I have spent a lot of time on gut clean up and food protocols over the last few articles, so I am shifting my focus to the liver. Once the gut and immune system are in order, the liver and mitochondria are the next place to start supplemental support.
Frankly, throwing support to the liver before the gut is cleaned up can be a double-edged sword. Yes, the gut is creating toxins, but most of that is directly related to the dysbiotic state of the intestines. Adding supplements to support the liver at this time may just end up putting more toxins into a leaky gut, leaving the patient feeling worse and not really accomplishing healing. The body can either heal the gut or detoxify the liver. So, once the intestines are healed, then liver function can be properly supported. A short review of the physiology then supplemental support will shed some light on the functional medicine approach to liver detoxification.
In general, we think of liver detoxification in two phases, Phase 1 and 2. The goal is to create water-soluble substances for excretion.
Phase 1 involves Cytochrome P450 group of enzymes. The CYP450 are in all tissues of the human body. Two primary functions are the creation and destruction of hormones, particularly cholesterol, estrogen, testosterone, and Vitamin D. They also act as the first group of enzymes to convert toxins, through the oxidase enzymes, to less toxic substances. Oxidation, reduction, and hydrolysis for detoxification occur in the liver. Some of these intermediate substances can actually be more toxic than the original substance. When this occurs, if the patient is deficient in the appropriate antioxidants, there may be further damage. This can be prevented by having adequate riboflavin, niacin, magnesium, iron, branched chain amino acids, flavonoids and certain phytonutrients such as indoles, like I3C for estrogen metabolism, and quercetin, to ensure reactions can take place and the intermediary can be shuttled to Phase 2 in a timely manner.
The antioxidants involved in protecting the body from the reactive intermediaries include:
- Branched chain amino acids
- Phytonutrients such as indoles, like I3C, and Flavanoids
- Nutrients Necessary for Efficient Phase 1Vitamins A,C,E
- Thiols – garlic, onions, cruciferous vegetables
Phase 2 Detoxification involves a process known as conjugation. Conjugation reactions include methylation, acetylation, glutathione conjugation, amino acid conjugation, and sulfation. The water-soluble molecule added allows toxins to be eliminated through the bile or urine.
Necessary nutrients include:
The clinical picture for liver dysfunction is varied. Non-alcoholic fatty liver (NAFL) is a growing epidemic. The number of toxins and the lack of real nutrient dense foods is to blame. Nearly one-third of Americans may have NAFL. Besides type-2 diabetes and hypertension, NAFL is associated with many vague symptoms. These symptoms may begin before the disease progresses, please be aware that a closer look at liver enzymes is necessary. The optimal value for ALT is 10-26UI/L, for AST is 10-26 UI/L and for GGT is 10-30UI/L. Any values outside of optimal indicate liver detoxification and/or pH issues. Symptoms associated with liver detoxification dysfunction include chronic headache of unknown origin, fatigue, confusion and difficulty concentrating, nausea, itchy skin, and rashes, long term weight loss plateau, and edema.
I’m sure most of you know the main symptoms, but I want to emphasize the importance of liver detoxification and patients with skin rashes and hives. We tend to want to go after their immune system, and of course, gut first always, but please keep in mind that some basic liver detoxification support is necessary as well. Also, for your weight-loss patients, getting stuck on a plateau is frustrating and enough for them to completely lose motivation. These patients have toxins accumulated in their fat in larger amounts. As they lose weight their body may not be able to keep up with the detoxification needs of the fat loss, and they get stuck. It’s time for a liver detox at this time.
My philosophy on liver detoxification is not about just increasing bile production. Remember, function first. I make sure they are on a modified Mediterranean diet with plenty of protein and vegetables, and low glycemic fruit, berries and apples, no starchy vegetables or grains. I also make sure they are taking a B-complex, which may need to be methylated. B-complex vitamins are cofactors for liver enzymes.
For the liver to be able to truly become more efficient at clearing the toxins, appropriate nutrients are necessary. Metagenics has been making UltraClear for as long as I can remember. It is the beginning product for these patients. I tend to start slow to get better compliance and let these patients ramp up their detoxification over a couple of weeks. After two canisters of UltraClear, I move to UltraClear Plus. The UltraClear Plus has added Phase 2 nutrients to maintain the balance of Phase 1: Phase 2 detox. After 2-4 canisters of UltraClear Plus, if the patient is still experiencing symptoms, I will shift to the UltraClear Plus pH which has added sodium citrate to improve pH balance.
Remember, enzymes like to work at a specific pH; if patients are still too alkaline, they will not detox as efficiently. For maintenance and for patients who are not responding, I use AdvaClear. It supports Phase 1 and 2 detoxification pathways. It can be used with any of the products and can be ramped up in dosage, 2 to 6 per day over the course of a month. I use 2 per day for maintenance dose for most of my patients who are poor detoxifiers. MetalloClear used in conjunction with the UltraClear can be very effective at clearing heavy metals, but this is a long and slow process. The patient needs to expect a 3-6 month time frame.
Liver detoxification can be rough on patients and they will need some extra support. Please let them know they will feel worse at some point in the process. Also, this is not a quick process, some of the enzymes necessary may take up to several weeks to be fully induced and working at full capacity. Patience is necessary.
As always, I am available for questions. You are welcome to email me at RestorCEO@gmail.com. Check out our new websites, TheGutsyGal.com, and RestorYou.com for more information.