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Clinical Pearls: Clarifying Detox

Published 15 days ago • 3 min read

COMING SOON: The Functional Medicine Collective...a mentorship and co-working space for clinicians who want more support!

The launch kicks off with a free 2-day workshop followed by an "ask-me-anything" - click the button below to get notified when registration opens!

This week's topic: Detox

Detox is another term that mainstream medicine considers more "woo" and unnecessary. An overview of today's email:

  1. What is detox?
  2. What tests can we use to assess "detox"?
  3. Practical clinical tips

1. What is Detox?

When discussing this topic, it's important to know the difference between "detox" and "detoxification".

"DETOX"

The word "detox" is often more of a colloquial term used to refer to a "cleanse" or removal of toxins from the body in order to reset after consuming foods or having a lifestyle that is potentially negatively impacting health. Many also see this process as a way to jumpstart a weight loss or wellness plan.

A "detox" protocol often includes:

  • Fasting
  • Drinking only fresh-pressed juices
  • Eating only certain foods (e.g. consuming organic foods, avoiding meats or foods that may have chemicals or hormones)
  • Using dietary supplements, herbs, or other commercial products
  • Cleansing the colon (lower intestinal tract) with enemas, laxatives, or colon hydrotherapy (also called “colonic irrigation” or “colonics”)
  • Sweating via a sauna
  • Ionic foot baths
  • IV therapy

Typically, "detox" protocols are not taught in functional medicine (integrative or naturopathic medicine is more likely to provide protocols). However, the majority of the above is often touched on in a comprehensive functional medicine training program.

"DETOXIFICATION"

In functional medicine the term "detox" is an abbreviation that refers to "detoxification." It is an ongoing process that the body engages in daily, and not a 5-10 day plan that is completed a few times a year.

When addressing detoxification, it is important to be familiar with terms like toxicants vs toxins, biotransformation, Phase 1 vs Phase 2 vs Phase 3 detoxification, methylation, glucuronidation, and more.

Check out one of my favorite review articles on this topic (or the IFM module on environmental health): Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application.

2. What tests can we use to assess detox imbalances or concerns?

Blood testing: Blood is a good way to evaluate liver function, indirect assessment of glutathione status, nutrient cofactors needed for optimal detoxification, and more. It is also a great way to look for (and rule out) acute exposures to heavy metals. I always run this when (or before) I run a urine test.

Clinical pearl: If screening for heavy metal exposure via blood or urine, ask patients to avoid rice (potentially high in arsenic) and high mercury foods (especially tuna and sushi) for a week before blood collection.

Hair analysis: There are many practitioners utilizing HTMA (hair tissue mineral analysis) and getting great results when they address mineral imbalances that correlate with toxicant levels. Research is lacking as to the validity of these tests, but a few practitioners in my current practice use it and are seeing amazing results (so even if the research is lacking, I am looking into training on this so I can use it in my practice to help more people).

Stool testing: A few markers in stool can be helpful for assessing the need for detoxification support, but it often doesn't tell us specific toxicants to address. These include some species of bacteria/fungi, beta glucuronidase, and inflammation markers.

Urine testing: The most common way to evaluate pesticides, man-made chemicals, glyphosate, and suspected chronic heavy metal tissue levels. These are usually non-provoked or provoked (provoked with a chelator), with provoked testing almost always yielding a positive result (I will discuss this in more detail in the mentorship). I highly recommend Dr. Paul Anderson's webinar on heavy metal detox (which includes why we should run a non-provoked test before a provoked urine test).

Clinical Pearl: Ideally a comprehensive support plan is initiated before any aggressive chelation or detoxification support plan to avoid what many refer to as "redistribution" of toxicants. This should always start with lowering inflammation and enhancing the mucosal layer of the gut.

3. Practical Clinical Tips

I particularly like IFM's approach for ensuring a safe approach to testing and treatment, and believe it is important to consider a patient's individual Cell Danger "state" before taking a deeper dive into detoxification. The top 3 questions from IFM:

  1. Is there a history of exposure?
  2. Are the patient's symptoms in line with a toxicant exposure? I.e. just because you find it on a lab does not indicate that the toxicant is the cause of a common symptom
  3. What is the patient's individual susceptibility?

As a practitioner, I get asked often by my patients about "detoxes" or "cleanses". I do utilize both a functional and integrative medicine approach (meaning I have a 10-day "detox" plan I will prescribe if I feel the patient can benefit from it), but I also consider all phases of detoxification and whether it is appropriate to pursue more testing in this area.

Thank you for being a part of this newsletter community. I hope these serve you in some way :)

Stay well, and enjoy the weekend ahead.

Meg

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