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Do you need to detox?

MagazineNovember 2014 (Vol. 25 Issue 8)Do you need to detox?

Before you embark on expensive detoxing, here's how to find out if your elimination systems are up to par, says Dr Sarah Myhill

Before you embark on expensive detoxing, here's how to find out if your elimination systems are up to par, says Dr Sarah Myhill.

Food is dangerous stuff. If you look at life from the point of view of a plant, it does not want to be eaten. So it has evolved many poisons to protect it. Examples include lectins, alkaloids, alkylating agents (such as glycosides in cycads that cause motor neuron disease), mycotoxins and so on. In contrast, meat and meat fat is non-toxic, as animals
have evolved other systems of defence-they can run away! I suspect the main ways in which meat may be toxic arises from the cooking of meat and fat at high temperatures, which results in toxic trans fats being produced or the fermentation of protein where there is upper fermenting gut-both complications of recent evolutionary changes. When humans learned to
cook and to farm, it introduced a new range of toxins, as carbohydrate-based foods can be fermented in the upper gut by a range of alcohols, d-lactate, hydrogen sulphide
and other agents.

Our detox systems evolved in response to toxins and waste products generated within the body. Any machine, to be running smoothly, not only requires a constant supply of materials, but a tidying-up of waste products. No machine is 100 per cent efficient, and the business of burning sugar in mitochondria (the 'power-plant' structures found in most cells that generate energy from food) in the presence of oxygen produces toxins in the form of free radicals. These are mopped up by antioxidant systems found within cells, extracellular fluid and the bloodstream. The gut, I suspect, is the biggest source of toxic stress. Blood draining from the gut passes via the portal vein directly to the liver to be dealt with. At rest the liver consumes a massive amount of energy-27 per cent of total energy consumption-to deal with this toxic load. Toxic stress also results from the fermenting gut. We normally ferment vegetable fibre in the lower gut to produce fuel in the form of short-chain fatty acids-one such, n-butyrate, is essential for nourishing the lining of the large bowel. However, where there is abnormal fermentation in the upper gut of carbohydrates and proteins, there is also the production of many toxins such as ethyl, propyl and butyl alcohols, hydrogen sulphide, d-lactate, oxalates and many others.

Gilbert's syndrome-a hereditary liver disorder characterized by too much bilirubin, so causing jaundice-may affect up to 10 per cent of the population. Although it's said to be a benign biochemical abnormality, actually it is symptomatic of an inability to detox through glucuronidation-when glucuronic acid derived from glucose (sugar) in the liver attaches to toxins, so allowing
their clearance from the body. Sufferers are less able to clear a toxic load and so are more susceptible to poisoning from toxins within or outside the body. Most suffer from fatigue, so this condition is commonly seen in my myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) patients. When cells are damaged or replaced because of wear and tear, injury or inflammation, large molecules too big to get into the bloodstream are released. These are then mopped up by the lymphatic system-a drainage network that courses throughout the body.
The contents are broken down for recycling in lymph nodes and finally empty into the inferior vena cava vein in the neck via the thoracic duct. Lymphatic drainage, as developed by Raymond Perrin, is a massage technique to facilitate this natural flow.

Because we live in an increasingly polluted world, we are putting more and more stress on our detox systems. However hard we try to keep our bodies unpolluted, we are all contaminated with
pesticides, volatile organic compounds (VOCs) and heavy metals, which bio- accumulate in our tissues. I have yet to find a single person with a normal fat biopsy or the absence of toxic
metals in urine following a chelating agent. In addition, there are noxious gases too. As if this were not enough, we consume toxins in the form of food additives, alcohol, caffeine and prescription drugs. It may be that, in isolation, these are not particularly toxic, but they still have to be cleared from the body by the same mechanisms as for more toxic substances. This creates a biochemical bottleneck and, as it takes longer for the total load to be reduced, the toxins hang around for longer and have greater potential for harm.

Some toxins get into the body and do severe damage, but evaporate or are detoxed before testing is possible. Examples include formaldehyde, noxious gases like carbon monoxide, sulphur dioxide and nitrous oxide, and radiation damage. Drugs of addiction such as heroin, cannabis and ecstasy have the potential for permanent damage (including death), but again may be undetectable by the time of testing. There are no tests for silicone diffusion from implants. We know that anyone with silicone implants will have silicone widely distributed about the body. The question is whether it is triggering inflammation in the body. This we can test for with a silicone sensitivity test, which measures the response of white cells to silicone.

