All About Detox

All About Detox

There are countless websites expounding on the problem of toxin chemicals in our toxic world and how we are all near death because of them. They also extol the virtues of their particular detox protocol, medication, supplement or cocktail which will fix you in no time at all, most of them with very little evidence behind them. So, is it all hocus-pocus? What works, what doesn’t and how do you go about detoxing if it is necessary?

I have tried to keep my discussion of this subject as evidence-based as possible. If you want to skip the science mumbo-jumbo and just find out how to detox, then go to the Recommendations section. If you are interested in more of the how’s, why’s and what’s, read on:

 

So what are toxins and why should we need to “detox” them.

Scientifically, ‘toxins’ is a word usually used to refer to poisons naturally made by living organisms, whereas the word ‘toxicants’ is used to refer to poisonous substances made by humans or introduced into the environment by human activity. However, I will stick to the use of the word ‘toxins’ as it is colloquially used, in the sense of a toxicant.1

Typical toxins are substances such as lead, mercury, cadmium, formaldehyde, BPA, DDT and glyphosate. They may negatively affect the body through damaging the nervous system (eg mercury) and immune system (DDT), affecting/mimicking hormones (eg BPA and phthalates), causing cancer (eg aflatoxin) and blood disorders (pesticides), and many other mechanisms.8

Conventional medicine will insist that detox is a metabolic process done mostly by the liver in which certain substances harmful to the body are inactivated or destroyed. These harmful substances, like heavy metals, can then be excreted into the gut through bile.55 This ability of the liver, conventional wisdom will tell you, need not be augmented or aided except perhaps in extreme circumstances such as acute poisoning where medically supervised chelation therapies may be used to remove the poison.

However, with the onslaught of toxins from so many sources in modern times (eg pesticides, herbicides, antibiotics and hormones in our food and water, air pollution, numerous harmful chemicals in the various substances we use on our skin, second hand smoke, plastic packaging, moulds) it makes sense that giving the body some help in removing some of these may be beneficial.

The question is are we toxic? Is there a need for detoxing? In the US alone 80 000 chemicals are registered for use with 2000 being added every year and very little testing done on any of these.2 Multiple harmful chemicals have been found in  up to 100% of pregnant woman3, umbilical cord blood of infants4 and amniotic fluid5. So even at the start of life significant exposure is occurring. Toxic chemicals have been found in the blood, sweat and urine of healthy and unhealthy subjects6 and are being linked to the rise in autoimmune disorders7. The national human adipose tissue survey (NHATS) tested for 54 chemical toxins in fat cells in the body. Five of the toxins were found in 100% of tissue samples and 12 more toxins were found in 80-90% of samples.8

While our bodies are built to deal with a certain level of toxic influence it is becoming clear that for many people, levels of various substances in the body may be becoming harmful. When the liver is unable to deal with the level of toxins entering the body they tend to get stored in adipose tissue (body fat). Since the brain is about 60% fat it is no surprise it can be seriously affected as well. When toxic load exceeds the body’s threshold to deal with it, damage to organ systems can occur.8

Unfortunately for some people, the ability of their liver to detoxify various chemical elements may be compromised by their genetics. Having a genetic polymorphism (a less functional form) of the MTHFR gene leads to a compromised ability to deactivate toxins, use vitamins B12 and folic acid and is implicated in cancer, Down’s syndrome, psychiatric disorders and many others.10 And this polymorphism affects 30-50% of the population reducing the effectiveness of the enzyme it produces 30-70%.9 This may explain why some people, who seem to have the same exposure to toxins as other people, are affected more quickly or adversely. In South Africa you can test to see whether you have the MTHFR polymorphism here.

 

Testing for toxins

So how can one test to see if they have a toxic burden? There are 3 main methods: blood, urine and hair. Fat biopsy is a gold standard but used mainly in a laboratory.

Blood testing for toxins is good for acute exposure as it gives a snapshot of current blood levels of a chemical. This does not however give a good idea of chronic exposure.

Urine testing can be done, usually over 24hrs to determine levels of toxins being excreted in the urine. This is also more of an acute test but is often augmented by administering a chelating agent such as DMPS or DMSA which binds to toxins, drawing them out of the tissues which can then be measured. This method is however expensive as it has to be done by a qualified practitioner and can make the patient quite sick due to the extra heavy metals circulating in the blood. Interpretation of the results is also controversial.11

Hair mineral analysis requires submitting a hair sample usually by post. It is safe and relatively inexpensive but only gives a view on chronic exposure not acute. In South Africa this can be done here. There is some controversy surrounding this method as well though.12

At the end of the day, if testing is done, it should be correlated with symptoms and then redone after any detox protocol to determine improvement. Some protocols suggest doing all 3 analyses to get a more rounded picture of exposure.

