Restoring the Whole Person With Nutritional and Botanical Detoxification: A Clinical Perspective

1. Restoring the Whole Person With Nutritional and Botanical Detoxification: A Clinical Perspective David B. Wood, ND B.S. Microbiology, University of Washington, 1977 N.D., Bastyr University, 1983 Cofounder, President: Trinity Family Health Clinic, PS, 1984 Cofounder, Vice President, CMO: Bio-Genesis Nutraceuticals, Inc, 2000

2. Recommending a Strategy By supporting the body’s natural detoxification pathways we can help our patients achieve a higher level of health. A true sense of well-being!

3. Vision Statement • Our bodies have always had to deal with toxins. Whether we are talking about metabolic waste products of our own metabolism or environmental toxins (xenobiotics), in order to survive and thrive our bodies use various detoxification pathways to stay clear of their damaging effects. • My vision is to provide clinicians with the means to effectively assist their patients detoxify and achieve a level of health that allows them to fully enjoy their lives. • To Promote True Restoration!

4. Goal and Objective • In order for your patients to achieve their highest health potential, you (the health professional) and your patient must realize that ongoing detoxification is foundational. While continuous exogenous support may not be necessary, healthy endogenous organ function is critical for exceptional health to be realized.

5. Goal and Objective • In this lecture I will review specific nutritional AND botanical support for enhancing Phase 1 and Phase 2 liver detoxification support as well as support for correcting intestinal dysbiosis and increased permeability ‘leaky gut’ conditions. • In this way I hope to help you: • Restore The Whole Person

6. Goal and Objective • In addition, it must be understood that in many ways the whole body is a detoxification organ. • Our goal as physicians is not simply to mobilize toxins, but rather, to enhance our patients health to such an extent that their endogenous detoxification processes keep them healthy.

7. “The human body is, in its living state, a unity, a complete and rounded whole. Every sensation, every manifestation of force, every interrelation of the material of one part is intimately concerned with the sensation, force, manifestation and interrelations of all the other parts; no part suffers without involving all the rest in suffering and alteration.” • S. Hahnemann, Organon of Medicine

8. Today’s Situation(Recent Past) • Xenobiotic exposure (1989) • 100% of human fat cell biopsies show elevated levels of known toxins (examples: styrene, 1,4-dichlorobenzene (moth balls, house deodorizers), xylene (gasoline, paints), plus many others. • 100,000+ chemicals are common in commercial use. • 25,000 (25%) are known to be hazardous.

9. Today’s Situation(Recent Past) • Xenobiotic exposure (Quantified 1989): • According to the 1989 Toxics Release Inventory National Report • 2,427,061,906 (billions) pounds of chemicals were emitted into our atmosphere. • 1,180,831,181 (billions) pounds of chemicals were released into the ground threatening our drinking water. • U.S. Environmental Protection Agency: Toxins in the community: national and local perspectives. The 1989 Toxics Release Inventory National Report. Washington, D.C.: Office of Toxic Substances 1991

10. Today’s Situation(Recent Past) • Xenobiotic Exposure (Quantified, 1989): • 551,034,696 (millions) pounds of industrial chemicals were dumped into public sewage systems. • 188,953,884 (millions) pounds of chemicals were discharged into our surface waters • These were only from reportable sources! • These statistics are from 1989 data. Today’s situation is probably worse! • Corsello S, Ghen M, Kamhi E, Kratz A, Taylor J, Zampieron E. Cellular Detoxification: An Integrative Approach to Anti-Aging. Intrnl J of Int Med, Vol.2, No.6, Nov/Dec 2000

11. Today’s Situation(Very Recent Past) • Xenobiotic exposure (Quantified 2000): • According to the 2000 Toxics Release Inventory (TRI) Public Data Release Report – Executive Summary • 1,661,326,638 (billions) pounds Total On- and Off site Releases • 88,756,085 (million) pounds Total Air Emissions • 14,621,472 (million) pounds Surface water Discharges (on site releases)

12. Toxics Release Comparison 1989 and 2000

13. Detoxification: Life And Health Depend Upon It! • Remember - • 100% of human fat cell biopsies positive for xenobiotic toxins: • Typical toxins present: • organic solvents • pesticides • herbicides • toxic metals

