CYP1B1 • Important role in cancer development due to its ability to

convert pro-carcinogens into genotoxic/carcinogenic metabolites

• Most notably hydroxylates estrogen to produce carcinogenic 4-OH metabolites

• Inducers: organochlorines (dioxin, PCBs), PAHs, benzopyrenes (cigarette smoke), UV light (skin), indolocarbazole (I3C metabolite), endocrine disruptors like BPA

• Inhibitors: DHEA, diindolylmethane, polyphenols, trans-resveratrol, pomegranate extract, red clover (Biochanin A) methoxylated flavonoids, methoxyestrogens

Phase I Intermediary Metabolites:

Protective Phytochemicals

• Carotenoids

• Ascorbic acid

• Tocopherols

• Selenium

• Copper

• Zinc

• Manganese

• Coenzyme Q10

• Thiols (garlic,

cruciferous

vegetables, onions)

• Bioflavonoids

• Silymarin

• Limonene

• Turmeric

• Green tea

Tailoring Antioxidant- and Phytonutrient-Dense Foods to Protection of Phase I Metabolites

Nutrient Food Sources Carotenes (vitamin A) Essentially all red, orange, yellow, and green plant foods

Ascorbic acid (vitamin C) All will be higher in vitamin C if uncooked: Bell peppers, papaya, citrus fruits, broccoli,

Brussels sprouts, strawberries, kiwi

Tocopherols (vitamin E) Sunflower seeds, almonds, spinach, Swiss chard, avocado, turnip greens, asparagus,

mustard greens

Selenium Brazil nuts, tuna, sardines, salmon, turkey, cod, chicken, lamb, beef

Copper Sesame seeds, cashews, soybeans, mushrooms (shiitake), sunflower seeds, tempeh,

garbanzo beans, lentils, walnuts, lima beans

Zinc Beef, lamb, sesame seeds, pumpkin seeds, lentils, garbanzo beans, cashews, quinoa,

turkey

Manganese Cloves, (gluten-free) oats, brown rice, garbanzo beans, spinach, pineapple, pumpkin

seeds, tempeh, soybeans

Coenzyme Q10 Meat, poultry, fish

Thiols Chives, daikon radishes, garlic, leeks, onions, scallions, shallots

Flavonoids Virtually all plant foods, including apples, apricots, blueberries, pears, raspberries,

strawberries, black beans, cabbage, onions, parsley, pinto beans, and tomatoes

Silymarin Milk thistle (herb), artichokes

Pycnogenol Small amounts in the peels, skins, or seeds of grapes, blueberries, cherries, and plums

– Glucuronic acid • Uridine‐diphosphate‐glucuronosyltransferases: UGT – Sulfate • Sulfonyltransferases: SULT – Glutathione • Gluthathione‐S‐transferases: GST – Acetate • N‐acetyltransferases: NAT – Amino acids • Taurine, glycine, glutamine – Methyl group • Methyltransferases; eg COMT

Phase II Enzymes: Conjugating Agents

Genetic Regulation of Detoxification Enzymes

Metals (Zn)

Keap1+Nrf-2

MTF-1

Antioxidant enzymes Superoxide dismutase (SOD) Catalase (CAT) NQO1 (NADPH Quinone 0xidoreductase 1) Phase II detoxification enzymes Glutathione-S-transferase (GST) Glutamate cysteine ligase (GCL) Glucuronyl transferase Metallothioneins (MT): Metal detoxification MT1/2 (Metallothionein proteins) HO-1 (Heme Oxygenase-1

ARE genes

Metallothioneins ARE MRE

Nrf-2

MTF1 (Metal-Responsive Transcription Factor) MRE (Metal Response Elements) Nrf2 (NF-E2 Related Factor 2) Keap1 (Kelch-Like ECH-Associated Protein) ARE (Antioxidant Response Element)

Classification of the Detoxification Enzymes

Yang et al. BMC Genomics 2011 12(Suppl 3):S2

Phase I Enzymes

Phase II Enzymes

Anti-oxidant

Enzymes

Cytochrome P450 (CYP)

Note: CYP is not the only phase I enzyme. It is the

main one.

Glutathione S-transferase (GST)

Methyltransferase (MT)

Sulfotransferase (SULT)

Glucuronosyl transferases (UGT)

Others

Superoxide dismutase (SOD)

Catalase (CAT)

Glutathione peroxidase

Others Others

Nutrients for Glutathione Support Vitamin B6 Magnesium Selenium

Methionine Cystine Glycine Folate

Alpha-lipoic acid

From Hodges RE and Minich DM (2015)

Amino acids used in phase II conjugation Glycine Taurine

Glutamine Ornithine Arginine

Nutrients for Methylation Support Methionine Vitamin B12 Vitamin B6

Betaine Folate

Magnesium

Nutrients supporting phase II enzymes

Foods for Targeted Detoxification

Glucuronidation Sulfation

Glutathione Methylation

Almond Apple

Broccoli Carrot

Chile pepper Cocoa

Cranberries Halibut

Pumpkin Sweet potato

Turmeric

Almonds Brazil nuts Egg Leek Onion Potato Scallops Spinach

Banana Beans Beets Broccoli Brussels sprouts Cabbage Cauliflower Eggs Legumes Potato Soy foods Spinach Sweet potato

Apples Artichoke hearts

Asparagus Cruciferous vegetables

Eggs Green tea

Oats Pomegranate Red peppers

Sprouted lentils Turmeric

Yogurt

Source: The Detox Prescription, Woodson Merrell, MD, 2013 195

Methylenetetrahydrofolate Reductase (MTHFR)

Methionine

SAMe

MS/B12

Betaine DMG

THF 5-MTHF Cystathionine

Cysteine

Glutathione

Transulfuration pathway

CBS/B6

Choline

CDP-Choline

Phosphatidylcholine

Phosphatidyl-ethanolamine

PEMT 3-SAM

3-SAH

BHMT

MAT SAHH

B6

MTs: DNMT, PEMT, GNMT, COMT

DIET

DIET DIET

5,10-methylene

THF

MTHFR B2,B3

SAH

Homocysteine

SHMT

Universal methyl donor

DHF

Folate

DIET

Two different copies of the MTHFR gene: • C677T • A1298C Wild type -/- Full strength of the enzyme Heterozygous +/- Some enzyme activity Homozygous +/+ Enzyme reduced 60-70%

MTHFR Gene Variants

197

• Elevated homocysteine • Low methionine • Low serum folate • Low serum vitamin B12 • Methylmalonic acid • SAMe:SAH

Functional Biomarkers Related to Methylation

198

• Elevated SAH may suggest impairments in the conversion to SAMe.

• Excess SAH inhibits methylation reactions. • Two-fold decrease in SAMe suggests

impaired methylation in autistic children

SAMe:SAH: Methylation Potential

199

• Clin Epigenetics. 2015 Feb 27;7(1):14. doi: 10.1186/s13148-015-0046-8. eCollection 2015. • AJCN. Dec 2004;80(6):1611-1617. • J Biol Chem. Sep 22 2000;275(38):29318-29323.

