Gulf War Syndrome
Detoxification . . . What Is IT?
The detoxification process is an elaborate mechanism conducted chiefly by the liver to eliminate both exogenous and endogenous toxins. The liver participates in the detoxification process, largely by the action of two sequential steps referred to as Phase I and Phase II systems. Phase I reactions involve blood filtration, bile excretion, and the interaction of enzymatic processes acting upon the toxin. Bile excretion is most efficient, in regard to the detoxification process, if adequate amounts of dietary fiber are simultaneously available to escort the toxin from the intestines.
Phase I detoxification involves a group of enzymes, referred to as the cytochrome P450 family. Some 50-100 enzymes make up the cytochrome P450 systems, with each enzyme working more efficiently at neutralizing certain classes of chemicals. Phase I enzymes can directly neutralize some chemicals, but most toxins are converted to an intermediate form of the toxin. The intermediate form is considered more toxic than the original and requires the action of Phase II detoxification to complete the cycle.
Ideally, Phase I and Phase II detoxification mechanisms work synergistically. If Phase I detoxification is highly active and Phase II detoxification is lethargic, the individual is referred to as a "pathological detoxifier," a condition which increases sensitivities to environmental poisons.
Phase II reactions include sulfation and glucuronidation, which are key to human detoxification, along with glutathione conjugation, methylation, amino acid conjugation, and acetylation. Phase II detoxification typically involves biochemical conjugation, in which various enzymes in the liver attach small chemical moieties to the toxin. The conjugation reaction neutralizes toxins and reactive intermediates left over from Phase I detoxification. Both Phase I and Phase II detoxification require assistance from a healthy supply of enzymes. Enzyme quantity can be influenced by dietary components. Green tea and products found in red wine grapes encourage glucuronidation and glutathione conjugation enzymes, respectively.
Glucuronidation, a significant pathway in the Phase II detoxification mechanism, is the combining of glucuronic acid with toxins, a process that requires the enzyme UDP, glucuronyl transferase (UDPGT). Foods rich in limonene, a monoterpene found in citrus peel, dill weed oil, and caraway oil, can increase UDPGT activity and encourage the glucuronidation mechanism.
Many commonly used substances--for example, aspirin, menthol, synthetic vanilla, acetaminophen, morphine, diazepam, digitalis, benzoates, and some hormones--are detoxified through the glucuronidation pathway. Beta-glucuronidase, regarded as a dangerous enzyme, interferes with the glucuronidation process, allowing toxic levels of drugs and contaminants to accumulate. Older individuals appear particularly susceptible to increased beta-glucuronidase formation because of long-term exposure to toxic agents.
A phytoextract, D-glucarate, has been shown to support the glucuronidation pathway by inhibiting the activity of beta-glucuronidase. D-glucarate may be obtained naturally by emphasizing apples, grapefruit, broccoli, and brussels sprouts in the diet and by supplementing with calcium-D-glucarate and vegetable concentrates. According to data released from the University of Texas M.D. Anderson Cancer Center, D-glucarate inhibited beta-glucuronidase by 57% in the blood, 44% in the liver, 39% in the intestines, and 37% in the lungs, thus protecting the action of the glucuronidation pathway (Dwivedi et al. 1990).
Murray et al. (1998) report that the glucuronidation pathway is also impaired in the 5% of the population with Gilbert's syndrome. Gilbert's syndrome is a benign hereditary condition characterized by hyperbilirubinemia (serum bilirubin level 1.2-3.0 mg/dL) and jaundice. The Gilbert's syndrome patient typically complains of loss of appetite, malaise, and fatigue, symptoms often identifiable with liver dysfunction.
If entry of noxious materials is not controlled, detoxification, a cleansing ritual, can no longer keep pace, and alternative measures to encourage detoxification should be employed. Many nutrients and therapies assist in detoxification but glutathione is particularly important since it contributes to both Phase I and Phase II detoxification mechanisms. According to Eric R. Braverman, M.D., glutathione lessens the toxicity of heavy metals, automobile exhaust, cigarette smoke, fungicides, herbicides, nitrates, solvents, plastics, detergents, insecticides, and drugs. Furthermore, repeated exposure to any of these toxins can deplete glutathione faster than it can be produced or absorbed. Vitamin C appears to be an excellent nutrient to increase glutathione stores by stimulating the rate of glutathione synthesis. Glutathione supplementation is also available for individuals not wishing to rely upon vitamin C for glutathione enhancement. Glutathione in 250-mg capsules, taken on an empty stomach 1 or 2 times daily, is the recommended dosage.