14. Without exception all humans have bio-accumulated toxins!

15. ‘Brain fog’ Chronic sensitivities chemical, air, food Joint Pain Hives, rashes Fluid retention Headaches Frequent illness Immune dysfunction hypo, hyper, auto ‘Feels unwell’ Partial loss or exaggerated sense of smell or taste Digestive disorders Chronic fatigue, exhaustion Unable to concentrate, irritable, confused Mood swings Restlessness Some of the Many Possible Symptoms in the Patient with Impaired Detoxification

16. Recommendation • Exercise • Have fun! Take up cycling, running, swimming, weights, dancing, walking, kayaking, bowling, inline skating, hiking. • Work at seeing life through the eyes of LOVE, JOY, PEACE AND FORGIVENESS. Very Detoxifying! • Be creative!

17. Recommendation • Exercise enhances circulation (blood and lymph) and perspiration • good circulation is essential to optimal detoxification • increased nutrient delivery to target tissues • cellular macro and micronutrient delivery • mitochondrial nutrient delivery • increased waste elimination capacity (washing via blood, lymph and elimination via lungs, skin, colon, kidneys) • improved oxygenation • Get moving!

18. Detoxification: Whole Body Approaches • ARC program: • Avoid: exposure to xenobiotics as far as is practical • What lifestyle changes is your patient willing to modify? • Reduce: stored accumulated toxic burden • Correct: imbalances and deficiencies that impair endogenous mechanisms for neutralization and elimination of toxins

19. First Do No Harm!

20. Detoxification: ARC Program • Nutritional strategies: • Positive lifestyle changes (diet, exercise, stress reduction) • Liver detoxification support • Intestinal detoxification support • Enhancing whole body detoxification • kidneys • circulation (blood, lymphatic) • perspiration • respiration (lung, nasal/sinus)

21. Recommendations • Diet: • Reduce or eliminate: • Processed/refined foods (high in chemical preservatives, artificial colors, artificial flavors, fillers, binders, sugar, hydrogenated oils, low in fiber and nutritional value) • Non-organic foods (high in pesticide, herbicide and hormone residues)

22. Recommendations • Reduce or Eliminate: • Fish (large predator) high in toxic metal content (especially Hg, .5 - 1.0 ppm) Principle of Bioacummulation • shark, swordfish, various bass, king mackerel, orange roughy, pike and porgy • Dairy (except Whey) promotes absorption of MeHg and enhanced enterohepatic circulation (EC) • EC: Instead of clearing toxin it is reabsorbed back into the systemic circulation

23. Recommendations • Rule out food/environmental allergy: • Allergic reactions will create inflammatory processes which over time may impair optimal detoxification • Create a ‘safe diet’. This diet is individualized for each patient based on their genetics (blood type), allergies, and consists of foods with lower toxic chemical residue.

24. Recommendation • Diet: • Balanced CHO/PRO/FAT intake (40/30/30) (“Choosing Health…” M. Percival) • Blood sugar balance • Insulin/cortisol regulation • elevated cortisol impairs detoxification , enhances EC • Prostaglandin regulation - reduction of inflammation

25. Recommendation • Positive Nitrogen balance • high CHO diets enhance toxic metal accumulation • Fish protein promoted excretion of Hg. Eat low Hg content (.12 - .14 ppm) seafood (shrimp, sardines, Alaskan pollock, most tuna and salmon. URL:http://www.epa.gov/ost/fish/ • Adequate amino acidsto support GSH (glutathione) production

26. Recommendation • Increase fluid intake • Pure water is essential to life. Water is the conduit for nutrient delivery and waste elimination. Our bodies are 70% water except in underlean individuals. • Water is essential for healthy kidney function • Adults - depending on activity/weight - approximately 8 - 8oz glasses of pure water per day.

27. Recommendation • Stress Reduction: • Stress is a killer! • Stress raises cortisol output and leads to connective tissue thinning, impaired cellular utilization of thyroid hormones, impaired immune system response and increased EC. • Stress interferes with the healthy circadian hormonal rhythms • Stress interferes with the healthy regulation of blood glucose and impairs insulin utilization.

