Chronic Illness-What Works? Understanding Metabolic Detoxification

Just because a healthcare concept is not new does not mean it should be overlooked as potentially important in improving health and reducing the burden of chronic disease. Today's post is Part Two in a series called "Chronic Illness: What Works," and I base my observations and recommendations on my 30+ years as a nutritional biochemist and healthcare advocate. In Part One of this series I discussed the Four R Program. Today I will focus on a therapy called "Metabolic Detoxification."

Years ago, the term "detoxification" was often only applied to a program for those with a drug or alcohol abuse issue, but today there are much broader and more significant applications of this concept in health care. What are the summary guidelines of a well-designed program that differentiates a "fad" detoxification program from a properly managed and professionally supervised metabolic detoxification program. From my experience, the characteristics of a safe metabolic detoxification program should include the following:

* Fresh vegetables and fruits that are organic
* Adequate calories and nutrient intake to prevent under nutrition
* Foods and supplements that are free of common food allergens such as gluten (from grains) and casein (from dairy)
* Elimination of stimulants, synthetic chemicals, alcohol, tobacco products and modified food ingredients
* Adequate amounts of fluid intake as pure water (6-8 glasses per day)
* Moderate amounts of exercise
* Adequate fiber to promote proper bowel function and prevent constipation
* Adequate (but not excessive) protein, with an emphasis on vegetable protein (my colleagues and I have found rice protein to be well tolerated)
* Intake of specific nutrients that have been found to support proper detoxification function, including epigallocatechin gallate from green tea, glucosinolates from cruciferous vegetables (broccoli, cauliflower, brussel sprouts, and cabbage), resveratrol from grapes and peanut skins, isoflavones from soy, and polyphenols and anthocyanidins from berries.

Let me give you a case study from the physicians at the Functional Medicine Research Center in Gig Harbor, Washington:

"Laura" was a 47-year-old mother of two teenage children who was seen a number of years ago. Her symptoms included pre-diabetes, elevated blood cholesterol and triglycerides, increased body weight over a five-year period, fatigue, depression, sleep disturbances, esophageal reflux disorder, and early signs of the onset of menopause, including hot flashes and night sweats. She had been prescribed several medications to manage her symptoms, and was told to go on a low-calorie diet and start a regular walking program for exercise. She had been on this combination therapy for a year with little improvement in her overall health and vitality.

In "Laura's" blood chemistry screen, doctors at our clinic noted that she had evidence of a marginally elevated liver enzyme profile, suggesting to them that she had early stage evidence of a fatty liver disorder. Research that had been published in the medical literature suggested that this condition might, in part, be due to excess accumulation of various toxic chemicals. This correlation between the accumulation of toxic chemicals termed "persistent organic pollutants" or "POPs" and alteration in liver function and chronic illness has been documented through studies by investigators at the School of Medicine in Daegu, Korea and the School of Public Health at the University of Minnesota in Minneapolis (Clin Chemistry 2007;53:109298; Diabetes Care 2007;30:622-28; Lancet 2008;371:287-888).

Our research group completed and published a clinical study with patients who suffered from the symptoms of toxicity and metabolic disturbance. The intervention program that was employed in this study was a diet that was free of additives, chemicals, and allergens, and enriched with nutrients that have been demonstrated to support the body's proper detoxification function. The results of this study were remarkable in that over the three weeks of the intervention the patients' symptom scores decreased more than 50% and biochemical evidence of improved liver detoxification function was confirmed (Altern Therapies 1995;1:62-70). This was the same metabolic detoxification "Laura" was engaged in and she had an amazing response to it. She was able to eliminate almost all of her medications over a period of twelve weeks while on the supervised program, but most importantly her sleep, energy, mood, and vitality all improved. She commented she "felt twenty years younger."

We would all like to have a complete understanding of the physiological and cellular processes related to how a personalized metabolic detoxification program results in the improvement of health. Unfortunately this is a very complicated story that is just now unfolding. Recently, this hypothesis as to the role of metabolic detoxification in reducing the risk to chronic disease has gotten some additional support with the publication in the Journal of the American Medical Association of an association between the level of the chemical bisphenol A (a substance used in the manufacture of certain soft plastics) in the urine and the risk to metabolic diseases such as diabetes, cardiovascular, and liver diseases (J Am Med Assoc 2008;300:1302-1308 and 1353-1354). It has also been reported in 2009 that chronic exposure to the herbicide Atrazine at low levels causes mitochondrial dysfunction resulting in insulin resistance and the risk to type 2 diabetes (PLoS one 2009;4:e5186,1-10). There is also evidence that the accumulation of toxic metals such as mercury, lead, or cadmium can also produce reduced mitochondrial function and lowered bioenergetics that correlates with the increased risk to various chronic diseases (Toxicol Appl Pharmacol 2008;231:34-42; Am J Clin Nutr 1995;61:646-650; and Free Radi Biol Med 1995;18:321-36).

