Detox. Seriously?

These days the media waves are cluttered with diets and products that claim to aide in detoxification.  Modern medicine is contemptuous of these claims and is quick to point out that there is very little science to support claims about detoxification.  Yet detoxification is an age-old treatment and has been used by traditional medicine systems the world over.  In Ayurvedic medicine, detox is a premier treatment, the pinnacle of which is Pancha Karma (PK).  PK involves an intensive regimen that includes simplified diet, herbs and therapeutic practices that help the body recover from the lingering results of improper diet, poor digestion and environmental toxins, the effects of which accumulate over time. In short: detoxification.  In India, many undergo these treatments in hospitals where the process is supervised by medical professionals.  More and more westerners, including myself, have also undergone these treatments.  In my case, I underwent PK to address troublesome symptoms of peri-menopause and can say unequivocally that after my Pancha Karma, I no longer experience my symptoms, the most troublesome of which were daily hot flashes.  As a side benefit, I lost ten pounds.

Methodical detoxification has a long track record in traditional medical systems other than Ayurveda, as well. I believe there is potential scientific basis as a useful therapeutic process, but suspect that those studies have not been undertaken because there is not a financial incentive to anyone in private healthcare to do the investigation.  Yet from the perspective of improving health overall (and reducing our overall need for expensive healthcare) it has potential to reduce health care spending.

One question to consider investigating is, why might these practices work?  We could start by looking at detox or cleansing as an intervention that removes stressors from a person’s diet or internal environment.  This therapeutic timeout gives the body an opportunity to reregulate its metabolic activities.  During this timeout, giving support with foods and/or herbs that upregulate the body’s natural detox systems can support the process.

From a Western science perspective, is this even possible?  While contemptuous of detox diets and herbs, modern medicine does actually recognize the process of detoxification in relation to alcohol and addictive drugs.  In the case of alcohol detoxification, it is well recognized that alcohol abuse causes damage to the lining of the gut as well as organ damage and nutritional deficiencies.  An alcoholic detoxing undergoes a specific medical regimen designed to support the body’s function while it recovers from alcohol poisoning.  The person is also given nutrients that are known to be deficient in those suffering from alcohol abuse.  It seems reasonable to extend the principle of a detox treatment to the known toxicity from carcinogens and pollutants which may affect metabolic function.

Some Science, Not No Science

While there is a dearth of science deeply examining detoxification, there is science that has examined certain parts of most detox programs.  Often, detox plans involve dieting, or at least restricting calories, by eliminating foods or macronutrients and including foods or herbs that support or help to restore healthy metabolism.  Recent science has investigated the benefits of intermittent fasting on markers of metabolic health and also on the effects of certain molecular components present in plant materials that appear to upregulate the activities of the detoxification systems in the liver.  There is also a growing body of science investigating the effects of micronutrients like flavonoids and beta-carotenes, etc., on the body’s ability to mitigate the effect of oxidative stress.

Recent studies in both rats and humans have examined the effects of the new diet-darling–intermittent fasting–which restricts calories severely on one or more days per week.  These studies have shown that intermittent fasting results in lower blood sugar and insulin levels, lower LDL cholesterol levels, decreased inflammation and lower oxidative stress.(1, 2, 3)  One study that examined the effects of calorie restriction combined with intermittent fasting resulted, not surprisingly, in decreased waist circumference (a measure of central adiposity or belly fat which is most correlated with negative health consequences) and lower weight as well as in positive changes in metabolic health markers.(2)

In a study that looked at the end-results of metabolism in the urine of rats subjected to dietary restriction, Wen, et al, found that the Phase II detoxification pathways were enhanced by dietary restriction.  Although detoxification pathways occur in other organs too, the liver is the primary site of detoxification.  Compounds that we ingest or the waste products of metabolic processes are metabolized by the liver so that they can be excreted.  One detoxification process is the CYP 450 pathway.  This is a two phase process, consisting of many enzymes, which is characterized by a first phase where fat-loving compounds are modified so that they are more water soluble.  These water soluble compounds are more reactive and could potentially cause oxidative damage, so they are further processed in a second phase where they are joined to other compounds that reduce their reactivity and allow their excretion from the body.(4)  Science is demonstrating that herbs traditionally used to support the liver, like dandelion and milk thistle, do induce or inhibit enzymes in this pathway(5,6) and that foods like garlic, cruciferous vegetables and citrus contain compounds that enhance these pathways.(7)

These fragments of scientific investigation into the overall area of detoxification suggest that methodical detoxification has a potential scientific basis as a useful therapeutic process.  In India, Pancha Karma has been practiced for at least 2000 years and has a long therapeutic record with a specific and accepted methodology.  Many therapies in traditional medical systems do not have a modern scientific basis but do have a long tradition of use and a historical track record.  We should not dismiss these therapies out of hand but learn from them and keep an open mind as to why they might work.  We should also keep in mind that modern scientific investigation is expensive and requires the allocation of a lot of resources and that cost might be a reason for lack of scientific evidence.

 References

  1. Reis de Azevedoa, F., Ikeokab, D., Caramellia, B. (2013)  Effects of intermittent fasting on metabolism in men.  Revista da Associação Médica Brasileira. 59(2):  167-173
  2. Kroeger, C.M., Klempel, M.C., Bhutani, S., Trepanowski, J.F., Tangney, C.C. and Varady, K.A. (2012)  Improvement in Coronary Heart Disease Risk Factors During an Intermittent Fasting/Calorie Restriction Regimen:  Relationship to Adipokine Modulations.  Nutrition and Metabolism.  9:98.  Available at:  http://www.nutritionandmetabolism.com/content/9/1/98
  3. Klempel, M.C., Kroeger, C.M., Bhutani, S., Trepanowski, J.F. and Varady, K.A. (2012)  Intermittent Fasting Combined with Calorie Restriction is Effective for Weight Loss and Cardio-Protection in Obese Women.  Nutrition Journal.  11:98.  Available at:  http://www.nutritionj.com/content/11/1/98
  4. Wen, H., Yang, H., An, Y.J., Kim, J.M., Lee, D.H., Jin, X., Park, S., Min, K. and Park, S.  (2013)  Enhanced Phase II Detoxification Contributes to Beneficial Effects of Dietary Restriction as Revealed by Multi-platform Metabolomics Studies.  Molecular and Cellular Proteomics.  12: 10.1074/mcp.M112.021352, 575–586
  5.  Dandelion, Natural Medicines Comprehensive Database. The Therapuetic Research Faculty.  Available at:  http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=ND&pt=100&id=706&ds=
  6. Hermann, R., von Richter, O.  (2012)  Clinical Evidence of Herbal Drugs as Perpetrators of Pharacokinetic Drug Interactions.  Planta Medica.  78(13):  1458-1477
  7. Lyon, M., Bland, J.S. Jones, D.S. “Clinical Approaches to Detoxificaion and Biotransformation.” The Textbook of Functional Medicine, Jones, D. ed. 2010, p. 545
  8. Begriche, K., Massart, J., Robin, M., Borgne-Sanchez, A., Fromenty, B. (2011) Drug-induced toxicity on mitochondria and lipid metabolism: Mechanistic diversity and deleterious consequences for the liver.  Journal of Hepatology.  54:  773-794
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One Response to Detox. Seriously?

  1. This is a fascinating post. Consistent with everything I’ve learned about detox pathways in the body. I have what I call an “detoxing diet”. And like your experience, my diet helped me avoid perimenopausal symptoms. Now that I’m 60ish, well past menopause, I’m still enjoying excellent health!

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