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Detoxification: The Good, the Bad, and the Ugly

- from the desk of Dr. Brkich

Types of Detoxes

Detoxification, or detox for short, is a popular buzzword. Detoxes come in many forms, such as cleanses, flushes, detox powders, detox diets, teas, combinations of detoxifying medicinal herbs, and homeopathic remedies. Some detoxes use irritant bowel stimulants that promote loose stools through their laxative effect, which can be erroneously interpreted as evidence of the body getting rid of toxins. Stimulant laxative promoting alkaloids from Senna or Cascara may provide a benefit for constipation by improving bowel transit time, but they provide little or no significant detoxification at an organ, tissue, or cellular level, which is where the rubber meets the road in total body detoxification.

Liver/Gallbladder Flush

A liver cleanse or gallbladder flush is a common detox, of which there can be many variations. Some use plant extracts that have effects on the liver and gallbladder such as milk thistle and artichoke. Others involve consumption of supraphysiological doses of an oil, most commonly olive oil, with a citrus juice such as lemon. The large bolus of oil causes the gallbladder to contract, which is a normal physiological response to ingesting fats. The idea behind it is that the vigorous gallbladder contractions, triggered by the large volume of oil, will squeeze out bile that may contain sludge, gravel, bacteria, or gallstones. This can be a good thing if gallstones are small enough to easily and safely pass through the entire length of the bile duct into the small intestine. If a stone is large enough, however, it can get lodged in the bile duct, obstructing outflow from the liver and pancreas. This constitutes a medical emergency requiring urgent surgery. We cannot survive biliary or pancreatic obstruction for very long. Those who happen to have gallstones, and take on the risk inherent in an oil-based liver/gallbladder flush, are playing Russian roulette, and would be well advised to not stray too far from a hospital.

With an oil-based liver/gallbladder flush, it is not uncommon to see small, green, pea-sized gallstones floating in the toilet afterwards. These so-called gallstones are really not gallstones at all. They are droplets, or micelles, of oil and bile clustering together to make pea sized round structures suggestive of gallstones. They are oil agglomerates that occur spontaneously in a detergent medium such as bile. It is possible that among these micelles there could be an actual gallstone that did, indeed, pass through.

People may report feeling better after a liver/gallbladder flush. This should not come as a surprise if stagnant, toxic bile is mobilized and excreted from the gallbladder. At the end of the day, however, a liver/gallbladder flush is not much more than a drop in the detox bucket if the very next day the same old eating and lifestyle patterns persist. Without long term dietary and lifestyle modifications, a scenario of continuous biliary dysfunction with stagnant bile persists. Just like stagnant waters are a breeding ground for mosquitoes, stagnant bile is a haven for opportunistic, infectious bacteria such as Bilophila wadsworthia, Bacteroides fragilis, Klebsiella, E. coli and others. Biliary dysfunction also results in malabsorption of essential fatty acids, as well as fat-soluble vitamins such as Vitamins A, D, E, and K2. Insufficient bile production by the liver and poor bile flow from the gallbladder are major drivers of illness and poor health. Unless the underlying cause is addressed, the condition may persist for years or decades, often resulting in cholecystectomy, or removal of the gallbladder. Removal of the gallbladder, even if symptoms are relieved, unfortunately, does not remove the cause, or reason why the gallbladder had to be removed in the first place. If the underlying root cause of the dysfunction continues, so will problems down the road, despite removal of the gallbladder, even if gallbladder symptoms are no longer present.

Heavy Metal Binders

There are detoxes that purport to remove toxins from the body. They may contain binders such as zeolite, activated charcoal, or bentonite clay. These binders can bind to toxic compounds in the stool and carry them out in the stool. They can be useful if they prevent toxins from being recirculated back into the liver. Their downside is that they also bind to essential food elements such as minerals, which get excreted in the stool.

