Restoring the Whole Person With Nutritional and Botanical Detoxification: A Clinical Perspective

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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

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Recommending a Strategy

• By supporting the bodys natural detoxification
  pathways we can help our patients achieve a
  higher level of health.
• A true sense of well-being!

3
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!

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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.

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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
• Restore The Whole Person

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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.

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• 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

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Todays 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.

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Todays 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

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Todays 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. Todays
  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

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Todays 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 On- and Off
  site Releases
• 88,756,085 (million) pounds Total Air Emissions
• 14,621,472 (million) pounds Surface water
  Discharges (on site releases)

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Toxics Release Comparison 1989 and 2000
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Detoxification Life And Health Depend Upon It!

• Remember -
• 100 of human fat cell
• biopsies positive for
• xenobiotic toxins
• Typical toxins present
• organic solvents
• pesticides
• herbicides
• toxic metals

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Without exception all humans have
bio-accumulated toxins!
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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

• Feels unwell
• Partial loss or exaggerated sense of smell or
  taste
• Digestive disorders
• Chronic fatigue, exhaustion
• Unable to concentrate, irritable, confused
• Mood swings
• Restlessness

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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!

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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
• Get moving!

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Detoxification Whole Body Approaches

• ARC program
• Avoid exposure to xenobiotics as far as is
  practical
• 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

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First Do No Harm!
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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)

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Recommendations

• Diet
• 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)

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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

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Recommendations

• 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.

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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

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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. URLhttp//www.epa.gov/ost/fish/
• Adequate amino acids to support GSH (glutathione)
  production

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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.

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Recommendation

• Stress Reduction
• Stress is a killer!
• 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.

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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.

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Recommendation

• Exercise IS A FOUR LETTER WORD?
• Remember when you were young you didnt think
  about exercise. You played!
• Have fun! Take up cycling, running, swimming,
  weights, dancing, walking, kayaking, bowling,
  inline skating, hiking.
• Be creative!

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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

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Get your patients moving!
Get your patient's moving!
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Recommendation

• Reduce Toxic burden
• Assess Detoxification Capacity Rule out
• Impaired detoxification
• appropriate laboratory tests
• 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)

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Labs Detoxification Capacity

• Some labs to contact for information on available
  screening tests
• Diagnos - Techs (1-800-87TESTS)
• Doctors Data, Inc (1-800-323-2784)
• www.doctorsdata.com
• Great Smokies Diagnostic Laboratory
• (1-800-522-4762) www.greatsmokies-lab.com
• Metametrix Clinical Laboratory
• (1-800-221-4640) www.metametrix.com

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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

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When in doubt treat the liver

• 
  Old Naturopathic saying

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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

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RecommendationSome 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

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RecommendationSome 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

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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 zinc-dependent biological
  processes.

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Recommendation

• Recent suggestions have implicated the
  metallothionein proteins (MTs) as potential
  scavengers of brain mercury.
• Aschner M et al, Methylmercury alters glutamate
  transport in astrocytes. Neurochem Int, 2000.
  37(2-3)p.199-206.

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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)

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Recommendation

• especially CYP3A4
• up to 50 of total CYP in human liver
• metabolizes approximately half of all therapeutic
  agents
• Oxidation
• Reduction
• Hydrolysis
• Hydration
• Dehalogenation

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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

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Recommendation

• 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

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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

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REDUCE STORED TOXINS
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Toxins
Endotoxins
end products of metabolism
bacterial endotoxins
Exotoxins
drugs alcohol
chemicals
agriculture
food additives
household
pollutants/contaminants
microbial
toxins
Reactions
( )
Phase I Liver Detoxification Pathway Supportive
Nutrients
pyridoxine (vit. B6)
amino acids
Antioxidant/Protective
Superoxide
(found in garlic, onions,
cruciferous vegetables)
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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
• EFAs
• antioxidants

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excretory
derivatives

• sulfation

Phase II Liver Detoxification Pathways Supporti
ve Nutrients
polar

• glucurondidation

• glutathione conjugation

water-soluble

• acetylation

• amino acid conjugation

Serum
Kidneys

• methylation

Urine
N-acetylcysteine, cysteine,
Bile
methionine are precursors
Feces/stools
Secondary
tissue damage
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Botanical and Nutritional Intervention for
Impaired Liver Detoxification

• Impaired Phase 2 (Conjugation)
• 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. 187-198, June 1998.

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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

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Botanical Intervention for Impaired Liver
Detoxification

• Single herbs useful to support and assist the
  liver in detoxification include
• Artichoke (Cynara scolymus)
• Burdock (Arctium lappa)
• Dandelion (Taraxicum officinalis)
• Milk Thistle (Silybum marianum)

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• 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

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Arctium lappa (Burdock root)

• Animal and invitro studies show that burdock may
  have
• Antibacterial, antineoplastic, antioxidant,
  antiretroviral, anti-inflammatory and
  hepatoprotectant properties.
• In addition to protecting the liver, burdocks
  antibacterial properties can help in
  detoxification by reducing the level of Bacillus
  subtilis and other bacterial pathogens.
• PDR of Botanical Medicine, 2004

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Death begins in the colon

• Old
  Naturopathic saying

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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

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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.
• 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.