Clinical Pearls: Promote healthy methylation • High intake of folate-rich green vegetables • Mediterranean diet may help to lower Hcy • Ensure adequate intake of vitamins B2, B6, B12, and

folate • Betaine can help regenerate methionine from Hcy • Avoid smoking • Avoid excessive coffee intake • Avoid high alcohol intake • Avoid physical inactivity • Minimize use of medications that interfere with folate (e.g.,

sulfasalazine, cimetidine, aminopterin, methotrexate, pyrimethamine, trimethoprim, and triamterene)

Antioxidant function Detoxifying function

GSH

GSH

GSSG

G R

Neutralized counterparts

G P x

Free radicals, H2O2 organic

peroxides

NADP+

NADPH

GSH

X

G S T

Further breakdown and excretion

GSH = glutathione; = glutathione disulfide; = xenobiotics

GST = glutathione S-transferase; GPx = glutathione peroxidase; GR = glutathione reductase

GSSG X

X

Glutathione: Antioxidant and detoxifying function

Clinical Pearls: Promote healthy levels of GST • GST SNP results in decreased detoxifying

activity • Nutritional support for GST:

– N-Acetylcysteine – Selenium – Niacinamide – Vitamin C Johnson and coworkers (Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in

healthy adults. Am J Clin Nutr 58:103-5, 1993) found that blood glutathione levels rose nearly 50% in healthy individuals taking 500 mg of vitamin C daily.

– Silymarin (Silymarin not only prevents the depletion of glutathione induced by alcohol and other toxins (Chrungoo VJ et al. Indian J Exp Biol. 1997 Jun;35(6):611-7.), but can increase the level of glutathione n the cells of the liver (hepatocytes) (Valenzuela A et al. Planta Med. 1989 Oct;55(5):420-2.), and possibly by up to 35%.

– Cruciferous vegetables, I3C (Traka M, Gasper AV, Melchini A, Bacon JR, Needs PW, et al. (2008) . PLoS ONE 3(7): e2568. doi:10.1371/journal.pone.0002568; Hawkey et al. Am J Clin Nutr 2005;82:1283–91.

– Alpha lipoic acid (Alt Med Rev 1998; 3(4):308.)

– Whey protein (Micke et al., Eur J Clin Invest 2001; 31(2):171)

Imbalanced Phase I & Phase II Activity Oxidative Stress and Cell Damage

Phase I CYP P450

Phase II Conjugation

Damage to DNA, RNA, Proteins

Reactive Intermediate Fat-soluble Xenobiotic

Inert water-soluble metabolite to be excreted

Causes of Impaired and Imbalanced Biotransformation

1. Overwhelming toxic exposure & dose (exogenous + endogenous)

2. Impaired elimination (constipation or decreased GI transit time; renal dysfunction)

3. Inefficient macronutrients 4. Deficiency of detoxifying substances

(antioxidants, cofactors, conjugating agents) 5. Dysregulation of detoxifying enzymes

(Phase I > Phase II) 6. Bacterial uncoupling of conjugation

Nutrients that balance Phase I & Phase II enzymes • Ellagic acid from pomegranates • Catechin from decaffeinated green tea • Watercress glucosinolates

Support multiple Phase II detoxification pathways • Sulfation: N-acetylcysteine, Sodium Sulfate • Acetylation: Vitamin B5, Magnesium • Methylation: Vitamin B12, Choline, 5-MTHF

Antioxidant and overall liver function support • N-Acetylcysteine • Silymarin • Vitamin C & Vitamin A

Additional Daily Support Addition of a daily phytonutrient supplement recommended to support balanced clearance of toxins

Green Tea Catechins • Enhance the induction of the Phase II enzymes,

glutathione S-transferase and quinone reductase

• Inhibit the overinduction of specific cytochrome p450 Phase I biotransformation enzymes

Ellagic Acid

Anti-proliferative and antioxidant properties

– Modulates Ph I biotransformation

– Enhances Phase II enzymes, glutathione S-transferase and quinone reductase

Watercress

• Cruciferous vegetable • Inhibit phase I, induce phase II (glutathione

peroxidase 1, superoxide dismutase 2, UDP-glucuronosyltransferase)

• Phenethyl isothiocyanate is main compound – chemopreventive (lung/esophagus)

Cancer Epidemiol Biomarkers Prev. 1999 Oct;8(10):907-13. Eur J Nutr. 2009 Dec;48(8):483-91. Epub 2009 Jul 28.

Sesame oils and phytochemicals as

detoxification agents.

• Hepatoprotective action by decreasing liver’s production of inflammatory

mediators and free radicals when exposed to toxins.

• The lignan, sesamin, influences lipid metabolism and liver function.

• Compared to a lignan-free diet, a diet containing sesamin, episesamin and

sesamolin caused 1.5- and 2-fold changes in the expression of 128 and

40, 526 and 152, and 516 and 140 genes, respectively, in rats.

• The lignans modified not only the mRNA levels of many enzymes involved

in hepatic fatty acid oxidation, but also those of proteins involved in the

transportation of fatty acids into hepatocytes and their organelles, and

regulating hepatic concentrations of carnitine, CoA and malonyl-CoA.

Ide et al. J Nutr Sci Vitaminol (Tokyo). 2009;55(1):31-43.

Takashi I, et al. JARQ 2003;37(3):151–58.

Silybum marianum

• Promotes the natural production of glutathione in the liver

• Supports liver and kidney function • Aids in cellular regeneration of the

liver • Promotes the elimination of waste

products and detoxification

•Lang I. et al. Immunomodulatory and hepatoprotective effects of in vivo treatment with free radical scavengers. Ital J Gastroenterol. 1990 Oct; 22(5) 283-7 Sonnenbichler J. et al. Muzes G, et al. Stimulatory effects of silibinin and silicristin from Silybum marianum on Kidney cells. J Pharmacol Exp Ther 1999; 290:1375-83. Effect of silimarin (legalon) therapy on the antioxidant defense mechanism and lipid peroxidation in alcoholic liver disease. Orv Hetil. 1990; 131(16): 863-866

• Caps 140 mg TID, standardized to 80% silymarin

• Crude powder 5 grams TID

• Fluid extract 3-5 ml TID

Dosing: Silybum marianum

Actives to support healthy liver detoxification

- Broccoli sprout powder - Milk thistle silymarin - Sesame seed powder - Schisandra - Turmeric - Polyphenols from:

– Green tea, Pomegranate, Artichoke

Personalized Nutrition Approaches: Tailoring Foods to Pathways

213

1. Fortify the ARE production of antioxidant enzymes

2. Maximize (hepatic) biotransformation pathways, such as methylation

3. Induce heavy metal metabolism and removal

4. Promote alkalinization

Established literature indicates upregulation of metallothionein with Zn supplementation

Aydemir et al. Proc Natl Acad Sci U S A. 2006 February 7; 103(6): 1699–1704.

