SNP4: Detoxification Protocols (Quack Asylum)

The Detox Argument

Dr. Mark Hyman is one person who has promoted detoxification “protocols” or diets on the basis of our exposure to toxins; at the start of this discussion he states that “everyone is a toxic waste dump”.

Basically the argument people put forward is something along the lines of… ‘many things we come into contact with are “toxins” and they can accumulate and compound in effect over time, causing a range of issues. Therefore, by removing these toxins (via a “detoxification protocol”), we can have better health.’

Example of such rhetoric: “Emerging research continues to support the hypothesis that toxicity is a major contributor to many chronic disease states. Many would argue that levels of individual toxins found in our food, water and environment are not significant enough to cause harm, however it is often the compounded effects of multiple poison exposure which is the greatest concern.” – Fx Medicine Australia

Indeed, as is common with the many topics we tackle in Quack Asylum episodes, there is some truth mixed into a broader incorrect position. So for example, in this case, the following things are indeed true:

• There indeed are many toxins in the environment that make their way into the body
• Industrialization and modernization have increased the number of these toxins
• There are detox pathways in the body, particularly at the liver
• Nutrients impact the functioning of these pathways

Many people promoting the need for detoxification, simply don’t understand that the body (particularly due to the roles of the liver and kidneys) can adequately detoxify us.

However, some advocates do accept our bodies can detoxify, and agree. But say that it’s an issue with total toxin burden (i.e. we just can’t clear the amount that we come in contact with in our modern environment). And example of this highlighted in the episode was Chris Kresser’s commentary here at [10.03 – 12.08].

Two aspects to consider:

1. Do we need to avoid all the mentioned “toxins”?
2. Does a “detoxification protocol/diet” lead to toxin elimination and improved health?

What is Detoxification? Phase I & II Liver Detoxification

A.D.M.E.:

• Absorption
• Distribution
• Metabolism
• Elimination (or excretion)

The liver is important for absorption because of a process known as “first pass metabolism”.

• So if the compound that’s being digested and absorbed is a drug, for example, it will go through the liver and a certain amount of that drug will be depleted.
• So drugs are designed to account for first pass metabolism, so that the amount that makes it through this first pass metabolism in the liver is a sufficient active dose of that drug.
• In the context of this discussion, rather than a drug, we might be talking about an environmental pollutant. So it undergoes first pass metabolism, and a certain amount makes it into circulation.
• From there, there are two phases at which detoxification takes place at the liver; phase I and II.

Detoxification at the liver has two primary phases: phase I and phase II.

Note: these are not processes that nutrients undergo metabolism via (as nutrients are “recognised” by the body.) This is specifically to remove toxins, or specifically “xenobiotic agents”.

Xenobiotic = a chemical substance found within an organism that is not naturally produced or expected to be present within the organism. Examples: drugs, pesticides, cosmetics, flavorings, fragrances, food additives, industrial chemicals and environmental pollutants.

Phase I Basics

• The phase I process is best thought of as conversion.
• Acts on lipophillic compounds; i.e. have an affinity for fat, bound to fat, fat-soluble
• Primarily orchestrated by a group of enzymes known as the cytochrome P450 enzymes.
  • [See here for further reading on the Phase I Cytochrome P450 enzymes.]
• These cytochrome P450 superfamily of enzymes are basically the first step in transforming xenobiotics into non-harmful compounds that can be excreted or dealt with.
• So these enzymes help to transform the original compound (toxin) into a reduced or oxidized version, that can then be converted again into another (typically safe) compound or to one that can be secreted.
• This compound can then pass to phase II.

Phase II Basics

• This is a phase known as conjugation
• There are six primary conjugation pathways:
  1. Amino acids conjugation
  2. Glutathione conjugation
  3. Sulfoconjugation (or sulfation)
  4. Methylation
  5. Acetylation
  6. Glucuronide conjugation (or glucoronidation)
• This phase can be simply thought of as taking the resulting compound that was converted in phase I, and basically binding to that (i.e. conjugating with that) compound, in order for that compound to then be successfully eliminated.
• So this typically involves changing the original fat-soluble or lipophilic compounds, and turning them into hydrophilic compounds (i.e water soluble) so that they can be excreted, primarily in urine.

Alcohol example: Alcohol broken down to acetaldehyde, which is then converted to acetate, which in turn is converted to carbon dioxide and water.

