Detox

Patients frequently ask me about "detoxing."  As an allopathic physician I have generally scratched my chin and have had little to offer.

The first question is:  what are toxins; where do they come from?

Let's face it.  Our world in many ways can be described as a toxic soup.  Most toxins come from things we eat.  We are constantly barraged by a host of chemicals: insecticides, pesticides, mycotoxins, biotoxins, industrial waste, heavy metals, ingredients on food labels we can't read, genetically modified foods etc... Our air is so toxic that oxygen bars exist in some countries.

We know that many of these toxins are poisonous and many have the ability to cause cancer.  Some fat soluble toxins will never be removed.

It is not surprising that patients want to be detoxed -- especially when they are chronically ill.

The first common sense thing is to limit intake of toxins as much as possible. This means spending a lot of money on organic foods. It is hard to get away from polluted air outside. But we can frequently remedy indoor sources of  toxins, such as toxic mold.

If we keep ingesting toxins there is no point in detoxing.

We have two organs which are incredibly effective in eliminating toxins: liver and kidneys. First and foremost, we should do everything possible to protect these vital organs.

The three most common causes of kidney failure are: diabetes, hypertension/atherosclerosis and chronic use of pain medicines such as Tylenol. These issues should be taken seriously -- a discussion of which is outside this blog.

We frequently abuse our liver with alcohol. We can also damage our liver when we take multiple drugs that require the same enzyme for detoxification. Your doctor/pharmacist should always check for drug interactions.  We need to be careful when we take medicines that are known to be toxic to the liver. For example, the use of statin drugs for cholesterol many be toxic to liver and muscles. These drugs may be medically necessary;  patients and their doctors should consider all factors on a case-by-case basis.

We need to make sure we intake adequate amounts of minerals. For example, selenium is required for function of our most important antioxidant, glutathione.

Glutathione is an essential antioxidant and detoxifying compound found within our cells. Glutathione levels decrease with age and can be depleted in the chronically ill.
Many patients get IV glutathione in doctors offices which appears to be beneficial, but the effects are short-lived. Glutathione is not absorbed when taken orally. However,  liposomal glutathione is available and has good oral adsorption.

In the world of alternative medicine many supplements are recommended to help with detoxification. Some include: SAMe, flavonoids, green tea extract, various fruits and vegetables, milk thistle and many others. There are too many to list.  Some tout the benefits of burbur.  This is outside my scope of practice, but I believe some of these therapies are helpful.

Coffee. Some people use coffee enemas.  I don't like the sounds of it.  There is evidence that coffee has clear liver protecting properties but I prefer to take mine by mouth.

Probiotics and gut flora are important.  Toxins may be removed in the colon.  Regular bowel movements are important. Chronic constipation should be avoided. An adequate fiber intake is key.

Some people think that chelation is helpful.  This therapy removes heavy metals. There are a number of ways of accomplishing this with IV and oral therapies.  This is a particularly controversial topic:  one I wish to skirt around.

Quinolinic acid is a very important neurotoxin.  My best bet has been to remove it from bile and excrete it though the gut with medicines like cholestyramine or Welchol.  Quinolinic acid is associated with  glutamate modulated excito-toxicity. The drug Namenda, used for Alzheimer's disease, may help mitigate this effect. Other strategies  are emerging.

My common sense approach regarding diet is to look at societies with the healthiest people and the highest per capita rates of residents over 100 years of age.  This occurs on a Japanese island and a Greek island.  Both have a low intake of meat and fish/seafood is the primary source of animal protein. The primary starch is either potatoes and coarse bread or rice. The diets incorporate fresh greens and legumes: chick peas and lentils in one case and soybeans in the other. Cow's milk is not used in these diets. However, goat milk products, including yogurt and cheese are used in the Greek diet. The composition of goat milk is similar to human milk. Sugar is not used, but honey is part of the diet. The Japanese exercise vigorously: the Greeks have no formal exercise but walk up steep hills and sometimes dance. The Greek diet incorporates fresh olives and olive oil.  Both drink teas (and coffee). Some consume moderate amounts of alcohol. Artificial beverages and sweeteners are not used: the same is true for sugary/fructose syrup, American style beverages. Both groups live on an island with perfect weather and are happier than we are. Incidentally, women live longer on Okinawa and men live longer in an island in Greece.

There are some treatments I am sure do not work. The most notorious is foot detox.  Here feet are bathed in an electrolyte solution and a gentle current is applied. The water turns brown and pieces of metal show up; the patient is told he/she has been detoxed.  It turns out that the process causes oxidation and electrolysis of the metals in the electrodes. The exact same effect is seen when no feet are placed in the bath. "And now for my next magical trick...." On the other hand, I am sure that foot baths are very soothing and promote relaxation; just don't shell out bucks for one.