Curcumin and Mercury Exposure

“The study indicates that curcumin, an effective antioxidant, may have a protective effect through its routine dietary intake against mercury exposure. ”

Agarwal J.Appl. Toxicol. 2010 215

Specific phytonutrients up-regulate genetic expression of metallothionein for support of heavy metal metabolism

Metabolic Detoxification The importance of metallothionein for support of heavy metal metabolism

Phytonutrients Metal-

activated transcription

factor-1

Metallothionein-1 Spent hops (Humulus lupulus),

pomegranate rind extract (Punica granatum), prune skin

extract (Prunus domestica), watercress plant extract

(Nasturitum officinalis)

Two 4-week serial interventions:

• Control Intervention: Standard American Diet w/ seafood exclusion and twice daily use of a dietary supplement

• Treatment Intervention: Modified Elimination Diet w/ seafood exclusion and twice daily use of a dietary supplement

• Clinical Endpoints:

• Primary: FIQ™ and Fibroquest™

• Secondary: Metallothionein mRNA, urinary toxic elements

Effect of Detoxification Powder and Elimination Diet DTX 5 – an 8 week pilot trial comparing two novel lifestyle interventions for the dietary management of symptoms associated with Fibromyalgia Syndrome including Toxic Element elimination in 8 women

Use of a Detoxification Powder Supplement and Elimination Diet Improves Markers of Quality of Life and Heavy Metal Metabolism

Modified elimination diet

plus 2 servings of detox powder daily

for 4 weeks.

Key Findings Target: Reduction of Markers • 51% reduction in Medical Symptoms

Questionnaire (MSQ) score, a measure of physical and mental well-being. A reduced score suggests fewer symptoms and better overall quality of life.

FMRC DTX5 8 Patient, 8 Week Detox Study

Protection Against Elimination of Mercury • Increased production of heavy metal detoxification proteins • Improved mercury elimination 74% over baseline

Heavy metal binding proteins

0.99

1.09

1.19

1.29

1.39

1.49

1.59

Metallothionein

% In

crea

se

Visit 1

Visit 7

MT1

/2 m

RN

A

54% Increase over Baseline

0.75

0.95

1.15

1.35

1.55

1.75

1.95

Visit 1 Visit 4 Visit 5 to 7

Mercury excretion

µg/2

4 ho

urs

74% Increase over Baseline

p= 0.028

p= 0.020

Detox Powder Supplement and Elimination Diet Clinically Effective in Improving Markers of Quality of Life and Heavy Metal Metabolism

Key Findings Target: Increase in Markers • Elevation of mRNA expression of

metallothionein, a cellular protein that plays a crucial role in the metabolism of heavy metals and attenuates their toxicity in the body.

• Significant elevation in creatinine-adjusted excretion of mercury.

Modified elimination diet plus 2 servings of

detox powder daily for 4 weeks.

55% Improvement 34% Improvement

Total FIQ

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

Visit 1 to 4

Visit 5 to 7

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Visit 1 to 4

Visit 5 to 7

FIQ Pain

FMRC DTX5 8 Patient, 8 Week Detox Study

Pilot trial subgroup analysis in subjects with mercury amalgams

Clinical Pearls: Heavy Metals

• Provide a complex antioxidant supplement • Ensure adequate methylation support • Examine heavy metal toxicity at the same

time you look at mineral depletion/insufficiency

• Give multi-mineral support • Induce sweating as a therapeutic modality

222

Personalized Nutrition Approaches: Tailoring Foods to Pathways

223

1. Fortify the ARE production of antioxidant enzymes

2. Maximize (hepatic) biotransformation pathways, such as methylation

3. Induce heavy metal metabolism and removal

4. Promote alkalinization

Metabolic Detoxification

Phase III Transport proteins

The water-soluble substances are excreted via the urine or stool. If they are not excreted they recirculate and can be

stored.

Metabolic Detoxification The importance of Acid-Alkaline Balance

“Metabolic detoxification using a high vegetable diet in conjunction with supplementation of an effective alkalizing compound, such as potassium citrate, may shift the body’s reserves to become more alkaline.”

High dietary intake of vegetables and

fruits result in a reduced dietary net

acid load (and improved

alkalinization) and indirectly improves

detoxification processes.

Proudfoot et al. J Tox Clin Tox 2004 Remer and Manz, J Am Diet Assoc. 1995; 95:791-797.

Personalized Medical Nutrition: A Full-Spectrum Approach to Pathways

227

• Adequate protein (complex + amino acids) • Nrf-2 upregulators (xanthohumol,

sulforaphane) • Phase II support and bifunctional modulators • Phytonutrient-based heavy metal

metabolizers • Adequate fiber for promoting excretion and a

healthy gut microbiome • MCTs for quick burning fuel and gut repair

Nutrition & Detox Overview

228

Detox from 50,000 ft. view

Liver Phase I &Phase II

When selecting a detoxification program, rely on approaches that address these well-defined elimination pathways

Kidney & GI Phase III

Heavy Metal Excretion Metallothionein

Biotransformation of toxic metabolites requires sufficient nutrition

Nutritional parameters that alter hepatic drug metabolism, conjugation, and toxicity “Diets restricted in calories, protein, … as well as those having low quality protein or high sugar content, can affect the component enzymes, cytochrome P-450 and the cytochrome P-450 reductase, … In addition, deficiencies of specific vitamins (riboflavin, ascorbic acid, and vitamins A and E) and minerals (iron, copper, zinc, and magnesium) affect the components and activities of the system.”

Fed Proc. 1986 Feb;45(2):142-8.

Dietary macronutrients and detoxification: Protein

– Protein deficiency lowers activity of detoxifying enzyme systems in lab animals.

– Human studies have shown similar results.

Anderson KE, Kappas A. Dietary regulation of cytochrome P450. Annu. Rev. Nutr. 1991; 11:141-167

High sucrose consumption slows down detoxification pathways in humans.

Dietary macronutrients and detoxification: Sugar

Guengerich FP. Effects of nutritive factors on metabolic processes involving bioactivation and detoxication of chemicals. Annu. Rev. Nutr. 1984; 4:207-31

– In animals, depression of detoxification pathways occurs in as little as 36 hours of fasting

– Autolysis theory

Dietary macronutrients and detoxification: Energy (kcal)

Guengerich FP. Effects of nutritive factors on metabolic processes involving bioactiva-tion and detoxication of chemicals. Annu. Rev. Nutr. 1984; 4:207-31

Sub-optimal or unhealthy nutrition modulates the toxicity of environmental pollutants More evidence to suggest that toxins become more inflammatory in the presence of an additive pro-inflammatory dietary environment (not just the sum of each one individually)

– PCBs + omega-6 fatty acids – POPs (PAHs) + high-sat fat diets

Healthful nutrition decreases the toxicity of pro-inflammatory pollutants • Anti-inflammatory nutritional antioxidants may

buffer/protect against toxicant-induced disease (liver diseases, tumor formation, endothelial cell activation) through cell-signaling mechanisms (Nrf2): – Polyphenols – Omega-3 fatty acids – Sulforaphane – Resveratrol

Is a Detox Diet an Elimination Diet?

239

• Fruits • Vegetables • Herbs • Spices • Nuts • Seeds • Legumes • GF Grains

240

Am J Public Health. 2012 February; 102(2): 212–213.

