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Restoring the Whole Person With Nutritional and Botanical Detoxification: A Clinical Perspective David B. Wood, ND B.S. Microbiology, University of Washington, 1977 N.D., Bastyr University, 1983 Cofounder, President: Trinity Family Health Clinic, PS, 1984 Cofounder, Vice President, CMO: Bio-Genesis Nutraceuticals, Inc, 2000 5/23/2017 Recommending a Strategy By supporting the body’s natural detoxification pathways we can help our patients achieve a higher level of health. A true sense of well-being! 5/23/2017 Vision Statement Our bodies have always had to deal with toxins. Whether we are talking about metabolic waste products of our own metabolism or environmental toxins (xenobiotics), in order to survive and thrive our bodies use various detoxification pathways to stay clear of their damaging effects. My vision is to provide clinicians with the means to effectively assist their patients detoxify and achieve a level of health that allows them to fully enjoy their lives. To Promote True Restoration! 5/23/2017 Goal and Objective In order for your patients to achieve their highest health potential, you (the health professional) and your patient must realize that ongoing detoxification is foundational. While continuous exogenous support may not be necessary, healthy endogenous organ function is critical for exceptional health to be realized. 5/23/2017 Goal and Objective In this lecture I will review specific nutritional AND botanical support for enhancing Phase 1 and Phase 2 liver detoxification support as well as support for correcting intestinal dysbiosis and increased permeability ‘leaky gut’ conditions. In this way I hope to help you: 5/23/2017 Restore The Whole Person Goal and Objective In addition, it must be understood that in many ways the whole body is a detoxification organ. Our goal as physicians is not simply to mobilize toxins, but rather, to enhance our patients health to such an extent that their endogenous detoxification processes keep them healthy. 5/23/2017 “The human body is, in its living state, a unity, a complete and rounded whole. Every sensation, every manifestation of force, every interrelation of the material of one part is intimately concerned with the sensation, force, manifestation and interrelations of all the other parts; no part suffers without involving all the rest in suffering and alteration.” S. Hahnemann, Organon of Medicine 5/23/2017 Today’s Situation (Recent Past) Xenobiotic exposure (1989) 100% of human fat cell biopsies show elevated levels of known toxins (examples: styrene, 1,4-dichlorobenzene (moth balls, house deodorizers), xylene (gasoline, paints), plus many others. 100,000+ chemicals are common in commercial use. 25,000 (25%) are known to be hazardous. 5/23/2017 Today’s Situation (Recent Past) Xenobiotic exposure (Quantified 1989): According to the 1989 Toxics Release Inventory National Report 2,427,061,906 (billions) pounds of chemicals were emitted into our atmosphere. 1,180,831,181 (billions) pounds of chemicals were released into the ground threatening our drinking water. U.S. Environmental Protection Agency: Toxins in the community: national and local perspectives. The 1989 Toxics Release Inventory National Report. Washington, D.C.: Office of Toxic Substances 1991 5/23/2017 Today’s Situation (Recent Past) Xenobiotic Exposure (Quantified, 1989): 551,034,696 (millions) pounds of industrial chemicals were dumped into public sewage systems. 188,953,884 (millions) pounds of chemicals were discharged into our surface waters These were only from reportable sources! These statistics are from 1989 data. Today’s situation is probably worse! Corsello S, Ghen M, Kamhi E, Kratz A, Taylor J, Zampieron E. Cellular Detoxification: An Integrative Approach to Anti-Aging. Intrnl J of Int Med, Vol.2, No.6, Nov/Dec 2000 5/23/2017 Today’s Situation (Very Recent Past) Xenobiotic exposure (Quantified 2000): According to the 2000 Toxics Release Inventory (TRI) Public Data Release Report – Executive Summary 1,661,326,638 (billions) pounds Total Onand Off site Releases 88,756,085 (million) pounds Total Air Emissions 14,621,472 (million) pounds Surface water Discharges (on site releases) 5/23/2017 Toxics Release Comparison 1989 and 2000 3,500,000,000 3,000,000,000 2,500,000,000 2,000,000,000 1989 2000 1,500,000,000 1,000,000,000 500,000,000 0 Total 5/23/2017 Air Water Detoxification: Life And Health Depend Upon It! Remember 100% of human fat cell biopsies positive for xenobiotic toxins: 5/23/2017 Typical toxins present: organic solvents pesticides herbicides toxic metals Without exception all humans have bio-accumulated toxins! 