28. Recommendation • Stress Reduction: • Encourage a healthy attitude toward life • Promote prayer and meditation • Prescribe ‘play time’ • Most adults take life too seriously! Encourage them to have fun. Most will need to schedule this for it to happen. • Take up a hobby • Drawing, painting, blowing bubbles, listening to relaxing music, going for walks, enjoying the beauty of creation. “Stop and smell the Roses.”

29. Recommendation • Exercise IS A FOUR LETTER WORD? • Remember when you were young you didn’t think about exercise. You played! • Have fun! Take up cycling, running, swimming, weights, dancing, walking, kayaking, bowling, inline skating, hiking. • Be creative!

30. Recommendation • Exercise enhances circulation (blood and lymph) and perspiration • good circulation is essential to optimal detoxification • increased nutrient delivery to target tissues • cellular macro and micronutrient delivery • mitochondrial nutrient delivery • increased waste elimination capacity (washing via blood, lymph and elimination via lungs, skin, colon, kidneys) • improved oxygenation

31. Get your patients moving! Get your patient's moving!

32. Recommendation • Reduce: Toxic burden • Assess Detoxification Capacity: Rule out: • Impaired detoxification: • appropriate laboratory tests: • liver detoxification panels (blood, urine, saliva - challenge test) • Organic acid panels (urine metabolic end product screening) • Urine, Serum or Hair heavy metal screening • Digestive/Microbial/Parasitology (stool) • Intestinal Permeability (lactulose/mannitol challenge - urine)

33. Labs: Detoxification Capacity • Some labs to contact for information on available screening tests: • Diagnos - Techs (1-800-87TESTS) • Doctor’s Data, Inc (1-800-323-2784) • www.doctorsdata.com • Great Smokies Diagnostic Laboratory • (1-800-522-4762) www.greatsmokies-lab.com • Metametrix Clinical Laboratory • (1-800-221-4640) www.metametrix.com

34. Labs: Toxic Burden • Accu Chem Labs (1-800-451-0116) • Pacific Toxicology (1-800-328-6942) • National Medical Services (national reference lab) • (1-800-522-6671) www.nmslab.com

35. “When in doubt: treat the liver” Old Naturopathic saying

36. Recommendation • Enhance endogenous Glutathione production (GSH): with ToxiHMF, UltraPure Whey protein, L- Glutamine • Some substances rendered less toxic by GSH: • Halogenonitrobenzenes and congeners - fungicides • 2-Chloro-S-triazines and cogeners - herbicides • Aryl Nitrocompounds - nitrates, nitrosamines • Phenoltetrabromphthaleins - dyes • Aryl & alkyl halides - solvents, intermediates • Aryl & alkyl esters - solvents, flavorings • Alkene halides - plastics (vinyl chloride) • Allyl compounds - intermediates

37. RecommendationSome substances rendered less toxic by GSH: • Alkyl methanesulfonates - dyes, detergents • Organophosphorus compounds - insecticides • Arylhydrocarbon epoxides (arene oxides) - solvents • Arylhalide epoxides - solvents • Other epoxide intermediates - solvents • Alpha, beta - unsaturated compounds • Arylamines, arylhydroxylamines, carbamates, and related compounds - phenols • Steroids - drugs (phenolics) • Quinones and catechols - drugs • Isothiocyanates - such as methylisocyanate • Trichloromethylsufenyls - pesticides

38. RecommendationSome substances rendered less toxic by GSH: • Tricarbamates - pesticides • Heavy metals - such as lead, mercury, arsensic, cadmium - found in paints, cans, gasoline, amalgam fillings, batteries, plating, food • Bacterial toxins - Clostridia difficile • Automobile exhaust, cigarettes • Many over-the-counter (OTC) and prescription (Rx) drugs - substances detoxified by the liver and too numerous to name • Braverman ER, Pfeiffer CC. The Healing Nutrients Within: Facts, Findings and New Research on Amino Acids. Keats Publishing, New Canaan, CT. p.101, 1987

39. Recommendation • Enhance endogenous Metallothionine production: Rx TriZinc + Ultra Pure Whey protein • “Metallothioneins (MTs) store and release essential metals, such as zinc and copper, maintaining the low intracellular concentration of free essential metals. Thus MTs fulfill a regulatory capacity and influence transcription, replication, protein syntesis, metabolism, as well as other zinc-dependent biological processes.”