Tools for detoxification

In order to detox properly, you need to do all of the following Remove the polluting source. There is no point in doing detox regimes without also addressing where the toxins are coming from. I would not advocate chelation therapy for toxic metals like mercury until the source of the toxin-say, dental amalgam-has been removed. Ensure good energy delivery. The business of detoxing
is greedy for energy and resources. Most of it happens in the liver which, at rest, consumes 27 per cent of total body energy production- more than the brain and heart combined!
Ensure good micronutrient status. Most toxins are rendered water-soluble first by oxidation by cytochrome P450 enzymes and then by tacking on a group of molecules such as glucuronide, glutathione, sulphate or amino acids. So if I measure glutathione in someone who is not taking supplements, almost invariably there is a deficiency. Glutathione is in great demand for detoxing and also for glutathione peroxidase, a vital antioxidant. There are other ways the body can detoxify: many fat-soluble chemicals can be got rid of through bile (but they're then reabsorbed in
the gut), while other toxins can be eliminated in faeces, or exhaled or sweated out of the body-or, as I call it, 'boiled off' from subcutaneous fat into the lipid layer of skin,
from where it can then be washed away. Take these seven steps to determine how toxic you are and to have a good clear out.

Test your ability to detox If you or your practitioner suspect you are having a hard time detoxifying, standard biochemical blood tests (for urea and electrolytes, including liver and kidney
function tests) can get a handle on your ability to detox. Urea and creatinine are measures of kidney function. Using an algorithm, glomerular filtration rate (GFR) can be calculated from
creatinine levels, age and gender. It should be above 90 mL/min. In my patients with severe CFS, I often see a low GFR, which makes sense- poor energy delivery makes the kidneys go slow.
Bilirubin is a yellow-orange pigment derived from the breakdown of red blood cells in the liver and excreted in bile. In the absence of liver pathology, high bilirubin levels indicate Gilbert's syndrome (see page 63), but even a high normal bilirubin level points to slow detox. Gamma-glutamyl transferase (GGT)-an enzyme induced in response to a load-is typically raised in
response to excessive alcohol consumption, although some prescription medications have the same effect. Liver detoxification profile measures the ability of the body to excrete substances like aspirin, caffeine and paracetamol (acetaminophen), from which one can infer which enzyme pathways are deficient. Glutathione-S-transferases are a family of enzymes involved in cellular detox.

When levels are high, this may also point to a toxic load. Lactate dehydrogenase is the enzyme necessary to clear lactic acid, vast amounts of which are produced when there is a switch from the usual anaerobic (with oxygen) to anaerobic (no oxygen) metabolism to produce energy. I suspect that high levels of this enzyme are symptomatic of such a tendency and point to poor mitochondrial function. Glutathione-an antioxidant produced naturally in the liver-should be in abundant supply, but is commonly deficient.

Test your toxic load

I find that a good history from a patient is an excellent guide. It gives an idea of what exposures have taken place and has implications for avoidance and/or detox regimes to pursue. However,
the results of tests constantly surprise me. I regularly use the following clinically useful tests to measure toxin levels. Fat biopsy-for pesticides and VOCs-is a very simple test to do: a 21G 0.8-mmgreen (wide-bore) needle is pushed into buttock fat and removed. The amount of fat contained within the bore is sufficient for analysis. This test doesn't pick up heavy metals because they're not significantly present in fat, but pesticides and VOCs are present (in mg/kg) at the sort of levels in blood similar to those from taking a therapeutic drug. Toxic metals. The usual ways
of measuring toxic metal levels in urine, blood and hair are unreliable because heavy metals are poorly excreted and bio-concentrate in organs like the heart, brain, bone marrow and kidney,
and so are not available for measuring. The answer is to use chelating agents like DMSA (dimercaptosuccinic acid, which contains molecules that bind to metal ions to remove them). This is well
absorbed from the gut, and chemically 'grabs' toxic and friendly minerals alike and gets rid of them through urine. It is excellent for diagnosing the toxicity of heavy metals like mercury,
lead, arsenic, aluminium, cadmium and nickel, among others. DNA adducts are a measure of which toxic chemicals have become stuck to DNA. I do this test for any condition that might be associated with damage to DNA, such as cancer. Gene studies for superoxide dismutase (one of the body's most potent natural antioxidant enzymes) often show evidence of gene
blocking (silencing), so tests for DNA adducts is a logical follow-up.

Translocator (TL) protein studies are indicated if mitochondrial function tests show blocking of TL protein, because these tests show why this vital process is malfunctioning.
Acumen Laboratories (Tiverton, Devon; 07707 877175) carry out fat biopsies, DNA adducts and TL protein studies. Biolab in London (www.biolab.co.uk; 020 7636 5959) handle toxic metal tests.