5/23/2017 Some of the Many Possible Symptoms in the Patient with Impaired Detoxification ‘Brain fog’ Chronic sensitivities chemical, air, food Joint Pain Hives, rashes Fluid retention Headaches Frequent illness Immune dysfunction hypo, hyper, auto 5/23/2017 ‘Feels unwell’ Partial loss or exaggerated sense of smell or taste Digestive disorders Chronic fatigue, exhaustion Unable to concentrate, irritable, confused Mood swings Restlessness Recommendation Exercise Have fun! Take up cycling, running, swimming, weights, dancing, walking, kayaking, bowling, inline skating, hiking. Work at seeing life through the eyes of LOVE, JOY, PEACE AND FORGIVENESS. Very Detoxifying! Be creative! 5/23/2017 Recommendation Exercise enhances circulation (blood and lymph) and perspiration good circulation is essential to optimal detoxification increased nutrient delivery to target tissues cellular macro and micronutrient delivery mitochondrial nutrient delivery increased waste elimination capacity (washing via blood, lymph and elimination via lungs, skin, colon, kidneys) improved oxygenation 5/23/2017 Get moving! Detoxification: Whole Body Approaches ARC program: Avoid: exposure to xenobiotics as far as is practical 5/23/2017 What lifestyle changes is your patient willing to modify? Reduce: stored accumulated toxic burden Correct: imbalances and deficiencies that impair endogenous mechanisms for neutralization and elimination of toxins First Do No Harm! 5/23/2017 Detoxification: ARC Program Nutritional strategies: Positive lifestyle changes (diet, exercise, stress reduction) Liver detoxification support Intestinal detoxification support Enhancing whole body detoxification kidneys circulation (blood, lymphatic) perspiration respiration (lung, nasal/sinus) 5/23/2017 Recommendations Diet: 5/23/2017 Reduce or eliminate: Processed/refined foods (high in chemical preservatives, artificial colors, artificial flavors, fillers, binders, sugar, hydrogenated oils, low in fiber and nutritional value) Non-organic foods (high in pesticide, herbicide and hormone residues) Recommendations Reduce or Eliminate: Fish (large predator) high in toxic metal content (especially Hg, .5 - 1.0 ppm) Principle of Bioacummulation shark, swordfish, various bass, king mackerel, orange roughy, pike and porgy Dairy (except Whey) promotes absorption of MeHg and enhanced enterohepatic circulation (EC) EC: Instead of clearing toxin it is reabsorbed back into the systemic circulation 5/23/2017 Recommendations 5/23/2017 Rule out food/environmental allergy: Allergic reactions will create inflammatory processes which over time may impair optimal detoxification Create a ‘safe diet’. This diet is individualized for each patient based on their genetics (blood type), allergies, and consists of foods with lower toxic chemical residue. Recommendation Diet: Balanced CHO/PRO/FAT intake (40/30/30) (“Choosing Health…” M. Percival) Blood sugar balance Insulin/cortisol regulation elevated cortisol impairs detoxification , enhances EC Prostaglandin regulation - reduction of inflammation 5/23/2017 Recommendation Positive Nitrogen balance high CHO diets enhance toxic metal accumulation Fish protein promoted excretion of Hg. Eat low Hg content (.12 - .14 ppm) seafood (shrimp, sardines, Alaskan pollock, most tuna and salmon. URL:http://www.epa.gov/ost/fish/ Adequate amino acids to support GSH (glutathione) production 5/23/2017 Recommendation Increase fluid intake Pure water is essential to life. Water is the conduit for nutrient delivery and waste elimination. Our bodies are 70% water except in underlean individuals. Water is essential for healthy kidney function Adults - depending on activity/weight approximately 8 - 8oz glasses of pure water per day. 5/23/2017 Recommendation Stress Reduction: Stress is a killer! 