242

243

Complexity Compassion Color

Organic vs. Fast Food Beef “LDL-cholesterol decreased more with the organic beef meal which had lesser amounts of saturated and trans fatty acids than in the fast food beef meal.”

Consumption of organic meat does not diminish the carcinogenic potential associated with the intake of persistent organic pollutants (POPs). • 76 samples of meat (beef, chicken, lamb) • Organic and conventional

245 Environ Sci Pollut Res Int. 2015 Apr 19.

Organically grown crops lower in heavy metal content

246

ORGANIC FRUIT AND VEGETABLES HIGHER IN PHYTOCHEMICALS

Asami DK, et al. Comparison of the total phenolic and ascorbic acid content of freeze-dried and air-dried marionberry, strawberry, and corn grown using conventional, organic, and sustainable agricultural practices. J Agric Food Chem. 2003 Feb 26;51(5):1237-41

Marionberries Corn

Conventional organic sustainable

Scrub!

Rank Food Food Prep/Serving Size Phytonutrient Amount

1 Carrots Dehydrated/1 cup 106,917 2 Collards(greens) Chopped, boiled/1 cup 18,527 3 Cocoa beans Ground, powder/1 cup 9,481 4 Beet greens Steamed, sautéed with butter/ 1cup 2,619 5 Broccoli Steamed, sautéed with butter/1cup 2,016 6 Brussel Sprouts Cooked, boiled, drained without salt/1 cup 2,389 7 Kale Steamed without salt/1 cup 1,112 8 Watercress cooked, boiled, drained, without salt/ 1cup 886 9 Swiss Chard Steamed, sautéed with butter/1 cup 895

10 Bok Choy Steamed/1 cup 865 11 Arugula Steamed, raw/1 cup 604 12 Spinach Steamed, sautéed with butter/1 cup 707 13 Cauliflower Steamed, sautéed with butter/1 cup 315 14 Tomatoes Chopped, heated as sauce/1 cup 186 15 Strawberries Raw/1 cup 184 16 Blackberries Raw/ 1 cup 171 17 Leeks Steamed/1 cup 135 18 Red Bell Peppers Chopped, raw, heated/1 cup 265 19 Mushrooms Chopped, sautéed with butter/ 1cup 238 20 Garlic Chopped, sautéed with olive oil/ 1 clove 109

The Top Phytonutrient Containing Foods

Effects of Processing on Antioxidant Content in Foods

Food Type of Processing Antioxidant Content % Compared to Non-Processed Food

Apples Peeling (-)33-66%

Carrots Steaming (+)291%

Carrots Boiling (+)121-159%

Cucumbers Peeling (-)50%

Asparagus Steaming (+)205%

Broccoli Steaming (+)122-654%

Cabbage, green Steaming (+)448%

Cabbage, red Steaming (+)270%

Green pepper Steaming (+)467

Red pepper Steaming (+)180%

Potatoes Steaming (+)105-242%

Tomatoes Steaming (+)112-164%

Spinach Boiling (+)84-114%

Sweet potatoes Steaming (+)413% Halvorsen BL, Carlsen MH, Phillips KM, Bohn SK, Holte K, Jacobs DR Jr, Blomhoff R. Content of redox-active compounds (ie, antioxidants) in foods consumed in the United States. Am J Clin Nutr. 2006 Jul;84(1):95-135. 2006. PMID:16825686.

Food Reintroduction Tracking Sheet

Day Food Digestion/

Bloating

Bowel

Function

Headache/

Pressure

Nasal or Chest

Congestion

Kidney-Bladder

Skin Function

Energy

Level

time food

Name:___________________________

Note: Please reintroduce only one new food at a time. Ingest it twice in the same day & then wait two days to see if you have a reaction. Assess your response over the

next 48 hours. You may insert different headings on this chart to correspond with whatever signs or symptoms that you may display. Important indicators which must be

charted include: digestion, bowel function and energy level. If you require more space use the back of this sheet and clearly mark the day, the food and your symptoms. If

you are unsure if you had a reaction, retest the same food in the same manner.

PART 3: Protocols for toxicant removal;

steps to living a clean life; Case studies

90 min.

Metabolic Detoxification is simply normalizing the body’s ability to metabolize, neutralize and excrete potentially harmful substances

While temporarily reducing any incoming potentially harmful chemicals or pollutants (xenobiotics).

Detox practices have withstood the test of time.

USING THE ELEMENTS TO DETOX

Water/Oil

Fire/Heat Air/Smoke

Earth/Clay

3 REASONS WHY MOST DETOXES DON’T

PROVIDE LONG-TERM RESULTS

WHY DO MOST DETOXES HAVE SO LITTLE STAYING POWER?

Reason #1. They deal with part of your body, not your whole body.

WHY DO MOST DETOXES HAVE SO LITTLE STAYING POWER?

Reason #2. They tell you what to take out, but they don’t focus on what to put in.

WHY DO MOST DETOXES HAVE SO LITTLE STAYING POWER?

Reason #3. They deal only with your physical body, not with your whole self.

106 chronically ill subjects N=84 on detoxification program N=22 controls

The 84 patients in the experimental group, who consumed a supplement, had a 52% reduction in symptoms over 10 weeks as measured by the Metabolic Symptoms Questionnaire. In comparison, the 22 patients on the control diet had only a 22% reduction of symptoms.

Bland et al. Alternative Therapies in Health and Medicine. 1995;1(5):62-71

Use of a Specially Formulated Supplement in a Metabolic Detoxification Program

Lifestyle factors determine whether we need detoxing • How we eat and drink • Whether we smoke • Whether we are physically active • The social networks we keep • The stress we experience • How much sleep we get and its quality

Who is at risk of toxin exposure? Look at their lifestyle…

264

• Obese • Lifetime dieter • Eats processed food • Uses personal care products • Bariatric surgery • Inflamed anywhere • Lived or lives on a farm or rural area • Lives in a city • Vietnam vet • High travel

A Typical Toxic Patient • Feels vaguely unwell, achy and/or persistently fatigued • Has persistent or recurrent irritable mood • Has multiple allergies and/or is sensitive to fumes, solvents,

cosmetics, and detergents • Has a history of “idiosyncratic” or paradoxical reactions to

medications or dietary supplements • Has a past medical history of one or more acute toxic

exposures • Has a history of chronic constipation or IBS • Has reproductive system disorders (PMS, endometriosis) • Has an autoimmune disease or chronic neurodegenerative

disorder • Has a personal or close family history of cancer

Needing a “Reset” 266

Heavy Metal Toxicity • Autistic children • Individuals with dental amalgams • Fish-eaters • Individuals with neurological weakness • Individuals with cognitive impairment /dementia • Individuals with behavioral disorders • Individuals with cardiovascular disease

267

The Clinical Framework

First consultation

Intake Form MDQ TEQ Timeline

Environment: Is there toxic exposure? Where?

Pt. Vulnerabilities: Toxic Load? Toxic Sx? Detox Ability?

