Textbook of Natural Medicine Second Edition Edited By



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Textbook of Natural Medicine

Second Edition

Edited By

Joseph E. Pizzorno Jr ND

President and Faculty, Bastyr University, Kenmore, Washington, USA

Michael T. Murray ND

Faculty, Bastyr University, Kenmore, Washington, USA







EDINBURGH  LONDON  NEW YORK  PHILADELPHIA  SYDNEY  TORONTO 1999

Chapter 50 - Detoxification

Michael T. Murray ND

Joseph E. Pizzorno Jr ND

INTRODUCTION



The concepts of internal cleansing and detoxifying have been integral to naturopathic philosophy since the profession’s inception over a century ago. The problem of “toxicity” has grown as the number and quantity of poisonous compounds in the air, water, and food have increased. A substantial and growing body of research now supports the significant impact on health of acute and chronic exposure to endogenous and exogenous toxins and the efficacy of an individual’s detoxification mechanisms (see Ch. 37 ).

Toxins damage the body in an insidious and cumulative way. Once the detoxification system becomes overloaded, toxic metabolites accumulate, and sensitivity to other chemicals, some of which are not normally toxic, becomes progressively greater. This accumulation of toxins can wreak havoc on normal metabolic processes.

This chapter identifies “toxins” and natural ways to sup-port their detoxification and elimination, with particular focus on enhancing the function of the liver, the body’s primary organ for neutralization of undesirable chemicals.

TOXINS



A toxin is defined as any compound that has a detrimental effect on cell function or structure. The discussion of toxins in this chapter is organized into the four areas:

heavy metals

chemical toxins

microbial compounds

breakdown products of protein metabolism.

Heavy metals



The heavy metals most commonly causing problems in humans are:

lead

mercury

cadmium

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arsenic

nickel

aluminum.



These metals tend to accumulate within the brain, kidneys, and immune system where they can severely disrupt normal function.[1] [2] [3] [4] [5] [6] It is conservatively estimated that up to 25% of the US population suffer to some extent from heavy metal poisoning. Hair mineral analysis is a good screening test for heavy metal toxicity (see Ch. 18 ).[1]

Most of the heavy metals in the body are a result of environmental contamination due to industry. For example, in the United States alone, industrial sources contribute more than 600,000 tons/year of lead into the atmosphere to be inhaled or – after being deposited on food crops, in fresh water, and soil – to be ingested.[1]

Common sources of heavy metals, in addition to industrial sources, include lead from the solder in tin cans and copper pipes, pesticide sprays, and cooking utensils; cadmium and lead from cigarette smoke; mercury from dental fillings, contaminated fish, latex paints and cosmetics; and aluminum from antacids and cookware.[1] Some professions with extremely high exposure include battery makers, gasoline station attendants, printers, roofers, solderers, dentists, and jewelers.[1] Unfortunately, arsenic and mercury have now also been found as contaminants or intentional additions to imported Chinese and Ayurvedic herbal medicines.

Early signs of heavy metal poisoning are vague or associated with other problems. Early symptoms can include:

headache

fatigue

muscle pains

indigestion

tremors

constipation

anemia

pallor

dizziness

poor coordination.

The person with even mild heavy metal toxicity will experience impaired ability to think or concentrate. As toxicity increases, so do the severity of signs and symptoms.[1] [2] [3] [4] [5] [6]

Numerous studies have demonstrated a strong relation-ship between childhood learning disabilities (and other disorders including criminal behavior) and body stores of heavy metals, particularly lead[7] [8] [9] [10] [11] [12] (see Ch. 135 ).

Chemical toxicants



This category of toxins, primarily dealt with by the liver, includes:

toxic chemicals

solvents, e.g. cleaning materials, formaldehyde, toluene, benzene, etc.

drugs

alcohol

formaldehyde

pesticides

herbicides

food additives.

Exposure or toxicity to toxic chemicals can give rise to a number of symptoms. Most common are psychological and neurological symptoms such as depression, headaches, mental confusion, mental illness, paresthesia, abnormal nerve reflexes, and other signs of impaired nervous system function. Respiratory tract allergies and increased rates for many cancers are also found in people chronically exposed to chemical toxins.[13] [14] [15] [16] [17] [18] [19]

Microbial compounds



The waste products and cellular debris from bacteria and yeast in the gut can be absorbed, causing significant disruption of body functions. Examples include:

endotoxins

exotoxins

toxic amines

toxic derivatives of bile

various carcinogenic substances.



