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Modulating Metabolic Detoxification Pathways with Nutrition and Lifestyle Strategies

Improving Patient Outcomes

by Melissa Blake, ND

Metabolic detoxification is a complex set of coordinating systems working together to neutralize and eliminate toxic substances from the body. It is an amazing and intricate design. As suggested by design expert Irene Au, just like any good design, “when it works, no one notices, but when it doesn’t, it sure stinks.”

Patients know far too well just how much it does stink. Excess toxic burden (too much in, not enough out) has been associated with a number of chronic conditions and debilitating symptoms ranging from cancer to mood swings.1-10

It seems that no system is immune to the impact. Toxin exposure, as well as an individual’s ability to excrete them, have been linked to the development of degenerative diseases of cognitive, neurological, cardiovascular, immune, musculoskeletal, dermatological, and endocrine origins.1-10

Toxins are everywhere; however, there are many ways to minimize the impact of exposure. Nutritional and lifestyle strategies include optimizing gut health, providing key nutrients that support the detoxification process, and reducing exposure to avoid “retoxification.” This article provides an overview of these approaches that support the body’s natural design to reduce disease susceptibility associated with (exogenous) toxic burden.

Health (& detoxification) begins with the gut

The first point of contact with many potentially harmful toxins is within the digestive tract. The gut therefore plays an important role in acting as a barrier that may prevent the absorption and need for the liver to metabolize toxins in the first place.11

Gastric emptying, membrane integrity, as well as bile and enzyme secretion, are essential components of the detoxification process.11

Bowel movements also matter in the world of detox. Supported by dietary fiber and a balanced microbiome, stool is an essential route of elimination for toxins.11


Clinical tips for a detox-ready gut:

  • Promote barrier integrity and function with a diet rich in plant foods and their phytochemicals. Consider targeted supplementation that includes quercetin, curcumin, and berberine for their role in supporting tight junction integrity.12
  •  Include bitter & aromatic functional foods that support digestion and consider supplemental digestive enzymes with meals. Foods with digestive benefits include ginger, peppermint, aniseed, fennel, citrus fruits, dandelion, artichoke, lemon balm, and chamomile.13
  • Optimize bowel movements and microbiome balance with fermented foods, fiber, and targeted probiotic therapy.14

Dilution is the solution to pollution

Proper hydration contributes to optimal detoxification in a number of ways. Once metabolized, toxins travel out of the body through urine and stool. Healthy kidney function is required for urinary excretion of toxins, supported by adequate water intake.11 Individuals struggling with constipation may benefit from increasing water intake to ensure healthy bowel movements as a route of elimination.14

Clinical evidence also suggests the pH of urine can influence the elimination of toxins. A diet rich in fruit and vegetables that supply alkaline minerals that increase the pH of urine and enhance the elimination of toxins.11, 15

Overall hydration matters, as does the quality of the drinking water. Tap water can contain a number of potential toxins, including pesticides, unhealthy levels of lead, and glyphosate.16,17 The Environmental Working Group (EWG) offers a filter guide and a tap water database that can be helpful patient tools when making decisions about water.18


Clinical tips to dilute the pollution:

  • Ensure patients are consuming plenty of fluids in the form of filtered water, herbal teas, soups, and hydrating foods such as fruit and vegetables.
  • Monitor urine pH and work to alkalinize with fruits and veggies.
  • Consider a mineral supplement to encourage alkalinity and effective excretion of toxins from the body.15

Detox is energy- and nutrient-dependent

Metabolic detoxification is a three-phase process.11 Figure 1 offers a visual representation of the steps as well as the multiple nutrients involved.

Figure 1. Liver Cell Detoxification Mechanisms (Click image to enlarge)

Various enzymes and nutrients are required to support optimal functioning of the pathways involved.11 In fact, metabolic detoxification is highly nutrient-dependent, relying on a balanced input of macronutrients and micronutrients to function optimally. The focus should therefore not be on one or two single nutrients but rather on a spectrum.11

As a clinician, why should we care? The research suggests that at least 1/3 of our patients are at risk for one or more nutrient deficiencies.19 If that’s not concern enough, evidence also suggests that more than half of the calories consumed come from ultraprocessed, nutrient-poor foods.20

It is not a far stretch to assume many of our patients are deficient in the nutrients required to support detoxification. Switching to a whole food program that includes adequate protein as well as an abundance of plant foods that provide minerals, vitamins, and antioxidants is a necessary step toward optimizing a patient’s detoxification capacity.

Research has determined a number of plant foods, and their associated phytonutrients, modulate, induce, or inhibit detoxification activity.11,21 Foods with clinical evidence to support their influence on detoxification include cruciferous vegetables such as cabbage, broccoli, Brussels sprouts, cauliflower, etc., (indole-3-carbinol),  turmeric (curcumin), green tea (catechins), and onions and apples (quercetin).21 Adding specific foods and targeted supplements may be necessary for patients to achieve optimal results.


Clinical tips to provide the spectrum:

  • Ensure patients are consuming a variety of plant foods that offer the spectrum of nutrients required for detoxification.
  • Be intentional with supplementation. Consider indole-3-carbinol, curcumin, quercetin, vitamins, and minerals.
  • Promote antioxidant status. Consider foods and supplements that provide N-acetyl-L-cysteine, green tea catechins, beta-carotene, and vitamins C and E for antioxidant support.
  • Ensure adequate protein intake.