General Labs

Physical Exam and Nutritional Status Assessment

Functional Labs SNPs

Clinical Process 1. Determine whether sx fit into what is known

about toxins 2. Assess severity of sx

• MDQ 3. Begin by identifying environmental triggers

• Toxin Exposure QN 4. Start reducing toxic triggers 5. Support organs of detox with adjunctive

nutrients and modalities 6. Transition into a maintenance program with

targeted nutrients and modalities for those who need it

Start with the home

Remove toxic foods

Replenish with healthy foods

273

Overarching Clinical Strategies for Effective Detoxification • Alter absorption of toxins • Alter gut detoxification processes • Alter genetic expression of cytochrome P450s

and conjugases • Alter posttranslational phosphorylation of CYPs

through specific kinase modulation • Alter enzymatic action of CYPs and conjugases

Mechanisms Connected to Toxins Oxidative Stress: Focus on the MITOCHONDRIA • Allergy • Autoimmunity • Brain fog • Cancer • Cardiovascular disease • Diabetes • Fatigue • Neurological compromise • Lung disease • Sensitization and pain syndromes 275

Mechanisms Connected to

Toxins Endocrine Disruption: Focus on the ENDOCRINE GLANDS • Implications for puberty and

sexual development • Fertility • Energy utilization • Glucose sensitivity • Neurological development

276

Estrogen Detoxification

Production

Metabolism

Tissue Binding

Excretion

COMT

CYP1A1 2-OHE1 Protective

Compound 2-methoxy-E1

CYP3A4

16α-OHE1 (carcinogenic)

Estriol

COMT Neutralized to 4-methoxy-E1

GST Neutralized to mercapturate

CYP1B1

4-OHE1

Quinones (carcinogenic)

reduced

“methylated”

“methylated”

Phase II Estrogen Excretion Phase II Catechol Estrogen Degradation

E2

&Estrone

Prevent Reuptake of Conjugated

Estrogens

Probiotics help to reduce the action of

beta-glucuronidase

Glucuronidation of

estrogen in liver

Cleaves glucuronide

Conjugated estrogen

excreted in bile

Excreted in Stool

Release of free estrogen into the gut

Re-absorption: Systemic estrogen toxicity

+++ Beta-Glucuronidase

Fiber and Estrogen Excretion

“Serum oestrone sulphate fell with wheat bran (mean intake 19.8 g day-') and with senna;”

“In conclusion, speeding up intestinal transit can lower serum oestrogen concentrations.”

Lewis et al., British Joumal of Cancer (1997) 76(3), 395-400

Ensure adequate water intake!

Vitamin C and Mg can also reduce

constipation.

4-Hydroxylated Estrogens

• Carcinogenic estrogen metabolite

• Binding affinity for ER equal to or greater than the parent E1 and E2.

• Reactive quinone formed from 4-OHE2 can produce a conjugate with GSH causing depletion of cellular thiol levels, making cells vulnerable to oxidative damage.

• 4-hydroxylation identified in breast tissue, ovary, adrenal gland, uterus, and in other cells.

• High estrogen 4-/2-OH ratio appears to be a marker for the presence of neoplasms.

• Further metabolism to quinone/semiquinone intermediates result in oxidative damage to DNA, lipids, and proteins.

Jefcoate et al. J Natl Cancer Instit monographs, 2000.; Van Duurson et al. Toxicol Appl Pharmacol. 2003 Aug 1;190(3):241-50. Lee et al. Nutr Res Pract. 2009 Fall;3(3):185-91. Epub 2009 Sep 30.

Preventing quinone formation

• “Formation of the quinones is prevented by methylation of the 4-catechol estrogens by the enzyme, catechol-O-methyltransferase (COMT). In addition, catechol estrogen quinones can be reduced back to catechol estrogens by NADPH quinone oxidoreductase 1 (NQO1) and/or are coupled with glutathione, preventing reaction with DNA.

• Thus, COMT and NQO1 are key deactivating enzymes.”

Singh et al. Relative imbalances in the expression of estrogen-metabolizing enzymes in the breast tissue of women with breast carcinoma. Oncol Rep. 2005 Oct;14(4):1091-6.

Cruciferous vegetable-derived indoles upregulate quinone reductase.

J Nutr Sci Vitaminol (Tokyo). 2002 Dec;48(6):477-82. Toxicol Appl Pharmacol. 2004 Jul 1;198(1):40-8.

More dietary cruciferous vegetables or indole-3-

carbinol/DIM to those with SNPs in E metabolism

4-OHE2 and NF-κß DNA binding “ROS overproduced by 4-OHE(2) increased the nuclear translocation of nuclear factor-kappaB (NF-kappaB) and its DNA binding through induction of IkappaB kinase alpha (IKKalpha) and IKKbeta activities.”

Park SA. 4-hydroxyestradiol induces anchorage-independent growth of human mammary epithelial cells via activation of IkappaB kinase: potential role of reactive oxygen species. Cancer Res. 2009 Mar 15;69(6):2416-24. Epub 2009 Mar 10.

4-OHE2 is inflammatory! Reduce NF-kB translocation with plant-

based anti-inflammatories

N-acetylcysteine blocks formation of cancer-initiating estrogen-DNA adducts in cells. • “In this study, we have evaluated the

effects of N-acetylcysteine (NAcCys) on the metabolism of two cell lines, MCF-10F (a normal human breast epithelial cell line) and E6 (a normal mouse mammary epithelial cell line), treated with 4-OHE(2) or its reactive metabolite, E(2)-3,4-quinone.

• This finding suggests that NAcCys, a common dietary supplement, could be used as a potential chemopreventive agent to block the initial step in the genotoxicity caused by catechol estrogen quinones.”

Zahid M, et al., N-acetylcysteine blocks formation of cancer-initiating estrogen-DNA adducts in cells. Free Radic Biol Med. 2010 Aug 1;49(3):392-400. Epub 2010 May 31. Park SA. 4-hydroxyestradiol induces anchorage-independent growth of human mammary epithelial cells via activation of IkappaB kinase: potential role of reactive oxygen species. Cancer Res. 2009 Mar 15;69(6):2416-24. Epub 2009 Mar 10.

Tocopherols and 4-OHE2-induced Oxidative Stress • “Our results showed that α-tocopherol

stimulates the up-regulated expression of DNA repair proteins, including BRCA1 and PARP-1.”

• “Study results indicated that in 4-OHE2 treated MCF-10A cells, the accumulation of intracellular ROS and depletion of GSH and MnSOD were significantly attenuated by γ-tocopherol.”

• “Exogenous α- and γ-tocopherol played a role as anti-cancer compounds by modulating 4-OHE2 induced oxidative stresses.”

Lee EJ et al. Modulatory effects of alpha- and gamma-tocopherols on 4-hydroxyestradiol induced oxidative stresses in MCF-10A breast epithelial cells. Nutr Res Pract. 2009 Fall;3(3):185-91. Epub 2009 Sep 30.