I do not believe that anyone knows exactly how a well designed metabolic detoxification program influences the body, but there is ample evidence from many studies to indicate that it can have a favorable impact on the immune and energy processing systems of the body. From work that we have done in our research laboratories as well as reading about the work of other investigators, I conjecture that part of its benefit is through the improvement of the function of the energy powerhouse in the cells called the mitochondrion. These organelles within the cells are very susceptible to toxicity. In a recent study from my own research group, we reported that a properly balanced metabolic detoxification program can have a favorable effect on the body's acid-alkaline balance, which in turn helps to regulate cellular mitochondrial function. (Altern Therapies 2007;13:62-70).

The answers are forthcoming, but in the mean time we need to recognize that history is a good teacher and that many people have benefited from a properly designed and implemented metabolic detoxification program. It is more than just a "feel good" experience. The outcome from these programs can be seen through the lens of improved blood chemistries, improved cardiovascular fitness tests, and improved cognitive and neurological test results. The results of a metabolic detoxification program can be objectively demonstrated.

To learn more about aspects of the program visit www.jeffreybland.com; to learn more about functional medicine education programs and referrals to practicing healthcare providers, visit www.functionalmedicine.org.

From my experience, metabolic detoxification therapy represents one of the three key successful programs for improving health and reducing the risk to chronic disease that can be administered at home under the supervision of a licensed health professional. Like "Laura," there are many people who could benefit from the administration of a properly designed metabolic detoxification program. I believe if we could implement this approach more widely in health care it would make a significant contribution to improving health and reducing the burden of chronic illness, while also helping people understand how to take charge of their own health.

In Part Three of this series, I will discuss my third choice of therapies for improving health, a therapeutic lifestyle change program.

 

Comments

[equianimi]

07:37 PM on 10/02/2009

I don't know why he didn't mention using a Sauna but that's one of the best ways to detox many toxins including heavy metals. The only studies I've seen compared heavy metals levels between sweat and urine and the sweat levels were markedly higher.

[kkdc]

01:38 PM on 10/02/2009

Eating lower on the food chain has proved to be better for people, the planet, and probably animals too.

[wawa76]

05:40 PM on 10/01/2009

The problem is that all doctors who are knowledgea­ble and can help you do not work insurance companies. I am talking about doctors who practice integrativ­e medicine, environmen­tal medicine, naturopath­s ...etc. they are very very expensive. office visits, labs tests (most tests they perform are not covered by insurance)­. add to it supplement that they prescribe and it has to be a certain brand because it is a doctor's line...etc which means more expensive.
they are effective but most people cannot afford their care and it is shameful.

[aznurse]

04:15 PM on 10/01/2009

was "Laura" taking medication­s for her high cholestero­l? It's been my experience that that could cause an elevated liver panel.

[Twopennygal]

02:42 PM on 10/01/2009

If you want protein, get it from real protein sources -- meat! Vegetable protein is incomplete and won't fill your needs properly.

And as to all those other things used for "detox", half of them make me sick (allergic to peanuts, broccoli gives me IBS, grapes are way too high in sugar, green tea tastes horrible..­.), so I'll stay away from them, thank you very much.

[alieninvader]

05:20 PM on 10/01/2009

It's very easy to get complete proteins with vegetables­. Rice and beans are complete. Soy is complete. Hemp is complete..­.just to name a few.

[Choicelady]

06:15 PM on 10/01/2009

No they are NOT. You can do very well as a vegan, but you cannot discount the need for B vitamins and other needs that come from only meat. We need to have a meat source that is uncontamin­ated with antibiotic­s, growth hormones, and toxins that is also affordable for the low income people who suffer the most from our lousy diet. Let's not be snobs about this - if Twopennyga­l has dietary problems, find alternativ­es for her. I cannot digest wheat which makes protein combining VERY limited! I can sympathize with Twopennyga­l even though I've found my way through the maze to a healthy diet - and one which my physician pooh-poohs­, but it works and works well. I'm bloat free for the first time in YEARS. And I am liking what i can eat. Twopennyga­l - send my your grapes, and I will send you high-quali­ty bread. Deal?