5/23/2017 Stress raises cortisol output and leads to connective tissue thinning, impaired cellular utilization of thyroid hormones, impaired immune system response and increased EC. Stress interferes with the healthy circadian hormonal rhythms Stress interferes with the healthy regulation of blood glucose and impairs insulin utilization. Recommendation Stress Reduction: Encourage a healthy attitude toward life Promote prayer and meditation Prescribe ‘play time’ Most adults take life too seriously! Encourage them to have fun. Most will need to schedule this for it to happen. Take up a hobby Drawing, painting, blowing bubbles, listening to relaxing music, going for walks, enjoying the beauty of creation. “Stop and smell the Roses.” 5/23/2017 Recommendation Exercise IS A FOUR LETTER WORD? Remember when you were young you didn’t think about exercise. You played! Have fun! Be creative! Take up cycling, running, swimming, weights, dancing, walking, kayaking, bowling, inline skating, hiking. 5/23/2017 Recommendation Exercise enhances circulation (blood and lymph) and perspiration good circulation is essential to optimal detoxification increased nutrient delivery to target tissues cellular macro and micronutrient delivery mitochondrial nutrient delivery increased waste elimination capacity (washing via blood, lymph and elimination via lungs, skin, colon, kidneys) improved oxygenation 5/23/2017 Get your patients moving! 5/23/2017 Recommendation Reduce: Toxic burden Assess Detoxification Capacity: Rule out: Impaired detoxification: appropriate laboratory tests: 5/23/2017 liver detoxification panels (blood, urine, saliva - challenge test) Organic acid panels (urine metabolic end product screening) Urine, Serum or Hair heavy metal screening Digestive/Microbial/Parasitology (stool) Intestinal Permeability (lactulose/mannitol challenge - urine) Labs: Detoxification Capacity Some labs to contact for information on available screening tests: Diagnos - Techs (1-800-87TESTS) Doctor’s Data, Inc (1-800-323-2784) www.doctorsdata.com Great Smokies Diagnostic Laboratory (1-800-522-4762) www.greatsmokieslab.com Metametrix Clinical Laboratory (1-800-221-4640) www.metametrix.com 5/23/2017 Labs: Toxic Burden Accu Chem Labs (1-800-451-0116) Pacific Toxicology (1-800-328-6942) National Medical Services (national reference lab) (1-800-522-6671) www.nmslab.com 5/23/2017 “When in doubt: treat the liver” Old Naturopathic saying 5/23/2017 Recommendation Enhance endogenous Glutathione production (GSH): with ToxiHMF, UltraPure Whey protein, L- Glutamine Some substances rendered less toxic by GSH: Halogenonitrobenzenes and congeners - fungicides 2-Chloro-S-triazines and cogeners - herbicides Aryl Nitrocompounds - nitrates, nitrosamines Phenoltetrabromphthaleins - dyes Aryl & alkyl halides - solvents, intermediates Aryl & alkyl esters - solvents, flavorings Alkene halides - plastics (vinyl chloride) Allyl compounds - intermediates 5/23/2017 Recommendation Some substances rendered less toxic by GSH: Alkyl methanesulfonates - dyes, detergents Organophosphorus compounds - insecticides Arylhydrocarbon epoxides (arene oxides) - solvents Arylhalide epoxides - solvents Other epoxide intermediates - solvents Alpha, beta - unsaturated compounds Arylamines, arylhydroxylamines, carbamates, and related compounds - phenols Steroids - drugs (phenolics) Quinones and catechols - drugs Isothiocyanates - such as methylisocyanate Trichloromethylsufenyls - pesticides 5/23/2017 Recommendation Some substances rendered less toxic by GSH: Tricarbamates - pesticides Heavy metals - such as lead, mercury, arsensic, cadmium - found in paints, cans, gasoline, amalgam fillings, batteries, plating, food Bacterial toxins - Clostridia difficile Automobile exhaust, cigarettes Many over-the-counter (OTC) and prescription (Rx) drugs - substances detoxified by the liver and too numerous to name Braverman ER, Pfeiffer CC. The Healing Nutrients Within: Facts, Findings and New Research on Amino Acids. Keats Publishing, New Canaan, CT. p.101, 1987 5/23/2017 Recommendation Enhance endogenous Metallothionine production: Rx TriZinc + Ultra Pure Whey protein “Metallothioneins (MTs) store and release essential metals, such as zinc and copper, maintaining the low intracellular concentration of free essential metals. Thus MTs fulfill a regulatory capacity and influence transcription, replication, protein syntesis, metabolism, as well as other zincdependent biological processes.” 5/23/2017 Recommendation “Recent suggestions have implicated the metallothionein proteins (MTs) as potential ‘scavengers’ of brain mercury.” 