Detoxification Basics

From alcohol and drug detoxification to colon cleanses that could just as easily be called “colon blow,” the word detoxification implies many things to many people. Thus, detoxification is often misunderstood as a key component to health for many of our patients. Clearly defined, detoxification provides a setting where people can move into change for 10 to 30 days and begin the process of healing. My patients start with the gastrointestinal tract then move to the liver. It makes sense to clean out and restore the pipes before dumping anything else into the sewer. Below, the basics of detoxification will be explored then an overview of the 4” R” Program, which is a great place to start any detox. The next article will delve into liver support and detoxification.

Supporting Organ System

The basic paradigm in functional nutrition of detoxification is one of supporting the function of the organ system. Water and juice fasting, master cleanses, psyllium and other fiber preparations, bentonite clay and charcoal all have a role. However, if the organ isn’t nutritionally sound, all of these solutions are superficial and will not have a sustained effect on the patient. It’s like asking the pistons to move without the oil, it just isn’t going to happen very long or very efficiently. The pipes may be clean, but they can’t function for long without the proper support.

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Who needs detoxification? Most of our patients don’t walk in the door eating clean and in perfect health. Many come in with stomach and digestive issues. Detox is a great place to start diets and can be very helpful to get past plateau’s during weight loss programs. It offers the body a break from antigenic, high-calorie foods while supporting the function of the organs optimally.

The standard 4” R” program comes from the Institute of Functional Medicine. It is the most basic gastrointestinal detox program and yet is still the “gold standard’ if you will.

Remove:

Remove all offending substances. This may include food, toxic exposures like additives, parasites, bacteria or yeasts. There are functional lab tests that can be performed. IgE and IgG food allergy tests are available. Both have their limitations. IgE tends to catch those foods the body reacts to immediately, where the IgG only catches delayed hypersensitivities, and it is controversial. We have found that many people know their food allergies, IgE reactions. However, most do not know their sensitivities, as in the IgG reactions, and IgG testing is beneficial.

I have learned that 99% of my patients are wheat and dairy sensitive, and the test results provide them concrete evidence to move away from those foods. We know that foods will induce NFkB, similar to microbial and viral super-antigens, a substance which moves from the cytosol to the nucleus to induce cytokine transcription, leading to inflammation and further increased intestinal permeability. At the very least, removing wheat and dairy is a great place to start a detox program.

Replace: 

What needs to be replaced? Patients will need a food plan so they know what to eat for a typical breakfast, lunch, and dinner. We have found medical food meal replacements like Clear Change Renew (Metagenics) or the CoreRestore program (OrthoMolecular) very helpful for patients due to the structure these medical foods provide. Patients can start with a 10-day program, and many will progress to 28 days after experiencing results. For stomach complaints, replacing digestive enzymes can be very beneficial. If the patient is complaining of feeling full or not digesting well, adding digestive enzymes with HCl is helpful.

Complaints of chronic iron deficiency or nausea after supplements indicate low stomach acid and high pH. Using HCl to combat this diagnosis can be helpful. Start with at least 150 mg of Betaine HCl per tablet, one tablet per meal, increasing up to 5 per meal. Some practitioners believe 500 mg tablet is also acceptable with the same instructions. If at any time the patient experiences warmth or heartburn, decrease the dosage to his or her comfort level. Over time, the patient will continue to need a lower and lower dosage. I use OrthoDigestzyme, it is gentle but highly effective and contains HCl as well as digestive enzymes.

Reinoculation: 

Imbalanced flora is implicated in many disorders from IBS and IBD to multiple types of arthritis, eczema, psoriasis, and autoimmune disorders. I start patients with Pro225 (OrthoMolecular). Pro225 contains, as its name would suggest, 225 billion colony forming units. It is designed for short term use and comes in boxes of 15 packets, which is perfect to add to a medical food or protein shake. This product does a great job of reinoculating the gut with the proper flora without causing too much gas and bloating.

The addition of pre-biotics, like FOS and short-chain fatty acids, may increase discomfort at this stage of treatment for patients, and waiting until their system is cleared for 10 days may offer better compliance. Also, the patient should be eating more fruits and vegetables during this time, thus naturally providing extra fiber and pre-biotics. Once the Pro225 treatment is finished, there are many strains of Lactobacillus and Bifidobacillus available. Physicians may have greater patient compliance by utilizing a product called Ease that combines the digestive enzymes with protected probiotics.

Repair: 

Repairing the system starts with the three previous steps. Missing one of those will negatively influence the results. It is not okay to give patients digestive enzymes only when they are eating a days’ worth of junk food. That is akin to giving antacids for heartburn without discovering the cause – which for most patients is a high carb diet and sugar. Many patients have had poor diets and are not digesting well, and therefore, dietary deficiencies are common.

The essential nutrients that are necessary for repair including glutamine have not been ingested, and essential fatty acids like EPA and DHA from fish oils have many studies to support their use for decreased inflammation and luminal repair, zinc and pantothenic acid. Finding a medical food with these properties is very helpful for compliance along with providing the nutrition necessary to repair the broken system. This is the step that is commonly missing. The intestinal epithelial cells must have the nutrition necessary to rebuild the structure. Juice fasts and colon cleansing products often do not address this issue, and patients end up deficient and right back where they started within a few weeks.

The 4” R” program can launch a great change for patients. Ten days is just long enough for the patient to start to feel good and provides a perfect time frame to encourage continued compliance.

Conclusion

A word of caution: if you really want lasting change with these patients, weekly follow up for about 8-12 weeks along with continued support for dietary change is essential. Patients are inclined to slip back into old habits very quickly as a “reward” for their hard work. It is up to you to be the doctor and have the necessary conversation. Be understanding, you know that eating lean protein, fruits, vegetables, and very little wheat and dairy is difficult; but in the long run, it helps prevent many chronic diseases. Clarify with the patient that the only way to have lasting health is to continue the healthy habits established during the cleanse.

The 4” R” program is a great place to begin if you have not offered detox programs in your office previously. It doesn’t require many products, and it can be introduced at an in-office workshop. Your patients will appreciate a new approach to their digestive system.