[bmonaghan]

01:54 PM on 10/01/2009

I am glad this subject is finally getting the attention it deserves. One of the herbicides mentioned here has been geting a lot of press (see link). What a lot of people don't realize is that heavy metals are present in 30% of natural supplement­s. I'm a big believer in using herbal infusions to rid the body of toxins. I agree that here is not a lot of science, but I have seen my liver numbers look a lot healthier and I feel much more energy.

http://www­.prlog.org­/10343433-­detox-or-d­ie-new-evi­dence-sugg­ests-ameri­cans-are-d­igesting-b­illions-of­-tons-of-t­oxic-poiso­ns.html

[Cherie King]

02:21 AM on 10/01/2009

i'm thinking of firing the doctor i was assigned to. I'm unemployed and I get assistance from the state, and when i don't eat i get sick. they kept saying to me i get sick a lot. I don't. I haven't had the flu in like 9 years and my onset of chronic illness can be linked to my lymphedema (which started in July 2004) of my lower left limb, after that i got mono and fatigue on occasion. I was diagnosed at the age of 14 with depression when i was maybe 86lbs. they assume i drink soda, i don't if i can avoid it. I am lucky sometimes to get at least 1 square meal a day, i snack yes. I think I eat too many complex carbs, don't exercise enough, don't drink enough water (Arizona). I don't like people saying i binge eat because I don't have the funds nor enough food in my home to support that theory. they didn't even tell me to start a food diary just see where i could be going wrong. nope, they just want to sell me stuff.

[Choicelady]

06:21 PM on 10/01/2009

I'm sorry, Cherie - I also have had indifferen­t doctors. Your entire well being is compounded by poverty and the lack of access to food you can afford. I'd love to tell you what would "work" - but a decent economy and a caring doc are not things I can control for you. I have contact with a lot of homeless people, and those living in homes on the edge. I think I'd urge you to get good bread, peanut butter, and fruits and veggies to have around - they're pretty cheap and a lot better than Cheetos (I LOVE Cheetos but they don't love me!) and other junk. If you can plan ahead, it helps. But I really do understand - too many friends in the same position, and it's not easy finding affordable food. We are a nation of abundance with too little for you. You will be in my heart. I wish I could do more.

[bthechangeyouseek]

12:37 AM on 10/01/2009

Sounds like healthy eating, moderate excercise. Knowing your panels does help. Although it's a bit expensive even with insurance.

[Angie Cordeiro]

12:54 AM on 10/01/2009

There are clinics all over the country that will do a blood panel for less than $35.00.

[bthechangeyouseek]

01:01 AM on 10/01/2009

Not here. To get a decent panel, including full cholestero­l, liver enzymes, thyroid, and white cell it's about $250. Depending on if your insurance includes your lab in the copay or not, it is quite expensive for many people; especially those without insurance.

There are many clinics who will run a simple test for less expensive, but not enough informatio­n to determine liver issues or other.

[degro038]

11:42 PM on 09/30/2009

I have to say, I was never one for the whole supplement­s/detox thing as I work out regularly and indulge only in moderation (and really, I'm just not a 'zen' kind of person)...­until I had an onset of chronic, never-endi­ng migraines for a period of 6 months. I was on every medication you can imagine and was even treated by a neurologis­t at the prestigiou­s Mayo clinic. Nothing worked. That is, until a holistic doctor recommende­d simple, OTC magnesium and riboflavin supplement­s.

Six months of debilitati­ng migraines cured in less than 24 hours. For $15 and no side effects.

[kkdc]

10:04 AM on 10/01/2009

The use of magnesium for migraines has been well known for a long time. In the hospital setting and some clinics, they do an iv drip of a magnesium solution. Congrats. Good for spasms and constipati­on as well.

[Twopennygal]

02:39 PM on 10/01/2009

Magnesium deficiency is chronic in the US. I supplement with magnesium over and above what's included in my Cal-Mag-Zi­nc-D supplement so I'm getting about equal parts calcium and magnesium. Also, I eat a lot of cucumbers (both as a weight-los­s aid -- filling and yummy -- and because it's a "super food" that helps with blood sugar regulation­, connective tissue health, etc.), which is high in magnesium. One other benefit of magnesium is that it helps keep you "regular." There are more and more studies coming out that show that fiber may not be as good for us as they say. Magnesium works more naturally and without all the side-effec­ts of fiber.

[Choicelady]

06:26 PM on 10/01/2009

Now think about this - nature supplies fiber, not magnesium. Maybe it's balance? If the people in Africa who are vastly healthier than we on their very high fiber diets had your view, they'd die looking for magnesium. The problems we have is someone says fiber is good and people take too much too quickly - that's not sensible. But fiber from foods adjusted to over time is GREAT, natural, and healthy. I do take magnesium, but the !Kong people in Africa could not do it and have NO colon cancer and other related problems we have no matter what we do.

[DaveinNorthridge]

11:38 PM on 09/30/2009

Once again, a rich people's solution to the problem. Organic fruits and vegetables­, rice protein, gluten- and casein-fre­e products, all of which carry a premium even at a Super Wal-Mart. Of course, the doctor's practice is probably only affordable if one can afford health insurance too. Don't tell me that you can do this on food stamps either, although that might at least have the function of lowering caloric intake because your money runs out faster.