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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

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Some of the Many Possible Symptoms/Indications of
Intestinal Dysbiosis

• Muscle aches
• Pain and/or swelling in joints
• Headaches
• Cant think/concentrate/poor memory
• Itching
• Digestive Sx
• Abdominal pain
• Constipation
• Diarrhea
• Gas/Bloating
• Mucus and/or blood in stool

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Consequence of detoxifying a patient with poor
intestinal healthYour patient will go through
detox reactions, feeling sick as your Rxd
treatment mobilizes toxins that are not being
effectively eliminated from the body
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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)

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Botanical and Nutritional Intervention
Intestinal Digestive Impairment

• 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)

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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)

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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.

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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

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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)

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Botanical and Nutritional Intervention
Intestinal Permeability Excess

• Rx repair factors Intestinal Repair Complex 1
  tsp BID TID and/or IRC caps 2-3 BID-TID
• 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)

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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

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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

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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
• E Coli, Streptococcus species. Mild against
  Proteus species.

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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
• 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.

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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)

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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
• Miller AL, Dimercaptosuccinic acid (DMSA), a
  non-toxic, water soluble treatment for heavy
  metal toxicity. Alt Med Rev, 1998. 3(3) p.
  199-207

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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

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DMPS vs. DMSA

• Toxicology
• raging debate over which is safer
• DMPS appears safer than DMSA (Chemet/Succimer/Capt
  omer) 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.

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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

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• Personally I rarely use DMSA or DMPS
• My products of choice are
• Toxi HMF
• BioAlkalizer
• (Occasional Use)

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A Word about N-acetyl
L-Cysteine (NAC)

• L-Cysteine Avoid Rxing.
• Combines with MeHg to form a compound which
  closely resemebles L-methionine.
• Using same transport system as L-methionine this
  compound easily crosses the BBB accumulating in
  the brain and kidneys
• Possible therapeutic intervention methionine,
  phyenylalanine and leucine can block transport
  across BBB

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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

85
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.

86
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.
• Ballatori N et al, N-acetylcysteine as an
  antidote in methylmercury poisoning. Environ
  Health Perspectives, 1998. 106(5)p.267-71

87
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.

88
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.

89
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)

90
Whey Protein

• Rx (BioG) UltraPure Whey Protein
• 1 Serving daily
• Increases endogenous production of GSH
• 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.

91
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.

92
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

93
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

94
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)

95
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

96
Intestinal Functional Foods

• Rx (BioG) Intestinal Repair Complex 1 tsp
  BID-TID or IRC capsules 2-3 BID-TID
• 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

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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

98
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

99
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

100
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!

101
Algorithm Detoxification with Nutraceuticals/Bota
nicals
Determine Patient needs Detox Program (Health
history, chemical/environmental
sensitivity Provocative testing, screening
questionaire(s))
Yes
Complicated?
Yes
1/4-1/2 dose Standard Intervention
No
Standard Intervention BioCleanse, Toxi
HMF, UltraPure Whey Protein, IRC powder,
Finocarbo plus, Sollievo, UltraFiber Plus,
ProFlora Plus
No
Finish Intervention
Response Favorable?
Yes
102
Standard Intervention 1/4-1/2 dose
Needs Botanical Support for Liver and/or
Kidney Function?
Liver Pathological detoxifier, abnl LFT, etc
Kidneys Elv BUN/Creatinine
Stinging Nettles Horsetail
Artichoke, Burdock, Dandelion, Milk Thistle,
BioLiv
Dysbiotic Bowel? Bacterial, Fungal or Ameobic
Pathogens
103
ParaBiotic Plus, Dysbioplex FNG Green Tea
caps Burdock Root (Complete first or Tx for at
least 2 weeks prior To starting Standard Detox
Intervention)
UltraGest, BioPan, PanZyme, or Vegizyme
Digestive Deficiencies? (HCl, Pancreatic, or SI
brush Border enzymes)
104
Ease it OutDavid 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)
• 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)

105
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

106
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!

107
Resources

• Primary
• Moss, J. Moss Nutrition Report. Monthly issues
  from March 2000 to February 2001.
  www.mossnutrition.com (mnr mnr)

108
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

109
Further Information

• BioGenesis Nutraceuticals, Inc.
• 1.866.272.0500
• David B. Wood, ND
• 425.778.5673
• dwoodnd_at_trinityclinic.com
• dwoodnd_at_bio-genesis.com

110
Beloved, I pray that you may prosper in all
things and be in health, just as your soul
prospers.3John2