Gut-derived microbial toxins have been implicated in a wide variety of diseases, including liver diseases, Crohn’s disease, ulcerative colitis, thyroid disease, psoriasis, lupus erythematosus, pancreatitis, allergies, asthma, and immune disorders.

In addition to toxic substances being produced by microorganisms, antibodies formed against microbial antigens can cross-react with the body’s own tissues, thereby causing autoimmunity. The list of autoimmune diseases which have been linked to cross-reacting antibodies includes rheumatoid arthritis, myasthenia gravis, diabetes, pernicious anemia, and autoimmune thyroiditis.

The immune system and the liver are responsible for dealing with the toxic substances that are absorbed from the gut.

Breakdown products of protein metabolism



The end-products of protein metabolism – ammonia, urea, etc. – cause significant problems if allowed to accumulate. Most are eliminated by the kidneys.

DETOXIFICATION MECHANISMS



The body eliminates toxins either by directly neutralizing them or by excreting them in the urine or feces (and to

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TABLE 50-1-- Major detoxification systems

Organ

Method

Typical toxin neutralized

Skin

Excretion through sweat

Fat-soluble toxins such as DDT and heavy metal such as lead and mercury

Liver

Filtering of the blood

Bacteria and bacterial products, immune complexes

Bile secretion

Cholesterol, hemoglobin breakdown products, extra calcium

Phase I detoxification

Many prescription drugs (e.g. amphetamine, digitalis, pentobarbital), many over-the-counter drugs (acetaminophen, ibuprofen), caffeine, histamine, hormones (both internally produced and externally supplied), benzopyrene (carcinogen from charcoal-broiled meat), aniline (the yellow dyes), carbon tetrachloride, insecticides (e.g. Aldrin, Heptachlor), arachidonic acid

Phase II detoxification




Glutathione conjugation

Acetaminophen, nicotine from cigarette smoke, organophosphates (insecticides), epoxides (carcinogens)

Amino acid conjugation

Benzoate (a common food preservative), aspirin

Methylation

Dopamine (neurotransmitter), epinephrine (hormone from adrenal gland), histamine, thiouracil (cancer drug)

Sulfation

Estrogen, aniline dyes, coumarin (blood thinner), acetaminophen, methyl-dopa (used for Parkinson’s disease)

Acetylation

Sulfonamides (antibiotics), mescaline

Glucuronidation

Acetaminophen, morphine, diazepam (sedative, muscle relaxant), digitalis

Sulfoxidation

Sulfites, garlic compounds

Intestines

Mucosal detoxification

Toxins from bowel bacteria

Excretion through feces

Fat-soluble toxins excreted in the bile

Kidneys

Excretion through urine

Many toxins, after they are made water-soluble by the liver


a lesser degree from the mucous membranes, lungs and skin). Toxins that the body is unable to eliminate build up in the tissues, typically in the fat stores and bone. The liver, intestines, and kidneys are the primary organs of detoxification (see
Table 50.1 ).

EXPOSURE DIAGNOSIS



Both recognition of exposure and assessment of the efficacy of the detoxification mechanisms are essential for effective detoxification of the patient. Exposure assessment is discussed here, while description of assessment of liver detoxification efficacy is integrated into the discussion of the liver’s detoxification pathways.

While an accurate and exhaustive history and physical examination will probably always be the mainstay of diagnosis of toxin exposure and build-up, a number of useful laboratory techniques have been developed for detecting toxins in the body.

Heavy metal assessment



For heavy metals, the most reliable measure of chronic exposure is the hair mineral analysis. Reliable results of hair analysis is dependent upon (1) a properly collected, cleaned, and prepared sample of hair, and (2) the test being performed by experienced personnel using appropriate analytical methods in a qualified laboratory. This procedure is discussed thoroughly in Chapter 18 .