The best ways to clear out
Treatment depends on the toxin involved, but some steps should be applied in every case. The following will enhance the body's ability to detox.
o Adopt a Stone Age diet (meat, fish, eggs, nuts, seeds, veg, berries and salads with occasional dairy, fruit and grains) micronutrient supplements, adequate sleep and exercise.
o Avoid constipation and thirst.
o If applicable-and it often is-treat the fermenting gut.
o Avoid sources of external toxic stress.
o Correct nutritional deficiencies and perhaps measure levels of minerals such as magnesium, zinc and selenium; minerals are essential cofactors that confer special properties to enzymes, so
allowing them to work.
o Glutathione is almost invariably deficient and can be corrected with supplements. Other sulphur-containing compounds may be helpful, such as methionine, N-acetylcysteine and alpha-lipoic acid. Suggested daily dosages: 250-500 mg glutathione; 250-500 mg methionine

Correct the methylation cycle

Simply taking a good multivitamin/mineral supplement plus essential fatty acids will go a long way towards correcting a 'broken' methylation cycle (a biochemical pathway that manages gene behaviour, acting like an on/ off switch, and contributes to a wide range of essential bodily functions, including detox, immune function, energy production and inflammation control). But there's a particular vicious cycle here-vitamins B12 and folic acid, essential parts of the methylation cycle, themselves need to be methylated-adding a methyl group to facilitate a chemical
reaction-to be of any use. Suggested daily dosages: 1 mg B12 (methylcobalamin; under the tongue, but ideally by injection); 800 mcg folate (ActiFolate); 50 mg (twice a day) B6 (pyridoxal-5- phosphate); 250 mg glutathione; 100 mg (twice a day) phosphatidylserine

Getting rid of toxic metals

Use trace minerals. Toxic metals bio-accumulate because of deficiencies of essential trace elements (often a metal). The idea is that if a trace element like zinc is deficient (and it commonly is), the body will grab something that looks similar. This means toxic metals like lead and cadmium are incorporated into the body instead- with dire results. The treatment is to give
larger-than-usual doses of trace elements to displace the toxic ones, together with a sulphur-containing protein, such as glutathione or methionine, to which the toxic metal sticks, so
allowing it to be dumped in urine. Glutathione and/or methionine. A typical regime to counter poisoning with nickel, lead or cadmium (divalent cations) would be zinc with methionine or glutathione. A typical regime for aluminium, mercury or arsenic poisoning (trivalent cations) would be selenium with methionine or glutathione. Suggested daily dosages: 30-50 mg zinc (at night); 250-500 mg methionine or glutathione; 500 mcg selenium (at night) High-dose iodine. Iodine sticks to toxic metals to make a soluble iodide, which can then be excreted. Suggested daily dosage: 12.5 mg iodine (Iodoral, one tablet) DMSA strips away toxic metals remarkably well. We know this from measuring toxic metals in urine following a dose of DMSA. Indeed, this is an excellent test for toxic metals. The only problem is that some people do not tolerate DMSA very well, and so have to rely on the other interventions listed above. If tolerated, though,
DMSA is the most reliable way to strip out mercury, lead, arsenic, cadmium and aluminium, among others. But as DMSA also strips away essential trace elements, don't take any
mineral supplements on the day. For the rest of the week, take physiological doses of essential trace elements in addition to the above regimes.

Duration of treatment depends on the degree of toxicity, but it's usually at least 16 weeks. There is no evidence that DMSA enters the brain, although reducing toxic metal levels in the body makes it likely they will also exit the brain too. Suggested daily dosage: 15 mg/ kg body weight DMSA (once a week) Clays such as kaolin and bentonite. I use this for people who cannot tolerate
DMSA. I don't have enough data to be sure it's effective, but there is every reason to suppose that these clays work. Again, it would be expected to also remove essential trace elements, so
I suggest supplementing these in a way similar to DMSA (alternating periods of high and low doses). On clay days, don't take trace minerals (except perhaps through the skin, as this
would not enter the gut). Suggested daily dosage: 5 g essential trace elements (three times a day, twice a week) Vitamin C. If tolerated, the best form of vitamin C is ascorbic acid, and the slight
acidity will render the urine pH acidic, which helps to strip out toxic metals. Suggested daily dosage: 4 g ascorbic acid Mobilizing toxic metals can make the patient worse. This may be because
of toxic and/or allergic reactions to the mobilized metal. With my more sensitive patients, I start with small doses and adjust according to response. Some people just cannot tolerate DMSA at all.
Whatever regime is used, retest for toxic metals in urine. This gives two points on the graph, so allowing an educated guess as to how much more treatment, if any, is required.