 

How do you go about detoxing?

Before attempting a detox protocol it is more useful to limit exposure to the toxins in the first place. Avoid and then eliminate. Detoxing will only take you so far if you are still piling on the toxins through daily habits. If you live in a cabin in the wilderness, drinking water from a mountain stream and catching and growing your own food, you can skip this section.

Avoidance

  1. Eat real foods that are organic, free range and less likely to contain hormones, antibiotics and pesticides (growing your own food is a great place to start). See the clean 15 vs dirty dozen13 for those foods that are better bought or grown organic versus those where it is not so necessary. Most packaged food contains added chemicals for storage, taste and other purposes, some of which may be harmful to the body.
  2. Avoid foods that are likely to cause inflammation in the body. See this article for a discussion of diets which can help prevent inflammation.
  3. Don’t store or heat your food in plastic.
  4. Drink water that is filtered or from a spring, and not from a plastic bottle, to reduce the chance of the water being contaminated by chemicals like BPA.
  5. Consider moving if air pollution is particularly bad in your area or look into a home air filter.
  6. Look for soaps, deodorants, shampoos, toothpaste, makeup and detergent that is made from human (and nature) friendly chemicals.
  7. Avoid smoking and second hand smoke.
  8. Avoid medications that are not absolutely necessary.
  9. Put your car aircon on recirculate when in heavy traffic.
  10. Have mercury amalgams removed from your teeth by a dentist very experienced in this procedure.

 

Elimination

Detoxification (i.e. changing a harmful chemical to a harmless one) is done by the liver. There are 3 main ways the body then eliminates these toxins from the body: gut, urine, and skin. So when we talk about detoxing we are either supporting the liver in its detox or aiding elimination of the toxins through gut, urine and skin.

The methods used for detox will stick mainly to those which have at least some decent scientific evidence for efficacy. Therefore there will not be discussion of colonic cleansing46 and green juicing even though they may be useful for some people. Although the scientific evidence for their efficacy in detoxing is poor, there are multiple sites to peruse if you would like to investigate these further.

  1. Liver support

Glutathione is the master antioxidant of the body and supports liver enzymes in protecting you from heavy metals and other toxins.14,15,16 Glutathione is broken down by digestion so it is better taken as the liposomal form or intravenously.17 Alternatively, one can supplement with n-acetylcysteine and alpha lipoic acid which are precursors and cofactors which increase glutathione production. 18,19

  1. Sauna

Studies have shown that sweating may release higher concentrations of toxins like heavy metals and BPA than are found in urine and blood.23,24 Besides the numerous other positive effects,25 one of the best methods of increasing sweating is sauna use. It has a long history of safe use in detox protocols around the world.26 Definite prescriptions are difficult to give but 10-60 min (depending on heat levels) 2-7 times a week has been shown to have a reduced risk of all-cause mortality.27 It is important to remember that mineral and water loss occurs along with the toxins so it is important to replace these after a session. Just add a pinch of Himalayan or sea salt to water.

NB: People with skin conditions, serious heart conditions or who are pregnant should avoid sauna use.

  1. Cold therapy

Cold acclimation has been shown to increase glutathione production, reduce uric acid48 and increase metabolic activity through stimulation of brown fat49 which may have an effect on weight-loss. Besides nothing feels as good as a cold shower after an intense sauna session.

  1. Weight-loss

Since, as established above, many toxins are stored in adipose tissue, any process that causes lipolysis or fat breakdown is likely to lead to release of these stored toxins. This has been shown in several studies.20,21,22 Therefore any diet which promotes weight-loss is likely to be effective, as is fasting.

  1. Exercise

Exercise provides the double whammy of lipolysis (fat breakdown) as well as sweating (see 2+3 above). I use high intensity interval training and this has been shown to promote fat loss better than regular steady state cardio training.54

  1. Supplements

Several supplements could be useful in the detox process:

a. Activated charcoal: this is normal charcoal which is heated and a gas is used to increase the number of holes or pores. As a result the surface area of 1 gram can be anywhere from 1500 to 3000m2.28 This allows activated charcoal to adsorb a large amount of poison or toxin. It has been used safely for over 150 years in the treatment of acute poisoning.29 Activated charcoal has also been shown to adsorb BPA30, aflatoxin31, metal ions32 and numerous drugs33, although its effect on alcohol is sadly poor.