Binding agents are often promoted for removing toxic metals such as mercury. This can be misleading because binders such as zeolite only work in the lumen of the gut. Because they are not absorbed into the body, they cannot perform intracellular detoxification. Binding agents are dependent on glutathione, metallothionein, and other intracellular detoxification mechanisms to flush the toxins out of the cells and into the blood, after which they get released into the gut. If the intracellular detoxification mechanisms are not functioning properly, having toxin binders in the gut is like having taxis parked at an airport where the passengers (intracellular toxins), missed the plane and are not on board, and the taxi (heavy metal binder), has to drive away empty. This is because binding agents are confined to the gut and do not get into the blood to be taken up by cells, tissues, and organs. Comprehensive detoxification requires removal of toxins from deep inside the cells, which then get excreted by the kidneys or the gut via the liver and gallbladder. Detoxification cannot occur if the kidneys, liver, and gallbladder are not functioning properly. This is commonly the result of low stomach acid, infection by opportunistic pathogens, SIBO, overgrowth of commensal bacteria (dysbiosis), biliary sludge, gallstones, and hepatic steatosis, also known as fatty liver.

The Body’s Natural Detoxification System

In a normal, healthy state, we all have a well-functioning natural system of detoxification throughout the body. This system works at the organ level via the digestive system, liver, kidneys, lungs, lymphatics, and the skin. At the cellular level it is mediated by compounds such as glutathione, lipoic acid, metallothionein, and the cytochrome enzyme system in the liver.

Enhancing the natural, innate mechanisms of detoxification at the cellular, tissue, and organ levels involves much more than a mere “gut-wash”. Unfortunately, that is just what many detoxes are. There is nothing wrong with a gut wash, just as there is nothing wrong with a car wash. The effects of a car wash are short lived if the car is constantly being driven through mud, dirt, and grime. The need for a car wash increases as the car gets dirtier. Similarly, detoxes become more important the more toxic one becomes. Doing a detox once in a blue moon is of little overall, long-term benefit if re-intoxication occurs shortly thereafter. A healthy diet, with a minimally stressful lifestyle, (easier said than done), supported by repletion of insufficient or deficient vitamins, minerals, phytonutrients, antioxidants, prebiotics, probiotics, postbiotics, sleep, and exercise, along with spiritual mindfulness, ensures around the clock detoxification using the body’s inherent, built-in, natural detoxification pathways. In an optimally healthy state, there is diminished need for periodic gut washes that are short lived in their effects and in the long run may distribute toxins from existing storage places to more vulnerable areas such as the brain, nerves, or kidneys, if improperly implemented.

Our Toxic World

We live in a world of ubiquitous toxic pollutants that inundate us in our modern-day life. Lessening our toxic burden is always desirable, as long as the detoxes do not generate more toxins or redistribute the toxins from safer storage places to more vulnerable tissues, which is always a concern. Intracellular detoxifiers can dislodge toxic heavy metals out of storage, and dump them into the blood, from which they can translocate into the brain if the innate detoxification mechanisms are not functioning optimally. This toxic insult to the brain is compounded by gut microbiome imbalance, or dysbiosis, with overgrowth of pathogens, and absence of essential keystone strains of health promoting bacteria that protect the integrity of the gut lining. A dysfunctional mucus barrier and loss of integrity of the gut epithelium, called leaky gut, are major drivers of brain inflammation that can be made worse by improper intracellular detox methods.

Nurture Nature

Reconditioning the gut microbiome with bitters, probiotics, prebiotics, postbiotics, and motility agents, such as natural physiological choleretics and cholagogues, reinforces the body’s inherent endogenous detox systems that are constantly working around the clock. The effect of these detox systems on our health cannot be replicated by low quality, commercial detoxes that are often heavily promoted, promising much, and delivering little.

High quality detoxes, on the other hand, can provide additional adjunctive support to a well-functioning innate detoxification system, especially during times when diet and lifestyle are compromised from time to time, as can often be the case for every one of us. However, reliance on periodic detoxes to replace a broken innate detoxification system is woefully insufficient. Reconditioning the gut with a healthy microbiome, and fortifying the metabolism with the full spectrum of essential nutrients is the most effective way to restore and maintain a perpetually self-detoxifying system. If this system is allowed to perform its function unimpeded, there are diminishing returns gained from periodic, gut-wash types of detoxes that, unfortunately, in many cases amount to little more than glorified laxative purges.

Bring your bullets with you

Because toxins have been so widely linked to morbidity (illness or disease) and mortality (death) worldwide, there are good reasons to take steps to lessen our toxic burden. Relying on ineffective detoxes can give a false sense of confidence and security, like a hunter with a powerful elephant gun, feeling safe in the wild, but not realizing that he forgot the bullets at home.

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