Detoxification in the Human Organism

Paul Reller, L.Ac.

Many claims are made of simple herbal products to detox the body and this is very appealing to the public. The herbs do not directly detox the body, though, unless they are direct chelaters, able to conjugate with and transport heavy metal toxicities. Instead, the herbs useful in detoxification aid the body's own processes of detoxification, which are highly developed in the human physiology, and often need to be optimized with healthy choices in medical treatment as well as diet and lifestyle. Utilizing a professional Complementary Medicine physician, such as a Licensed Acupuncturist with extensive herbal knowledge as well as experience with nutrient medicine, insures that this process of detoxification is achieved.

To make the most intelligent choice of products to detox, it is best to understand what this process really is. Detoxification in the body is mostly performed by the liver, which houses Kupfer cells that contain rich quantities of macrophages to clear unwanted cells and toxins from the blood, and is also able to conjugate difficult toxins to bile salts to facilitate excretion if these chemical cannot be broken down. The other major way of clearing in the body is thus by excretion from the intestines and bowel. Excretion of toxins via the fluids, by sweating and urination is a much less effective way of elimination in the body. Health of the liver and intestinal tract is therefore of utmost importance in detoxification. The kidney plays a less potent role to excrete, ridding the body of excesses of normal chemicals that are broken down in the detoxification process, but many toxins are not able to pass the blood filters into the kidney.

Standard detox regimens include 1) aiding the liver to cleanse the blood more efficiently with diet, herbs, supplements and acupuncture, and 2) aiding the bowels in the elimination and excretion of stored toxins through fasting, colon cleanse, diet, herbs, probiotics, and acupuncture. Added to this is 3) tissue clearing through antioxidant activity and chemicals that attract and bind to heavy metals, such as EDTA (chelation). Clearing of toxins via sweating is touted but has little significant effect in studies. The number of ways that we might help the detoxification processes in the body are numerous, and should be tailored to the individual goals. Standard modern medical practice utilizes activated charcoal and milk thistle to detoxify the liver when acute liver toxicity threatens the health, utilizing both methods with great success, and both of these products are available and safe in standard practice. Chelation therapy using strong intravenous chemicals is also becoming a popular practice across the world, although it is still not accepted by the standard medical community in the United States except with acute threatening toxicities. For nontoxic chelation a formula utilizing EDTA and chlorella is now standard and effective for helping the body to eliminate heavey metal toxin accumulation. For patients concerned with accumulated toxicity that is less acute, and simpler, such as toxicity from cigarette smoking, alcohol abuse, or common environmental pollutants, a course of herbs and key nutrient supplements to enhance the liver glutathione and enzyme metabolism may be the focus of therapy, and acupuncture may enhance this process greatly.

What toxins are we clearing?

Accumulations of environmental chemicals from cleaning products, flame retardants, plastics etc., air and water pollutants, and chemicals from the food are the major toxins in our bodies. Of special importance is the accumulations in our tissues, especially in the organ tissues and central nervous system, of small particle heavy metals, such as lead and mercury, that enter our bodies from the air or via the food chain and water supply. We must thank the Obama administration in 2010 for finally enacting effective EPA regulations that curtail the enormous tonnage of airborne lead and mercury toxins in the major industries creating this toxicity, coal-fired power plants, smelters, chloralkili producers, and concrete manufacture. Other heavy metal toxicities are also of concern, not the least of which is iron accumulation. This issue is more thoroughly addressed in my article on lead and mercury on this website. In some individuals, the toxins that are most damaging are composed of the chemicals resulting from breakdown of various pharmaceutical drugs. This is dependant on the types of medications and the number of medications being broken down, or catabolized, in the body. Examples of this toxicity are cited below in additional information links. The amount of toxic pesticides, chemical fertilzing agents, and other farm chemicals is growing as corporations take over more and more of our nation’s farms and destroy more and more of the natural barriers to erosion and runoff into our water supply. As the rate of topsoil depletion accelerates, the need for more chemicals to maintain high crop yields increases. This toxicity also empties into our oceans and accumulates in our seafood. Mining and drilling, especially as we go deeper into the earth, with natural gas fracturing methods, and shale oil drilling, also creates massive amounts of water toxicity due to the need to use water to create pressure to break up rock and force oil and gas to the surface. Much of this “fracking” wastewater contains radioactive and heavy metal contaminants from deep in the eath, and this is dumped into our water supply. Natural toxins are also created by the body’s metabolism, the most damaging and ubiquitous being the oxidant free radicals, and excesses of protein fragments, but normal healthy bodily function and diet are effective in eliminating natural toxic accumulations, unless the body is overly stressed by ill health or obesity. In addition, acetaldehyde toxicity is an area of focus in recent years, and is related to alcoholism and chronic candidiasis as well as environmental aldehydes.