Reduce the retox

Practitioners have the ability to provide patients with empowering tools and education to reduce their exposure to various environmental toxins and prevent burden. The most powerful and empowering tool we have as lifestyle medicine practitioners is in food. The greatest source of toxicity for humans comes from the food and water we consume; therefore, modulating detoxification begins with what patients are putting on their plate.22

Reduce what comes in

  • Limit food that contain additives & food packaging chemicals.
  • Choose local and organic options whenever possible. Follow the guidelines outlined by the EWG to help spend grocery dollars wisely.
  • Consider water quality and choose filtered options when possible to reduce exposure to pollutants commonly found in drinking water.

Promote what goes out

  • To provide the diversity of nutrients required to support the energy-demanding processes involved in detoxification, patients should consider a whole, unprocessed diet rich in colorful plant foods.
  • Move beyond a liver-only focus and ensure protein, fiber, probiotics, and water are emphasized and optimized.
  • Integrate targeted supplementation to support the three phases of detoxification (Figure 1).

Final thought

This article focuses on exogenous/environmental toxins; however, to avoid mentioning the toxic impact of stress, loneliness, lack of purpose and connection, etc., would be missing the point. Detoxification is more than a 10-day program. Detox is a daily occurrence that includes every aspect of the mind and body. It is essential to figure out all the elements contributing to toxicity and to find a lifestyle that supports the body’s natural ability to achieve balance.

Good food, clean water, restorative sleep, movement, time in nature, and friendship are all considerations within a well-designed, lifestyle medicine approach to detoxification.

Citations

  1. JK et al. Evidence supporting a link between dental amalgams and chronic illness, fatigue, depression, anxiety, and suicide. Neuro Endocrinol Lett. 2014;35:537-552.
  2. Moro AM et al. Early hematological and immunological alterations in gasoline station attendants exposed to benzene. Environ Res. 2015;137:349-356.
  3. Callahan CL et al. Chlorpyrifos exposure and respiratory health among adolescent agricultural workers. Int J Environ Res Public Health. 2014;11:13117-13129.
  4. Bowler RM et al. Dose-effect relationships between manganese exposure and neurological, neuropsychological and pulmonary function in confined space bridge welders. Occup Environ Med. 2007;64:167-177.
  5. Baker MG et al. Neurological outcomes associated with low-level manganese exposure in an inception cohort of asymptomatic welding trainees. Scand J Work Environ Health. 2015;41:94-101.
  6. Freitas F et al. Urinary 1-hydroxypyrene is associated with oxidative stress and inflammatory biomarkers in acute Myocardial Infarction. Int J Environ Res Public Health. 2014;11:9024-9037.
  7. Chin-Chan M et al. Environmental pollutants as risk factors for neurodegenerative disorders: Alzheimer and Parkinson diseases. Front Cell Neurosci. 2015;9:124.
  8. Genuis SJ et al. Toxicant exposure and bioaccumulation: a common and potentially reversible cause of cognitive dysfunction and dementia. Behav Neurol. 2015;2015:620143.
  9. Tang M et al. Exposure to organochlorine pollutants and type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2014;9:e85556.
  10. Rochester JR. Bisphenol A and human health: a review of the literature. Reprod Toxicol. 2013;42:132-155.
  11. Metagenics Institute. The role of detoxification in the maintenance of health: Research review. 2018; MET2221. https://www.metagenicsinstitute.com/wp-content/uploads/2018/07/MET2221-Detoxification-Research-Review_MI.pdf
  12. Panwar S et al. Role of barrier integrity and dysfunctions in maintaining the healthy gut and their health outcomes. Front Physiol. 2021;12:715611.
  13. Valussi M. Functional foods with digestion-enhancing properties. Int J Food Sci Nutr. 2012;63 Suppl 1:82-89.
  14. Fathallah N et al. Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality. Presse Med. 2017;46(1):23-30.
  15. Mousa HA. Health effects of alkaline diet and water, reduction of digestive-tract bacterial load, and earthing. Altern Ther Health Med. 2016;22 Suppl 1:24-33.
  16. Environmental Working Group. https://www.ewg.org/tapwater/ewg-standards.php. Accessed January 13, 2022.
  17. Centers for Disease Control. https://www.cdc.gov/healthywater/drinking/public/water_treatment.html. Accessed January 13, 2022.
  18. Environmental Working Group. https://www.ewg.org/tapwater/. Accessed January 13, 2022.
  19. Bird JK et al. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. 2017;9(7):655.
  20. Martínez Steele E et al. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6:e0098
  21. Hodges RE et al. Modulation of metabolic detoxification pathways using foods and food-derived components: A scientific review with clinical application. J Nutr Metab. 2015;2015:760689.
  22. Rather IA et al. The sources of chemical contaminants in food and their health implications. Front Pharmacol. 2017;8:830.

 

Melissa Blake, ND is the Manager of Curriculum Development at Metagenics. Dr. Blake completed her pre-medical studies at Dalhousie University in Halifax, Nova Scotia and obtained her naturopathic medical training from the Canadian College of Naturopathic Medicine. Dr. Blake has over 10 years of clinical experience, specializing in the integrative and functional management of chronic diseases.

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