Mechanisms Connected to Toxins

Genotoxicity: Focus on DNA

• Carcinogenesis • Mutagenesis • Epigenetic changes

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Mechanisms Connected to Toxins Enzyme Inhibition: Focus on FUNCTIONAL PROTEINS

• Receptor binding • Enzyme inhibition

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Mechanisms Connected to Toxins Dysbiosis: Focus on GUT MICROBES • Alteration of gut flora • Changes in digestion, bioavailability/absorption, elimination, detoxification, and immune function

• Transformation of toxicants

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Detoxing and Repairing the Gut

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You may need to have patients do the

5R program before a detox!

Remove

Replace

Re-inoculate

Regenerate

Rebalance

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Phase III: Efflux Multidrug Resistant‐Associated Proteins

• Family of ATP‐binding transporters • Slow or reverse xenobiotic accumulation • Efflux xenobiotics ‐ either free or as

glucuronide, sulfate and glutathione conjugates out of cell

• P‐glycoprotein (MDR1, ABCB1) • Multidrug resistance associated proteins

(MRPs, ABCC) Glavinas H, et al. Curr Drug Deliv. 2004;1(1):27‐42.

Encourage healthy intestinal

excretion with three nutritional

factors Improve Gut Ecology

Supply factors shown to assist in estrogen and fat soluble metabolic waste and toxin

excretion Lipotropic factors choline, B6, FA, B12 Promote bile synthesis and efficiently bundle toxins and estrogen metabolites for removal from the body via the gut

Probiotics

L. Acidophilus and Bifidobacteria lactis BI-

07 – beta glucuronidase deactivation

Fiber

Insoluble fiber Soluble fiber Lignins (fiber) – transit time

Nutrients for Healthy Bile Flow

• Take nutrients/herbs at mealtime

• Might worsen gallstones by increasing bile flow

• Nutrients and herbs to assist with healthy bile flow and gallbladder function as well as fat metabolism

– Vitamin C, B6, folic acid, B12, Mg, choline, inositol, taurine, methionine, betaine HCl

– Artichoke leaf extract (Cynara scolymus) and other bitters

Herbs, Their Phytochemicals & Bile

Flow

• Cynara scolymus • Citrus reticulata

Chlorogenic acid Cynarin Scolymoside Hyperoside Caffeic acid Rutin Luteolin

Hepatoprotective Hypocholesterolemic

Dietary Fat and Toxins • Lower-fat versions of protein sources (e.g.,

legumes, nuts, or lean meat) • In a human case study, supplementing

with olestra (25 g/day) increased the excretion of multiple PCBs and related contaminants upwards of 11-fold compared with normal diet.

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Fortify the gut against toxins with a prebiotic and probiotics combination • Reduce pathogens

through diet • Prebiotics help cultivate

healthy gut flora • Probiotics assist by

repressing pathogen colonization; lower gut pH to effectively block competition by pathogens

Gibson GR, McCartney AL, Rastall RA. Prebiotics and resistance to gastrointestinal infections. Br J Nutr. 2005 Apr;93 Suppl 1:S31-4.

Probiotics and Toxin Elimination Consumption of probiotic yogurt had a protective effect against further increases in mercury and arsenic blood levels in the pregnant women... Elevated blood lead was associated with increases in Succinivibrionaceae and Gammaproteobacteria relative abundance levels in stool.

300 MBio. 2014 Oct 7;5(5). pii: e01580-14. doi: 10.1128/mBio.01580-14.

Fibers provide a mechanical way to remove toxins

Soluble & insoluble fiber from vegetable,

nut, legumes, seeds, fruit, and gluten-free

grain sources

Chlorophyll and chlorophyllin as a

binder in the gut

• Anti-mutagen

– Anti-carcinogen (Inhibits the induction of liver, skin, esophageal and stomach cancer)

– Inhibits carcinogen binding to DNA

– Binds to reactive carcinogens and prevents their binding to macromolecules

• Supports phase I and II detoxification

• Antioxidant

• Greater than 50% reduction of aflatoxin binding to DNA in large study in China (Groopman and coworkers)

Egner PA, et al. PNAS. 2001 Dec 4;98(25):14601-6. Epub 2001 Nov 27.

Bitter Plants and the Gut: Bile Function & Metabolic Receptor Activation

Singh N. et al. Biochem Biophys Res Commun. 2011 Mar 4;406(1):146-51. Epub 2011 Feb 12.

Green tea Soy Leafy greens Caffeine Bitter melon Berberine Fenugreek

When you know the mechanisms, you know which tests to run

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A General List of Possibilities • Blood glucose and insulin • Blood lipids • Blood pressure • Homocysteine • Oxidative stress/TBARS/8-OH-dG • SNPs for detox enzymes: COMT and MTHFR • Gut flora panel • Pesticide levels • RBC Micronutrients (e.g., selenium, copper, zinc) • Female hormone panel • LFTs, particularly GGT

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Lab Tests For evaluating toxicity

1. Nutrition & Gut Tests

2. Cellular Stress Evaluation

3. Toxin Levels

4. Genetic Variability

Cellular Stress

Nutrition & Gut

Toxin Levels

Genetic Variability

Investigate SNPs for Phase I and Phase II Detox Enzymes

Standard Treatment

• Remove the exposure source – Air, food, water

• Supplementation – IV and oral – Assess nutrient needs and SNPs

• Sauna/sweat and other cleansing modalities (covered in detox)

Sweat helps to excrete metals • Blood, urine, and sweat were collected from

20 individuals (10 healthy participants and 10 participants with various health problems) and analyzed for approximately 120 various compounds, including toxic elements.

• Many toxic elements appeared to be preferentially excreted through sweat.

• Induced sweating appears to be a potential method for elimination of many toxic elements from the human body.

Arch Environ Contam Toxicol. 2011 Aug;61(2):344-57. doi: 10.1007/s00244-010-9611-5. Epub 2010 Nov 6.

Human excretion of bisphenol A: blood, urine, and sweat (BUS) study

In 16 of 20 participants, BPA was identified in sweat, even in some individuals with no BPA detected in their serum or urine samples.

J Environ Public Health. 2012;2012:185731. doi: 10.1155/2012/185731. Epub 2011 Dec 27.

Human elimination of phthalate compounds: blood, urine, and sweat (BUS) study • Some parent phthalates as well as their metabolites

were excreted into sweat. All patients had MEHP (mono(2-ethylhexyl) phthalate) in their blood, sweat, and urine samples, suggesting widespread phthalate exposure.

• In several individuals, DEHP (di (2-ethylhexl) phthalate) was found in sweat but not in serum, suggesting the possibility of phthalate retention and bioaccumulation.

• On average, MEHP concentration in sweat was more than twice as high as urine levels.

ScientificWorldJournal. 2012;2012:615068. doi: 10.1100/2012/615068. Epub 2012 Oct 31.

Standard Treatment

• Indoor air – Off-gassing? Carpet, furniture, paint, etc.