As stated, synthetic medications, and the products created from the catabolism of synthetic medications, are treated as toxins in the liver and intestinal tract. The rate of chemical breakdown in the liver, or detox, usually determines the levels of prescription drugs in the body. When liver detoxification is not efficient, these levels of circulating synthetic drugs may be altered, resulting in overdosage and potential harm. Many side effects of medication occur well after starting the medication, and are the result of slow increases in circulating levels of the chemicals because of inefficient breakdown, or catabolism, of the drug. There are many published cautions or contraindications in drug combination, and these are mainly addressing the drugs that use the same metabolic methods of breaking down the drugs in the liver. Too often, these contraindications and warnings are ignored. The family of liver enzymes referred to as P450 are the most well known metabolic factors that regulate the rate of drug catabolism. Dangerous drug interactions may occur when one drug inhibits or induces a P450 enzyme activity and slows or speeds the breakdown of other drugs in the liver, resulting in altered levels of circulating dosage. By taking a number of drugs that utilize the same P450 enzymes, the chance that the circulating levels will be altered over time increases. Sometimes, the stress that this creates on the liver contributes to unhealthy liver function, which may significantly decrease the ability of the body to detoxify.

Addressing liver health is of prime importance in detoxification. It is best to decrease the stress on the liver by decreasing the amount of chemicals in the body, by adopting a more natural diet and home environment, and by decreasing medication dependency whenever possible. Most drugs are immediately broken down by a certain percentage in the liver (over 4-12 hours), although some directly deposit in the body tissues, such as muscle, fat and bone, and may accumulate, just as other chemical toxins do. The rate of immediate breakdown, or catabolism, is called the half-life, implying that half of the drug is broken down into metabolites in a short period of time. This determines the time between dosage of the drug. The more prescription drugs that are taken the more stress is placed upon the liver detoxification system, probably resulting in less efficiency in detoxifying unwanted chemicals or pollutants that we ingest by eating, drinking or breathing, as well as the other drug metabolites. When the liver is unable to clear toxins and chemicals efficiently, these environmental toxins and drug catabolites may circulate and deposit in the body tissues, often with fatty encapsulations to prevent contact with normal tissues. This type of tissue accumulation increases over time and eventually contributes to degeneration, disease and aging.

The rate, or efficiency, of toxin breakdown, or catabolism, in the liver is primarily determined by the enzyme metabolism. Enzymes are a class of molecules, mostly proteins, that regulate rates of metabolism and catabolism. When the liver is dysfunctional, the blood tests show that the liver enzyme transanimases are high in circulating blood. These are termed AST and ALT on your blood tests. High transanimases in circulation implies a problem with liver function, and/or high stress put upon the liver. Normal levels are exceeded in liver disease, but even levels in the high end of the normal range imply liver stress of a subclinical nature. More important enzymes of detoxification, such as glutathione peroxidase, are not routinely analyzed in blood tests. Enzyme metabolism may be normal on the blood test, but the liver may still have problems affecting detoxification metabolism. If the liver tissues accumulate toxic metabolites, such as oxidant free radicals, the tissues may become inflamed, and may harden (cirrhosis), and this may decrease efficiency of liver metabolism significantly. Fatty accumulation in the liver in the form of stored glycogen may also decrease the capacity of the liver to detoxify, as well as trap toxins in fatty accumulations. Excess consumption of fructose contributes greatly to this fatty liver accumulation, and poor liver function, or excess liver stress impairs the ability to the liver to catabolize glycogen stores at a fast enough rate. Therapy is directed toward clearing antioxidants and protein fragments, increasing circulation, and aiding the enzyme and glutathione metabolism in the liver. The degree of ill health of the liver is determined by the physician, who then prescribes the most tailored logical combination of herbs and supplements. Typically, a short course of herbal formula, with milk thistle, Vitamin B6, L-cysteine, L-glutamine, OptiZinc, alpha-lipoic acid, and N-acetylcysteine optimize the goals above. Proteolytic enzymes may also benefit tissue clearance in the liver. This course of nutrients optimizes various antioxdant pathways and provides the best bioavailability of glutathione, the key antioxidant.