[invirginia]

12:47 PM on 10/01/2009

Try a local farmer's market for reasonably priced fresh vegetables­. Dry beans (of which there are many types), rice, and some creativity can really stretch your grocery dollars.

[Choicelady]

06:32 PM on 10/01/2009

Depends on the farmers market and accessibil­ity to one. If you're in South Central LA, forget that! If you're in Berkeley, you'd be better off at Safeway in terms of price. You have hit on a huge problem - healthy living, especially organics, is being created as a rich person's haven. Read "Crunchy Cons" by some doofus (I forget his name) who sees the market as an important force in letting him and his family corral natural foods and environmen­ts - at the expense of those who really, REALLY need them. The idea of healthy living as a Common Good is still the minority view. There is a middle road - dry beans and rice fixed at home; homemade soups and stews, etc. that may not be organic but are more affordable and healthier for those on food stamps. But let's indeed be real - I cannot eat wheat. That means I pay a minimum of $4 for a loaf of alternativ­e grain bread that's half the size of most loaves. Who that is poor could sustain that? Pasta? Brown rice pasta costs the earth! So yes - avoiding gluten an casein etc. is a rich person's issue.

[yogajan]

09:44 PM on 09/30/2009

One cannot walk into a gym, chiropract­or's office, gynecologi­st office, hair dresser, nail salon or just about any physician'­s office without them trying to sell you some supplement­, skin care product, botox or vitamin. It is such a shame that our health care system has come to this. I can assure you that they will NEVER get my money for any of the products they are selling.

No one has shown me the evidence (peer reviewed type) that detoxifica­tion has any benefit, except to line the pockets of the people who are promoting it. Listen to you body, use common sense and some moderation and you will be amazed at how well you feel and how much more money you will have to do something fun.

[Angie Cordeiro]

10:34 PM on 09/30/2009

"One cannot walk into a gym, chiropract­or's office, gynecologi­st office, hair dresser, nail salon or just about any physician'­s office..."

Haven't been in my neck of the woods, glad the people I do business with are of another sort...

[yogajan]

11:11 AM on 10/01/2009

You wrote, "people I do BUSINESS WITH" (caps, mine) and that says it all. Take away the economic incentive, the multi-leve­l marketing, the financial motive and replace it with pure science. Now, that would be interestin­g.

[mgray34]

01:01 AM on 10/01/2009

Well here's a real live study of a supplement that was tested in double blind placebo test if you're interested­. I understand your frustratio­n with people pushing supplement­s. Unfortunat­ely, there is a lot of garbage out there. People need to research before they buy, period.

All I know is the stuff in this study that I'm using has detoxed my body. I've lost 7lbs, my blood pressure and cholestora­l have gone down and I'm sleeping better. I'm a customer for life.

http://ow.­ly/lmh2

[JarlNjord]

09:17 PM on 09/30/2009

Toxins ??? Are any of these alternativ­e/integrat­ive practition­ers actually scientific­ally measuring the "Toxin" load in their "patients" (better described as "clients")­? What - Hair analysis? Live cell analysis? Do they measure again after a course of "treatment­" or diet? Let's see the long term double blinded randomized controlled studies with thousands of participan­ts over multiple years that are published in well known and respectabl­e peer reviewed scientific and medical journals! No more anectodal evidence.

[Angie Cordeiro]

09:39 PM on 09/30/2009

Liver and kidney function numbers in a regular panel yearly blood test, before and after is proof enough for me, what is your proof otherwise.

[yogajan]

10:24 PM on 09/30/2009

Angie, you have it backwards. It is up to the people promoting detoxifica­tion to prove that it is safe and effective. My kidney, liver and other blood tests are all within normal limits and I don't "detoxify"­; I just let my body do what it is supposed to do. Look up the definition of homeostasi­s and you will understand how the body fixes itself.

[Cay]

08:54 PM on 09/30/2009

Yikes, I guess this means I'll need to stop my weekly interferon injections­. Sure this treatment has been shown in double-bli­nded studies to reduce MS exacerbati­ons by one-third and in my case coincided with a reduction from four a year to less than one (still walking after ten years.) But heck, I could rid myself of this chronic MS once and for all! Thanks, Dr. Bland!

[Choicelady]

06:37 PM on 10/01/2009

I think I'd think that over? Why not do both? Western medicine has a good place in your life, too!

[Cherie King]

08:48 PM on 09/30/2009

I had Mononucleo­sis with Jaundice, kind of screwed up my liver, so my liver lipids go up and down. So if they are basing my need to change by a digital scale that may be putting me 10lbs heavier and slightly high liver lipids someone sucks at being a medical profession­al.

[Lesscancer]

08:38 PM on 09/30/2009

Great post.
Unlike current health care models of treating after the fact-preve­ntion often is not bought off a shelf.
www.youtub­e.com/less­cancer

Bill Couzens Founder Less Cancer