Chemical exposure



For determining exposure to toxic chemicals, a detailed medical history is essential. When appropriate, the laboratory analysis for this group of toxins can involve measuring blood and fatty tissue for suspected chemi-cals. Table 50.2 lists common indications for suspecting chemical exposure.

Recently, innovative laboratory assessment methodologies for the assessment of chemical exposure have become commercially available. Perhaps the most promising is urinary organic acid analysis. Traditionally only used to assess and define inborn errors of metabolism that cause death within the first year of life or severe mental retardation, metabolic profiling has now become useful for identifying enzyme impairment due not only to genetic diseases but also to nutritional deficiencies and chemical poisoning (see Ch. 29 for a full discussion of this useful methodology).



TABLE 50-2-- Common indications for suspecting chemical exposure

More than 20 pounds overweight

Diabetes

Presence of gallstones

History of heavy alcohol use

Psoriasis

Natural and synthetic steroid hormone use

  —anabolic steroids

  —estrogens

  —oral contraceptives

High exposure to certain chemicals or drugs

  —cleaning solvents

  —pesticides

  —antibiotics

  —diuretics

  —non-steroidal anti-inflammatory drugs

  —thyroid hormone

History of viral hepatitis

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Microbial compounds



A number of laboratory techniques are available to determine the presence of microbial compounds. Those most commonly used include tests for the presence of abnormal microbial concentrations and disease-causing organisms in the stool (see Ch. 9 ), microbial by-products (see Ch. 31 ), endotoxins (erythrocyte sedimentation rate is a rough estimator), and bacterial overgrowth in the small intestine (see Ch. 7 ).

Breakdown products of protein metabolism



The determination of the presence of high levels of breakdown products of protein metabolism and kidney function involves both blood and urine measurement of these compounds (see Ch. 31 ).

LIVER DETOXIFICATION

Overview

The liver is a complex organ that plays a key role in most metabolic processes, especially detoxification. The liver neutralizes a wide range of toxic chemicals, both those produced internally and those coming from the environment. The normal metabolic processes produce a wide range of chemicals and hormones for which the liver has evolved efficient neutralizing mechanisms. However, the level and type of internally produced toxins increases greatly when metabolic processes go awry, typically as a result of nutritional deficiencies. These non-end-product metabolites have become a significant problem in this age of conventionally grown foods and poor diets (see Ch. 108 ).

Many of the toxic chemicals the liver must detoxify come from the environment: the content of the bowels and the food, water, and air. The polycyclic hydrocarbons (e.g. DDT, dioxin, 2,4,5-T; 2,4-D, PCB, and PCP), which are components of various herbicides and pesticides, are one example of chemicals that are now found in virtually all adipose tissues measured. Even those eating unprocessed organic foods need an effective detoxification system because all foods contain naturally occurring toxic constituents.

The liver plays several roles in detoxification: it filters the blood to remove large toxins, synthesizes and secretes bile full of cholesterol and other fat-soluble toxins, and enzymatically disassembles unwanted chemicals. This enzymatic process usually occurs in two steps referred to as phase I and phase II. Phase I either directly neutralizes a toxin, e.g. caffeine, or modifies the toxic chemical to form activated intermediates which are then neutralized by one or more of the several phase II enzyme systems. These processes are summarized in Figure 50.1 .

Figure 50-1The liver’s detoxification pathways.



Proper functioning of the liver’s detoxification systems is especially important for the prevention of cancer. Up to 90% of all cancers are thought to be due to the effects of environmental carcinogens, such as those in cigarette smoke, food, water, and air, combined with deficiencies of the nutrients the body needs for proper functioning of the detoxification and immune systems. The level of exposure to environmental carcinogens varies widely, as does the efficiency of the detoxification enzymes, particularly phase II. High levels of exposure to carcinogens coupled with slow detoxification enzymes significantly increases susceptibility to cancer.

The link between the detoxification system’s effectiveness and susceptibility to environmental toxins, such as carcinogens, is exemplified in a study in Italy of Turin chemical plant workers who had an unusually high rate of bladder cancer. When the liver detoxification enzyme activity of all the workers was tested, those with the most dysfunctional detoxification system were the ones who developed bladder cancer.[20]
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