Studies have shown that common environmental toxins, or pollutant chemicals, accumulate in the body tissues. Even a healthy person with a good diet, in an urban area, accumulates a large amount of toxic chemicals in the tissues over time. The older we are, the more difficult this detox becomes. Since true detox of our tissues is a complicated process, repeated, or habitual, detoxification help is the only real way to clear the body of toxins. Promotion of liver and intestinal health, as well as the avoidance of as many chemicals as possible is also essential, and should become a lifelong process. This involves a diet of organic foods, unpolluted water, and breathing of unpolluted air whenever possible, as well as avoidance of household chemicals such as chemical cleaning products. When this entire regimen is adopted, maximum detox is achieved. Since elimination by the GI tract is one way of detoxifying, fasting may also be a valuable aid, if you can tolerate fasting. What is most important, once again, is a healthy functioning GI and liver system. You may want to correct your digestive problems, and improve liver health with a course of treatment before adopting a detox regimen. This will insure better results. Herbal therapies may also provide stronger intestinal detoxification. Herbs with a high content of tannic acids can precipitate toxic substances in the intestinal lumen, converting them to insoluble substances, so that a high fiber diet or fast can eliminate them. Wu bei zi is an herb used in China for this purpose. Safe and effective herbal and nutrient chelating formulas may be utilized under guidance periodically. Acupuncture works in a symbiotic fashion to help the body detoxify and eliminate more efficiently.

The subject of detoxification is not as simple as many advertisers would lead you to believe. A simple change in diet with a mild herbal formula that aids the intestinal tract helps, but is only mildly effective. Once again, the medical advice presented on medical websites such as this one is more complicated than we would wish for. The idea that the human physiology is simple, and correcting problems with our health can be achieved with the magic pill or simple routine, is a fairy tale, though, that we all buy into in a consumer society. It's easier to advertise simple solutions, and so this is what we repeatedly hear. Reality is more complicated, but can be simplified by putting the process into the hands of a professional and following the professional advice.

So what about all these advertised products to detox and colon cleanse?

We see that products with a few simple herbs may help but are not the complete answer to detox. The claims are overblown. Be especially wary of products that don’t list the ingredients, spend too much on advertising, and support the product with the endorsement of a single M.D. Standard medical schools provide no instruction in herbal medicine and little nutritional medicine. Trust the professional herbalist that has graduated from a medical college specializing in Traditional Chinese Medicine (acupuncture et al) or Naturopathy. To really achieve detox one should work to develop a complete program. Guidance by a professional holistic or naturopathic physician is highly recommended due to the complexity of the process. There are a number of products that can be very potent and valuable in detox, though. Let’s discuss a few of these most valuable products I use and see and how they work.

Glutathione S transferase is a family of enzymes of the liver that is used by cells to detoxify and clear toxins and drugs from the body. The P450 and glucuronosyl transferase are emphasized in drug clearing metabolism, but the glutathione enzyme activity has a greater relationship to clearing toxins and cancer causing compounds. Sandalwood essential oil (most safely taken as alcohol extract or double boil water extraction), St. Johnswort and other herbs are found to be potent in increasing this enzymatic activity, as well as the combination of nutrient supplements already mentioned. St. John's Wort (Di er cao), contains a high level of quercetin and quercitrin as well, potent antioxidants, as do many Chinese herbs used to clear and protect the liver. Milk thistle has been well studied and found to benefit liver function and speed enzymatic detox, as have schisandra berries (wu wei zi), turmeric (jiang huang), and alpha lipoic acid (R-lipoic acid is the more active form). Schisandra chinensis berries have been proven to significantly increase the liver glutathione level and glutathione reductase enzyme activity. A percentage of the population lacks the 2D6 gene and has difficulty in liver detox metabolism, and these people are especially in need of herbal and nutrient aids. Studies also confirm that a percentage of the population lacks other significant genetic coding for liver detoxifying enzymes, P450, glutathione S-transferase, and N-acetyl transferase, increasing their risk for leukemia and stomach cancers significantly. The benefits of these detoxifying regimens in preventative medicine appear great in recent scientific study (see citations below).

Formulas in TCM utilize a number of herbs to work synergistically to improve liver function. I utilize such formulas as Ecliptex, Shu Gan +, Adv Chole Clear, and others, which are prescribed based on the individual’s overall health diagnosis. The NIH is currently entering phase three of clinical trials of the simplest liver formula, Xiao Chai Hu Tang, called Sho-Saiko-to in the Japanese clinical trials of liver clearance of Hepatitis C. To check out the study parameters presented by the NIH, click here: http://clinicaltrials.gov/ct2/show/NCT00633230.

Activated charcoal is very effective to attract toxins from the intestinal tract. Flax, fennel and fenugreek seeds have long been used in traditional medicine to cleanse the intestinal tract. The best way is to mix the seeds, take a heaping tablespoon each day, soak in warm water, and then chew thoroughly and swallow. This tastes weird because of the mucilage, but will be very effective if taken for a week or so daily.