5/23/2017 Aschner M et al, Methylmercury alters glutamate transport in astrocytes. Neurochem Int, 2000. 37(2-3):p.199-206. Recommendation Balance Phase 1 to Phase 2 processes Phase 1 processes (cytochrome P450 family) modification of toxin to bioactive intermediate compound which can now be prepared for elimination through Phase 2 conjugation Phase 1 cytochromes throughout body (liver, intestine, adrenals, skin, brain, breast, etc) 5/23/2017 Recommendation especially CYP3A4 up to 50% of total CYP in human liver metabolizes approximately half of all therapeutic agents Oxidation Reduction Hydrolysis Hydration Dehalogenation 5/23/2017 Recommendation Balance Phase 1 to Phase 2 processes Phase 2 processes (conjugation of bioactive intermediate compound with water-soluble substrate for preparation for elimination via urine or biliary-stool) Glutathione conjugation Sulfation Glucuronidation 5/23/2017 Recommendation 5/23/2017 Methylation Acetylation Amino acid conjugation A variety of chemicals (exogenous/endogenous) are conjugated through the above pathways. For additional information see: Functional Assessment Resource Manual. Great Smokies Diagnostic Laboratory Recommendation Balance between Phase 1 and Phase 2 pathways is the key. Phase 1 (excessive): excessive free radical reactive intermediate production. Possible liver damage, cancers, etc. Phase 1 (suppressed): inability to detoxify substance. Bioacummulation of toxin. Phase 2 (depressed): inability to conjugate and clear reactive intermediates produced from Phase 1 5/23/2017 REDUCE STORED TOXINS Xenobiotic Detoxification PHASE II Nonpolar Xenobiotic PHASE I Cyt.P450 oxidation reduction hydrolysis Conjugation reactions Intermediary Metabolite More polar More water-soluble Excretion in some instances *sulfation *glucuronidation *glutathione conjugation *acetylation *amino acid conjugation *methylation Conjugated Metabolite Polar Water-soluble Excretion Serum-kidneys-urine or Bile-faeces *Toxins = Endotoxins *end products of metabolism *bacterial endotoxins Exotoxins *drugs *alcohol *chemicals agriculture food additives household pollutants/contaminants Phase I *microbial [cytochrome P450 enzymes] intermediary metabolites * toxins Reactions nonpolar (lipid-soluble) •oxidation •reduction •hydrolysis •hydration •dehalogenation lipid-soluble (nonpolar) toxins stored in adipose tissue contribute to mobilized toxin load more polar Enzymes, Cofactors & more water-soluble) Other Nutrients Used ( riboflavin (vit. B2) niacin (vit. B3) Reactive Oxygen pyridoxine (vit. B6) Intermediates folic acid vitamin B12 glutathione branched-chain amino acids flavonoids phospholipids Antioxidant/Protective Nutrient/Plant Derivatives Phase I Liver Detoxification Pathway & Supportive Nutrients Superoxide Free radicals carotenes (vit. A) ascorbic acid (vit. C) tocopherols (vit. E) selenium copper zinc manganese coenzyme Q10 thiols(found in garlic, onions, & cruciferous vegetables) bioflavonoids silymarin pycnogenol catechins (green tea) Secondary tissue damage Botanical and Nutritional Intervention for Impaired Liver Detoxification Impaired Phase 1 (Cytochrome P450 system) lipotrophics B2, B3, B6, B12, folic acid, NADH acetyl l-carnitine taraxicum chelidonium chionanthus catechin EFA’s antioxidants 5/23/2017 Phase II intermediary metabolites Phase II Liver Detoxification Pathways & Supportive Nutrients [conjugation pathways] sulfation glucurondidation glutathione* conjugation acetylation amino acid conjugation excretory derivatives polar water-soluble Serum glycine taurine glutamine ornithine arginine methylation *N-acetylcysteine, cysteine, methionine are precursors Kidneys Urine Bile Feces/stools Secondary tissue damage Botanical and Nutritional Intervention for Impaired Liver Detoxification Impaired Phase 2 (Conjugation) 5/23/2017 amino acids: Whey protein, glutamine, methionine, aspartic acid, glycine, ornithine, arginine, cysteine, NAC, taurine Fe, Mo, Mg, Zn, Cu, Se Mg sulfate, Na sulfate cruciferous vegetables soy, garlic, ellagic acid reduced glutathione Liska DJ. The detoxification enzyme systems, Alt Med Rev, Vol.3, No. 3, pp. 187198, June 1998. Botanical and Nutritional Intervention for Impaired Liver Detoxification Hypoallergenic CHO/PRO/FAT ratio balanced diet Balanced nutrients to support Phase 1 & Phase 2 detoxification pathways (individualized based on lab tests) Cholagogues