At one time, Paavo Airola, N.D., Ph.D. referred to fasting as the royal road to health and long life. Fasting is a popular method of detoxification because the body can begin extricating the noxious materials rather quickly, allowing the body to commence the healing process. Literally, fasting means to deprive oneself of food for a specific period, usually for therapeutic or religious purposes. Medical journals have presented articles that support fasting as a therapeutic means of ridding hazardous materials from the body (Imamura et al. 1984).
If there is a down side to fasting, apart from dietary abstinence, it would be the caution required as pollutants are released from internal caches. During a fast, the concentration of toxins in the urine can be 10 times higher than normal. After the toxic load is decreased, the body has greater latitude to concentrate upon the healing process.
A professional who understands the detoxification process best implements a fast. Many practitioners prefer juice fasting to water fasting, believing the juices expedite the process of detoxification and impose less stress upon the individual. (It is recommended that juices be diluted with distilled water.) Also, a professional will know how to deal with a Herxheimer's reaction, which alludes to symptoms initially appearing more intensified as toxins are freed. The nervous system is particularly vulnerable to the release of fat-soluble toxins.
Some individuals who fast report being energized, but this usually occurs after repeated short fasts have eliminated many of the toxins and the internal milieu is cleaner.
The initial fasting experience in a toxic individual most often produces a feeling of fatigue, as the body does battle with the poisons. For this reason, working individuals may wish to plan a short fast (with the aid of their healthcare professional) over a weekend when the workload is lighter. The body is extremely engaged as noxious materials are being extracted. Conversely, the digestion of foodstuffs requires a tremendous work effort; therefore, a sabbatical from food allows the body the energy for detoxification.
Starting a fast and breaking a fast require special guidance, so that the cleansing effort is not lost by inappropriate binge eating. Fasting is not for everyone; a hypoglycemic often finds it extremely difficult to fast, even for short periods of time. A guided fast may, however, prove a valid therapy for some individuals wishing to expedite the detoxification process.
Many practitioners believe that the best approach to detoxification is a gradual, but ongoing process. There are a number of herbs that historically have had an impressive reputation as detoxifying and blood purifying agents. A popular term that an herbalist might use for agents that clean up the bloodstream is an "alterative," meaning the constituents of the blood are gradually being changed from a state of poor health to one of wellness. The herbs facilitate the filtration of toxins and wastes while killing poisons and balancing nutrients and plasma substances.
A number of herbs have a similar purpose in the blood purification and liver detoxification process. Often, herbalists combine herbs of similar likeness into a complex, believing the synergistic value of the herbs delivers greater efficacy than a single herbal. A list of these "clean-up herbs" and a brief description of their contribution to the detoxification mechanism follow.
Hepatics, Alteratives, Diuretics, Laxatives, and Diaphoretics
Dandelion root (Taraxacum officinalis), an excellent blood purifier, assists in many ways to boost the detoxification process. While dandelion root enhances the performance of the liver, dandelion leaves have a diuretic action, pulling toxins and excess water from the body.
Licorice (Glycyrrhiza glabra), though from a different herbal family than dandelion (licorice from Leguminosae and dandelion from Compositae), is also regarded as an alterative. Licorice protects the blood supply by defending the liver, the detoxification plant of the body. In fact, so strong is licorice's contribution toward detoxification that Mowrey (1986) reminded us that the Chinese have dubbed it the "The Great Detoxifier." Licorice is best used as part of a complex containing various other herbs and is usually well tolerated in this application. Licorice contains estrogenic properties and could elevate blood pressure or heighten adrenal expression, if administered in large amounts.
Pau D'Arco (Tabebuia heptaphylla) is an effective blood purifier, extracting toxins that lead to blood toxicity. Pau D'Arco also protects the liver while the liver is aggressively involved in neutralizing poisons.
Yellow dock (Rumex crispus) primarily affects liver function, enhancing the detoxification mechanism and increasing straining of contaminants and purification of the bloodstream. Ritchason (1995) reports that yellow dock is regarded as a favorite alterative among many individuals, sometimes using it against arsenic poisoning. Yellow dock attains tonic status by increasing energy and vitality throughout the body with particular emphasis upon the muscular, nervous, and digestive systems. Eclectics commonly used yellow dock when they perceived that blood-borne toxins instigated the appearance of skin diseases, for example, a rash.
Sarsaparilla root (Smilax officinalis) attacks and neutralizes microbial substances in the bloodstream through its antibiotic activity. By acting as a diuretic and diaphoretic (promotes perspiration), sarsaparilla encourages excretion of toxins and waste materials and acts as an antidote for various poisons. Heavy metallic contaminants in the blood can be extracted from the system with the judicious use of sarsaparilla. Sarsaparilla exerts strong power over fibers and tissues of the nervous system that may be particularly beneficial to the Gulf War veteran.