Most advertised herbal detox formulas use simple herbal strategies with fennel, dandelion root, etc. These herbs are beneficial but not extremely effective chemically in aiding liver function or bowel elimination, and they certainly do little to aid chelation. These herbal products are often based on the most common herbs appearing in research, are very gentle, and may have little noticeable impact, and thus generate less complaint of the common clearing effects sometimes seen when the body goes through a more vigorous detoxification, which may include itching, stomach upset, or loose bowel movements. Does the patient know that these products are working? The answer is no. These products are kept simple and achieve mild stimulation, giving the patient the impression that they are detoxing because they feel a little better when a healthy diet and herbal supplements are used. Most often these simple commercial products do not utilize sound science and have exagerrated claims of effectiveness. While commonly advertised detox herbal products may not provide a strong detox stimulation, they can’t hurt. Dandelion, burdock, fennel, fenugreek, and nettle can all be added to your diet and give benefit in aiding the body's natural detoxifying mechanisms. To achieve a potent detoxification, though, utilizing professional individualized protocol to achieve specific detox goals is recommeded.

Some combinations of herbs and nutrient medicines provide intelligent formulas to achieve detoxificating goals. Acetaldehyde toxicity is common in the population, via chronic candidiasis, air pollution, excess alcohol consumption, etc. and the product AL Cofactors by Vitamin Research includes key nutrients to help the body clear this toxicity and promote increased glutathione metabolism. Such products as this provide an economical treatment product to help achieve goals. It must be noted, though, that taking even such a well formulated product does not achieve complete detoxification and clearance, and each patient is an individual, with different detox needs. This is why a professional that is knowledgeable is able to help you achieve these goals in an objective manner that is thorough and comprehensive.

To reiterate, detoxification and removal of stored heavy metals (chelation) are processes that each healthy body engages in daily. The patient may want to increase the rate of detoxification and chelation, and a variety of strategies, ranging from very gentle, to very strong, are available. Very potent chelation and detoxification needs to be supervised in a clinic, while gentle protocols can be utilized at home, or with therapy from a professional herbalist and Complementary Medicine physician utilizing nutrient medicine. Products on the grocery or drugstore shelf may not be dependable, or may be too gentle. A TCM physician with knowledge of this therapy may utilize three strategies. One, herbs and supplements that are proven to aid the liver in its natural detoxification processes, and the glutathione system in its cellular detox can be prescribed; two: intestinal clearing may be aided by herbal formulas, activated charcoal, and various specific herbs and nutrients, individually prescribed on a case-by-case protocol; and three: chelation of heavy metal and toxin accumulation in tissues can be stimulated with a variety of herbal and nutrient products. You may read more about chelation of heavy metals, and heavy metal environmental toxins on another article on this website, and you may read more about the glutathione metabolism as well.

Information Resources

1. An example of medication breakdown, or catabolism, in the liver, which produces even more harmful chemicals than the medication itself, is cited in this study of AZT catabolites: http://molpharm.aspetjournals.org/cgi/content/abstract/39/2/258
2. A conservative but informative article from the American Heart Association explains some of the pharmacodynamics of prescription drugs and the effect on the liver, with drug-drug contraindications and explanation of ill effects on the liver metabolism with statin drugs to lower cholesterol: http://circ.ahajournals.org/cgi/content/full/109/23_suppl_1/III-50
3. A 2000 FDA labeling approval for a synthetic estradiol oral contraceptive reveals that concentrations of drugs in the body vary considerable from person to person depending on the individual health of the liver metabolism and competition for detox pathways: http://www.fda.gov/cder/ogd/rld/19190s34.pdf
4. A 2008 study published in the European Journal of Cancer Prevention showed that a percentage of the population is born with genetic polymorphisms, or tendency to express misshapen protein enzymes, related to alleles expressing P450, glutathione S-transferase and N-acetyl transferase. In the population with deficient expression of both the glutathione and acetyl transferase enzymes, risk of acquiring acute myeloid leukemia, or bone marrow cancer, increased nearly 12%: http://www.ncbi.nlm.nih.gov/pubmed/18287869. Another study in 2000 found a significant relationship between deficient expression of P450 and glutathione transferase enzymes and esophageal cancers: http://www.ncbi.nlm.nih.gov/pubmed/10868687. These studies were a follow-up to a 1997 study of glutathione deficiency genotypes and the relationship to cancer susceptibility by the University of Pennsylvania School of Medicine: http://www.ncbi.nlm.nih.gov/pubmed/9298582?

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.