to support liver elimination via biliary system Rx: (BioG) BioLiv 1-2 BID - TID Hepatoprotectants (tissue protective factors vitamin, mineral, amino acid, botanical) Rx: (BioG) BioLiv 1-2 BID - TID 5/23/2017 Botanical Intervention for Impaired Liver Detoxification Single herbs useful to support and assist the liver in detoxification include: 5/23/2017 Artichoke (Cynara scolymus) Burdock (Arctium lappa) Dandelion (Taraxicum officinalis) Milk Thistle (Silybum marianum) Artichoke has been used traditionally for liver and gallbladder complaints It assists in detoxification by enhancing bile flow (cholagogue activity) thus supporting enhanced clearance of toxins via the biliary/colon route 5/23/2017 Arctium lappa (Burdock root): Animal and invitro studies show that burdock may have: Antibacterial, antineoplastic, antioxidant, antiretroviral, antiinflammatory and hepatoprotectant properties. In addition to protecting the liver, burdock’s antibacterial properties can help in detoxification by reducing the level of Bacillus subtilis and other bacterial pathogens. PDR of Botanical Medicine, 2004 5/23/2017 5/23/2017 5/23/2017 “Death begins in the colon” Old Naturopathic saying 5/23/2017 Why is Intestinal Health Important? Healthy liver phase 1/phase 2 balance will be difficult to achieve if leaky gut and microbial dysbiosis are present CYP3A4 (high intestinal activity): involved in steroidal hormone metabolism (testosterone, progesterone, estradiol, androstenedione, cortisol) Enterohepatic circulation (EC) will recycle toxin interfering with elimination 5/23/2017 Why is Intestinal Health Important? Putrefaction, fermentation, leaky gut and microbial dysbiosis will increase endotoxin load (indican, skatcol, putricine, cadaverine, etc., many) on the liver making exotoxin (xenobiotic) elimination inefficient at best. 5/23/2017 Rowland, IR. Toxicology of the colon: Role of the Intestinal microflora, in Gibson GR & Macfarlane GT eds., Human Colonic Bacteria: Role in Nutrition, Physiology, and Pathology, CRC Press, Boca Raton, 1995, pp. 155-174. Some of the Many Possible Symptoms/Indications of Intestinal Dysbiosis Hx Frequent ABO Tx, Corsticosteroids, BCP use High CHO, sugar diet Sensitive to perfumes, chemicals, cigarette smoke Worse damp, wet weather Crave sugar, bread, EtOH Fatigue, lethargy, ‘drained’ Feeling ‘spacey or unreal’ Allergies food, airborne, chemical Chronic Sinus Sx Numbness, burning or tingling 5/23/2017 Some of the Many Possible Symptoms/Indications of Intestinal Dysbiosis Muscle aches Pain and/or swelling in joints Headaches Can’t think/concentrate/poor memory Itching Digestive Sx Abdominal pain Constipation Diarrhea Gas/Bloating Mucus and/or blood in stool 5/23/2017 Consequence of detoxifying a patient with poor intestinal health: Your patient will go through “detox reactions”, feeling sick as your Rx’d treatment mobilizes toxins that are not being effectively eliminated from the body 5/23/2017 Botanical and Nutritional Intervention Intestinal Digestive Impairment Stool alkalosis and/or elevated valerate, isobutyrate, meat fibers and indican Rx:(BioG) UltraGest or PanZyme 1-2 BID TID with meals Hydrochloric acid (Betaine and/or Glutamic Acid HCl) Botanical Bitters (Gentiana lutea) Pancreatic enzymes + HCl (PanZyme) 5/23/2017 Botanical and Nutritional Intervention Intestinal Digestive Impairment 5/23/2017 decreased chymotrypsin, elevated triglycerides, cholesterol, positive for undigested carbohydrates Rx: (BioG) BioPan or Vegizyme 1-2 BID TID before meals Pancreatic enzymes Vegetable enzymes (for those with pork allergy or evidence of small intestine brush border enzyme deficiency) Botanical and Nutritional Intervention Intestinal Digestive Impairment Stool (elevated bowel pathogens: bacterial, fungal, amoebic, etc.) Pathocidal treatment (kill them suckers!) Rx: (BioG) ParaBiotic Plus 1-2 BID - TID with meals or if only fungal: Rx: Dysbioplex FNG ½ to 1 tsp BID or appropriate therapy based on stool sensitivity tests Natural options (berberine, garlic, olive leaf, uva ursi, grapefruit seed extract, artemesia, oregano, black walnut, thyme oil, tea tree oil, undecylenic acid, caprylic acid) 5/23/2017 Botanical and Nutritional Intervention Intestinal Dysbiosis Correction Beneficial Bacteria (decreased) Rx: ProFlora Plus 2 QD- BID without food appropriate probiotic (human specific, able to bind to receptor sites) L. acidophillus, L. rhamnosus Bifidobacteria Treatment initiated after completion of antimicrobial phase. 