However, it must be said that there are few studies showing that it will work under non-poisoning circumstances to remove toxins from the body34, although lack of evidence does not mean this may not be happening to some extent.

It should also be noted that other vitamins, minerals, medications and food nutrients will also be adsorbed, so avoid ingesting other substances (besides water) at least 1 hour before or after taking the activated charcoal.35

b. Clay: bentonite and zeolite clays have similar properties to activated charcoal but less evidence in terms of toxicant adsorption.

c. Chlorella: this is a single-celled fresh water microalgae. Studies show it has the ability to absorb lead36, uranium37, mercury38 and various metals39. It has also been shown to reduce the dioxin content of breastmilk in 35 women when they took 6g per day.40

Unlike with activated charcoal, chlorella also has various other nutrients and is a good source of B vitamins, protein, magnesium, iron, vitamin A and zinc.41

d. Selenium: binds to mercury rendering it non-toxic.50 Found in good concentrations in foods like brazil nuts. So it is worth eating with fish.

e. Niacin: vitamin B3 is included here since it is so commonly quoted in the detox community as an agent for producing lipolysis. However, I have not yet seen the evidence for this effect. In fact the study evidence is to the contrary – it inhibits lipolysis.42,43,44 It is particularly good, though, at increasing HDL and reducing LDL cholesterol.45

f. N-acetyl cysteine (NAC) and alpha lipoic acid (ALA) (see number 1 above)

g. Methylcobalamin and folate. These are the natural food forms of vitamin B12 and B9 respectively which are especially important to take if you have the MTHFR polymorphism discussed above, as they are involved in supporting the liver’s detoxification pathways along with other B vitamins. Folic acid is a non-methylated synthetic supplement which may be associated with cancer47, and should be avoided.

 

  1. Chelation therapy

This involves using pharmaceutical substances such as EDTA, DMSA and DMPS orally or intravenously to bind to heavy metals and pull them out of the tissues. This method is very effective but is best done under medical supervision as it can cause severe side effects and cause redistribution of the toxic metals in the brain and other parts of the body if not done correctly.51,56 Chelation therapy should be done slowly and carefully especially in those who are sick and it may be necessary to first start by supporting liver and kidney detox and elimination functions before starting chelation therapy.56

Chelation therapy should probably be reserved for those who have significant symptoms related to heavy metal toxicity, have been heavily exposed to toxic metals or who are having mercury amalgam removal from teeth. Those looking to investigate this method further can go here and here.

 

Recommendations

Detox is a controversial topic but I think there is enough evidence that the potential benefits of following a basic protocol to reduce exposure to, and improve elimination of, toxins far outweigh any risks. In fact, even if it was shown in future that there is no benefit, in terms of detox, to the following protocol, there are still multiple other health benefits to be obtained.

This protocol is for those who want to reduce the impact of the toxins of living in modern society on their bodies. If you have had a significant exposure to heavy metals or other toxins, are considering or have already had mercury amalgams removed from the teeth, or have evidence of a high toxin levels causing illness in your body, then it is suggested that you consult with a medical practitioner skilled in toxicology and chelation therapy.

The first port of call in any detox program must be to avoid or reduce exposure as explained above. In terms of actively increasing elimination of toxins, the following protocol may be helpful:

 

Detox Protocol

  1. Drink a glass of water an hour with a pinch of a good sea salt or Himalayan salt an hour before exercise.
  2. Take approx. 500 mg activated charcoal or 2-6 grams of chlorella or a clay (not on the same day but should be alternated) just before exercise.
  3. Exercise for 30 min. HIIT is best.
  4. Sauna for as long as it takes to get a good sweat going and becomes unbearable to stay there. This will vary depending on the sauna temperature and humidity and individual tolerance. Sweat lodges and steam rooms should also do the trick. Avoid this step if you are pregnant or have a significant skin or heart condition.
  5. Cold shower or ice bath or just dip in the nearest cold body of water if available.
  6. Repeat steps 4+5 if time allows.
  7. Repeat step 1.
  8. Take a liposomal glutathione or NAC and ALA supplement at least 60 minutes after the activated charcoal. This could also be done at the same time as point 1, depending on your preference.