You’ll often see those advocating for supplements or diets to help detox, start highlighting how different nutrients are involved in the pathways discussed above. For example, you’ll see images like this:

Example of How Detoxifcation Pathway Facts Get Turned Into Pseudoscience: Gluathione

1. Glutathionation is involved in heavy metal removal
2. Glutathione conjugation is a route of phase 2 detoxification in the liver
3. Nutrients in foods from the brassica family (cabbage, broccoli, Brussel sprouts) are inducers of this Glutathione conjugation.
4. Glutathionation can be supported by N-acetyl-cysteine, selenium and alpha-lipoic acid.
5. Glutathione is a tripeptide made up from the amino acids glutamine, glycine and cysteine, and so these substrates are crucial to get to boost detoxifcation.
6. So “treatment” may be directly with glutathione supplementation (or IV drip, as per below), juices/smoothies based on cruciferous veg, supplementation with N-acetyl-cysteine, selenium, alpha-lipoic acid, glutamine, glycine, and cysteine.

What are toxins that need to be removed?

• Heavy metals – Mercury, Lead, Arsenic
  • Heavy metals & CVD
• Endocrine disrupting chemicals (EDCs)
  • Pesticides
  • Persistent organic pollutants (POPs)
  • Phthalates
  • Parabens
  • Nanomaterials in cosmetic products
  • Dioxin
  • BPA – e.g 1, e.g. 2,
  • Asbestos
  • Mold/mycotoxins
• Endogenous toxins (i.e. those from processes in the body)

Example of avoiding toxins in foods: Environmental Working Group’s “Dirty Dozen” (foods that are high in pesticide residues) and “Clean 15” (foods that are typically low in pesticide residues) lists.

What are the claimed methods of reducing the toxic load?

• Foods
  • Cruciferous vegetables
  • A whole list of foods and bioactive compounds have been proposed to have an impact on detoxification systems
• Diets
  • Institute of Functional Medicine – Detox Food Plan (see section below)
• Supplements/nutrients
  • e.g. sulforaphane
  • Quacks often recommend: NAC, milk thistle, turmeric, dandelion, etc.
  • Mark Hyman did a Q&A with Goop (LOL) on heavy metals. Just look at this list of foods and 8 different supplements he recommends.
• Cleanses
  • Toxin cleanses appeal to a drive for purity
  • Purification rituals date back to the earliest reaches of recorded history.
• IV Drips
• Sauna use

You then get wild combinations of scaremongering and strict life rules by some anti-toxin quacks. For example, consider these recommendations from Joe & Lara Pizzorno who recommended you:

• Do: eat organic, 50g+ fibre, remove shoes before entering house, use air filters, use water filters, make your own cleaning agents, grow your own food
• Don’t: eat farmed fish, use non-stick cooking utensils, use cosmetic products, eat foods from cans, use plastic food storage, use air freshners

Protocol Example: Detox Food Plan from the Institute of Functional Medicine

The IFM’s “Detox Food Plan” can be found here. From that, we see such claims as:

• Page 7: “While the Detox Food Plan reduces intake of common food triggers, making it similar to the Elimination Diet, it focuses on long-term nutritional support of the major body systems involved with detoxification, such as the gut and liver. It places a stronger emphasis on eating clean foods for life, reducing food contact with plastics or other potential contaminating elements, and eating organic foods when possible. Additionally, a metabolic detox plan may involve more rigorous nutritional intervention with medical food powders and dietary supplements, and even fasting from food or eating only specific foods on certain days to further drive or amplify the effectiveness of the detoxification system”
• “Specific amino acids (building blocks of protein) are required for certain types of toxin clearance. Therefore, this food plan suggests high-quality protein as an essential cornerstone to ensure that detoxification processes are efficient and effective.”
• Page 9: “The Detox Food Plan emphasizes stringent measures to reduce the intake of toxins of all kinds by encouraging the intake of organically grown, non-genetically modified foods; lean, grass-fed animal meats or wild-caught fish; minimally refined, cold-pressed oils; and by reducing exposure to canned or plastic-containing foods and liquids”
• Page 10: “Enzymes involved in detoxification (phase I, phase II) within the liver are well recognized. Once enzyme imbalances are assessed, food and/or nutritional supplements can be tailored to support, modulate, induce, or inhibit these enzymes to optimize detoxification in the body. Imbalances between phase I and phase II detoxification can cause accumulation or overproduction of toxic intermediate metabolites”
• Page 10: “When the toxin load is reduced and whole foods that support the liver and gut are increased, hormones can come into proper balance. Targeted hormone-balancing foods are featured in this plan for those who require such support.”
• Dairy and gluten not allowed on plan
• Certain foods are considered to be “Therapeutic Foods”:
  • Soy, soybeans, edamame
    • Isoflavones from soy influence phase I and phase II liver detoxification
    • High methionine-containing food, making it important for methylation
  • All of the nuts and seeds and their respective butters or pastes, especially sesame seeds and flaxseeds
    • provide anti-inflammatory oils, quality protein, and phytonutrient compounds like lignans, which support ongoing detoxification
  • Coconut oil
    • “contains medium-chain triglycerides that can provide energy sources to the gut and liver, particularly when undergoing a metabolic detoxification”
• Goal: consume at least 8 to 10 servings per day of non-starchy vegetables, “to aid in liver detoxification and the elimination of toxins from the gut”
• Page 19-20: List of nutrients involved in the detoxification pathways, with listed foods that contain those nutrients