5/23/2017 Botanical and Nutritional Intervention Intestinal Dysbiosis Correction Beneficial Bacteria (growth factors) Rx: Diet (CHO/PRO/FAT ratio balanced) Diet - increase fiber intake (food sources, Rx flax, psyllium, etc) FOS (fructo-oligosaccharides) Whey protein - UltraPure Whey Protein 5/23/2017 Botanical and Nutritional Intervention Intestinal Permeability Excess “Leaky Gut” factors: decreased SIgA, increased urinary lactulose, increased lysozyme, increased lactoferrin, etc. correct digestive deficiencies avoid allergens (esp food, but also best to reduce environmental) balance flora (eliminate pathogens, increase beneficial) 5/23/2017 Botanical and Nutritional Intervention Intestinal Permeability Excess 5/23/2017 Rx repair factors: Intestinal Repair Complex 1 tsp BID – TID and/or IRC caps 2-3 BIDTID Note: powder and capsule formulas differ Glutamine, NAG Disaccharidase enzymes Botanicals (aloe, ulmus, althea, glycyrhiza) Additional support: Butyric acid, Vitamin E, antioxidants reduce toxic metal burden (esp. Hg) Botanical Intervention Intestinal Permeability Excess Finocarbo plus is useful in balancing the digestive function: Reduces indigestion Reduces bloating, intestinal gas Reduces abdominal discomfort Aides in toxin absorption Enhances gastric and biliary secretion 5/23/2017 Botanical Intervention Constipation Sollievo combines the laxative properties of Senna with herbs that promote healthy intestinal regulation. This formula reduces the side effects of anthrquinones. During any detoxification program CONSTIPATION should be avoided. Sollievo can assist the detox program by maintaining normal bowel regularity 5/23/2017 Recommendation: Nutritional Intervention Correct: Benefits of reducing bowel pathogens and enhancing friendly bacteria Pathogens can deconjugate toxins ‘activating’ them Pathogens enhance EC allowing toxin to be reabsorbed rather than eliminated Green Tea has antimicrobial activity against 5/23/2017 E Coli, Streptococcus species. Mild against Proteus species. 5/23/2017 Recommendation: Nutritional Intervention Imbalanced Flora (E.coli, streptococci, staphylococci, and yeasts - predominate methylators) can: methylate inorganic mercury (poorly absorbed) to methyl mercury (MeHg) (easily absorbed) Beneficial bacteria can: 5/23/2017 demethylate soluble MeHg into poorly absorbed inorganic mercury (Hg), which is more easily eliminated via the stools Chipman JK & Coleman R. Mechanism and consequences of enterohepatic circulation, in Hill MJ ed., Role of Gut Bacteria in Human Toxicology and Pharmacology, Taylor & Francis, Bristol, PA, 1995, pp. 245-259. Botanical Intervention for Enhanced Kidney/Bladder Toxin Clearance Assisting toxin clearance through the kidneys should not be overlooked. Here are two botanicals that I especially like: Horsetail (Equisetum arvense) Stinging Nettle (Urtica dioica) 5/23/2017 5/23/2017 5/23/2017 Chelation DMPS (2,3-dimercapto-1-propanesulfonic acid) Ruprecht J, Scientific Monograph: Dimaval (DMPS). 1997, Houston Tx: Heyltex Corp. DMSA (2,3-dimercaptosuccinic acid) Rx: (TR) Captomer 5/23/2017 Miller AL, Dimercaptosuccinic acid (DMSA), a nontoxic, water soluble treatment for heavy metal toxicity. Alt Med Rev, 1998. 3(3): p. 199-207 Chelation NAC (N acetyl - L - Cysteine) Rx: ToxiHMF 2-3 BID Green foods (Barley grass, Rye grass, spirulina, macro and micro trace minerals, etc.) Rx: BioAlkalizer 1 tsp QD-BID 5/23/2017 DMPS vs. DMSA Toxicology raging debate over which is safer DMPS appears safer than DMSA (Chemet/Succimer/Captomer) for adverse side effects However slow methodical removal using DMSA has had good patient compliance with few side effects DMPS increases excretion of Zn, Cu. DMSA conflicted reports some say does, some reports says no significant mobilization. 