons fresh lemon and/or lime juice (about 1/2 crushed or squeezed lemon/lime) 1–2 tablespoons of real maple syrup 1/10 teaspoon cayenne pepper (a small pinch) Purified, spring, or mineral water (carbonated water can also be used) In a tall glass combine the juice, syrup, and cayenne. Fill the glass with water and stir well. Add crushed ice as desired. Enjoy throughout the detox, especially during fasting on day 4. Diluted fruit juice of any variety (1/2 real juice and 1/2 water) is also recommended. Optional supplements list for advanced detox regimen: • Hydrolyzed whey protein powder 10 g powder two times per day mixed in smoothies or juice. Whey protein contains bonded cysteine that increases glutathione, a potent antioxidant, immune modulator, and detoxifier. • Pectasol powder (modified citrus pectin-MCP, NOT pectin fiber) 10 g powder two times per day mixed in smoothies. MCP is absorbed in the gut and chelates heavy metals in the body that flow to the kidneys and liver where they are eliminated. It may be easier to find online. • Milk thistle crude extract capsules 500–1000 mg three times per day with meals. This is a safe and beneficial herb used for 7 days for liver support. • Dandelion root capsules, 500–1000 mg three times per day with meals. This is a safe and beneficial herb for kidney and gallbladder support. It may increase urination. • Multivitamin tablet, one daily with a meal. • Turmeric capsules, 500–1000 mg three times per day with meals. This is a safe and beneficial herb used for 7 days for inflammation and gut support. • Probiotics, one capsule three times per day. This is a safe and beneficial supplement used for 7-10 days to colonize the gut with healthy supportive bacteria. • Fish Oil omega-3 essential fatty acids, 1000 mg total of EPA and DHA daily in liquid or capsule form. Vegetarian options include 2 tablespoons (T) daily of ground flaxseed or flax oil mixed in with smoothies. This supplement is used to reduce inflammation in the body. • Extra virgin, cold-pressed, organic olive oil, 2 tablespoons in smoothies twice a day (and used in any amount in food for cooking). This healthy oil is rich in essential fatty acids. • DAY OF FASTING ONLY: Activated charcoal or bentonite clay capsules, 500–1000 mg three times per day to bind gut toxins, but only taken during fasting. Always take 1-2 hours before or after anything else by mouth. Probiotic fleet enema regimen (this is should be done after a bowel movement) What you’ll need: * Over-the-counter saline Fleet Enema (4.5 oz, or 133 mL). * Unscrew the Fleet enema cap to access the saline solution. * Dissolve 2 probiotic capsules from 3 different probiotic brands/varieties and pour in the contents into the fleet enema solution (each of the 3 different probiotic brands should include a bacterial strain that is different from the other 2 brands for variety). * Laying on your LEFT side, insert the probiotic enema rectally, and squeeze the bottle firmly, and then remove. * Suggested body poses for use immediately after (rest in each pose for 20-30 seconds): LEFT side, BACK (bridge pose), RIGHT side, child-pose, hands-&-knees, then stand up. * Hold the enema as long as you can. From University of Wisconsin Integrative Medicine, “Detoxification” Patient Handouts, www.fammed.wisc.edu/integrative/modules
Patient Handout Detoxification Program. (From University of Wisconsin Integrative Medicine, “Detoxification” Patient Handouts, www. fammed.wisc.edu/integrative/modules.)
ACKNOWLEDGMENT Special thanks to Mandy Fortney for reviewing, testing, and improving this detox program. REFERENCES References are available online at ExpertConsult.com.
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