As discussed above, each of these steps has some effect on its own in terms of detox, so it not necessary to do the entire protocol to get some benefit. However, stacking the various steps is likely to produce a greater combined effect. Following a protocol like this 1 or 2 times a week is advisable, although as described above, the more times you sauna a week, the greater seem to be the effects on long term health.

Let me know if you have any positive or negative experiences associated with detox or think something should be added to the discussion.

 

References: 

  1. https://en.wikipedia.org/wiki/Toxicant
  2. https://ntp.niehs.nih.gov/about/index.html
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114826/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410737/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1241723/
  6. https://www.researchgate.net/publication/47701626_Blood_Urine_and_Sweat_BUS_Study_Monitoring_and_Elimination_of_Bioaccumulated_Toxic_Elements
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114837/
  8. http://www.altmedrev.com/publications/5/1/52.pdf
  9. http://www.nejm.org/doi/full/10.1056/NEJM200104123441517
  10. https://www.ncbi.nlm.nih.gov/pubmed/24091066
  11. http://www.quackwatch.com/01QuackeryRelatedTopics/Tests/urine_toxic.html
  12. http://nutritionalbalancing.org/center/htma/science/articles/htma-facts.php`
  13. https://www.ewg.org/foodnews/
  14. https://www.ncbi.nlm.nih.gov/pubmed/16513172
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882944/
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654245/#B20
  17. https://www.ncbi.nlm.nih.gov/pubmed/20535554
  18. https://www.ncbi.nlm.nih.gov/pubmed/9288403
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540061/
  20. https://www.ncbi.nlm.nih.gov/pubmed/16989697
  21. https://www.ncbi.nlm.nih.gov/pubmed/11093288
  22. http://www.medpagetoday.com/publichealthpolicy/environmentalhealth/22080
  23. https://www.hindawi.com/journals/jeph/2012/185731/abs/
  24. https://www.hindawi.com/journals/jeph/2012/184745/#B30
  25. https://www.foundmyfitness.com/reports/sauna-report.pdf
  26. https://www.ncbi.nlm.nih.gov/pubmed/21951023
  27. http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2130724
  28. http://www.sciencedirect.com/science/article/pii/S0196064489808418
  29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306980/
  30. http://pubs.acs.org/doi/abs/10.1021/es0481169
  31. https://www.ncbi.nlm.nih.gov/pubmed/6782748
  32. http://www.sciencedirect.com/science/article/pii/S0255270107001572
  33. http://onlinelibrary.wiley.com/doi/10.1002/jps.2600661139/abstract
  34. https://healthybutsmart.com/activated-charcoal/
  35. https://www.ncbi.nlm.nih.gov/pubmed/9482427
  36. https://www.ncbi.nlm.nih.gov/pubmed/12781705
  37. https://www.ncbi.nlm.nih.gov/pubmed/16260049
  38. https://www.ncbi.nlm.nih.gov/pubmed/17031617
  39. https://www.ncbi.nlm.nih.gov/pubmed/16583260
  40. https://www.ncbi.nlm.nih.gov/pubmed/17472477
  41. http://nutritiondata.self.com/facts/custom/569428/2
  42. https://www.ncbi.nlm.nih.gov/pubmed/16018973
  43. https://www.ncbi.nlm.nih.gov/pubmed/12873710
  44. http://diabetes.diabetesjournals.org/content/61/12/3172
  45. http://www.medscape.com/viewarticle/712122_1
  46. http://www.mdedge.com/jfponline/article/64413/gastroenterology/dangers-colon-cleansing
  47. http://www.nbcnews.com/id/35874922/ns/health-diet_and_nutrition/t/your-breakfast-giving-you-cancer/#.WAC18OB97IU
  48. http://www.sciencedirect.com/science/article/pii/0891584994900302
  49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726172/
  50. https://www.ncbi.nlm.nih.gov/pubmed/20561558
  51. https://www.hindawi.com/journals/tswj/2013/219840/
  52. http://drpompa.com/additional-resources/health-tips/heavy-metal-detox-safe-heavy-metal-chelation-and-mercury-amalgam-removal/
  53. http://www.livingnetwork.co.za/chelationnetwork/chelation-the-andy-cutler-protocol/
  54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991639/
  55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091928/
  56. http://mercola.fileburst.com/PDF/ExpertInterviewTranscripts/Interview-ChristopherShade-Metal-Detoxification.pdf

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