5/23/2017 DMPS vs. DMSA Effectiveness Both are definitely effective DMSA most effective for removing from all organs except kidneys eventually DMSA equals kidney Hg elimination of DMPS DMPS most effective for kidney Hg removal (135% incr. Excre) DMPS + Potassium citrate 163% increased excretion Potassium citrate + NAC 163% increased excretion 5/23/2017 Personally I rarely use DMSA or DMPS My products of choice are: Toxi HMF & BioAlkalizer (Occasional Use) 5/23/2017 A Word about: N-acetyl L-Cysteine (NAC) L-Cysteine: Avoid Rx’ing. Combines with MeHg to form a compound which closely resemebles L-methionine. Using same transport system as Lmethionine this compound easily crosses the BBB accumulating in the brain and kidneys Possible therapeutic intervention: methionine, phyenylalanine and leucine can block transport across BBB 5/23/2017 A Word about: N-acetyl L-Cysteine (NAC) NAC: Concerns from some researchers that NAC may have the same effect as L-cysteine no research to back up concerns. Statements were opinions only. Based on L-cysteine research, not NAC research research actually shows NAC enhances MeHg elimintion 5/23/2017 NAC “NAC efficiently mobilized methylmercury from all tissues examined, including the brain. The Hg content of blood, kidneys, and liver in mice that received NAC was approximately 10-20% that of control animals, whereas brain levels were decreased to about one-half those of controls.” 5/23/2017 NAC “Nearly 90% of the dose was eliminated in only 2 days when mice were exposed continuously to NAC in their drinking water.” “The rapid urinary excretion of NAC most likely explains its ability to enhance urinary methylmercury excretion.” 5/23/2017 Ballatori N et al, N-acetylcysteine as an antidote in methylmercury poisoning. Environ Health Perspectives, 1998. 106(5):p.267-71 NAC “N-Ac-L-Cys did not increase cerebral MeHg uptake showing that addition of an acetyl group to L-Cys abolished its ability to increase cerebral MeHg levels.” Thomas DJ and Smith JC, Effects of coadministered low-molecular weight thiol compounds on short-term distribution of methyl mercury in the rat. Toxicol Appl Pharmacol, 1982. 62(1):p.104-110. 5/23/2017 NAC “The ability of NAC to enhance methylmercury excretion when given orally, its relatively low toxicity, and its wide availability in the clinical setting indicate that it may be an ideal therapeutic agent for use in methylmercury poisoning.” Ballatori N et al, N-acetylcysteine as an antidote in methylmercury poisoning. Environ Health Perspectives, 1998, 106(5):p. 267-71. 5/23/2017 NAC NAC does not effect tissue distribution of essential minerals! (Ca, Mg, Fe, Zn, Cu) When Potassium citrate is given with DMPS or NAC elimination of Hg in the urine was further increased Note: ToxiHMF (contains NAC, K Citrate and other chelators) 5/23/2017 Whey Protein Rx: (BioG) UltraPure Whey Protein 1 Serving daily Increases endogenous production of GSH 5/23/2017 Bounous G, Gold P, The biological activity of undenatured dietary why proteins: role of glutatione (Abstract). Clin Invest Med, 1991. 14(4):p.296-309. Whey Protein excellent source of cysteine/cystine “Whey protein, derived from milk, contains about 2.5-3.0 percent cysteine/cystine and about 22 to 25% percent branched chain amino acids. Therefore, a high quality, partially hydrolyzed whey protein product provides a good source of cysteine/cystine to support intracellular GSH production and metallothionein synthesis, yet adequate leucine to minimize the transport of metals into the CNS.” Quig D., Cysteine metabolism and metal toxicity. Alt Med Rev, 1998. 3(4):p.262-70. 5/23/2017 Ratio Balanced Functional Foods Rx:(BioG) BioCleanse or BioInflammatory Plus Functional Foods Several Advantages for the patient and doctor balanced CHO/PRO/FAT profile hypoallergenic (typically rice protein) balanced vitamin, mineral, antioxidant profile Phase 1/Phase 2 detoxification pathway support promoting balanced detoxification pathways 5/23/2017 Ratio Balanced Functional Foods Easy way to get the foundation in place for your toxic patient. Designed specifically to help those individuals with impaired detoxification pathways Can modify dosage up/down to suit patient needs Can add supportive capsule product(s) to increase coverage Choose from Functional Food for general detox needs or Functional Food for patients with underlying inflammatory conditions who need detoxification support 5/23/2017 Ratio Balanced Functional Foods General recommendations: Follow dosing according to schedule in product handout Generally set up for 17 - 21 day cleansing program. Can be used indefinitely for chronic patients. Determine maintenance dosage. Dosage can be modified for each individual - PRN Have patient follow hypoallergenic diet also detailed in product information handout (Elimination