Stillingia root (Stillingia sylvatica) has the nature of an alterative and is beneficial in disease states that affect the skin, for example, psoriasis and eczema. Stillingia, though extremely beneficial in blood purification, is best used in small amounts, complexed with other herbs such as prickly ash (Zanthoxylum americanum). Prickly ash bark is a diaphoretic, assisting in the discharge of toxins.
Burdock root (Arctium lappa), according to Santillo (1984), is a traditional blood purifier, or alterative, with diuretic and diaphoretic activity. Burdock is considered an appropriate herb for eliminating long-term impurities from the bloodstream. It can neutralize most poisons, relieving kidney and lymphatic systems. Hepatic functions are influenced by burdock, barberry (Berberis vulgaris), and Oregon grape root (Berberis aquifolium), preparing the liver for more efficient detoxification.
Cascara Sagrada bark (Ramnus purshiana) is regarded as a reliable laxative herb, contributing to the elimination of toxic debris from the colon. It usually accomplishes this task without the miseries associated with laxatives. Buckthorn bark (Rhamnus frangula) is also considered a laxative, having an energetic, evacuative effect and stimulating bile production from the liver. Buckthorn is regarded as a bitter herb, capable of expelling impurities.
Ritchason (1995) regards echinacea (Echinacea augustifolia) as one of the premier alteratives, echinacea having been called the "King of Blood Purifiers." It appears to stimulate the elimination of waste products by stabilizing the relative percentage of neutrophils to other leukocytes in the blood. Historically, echinacea has been used to purify the blood after noxious exposures, for example, venomous wounds and blood poisoning, by improving lymphatic filtration and drainage. Echinacea often benefits a toxic headache with vertigo and a confused mental state when the condition is predisposed by toxemia.
Kelp and algin appear important adjuncts to any cleansing program since they bind radioactive barium, cadmium and zinc in the gastrointestinal tract, hindering absorption. Kelp appears to reduce the risk of environmental poisoning by acting as a nondigestible fiber, increasing fecal bulk while enhancing the immune response. A factor found in kelp, sodium alginate, binds with radioactive strontium-90 in the intestines and carries it out of the body. (Findings reported at the Gastrointestinal Research Laboratories of McGill University in Montreal.) (Note: Some herbalists regard Norwegian kelp freer of impurities and, by various standards, the preferred form to use.)
McCaleb et al. (2000) report that red clover (Trifolium pratense) has a long history of usage as a blood-cleansing herb that thins the blood, aids digestion, and stimulates detoxification through the liver and gall bladder. It has merit when used as a single herb, or if complexed with other purifying herbs. The user should be aware, however, that red clover possesses estrogenic activity, and since it thins the blood, it may be inappropriate for some supplemental regimes.
Cayenne (Capsicum annum) is added as a catalyst in many herbal complexes to enhance the effectiveness and delivery of other herbs. It also has a diaphoretic action, encouraging the expulsion of toxins through perspiration.
Many variations of these herbs are available through either health food stores or the supplier.
Milk Thistle (Silybum Marianum) Complexed with Phosphatidylcholine
The tradition involving milk thistle (Silybum marianum) as an herbal medicinal dates back over 2000 years, with Dioscordes using the extract to treat mushroom poisoning and snake bite (1st century CE). The modern use of milk thistle, according to Ogletree et al. (1997), began in 1949 when animal studies confirmed that it could protect the liver from the toxic effects of carbon tetrachloride. In 1968, an active ingredient was isolated and named silymarin. Milk thistle has been the subject of over 100 clinical trials, primarily for liver disease. More recently, milk thistle has emerged as a staple in emergency procedures throughout Europe to treat amanita mushroom poisoning and as a protectant against toxins found in acetaminophen.
Highly polluted areas, like the Gulf War arena, exacerbate the production and activity of free radicals, the harbinger of most degenerative disease. Ogletree et al. (1997) state that the hepatoprotective effects of milk thistle are accomplished via three main pathways: (1) antioxidant activity, (2) protection of the hepatocellular membrane, and (3) stimulation of hepatocytes.
A human study evaluated the effectiveness of milk thistle on occupational exposure to liver toxins, primarily solvents, paints, and glues. The study was placebo controlled, with 35 participants receiving 420 mg a day of milk thistle, while 20 subjects received a placebo. At the end of the treatment period (15-20 days), there was a meaningful decrease in liver enzymes (aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase) and bilirubin in the milk thistle group. There were no improvements observed in liver function in the placebo group (Boari et al. 1981). Complexing silymarin with phosphatidylcholine (PC) enhances the bioavailability of the herb, while PC itself is highly regarded as a hepatoprotective agent.