If levels don't fall as expected, there are two possible reasons: ongoing contamination from an unidentified source; or redistribution of toxic metals. Sometimes it's like peeling the layers off an onion; the heavy metals seem to come out in quantum leaps. Simply continue the detox therapy until a downward trend is seen. Every milligram of DMSA pulls out a load of toxic metals.

Getting rid of pesticides and VOCs

The best method is through 'heating systems'. The source of heat does not matter very much-exercise, hot baths, saunas and sunshine should all be effective. But many patients, especially my severe ME/CFS patients, are intolerant of heat. This is where far infrared (FIR) saunas are helpful. FIR heat penetrates several centimetres into the skin and subcutaneous tissues to mobilize chemicals without initially increasing core temperature. This way the heat is much better tolerated. Indeed, it is likely that FIR has other benefits over and above simple heating- perhaps this is part of why we love to lie in the sun, as sunshine addiction seems very common. It also seems to gives us a feeling of wellbeing and energy! The idea behind FIR saunas is that toxic chemicals that have been dumped by the body in fat, including subcutaneous fat, are shaken up and 'boiled off' through the skin where they dissolve on the lipid layer on the skin surface. Showering off these chemicals is as important as the sauna as, otherwise, they would simply be reabsorbed. It is not necessary to sweat for a FIR sauna to be effective-most chemicals come out in the first
5-10 minutes-so little and often can get the best results. If there is excessive sweating, then rehydration should include minerals and salt (about 1 g multiminerals and 2 g salt in one
litre of water). Sweat is essentially blood without cells and large molecules-but with all minerals present.

Roughly speaking, 50 FIR saunas will cut the total toxic load in half. As chemicals are removed exponentially, a further 50 saunas will reduce the total load to 25 per cent of the total and so on. But it's ever possible to get rid of every last toxic molecule. You will end up in a state of equilibrium with the environment-which, of course, is always polluted. I have done fat biopsies, DNA
adducts and/or gene studies on patients before and after FIR saunas. Levels of pesticides and VOCs come down reliably well. It may be that other techniques work just as well, such as exercise
(though not for my ME/CFS patients), traditional saunas (again, not tolerated by ME/ CFS patients), and hot Epsom salt baths (500 g Epsom salts in 15 gallons of water) where you
soak for 30 minutes and, as the toxic chemicals are removed, magnesium and sulphate are absorbed, so providing valuable detox raw materials. Although these techniques all should work
in theory, I do not yet have data to support such a conclusion. Some people are made ill even by FIR saunas. I suspect this may partly result from chemicals being mobilized into
the bloodstream, where they may cause acute poisoning. FIR saunas do not get rid of toxic metals.

Cleaning up your fat stores

Fats, oils and essential fatty acids (EFAs) are the building blocks from which cell membranes are made. Nearly all biochemical processes take place on cell membranes. They hold enzymes in
just the right configuration to allow the biochemistry to proceed efficiently. But the pollutants in our lifestyles bio- accumulate in our fat and cell membranes, with a major potential to disrupt normal enzyme functioning. Yet, simply consuming large amounts of clean organic fats and oils helps to displace these toxic oils. Dr Patricia Kane, based in New Jersey in the US, uses high doses of these clean oils intravenously and claims remarkable success across a range of neurological disorders. In the UK, the Burghwood Clinic (Banstead, Surrey) offers phospholipid exchange (a technique pioneered by Dr Kane to correct the proportions of fats and oils needed to replenish cell membranes; see www.burghwoodclinic.co.uk). I recommend oral high-dose organic oils
containing omega-6 and -3 EFAs in a 4:1 proportion, respectively, for purposes of detoxification. Hemp oil is naturally very close to this ratio.

Water. I do not advocate drinking lots of water as a detox method. While you may drink pure water, you won't urinate pure water, as friendly minerals are also washed out and lost. Some of the most poorly nourished people I see are those who believe it is healthy to drink several litres of water a day. An adequate intake for men is roughly 3 L/day (about 13 cups) of total beverages
and, for women, 2.2 L/day (about 9 cups), assuming no excessive sweating. Water should be taken with multiminerals and salt (if not already in the diet).

Dr Sarah Myhill is a British GP and author who has spent many years studying the causes of disease, especially the relationship between mitochondrial malfunction and fatigue. Her book The Diagnosis and Treatment of Chronic Fatigue Syndrome is available to buy on Amazon for lb14.99.


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