phase) 5/23/2017 Ratio Balanced Functional Foods After detox add foods back according to program directions (Challenge phase) Watch for any symptoms of allergy. Develop long term ‘safe diet’ based on patient response during reintroduction of avoided foods 5/23/2017 Intestinal Functional Foods Rx: (BioG) Intestinal Repair Complex 1 tsp BID-TID or IRC capsules 2-3 BIDTID Advantages: Nutritional support for “Leaky Gut” repair Ease of use: everything in one pleasant tasting product Simplifies treatment for patient improving compliance Can be mixed with BioCleanse or BioInflammatory Plus Functional Foods 5/23/2017 Intestinal Functional Foods Soothing factors for intestinal inflammation Digestive support with brush border disaccharidase enzymes (amylase, cellulase, invertase, lactase, maltase) Support for intestinal CYP enzyme balance and glutathione production 5/23/2017 Summary: General Treatment Outline Avoid/Reduce/Correct (ARC) Diet - Hypoallergenic, organic, balanced CHO/PRO/FAT, avoid dairy (except whey) Chelation - DMPS, DMSA (Captomer), ToxiHMF, green foods: BioAlkalizer 5/23/2017 Summary: General Treatment Outline Enhance endogenous elimination - Ratio balanced functional foods such as BioCleanse or BioInflammatory Plus , ToxiHMF, UltraPure Whey, TriZinc, Glutamine powder or (IRC), Glutathione, L-Histidine, Garlic7000, UltraFiber, ProFlora Plus, digestive aides Enhance protective factors - antioxidants (ARLA, Vit. E, Selenium, etc.), B vitamins, EFA (esp. Omega 3), botanicals 5/23/2017 Vis Medicatrix Naturae: The Healing Power of Nature Our bodies strive for health and healing. This is innate. Supply what the body needs and it will heal itself. Work with the body, not against it! 5/23/2017 Algorithm: Detoxification with Nutraceuticals/Botanicals Determine Patient needs Detox Program (Health history, chemical/environmental sensitivity Provocative testing, screening questionaire(s)) Yes Complicated? Yes No + Standard Intervention: BioCleanse, Toxi HMF, UltraPure Whey Protein, IRC powder, Finocarbo plus, Sollievo, UltraFiber Plus, ProFlora Plus 5/23/2017 Response Favorable? 1/4-1/2 dose Standard Intervention Yes No Finish Intervention Standard Intervention 1/4-1/2 dose + Needs Botanical Support for Liver and/or Kidney Function? Liver Kidneys Pathological detoxifier, abnl LFT, etc Elv BUN/Creatinine Artichoke, Burdock, Dandelion, Milk Thistle, BioLiv Stinging Nettles Horsetail Dysbiotic Bowel? Bacterial, Fungal or Ameobic Pathogens 5/23/2017 ParaBiotic Plus, Dysbioplex FNG Green Tea caps Burdock Root (Complete first or Tx for at least 2 weeks prior To starting Standard Detox Intervention) Digestive Deficiencies? (HCl, Pancreatic, or SI brush Border enzymes) 5/23/2017 UltraGest, BioPan, PanZyme, or Vegizyme “Ease it Out” David Quig, Ph.D. Scientific Symposium 8/2000 International and American Associations of Clinical Nutritionists Detox slowly Optimize function Liver Gut (Do not detoxify a constipated patient, remember EC) 5/23/2017 Lewis SJ & Heaton KW. The metabolic consequences of slow colonic transit (Abstract), Am J Gastroenterol, Vol. 94, No. 8, pp. 2010-2016, August, 1999. Kidneys Blood sugar balance (Insulin/cortisol) Concluding Thoughts Healthy endogenous detoxification is critical for full health potential to be realized Resist the “green medicine” approach of symptom/prescription Tolle Causum: Identify and Treat the Cause 5/23/2017 Concluding Thoughts Work to improve your patients health at the cellular level Healthy cells produce healthy glands/organs and balanced chemical processes, which allow us to be healthy, coping with our internal/external environmental challenges Restoration cannot occur until these conditions are met! 5/23/2017 Resources Primary Moss, J. Moss Nutrition Report. Monthly issues from March 2000 to February 2001. www.mossnutrition.com (“mnr mnr”) 5/23/2017 Resources Secondary Functional Assessment Resource Manual, Great Smokies Diagnostic Laboratory Crinnion, W. Chemical Sensitivity: Natural History, Causes and Treatments, 45th Annual NW Naturopathic Physicians Convention, Tacoma, WA. May 11-13, 2001 5/23/2017 Further Information BioGenesis Nutraceuticals, Inc. 1.866.272.0500 David B. Wood, ND 5/23/2017 425.778.5673 [email protected] [email protected] “Beloved, I pray that you may prosper in all things and be in health, just as your soul prospers.” 3John:2 5/23/2017