• Mold exposures • Air filters • Water filters

What about chelation? • Pharmacological

– Protocol varies depending on severity – Zn/Mg may be utilized/mobilized during process

• Botanical/Nutritional – Thiamin: 75-300 mg – Vitamin E: 200-800 IU – Garlic: 700-2800 mg – Zinc: do not exceed 40 mg/day – NAC: 600 mg – Glutathione support: acetylated, vitamin C, whey, cruciferous veg – Probiotics – Phytonutrients: curcumin (binds Hg), silymarin, pomegranate berries,

andrographis

Lipophilic Toxin Removal • Seaweed (wakame) • Chlorella • Matcha green tea • Rice bran fiber • High-fat bolus (Olestra; keto-adaptation)

Dietary Supplement Powder Alone?

• Patients who are not dietary compliant • Need demonstrated relief of symptoms

Case Study #1 Dietary Supplement Powder Intervention

• 68 yo Caucasian male, urban dweller • HTN, arrhythmia, amalgams • No dietary change • 54% reduction in MDQ after 1 week introduction of

dietary supplement powder • Reported some sinus congestion, frequent urination • 4.4# weight loss at Day 14 • BP steady, no change • Two amalgams loosened while taking product

Case Study #2 Dietary Supplement Powder Intervention • 64 yo Caucasian female, urban dweller • Migraine headache sufferer, had amalgams

removed 5 yrs ago • No dietary change • 75% reduction in MDQ after 7 d introduction of

dietary supplement powder; Another 50% reduction at day 14

• Some stress, poor sleep, slight headache on day 13 • Eyes achy, teeth achy • No weight loss • BP steady, no change

Case Study #3 Dietary Supplement Powder Intervention • 60 yo Caucasian female, suburbs • RA dx, but asymptomatic with healthy lifestyle • No dietary change • 68% reduction in MDQ after 7 d introduction of

dietary supplement powder; • States that she is “sleeping better and deeper” • Long-time rash in back of neck went away after the

first week • No weight loss • Has increased energy

My basic approach to detox • Nutrition

– Nutrient dense foods – Removal of food triggers

• Dietary supplements – Supportive nutrients – Targeted to pathways

• Lifestyle factors – Sweat – Sleep – Relationships

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How is Whole Detox different?

SEVEN SYSTEMS OF HEALTH

+ + +

COLOR BODY LIFESTYLE NUTRITION

THE SEVEN SYSTEMS OF HEALTH

PERSONALIZE YOUR DETOX WITH THE SPECTRUM QUIZ

PERSONALIZE YOUR DETOX WITH THE SPECTRUM QUIZ

7 Detox Modalities for 7 Systems

• Nutrition • Emotion log • Thought pattern activity • Physical movement • Affirmations • Visualizations • Meditations

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System One Adrenal Glands, Immune System, DNA, Bones, Survival Community, Foods

Focus on physical body detox

System Two Ovaries/ Testes, Reproduction, Fertility Urinary System, Colon, Partnerships, Creativity, Foods

Focus on emotional detox

System Three Digestive System, Blood Sugar, Work Life Balance, Energy Production, foods

Focus on work-life balance detox

System Four Thymus, Blood Vessels, Lungs, Compassion, Expansiveness, Service, Foods

Focus on movement detox

System Five Thyroid Gland, Throat, Mouth, Ears, Nose, Speaking, choice, Authenticity, Sea foods

Focus on word/speaking detox

System Six Pituitary Gland, Brain, Neurons/ Neurotransmitters, Sleep, Mood, Thoughts, Intuition, Foods

Focus on sleep/mood/visualization detox

System Seven Pituitary Gland, Brain, Neurons/ Neurotransmitters, Sleep, Mood, Thoughts, Intuition, Foods

Focus on connection detox

Whole Detox Success Story: Pregnancy

Last year I did the detox with Deanna and we were blessed with the conception of this little gift [a baby boy]. I have a 9 year old girl and always wanted her to have a brother but when I reached 40 I accepted that she was going to be an only child. At 44 after the detox I got this surprise. We had a natural birth no drugs and he is very happy and healthy. – R.M.

Whole Detox Success Story: Letting go of emotional trauma

I see so many pieces that have deeper connections for me. I would like to thank you because this Detox, Deanna Minich is bringing me to a level of healing of my heart that I did not expect. It feels good to feel my earth be light and happy at a deeper level than it has been for a few years. I did not realize how much pain I was holding on to since my daughter’s death. -L.C.

Whole Detox Success Story: Embracing self-care

I now see myself as a literal WHOLE SELF and not as a function of my outputs into society. I am a complete person with no one aspect more in control of me than any other. I look around and have seen that I now gravitate towards very colorful things, and that I am making decisions based on ME MYSELF and I. This is a first for me. And again, no one has called me selfish. My husband has even applauded me for finally, after 10 years, putting myself on my own client list and putting time into my own self care. – J.W.K.

Whole Detox Success Story: Better Sleep

…for the past 3 nights, I have slept all night long without my usual 3 hour waking period between 1:00 and 4:00. I suspect this detox thing is the main helper. I can hardly wait for bed now. It's kind of a miracle for me since I have not slept all night in, well, I don't know how long. –T.P.

Whole Detox Success Story: Whole Self Transformation!

…how my life has transformed since l started my first 21 day detox April 2015 *77 pounds lighter *clear skin *feel l have a purpose *excited to cook and eat... *l think in colour *enriched my yoga teaching I have detoxed all my personal care products and even my hair dye! I live a detox life now l get rid of what l dont need and embrace what makes me happy.

LASTING LIFESTYLE CHANGE WITH WHOLE DETOX

Food reintroductions

Eating the rainbow

Paying attention to color

Results from large online Whole Detox program

• N=2,902 • N=682 total pre- and post-survey

responses

Summary of Percent Change MSQ

MSQ Changes

Case Study #1 CC: • 66 yo Caucasian male, identical twin • Retired police officer 39 y, currently works

part-time self-employed as a funeral director Happily married for 40+ yrs with 3 grown children

• Primary complaint: L side hip pain, recently dx as OA

• Other conditions: HTN (2000), hand tremors (2000), fatigue, atrial fibrillation (2009)

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Case Study #1 Family Hx: • Mother (d. 62 yo): Breast and bone ca, double

mastectomy, osteoporosis • Father (d. 71 yo): T2DM, MI, amputation of R toe,

HTN • Brother (70 yo): Morbidly obese, T2DM, CVD,

veteran, recently diagnosed kidney failure • Brother (66 yo): R side hip pain, HTN, borderline

diabetic, hand tremors • Sister (60 yo): Smoker, hx breast ca, hysterectomy,

heavy use alcohol • Brother (d. 46 yo): T2DM, died of MI • Brother (d. 37 yo): Brain tumor

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Case Study #1 Known Toxic Exposures: • Embalming fluids – 40+ years • Lives in urban area • For 14 years, lived close to a chemical factory • Grew up in a funeral home adjacent to a bus

barn in the inner city • Had some water damage in basement – self-

remediated • Polypharmacy • Mouth is “full of amalgams”

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Case Study #1 Known Toxic Exposures: • Polypharmacy

Sotalol 80 mg BID (HTN) Lisinopril/HCTZ 20-25 mg QD (HTN) Rivaroxaban (Xarelto) 20 mg QD (blood thinner) Amlodipine 5 mg QD (HTN)

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Case Study #1 Known Toxic Exposures: • Diet

– Eats gluten, dairy, sugar – Drank soft drinks (regular) – Has strong sweet tooth – Doesn’t get vegetables unless wife cooks a meal for

him – Likes bread, eats every day – Drinks milk (goes through a gallon a week) – “I love

milk.” – Eats out 2-3 times per week – Drinks very occasionally (hard liquor)

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Dietary Supplements Fish oil (anti-inflammatory/anti-clotting) Zn Probiotics Mg glycinate Coenzyme Q10 MVM

Case Study #1

Case Study #1 Known Toxic Exposures: • Lifestyle

– Sleeps 8-9 hours nightly (9 PM – 6 AM) – Sleeps soundly, gets tired easily – Not able to be physically active due to L hip

pain; hobbles and has a hard time keeping up. Pain began 6 years ago (2008) and has continued getting worse.