40. Recommendation • “Recent suggestions have implicated the metallothionein proteins (MTs) as potential ‘scavengers’ of brain mercury.” • Aschner M et al, Methylmercury alters glutamate transport in astrocytes. Neurochem Int, 2000. 37(2-3):p.199-206.

41. Recommendation • Balance Phase 1 to Phase 2 processes • Phase 1 processes (cytochrome P450 family) • modification of toxin to bioactive intermediate compound which can now be prepared for elimination through Phase 2 conjugation • Phase 1 cytochromes throughout body (liver, intestine, adrenals, skin, brain, breast, etc)

42. Recommendation • especially CYP3A4 • up to 50% of total CYP in human liver • metabolizes approximately half of all therapeutic agents • Oxidation • Reduction • Hydrolysis • Hydration • Dehalogenation

43. Recommendation • Balance Phase 1 to Phase 2 processes • Phase 2 processes (conjugation of bioactive intermediate compound with water-soluble substrate for preparation for elimination via urine or biliary-stool) • Glutathione conjugation • Sulfation • Glucuronidation

44. Recommendation • Methylation • Acetylation • Amino acid conjugation • A variety of chemicals (exogenous/endogenous) are conjugated through the above pathways. • For additional information see: Functional Assessment Resource Manual. Great Smokies Diagnostic Laboratory

45. Recommendation • Balance between Phase 1 and Phase 2 pathways is the key. • Phase 1 (excessive): excessive free radical reactive intermediate production. Possible liver damage, cancers, etc. • Phase 1 (suppressed): inability to detoxify substance. Bioacummulation of toxin. • Phase 2 (depressed): inability to conjugate and clear reactive intermediates produced from Phase 1

46. REDUCE STORED TOXINS

47. Phase I intermediary [cytochrome P450 enzymes] metabolites more polar Enzymes, Cofactors & more water-soluble Other Nutrients Used nonpolar • oxidation (lipid-soluble) riboflavin (vit. B2) • reduction niacin (vit. B3) • hydrolysis Reactive Oxygen • hydration folic acid Intermediates • dehalogenation vitamin B12 glutathione branched-chain flavonoids phospholipids Nutrient/Plant Derivatives carotenes (vit. A) lipid-soluble (nonpolar) ascorbic acid (vit. C) toxins stored in adipose tocopherols (vit. E) tissue contribute to selenium mobilized toxin load copper zinc manganese coenzyme Q10 Secondary thiols Free radicals tissue damage bioflavonoids silymarin pycnogenol catechins (green tea) *Toxins = Endotoxins *end products of metabolism *bacterial endotoxins Exotoxins *drugs *alcohol *chemicals agriculture food additives household pollutants/contaminants *microbial * toxins Reactions ( ) Phase I Liver Detoxification Pathway & Supportive Nutrients pyridoxine (vit. B6) amino acids Antioxidant/Protective Superoxide (found in garlic, onions, & cruciferous vegetables)

48. Impaired Phase 1 (Cytochrome P450 system) lipotrophics B2, B3, B6, B12, folic acid, NADH acetyl l-carnitine taraxicum chelidonium chionanthus catechin EFA’s antioxidants Botanical and Nutritional Intervention for Impaired Liver Detoxification

49. Phase II [conjugation pathways] intermediary metabolites glycine taurine glutamine ornithine arginine excretory derivatives • sulfation Phase II Liver Detoxification Pathways & Supportive Nutrients polar • glucurondidation • glutathione*conjugation water-soluble • acetylation • amino acid conjugation Serum Kidneys • methylation Urine *N-acetylcysteine, cysteine, Bile methionine are precursors Feces/stools Secondary tissue damage

50. Botanical and Nutritional Intervention for Impaired Liver Detoxification • Impaired Phase 2 (Conjugation) • amino acids: Whey protein, glutamine, methionine, aspartic acid, glycine, ornithine, arginine, cysteine, NAC, taurine • Fe, Mo, Mg, Zn, Cu, Se • Mg sulfate, Na sulfate • cruciferous vegetables • soy, garlic, ellagic acid • reduced glutathione • Liska DJ. The detoxification enzyme systems, Alt Med Rev, Vol.3, No. 3, pp. 187-198, June 1998.