Question to consider: would someone following such a diet plan still experience the reported health improvement if eating a comparable amount of vegetables, fruit, quality protein, fibre, etc., except… they didn’t follow the guidance around avoiding GMOs, plastic packaging, etc., and/or didn’t bother with any “detox” supplements?

On their website, in support of their Detox Food Plan, the IFM state: “Dietary changes can help patients with elevated toxicant exposures. Foods that may support the biotransformation of polychlorinated biphenyls (PCBs), for example, include cruciferous vegetables, berries, soy, garlic, and spices like turmeric.”

The supporting reference they give is a paper by Hodges & Minich (2015). However, directly from that paper we see the authors state:

• “One of the limitations that comes to the forefront in this collection of studies is how the information, in many cases, is constrained primarily to studies in cells or animals. It remains questionable as to whether similar effects would be seen in humans at moderate, reasonable doses.”
• “… at this time, it is best to take precaution in firmly advocating foods or food-based nutrients that only have cell or animal data as support. It is best to rely on the clinical studies that have been published to date in making more firm recommendations.”

Mold & Mycotoxin Toxicity

The unhinged claims about mold toxicity can be found in this podcast with Evan Brand and Paul Saladino.

Activated charcoal:

• not absorbed into the body
• is put into the gastrointestinal tract to reduce the absorption of drugs and other poisons after they have been ingested, but before they have been absorbed
• has become a routine part of poisoning protocols in the ER

Who typically does a “cleanse, detoxification diet”?

Study by Davisson & Sofka (2019): “While participants in Appalachia could benefit from a program that could improve health, this program’s participants did not share socioeconomic characteristics reflective of most people from that area. Most were college-educated females with a reported family income and level of education that were higher than the average population”

Advice from The American Academy of Clinical Toxicology

The American College of Medical Toxicology and The American Academy of Clinical Toxicology have an info sheet titled ‘Ten Things Physicians and Patients Should Question’. Five of most relevance to this discussion:

1. Don’t use homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.
2. Don’t order heavy metal screening tests to assess non-specific symptoms in the absence of excessive exposure to metals.
3. Don’t recommend “detoxification” through colon cleansing or promoting sweating for disease treatment or prevention
4. Don’t order tests to evaluate for or diagnose “idiopathic environmental intolerances,” “electromagnetic hypersensitivity” or “mold toxicosis.”
5. Don’t perform hair or nail testing for “metal poisoning” screening in patients with nonspecific symptoms.

Conclusions

Consider the studies used in support of such claims:

• Issues with cell/in vitro studies: the lack of pleiotropic activity that occurs in a complex, living system with multiple detoxification systems working simultaneously
• Issues with animal studies: often difficult to extrapolate to individuals due to the degree of variability in genotype and environmental phenotype seen in the diverse human population.
• Issues with going high-dose on a supplement or a nutrient (i.e. via juicing), based on associations of it’s beneficial effect as part of a dietary pattern.
  • “… certain foods exhibited a particular activity on an enzyme, while, at higher doses, they had another, opposite effect.” – Hodges & Minich (2015)

“There is no scientific consensus on whether chronic very-low-dose exposure to substances like POPs is harmful to human health. And it is this uncertainty (and fear) that has bolstered the current alternative-health detoxification market. Preying on these innate fears of “poisoning from within”, the industry promotes the view that any exposure, no matter how slight, is harmful, and that alternative-medicine detoxification will help. Many detox diets and diet kits claim to remove unspecified “toxins” from the body. Other approaches promoted claim to bolster the ability of organs like the liver to work more effectively.” – Scott Gavura, Science Based Medicine

What we know:

• There are a large number of toxins in the environment, many of which can potentially be deleterious to health
• The detoxification pathways in the liver are supported by many nutrients and phytochemicals
• If those pathways are hampered, that is problematic
• A diet full of vegetables, fruits, etc. that contains micronutrients, phytonutrients, etc. is beneficial. A lack of nutrients is a problem

What is not supported:

• A specific protocol is needed to detox your system
• Supplementing specific compounds will lead to better health outcomes due to more detoxification
• You need to avoid toothpaste, non-stick pans, plastic containers, etc.

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