– Notes “weak muscles”, esp. L thigh; continues to get worse

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Case Study #1 Objective: • Wt: 194; Ht: 5’8”; BMI=29.5; WC: 38.5” • SBP: 125-130; DBP: 70-75 (with meds) • Labs (11/2013)

– TChol 202 mg/dL – TG 153 mg/dL – LDL-C 125 mg/dL – HDL 46 mg/dL

• MSQ: 76 • AST/ALT: Elevated entire life; same for twin • No direct labs to assess toxicity

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Case Study #1 Assessment: • Osteoarthritis of L hip • Hypertension • Overweight • Hand tremors • Fatigue

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Takes fish oil; OA; difficult to walk due to hip pain; BMI 28

Andropausal, BMI 28;

Lipids WNL; HTN; 3 HTN meds; Takes CoQ10

Regular BMs, lifelong elevated LFTs (same for twin), had rxn to warfarin; MD changed Rx;

Low energy Gluten? Dairy? Sugar? Long time stress as police officer

Polypharmacy, several amalgams, embalming fluid exposure

Sleeps ~8-9 h per night None – gets easily stiff after sitting; hard to get moving

Eating filled with potential food triggers; Eats dairy, gluten, non-restricted diet; Sweet tooth

Retired, but continues to work; Has violent dream outbursts acc. to wife

Healthy marriage. Minimal friendships

No sx; Takes a regular probiotic; Genetic tendency towards CD and colon ca

Inflammation in hip – OA; Takes Zn

Fam hx cancer, T2DM; identical twin with similar health issues; Raised in an urban area; Genetic predisposition towards CD, colon ca acc to 23andMe report

Case Study #1 Plan: • Will participate in the Detox Challenge • Wife is helping to make meals so he can stay

compliant

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Case Study #1 Visit #2 – 2 weeks • 100% compliant with the elimination diet • Has much more energy; sleeping less • Says his hip pain has reduced 40%. • BP is going down, and he said it’s too low. Avg

100-110/60-65. Feels dizzy. • Has lost 8#. Pants not fitting well. • States he is going to see his MD in 2 weeks to

have BP checked.

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Case Study #1 Visit #3 – 4 weeks • 100% compliant with the elimination diet • Energy has remained high. • Hip pain is reduced, he is walking better, but still

not 100%. Questioning whether he should still have hip replacement surgery.

• MD took him off of amlopidine. MD is amazed at the weight loss. Tested thyroid to be sure all is well – no significant findings.

• Has lost 16#. Some concern he might be getting too thin.

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Case Study #1 Visit #4 – 14 weeks • Still following the elimination diet about 80% of the

time • Energy is good. Some fatigue remains. Can sleep

for long stretches. • Hip pain has improved, but will still have hip

replacement surgery in Jan 2015. • BP continues to be in good zone. Last BP

reading: 131/73. • Weight has gone down 30#+. Wt: 162.8# • Overall, feels good and is preparing for a speedy

recovery from hip surgery.

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PATIENT PROTOCOLS

MSQ score <50 Accelerated Program: 10 Day Program • A unique program targeted for those patients with

a low level of symptomology

• Lack of a serious chronic disease or symptoms • Medical Detox Questionnaire (MDQ) score under 50 • Self-assessed stress level mild-moderate

Patients Follow 3-Step Program Step 1 – Initial Clearing Days 1 - 4 Patients will begin an eliminate food plan while gradually

increasing detox powder & phytonutrient supplement for balanced detoxification

Step 2 – Metabolic Detoxification Days 5 - 7 Patients will eliminate additional food choices and increase

servings of detox powder & phytonutrient supplement for balanced detoxification

Step 3 – Reintroduction Days 8-9 Patients will begin to reintroduce foods while decreasing the

servings of detox powder & phytonutrient supplement for balanced detoxification

Considerations/Recommendations Mild headaches and muscle aches

• These are common complaints on day two and three of the program as a result from the elimination of coffee, consider recommending additional magnesium

Constipation

• Constipation should be resolved before beginning on the program, consider magnesium citrate

Patients should not be hungry on the program

• Encourage eating as much of the allowed foods as they want

Patients should have a daily bowel movement on program • Recommend a fiber supplement for those that need extra

support

Therapeutic Program: 28 Day Program

• Uniquely suited to the individual with significant symptomatology

• Gold standard for determining food allergies

• Presence of symptoms of ongoing fatigue condition including pain

• Medical Detox Questionnaire (MSQ) score over 50 • Self-assessed stress level - high

*Based on clinical research at the Functional Medicine Research Center: Lamb J. Altern Ther Health Med. 2011 Mar-Apr;17(2):36-44.

Detoxification Questionnaire score >50

Patients Follow 3-Step Program Step 1 – Initial Clearing Days 1 - 6 Patients will begin an eliminate food plan while gradually

increasing detox powder & phytonutrient supplement for balanced detoxification

Step 2 – Metabolic Detoxification Days 7 - 13 Patients will eliminate additional food choices and increase

servings of detox powder & phytonutrient supplement for balanced detoxification

Step 3 – Reintroduction Days 14-28 Patients will begin to reintroduce foods while decreasing the

servings of detox powder & phytonutrient supplement for balanced detoxification

Reduces the amount of incoming toxins Elimination diet

Provides nutritional support Low-allergy-potential protein and carbohydrates with highly bioavailable vitamins, minerals, and antioxidants

Provides additional nutritional support to promote Phase I and Phase II enzyme balance Appropriate urinary pH Expression of metallothionein Fiber to support elimination (phase III)

Address the three essential components of metabolic detoxification

Conclusions • The effects of toxic exposure can be potentially

deleterious due to the individual differences in physiology, environment, psychology, and lifestyle patterns.

• Personalized assessments provide a tool to assess toxin burden.

• A personalized lifestyle medicine program for modern-day toxicity incorporates an individualized approach to food, supplements, activity, environment, and stress modulation.

• Tailoring therapies to a patient should result in the best outcome for the person. 370

WHOLE DETOX WHOLE person

WHOLE body

WHOLE food

WHOLE system of ancient tradition and modern medicine

WHOLE

DETOX www.deannaminich.com

www.whole-detox.com

Resources

• http://www.ehcd.com/