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From the Publisher.

When I first started practicing integrative and functional medicine, we referred to it as alternative and holistic medicine. My introduction to this medical practice was riddled with controversy. There was chelation therapy, intravenous injections of vitamins and minerals, electroacupuncture, homeopathic medicine, herbal therapies, proprietary glandular supplements, environmental medicine desensitization, cancer vaccines and other unapproved therapies, colonic enemas, and more. From a diagnostic standpoint, we had hair analysis evaluation of trace and toxic elements, dark field microscopy, EAV and energetic diagnosis, kinesiology muscle testing, thermography, plethysmography, blood food allergy screening, and unproven cancer blood screening.

In the clinic in which I had been working, the hair analysis study of toxic elements brought us the greatest controversy with the medical board. We brought on board the great minds in nutritional medicine to defend why hair analysis offered a valid diagnosis of toxic metal burden. Concurrently, there was a number of skeptics, "quackbusters," who argued that hair analysis offered no acceptable understanding of toxic metal body burden. When we did do serum studies of toxic elements, there was generally little confirmation of the toxic element analysis. Moreover, toxic element studies performed on the same hair sample did not provide matching results in different labs; in fact, split specimens sent to the same lab sometimes provided contradictory results. This made an understanding of toxic element burden in patients difficult to accomplish. Practitioners developed their own "algorithms" (they didn't use that term) to understand hair analysis and make diagnoses. Still, despite the controversy, we were convinced that many if not most patients carried a toxic element burden and a chemical burden, even if these could not be diagnosed with 100% confidence. Moreover, we recognized that detoxification of toxic elements and chemicals was critical if we were to restore a patient's health. Despite its controversy, chelation was the right choice to unload toxic metals while sauna sweating was appropriate to excrete petrochemicals, pesticides, plasticizers, drugs, and other chemicals.

Several decades after my introduction to integrative medicine, detoxification or "detox" has become a process that is accepted as a regular health strategy by the general public. Detox kits offer herbals and absorptive clays to cleanse the digestive tract. Oral and intravenous chelation and infrared sauna use have become widely available. Herbal therapies are widely used in supplementation programs. But the rationale for why these treatments work has not been readily forthcoming. Despite the growing recognition that we are accumulating toxic chemicals and metals, medicine has largely ignored the problem, opting to only address the problem when poisoning is diagnosed. Dr. Joseph Pizzorno addresses "how hidden poisons in the air, water, food, and products we use are destroying our health--and what we can do to fix it." Pizzorno is co-author of The Encyclopedia of Natural Medicine and The Textbook of Natural Medicine. He founded and served as president of Bastyr University for 22 years. Pizzorno is the editor-in-chief of Integrative Medicine A Clinician's Journal and serves on the board of the Institute for Functional Medicine. In 2017 he authored The Toxic Solution: An Eight-Week Program to Detox Your Life.

Pizzorno's program offers a four-part program to detoxify over the course of two months; his program is backed by peer-review studies and is evidence-based. In the theory section, Pizzorno shows that there is a close correlation between the industrial production of chemicals and clinical prevalence of diabetes and metabolic syndrome. While we generally think that chemical and metal toxicity is associated with industrial, agricultural, and mining work, Pizzorno argues that these toxins are accumulating in individuals involved with office work and household activities. Toxic burden does not require a point source of major chemical exposure, although this would be a critical area requiring detoxification and elimination of ongoing exposure. Instead, toxic burden builds up slowly, accumulating with household and office use of cleaning products, pesticides, and plastic food and water containers. Additionally, the widespread use of hair and beauty products is contributory in chemical burden. The consumption of non-organic, GMO foods, that are processed, sugary, and loaded with trans fats, also burden one with chemicals and metals.

Pizzorno's program is not for those who are addicted to their junk foods, hair products, and chemical cleansers. Nor is it appropriate for those who are unwilling to commit to the work of detoxification. The first phase of the program requires a two-week elimination of offending foods with an elimination of processed foods, gluten-containing foods, dairy products, beef and chicken, farmed fish, non-organic fruits and vegetables, soy, refined sweeteners, alcohol and recreational drugs, salt, and city/tap water. What does that leave to eat? Well, organic fruits, vegetables, beans, ocean fish, and gluten-free grains. Pizzorno offers a two-week menu with five meals per day, but it does take some preparation to cook these foods. Accompanying this restricted diet, Pizzorno wants one to give up using chemicals in the household and limit chemicals in hair-and-beauty-products. He offers patient-friendly programs to determine what chemical products are being used and what needs to be eliminated.

The second phase of the program focuses on "cleaning up the gut." The five steps require that 1) the bad bacteria in the gut are killed; 2) toxic chemicals released by the bacteria are bound; 3) good bacteria reseed the gut; 4) the gut is repaired; and 5) gut damage thereafter is avoided. For killing the bacteria, Pizzorno recommends the use of fiber, goldenseal root powder, and garlic supplementation. Repairing the gut requires probiotic, fresh cabbage juice, and quercetin. The third phase of the program "restores the liver," while the fourth phase "revives the kidney." Pizzorno states that the dietary and herbal detox for the kidney reduces kidney function abnormality. Although he offers some cases of individuals who normalized kidney functioning following the detox, there was no controlled study confirming the protocol's efficacy. The final phase of the detox employs the sauna but not chelation; Pizzorno cautions individuals not to do aggressive detox techniques before the initial phases of dietary modification, gut clean-up, liver detox, and kidney detox are completed.

The Toxin Solution is a systematic approach to detoxification that is well-documented and spelled out in detail. The book is easy to read for the patient and an excellent guide for the practitioner. When the patient is looking to do a detox program, Pizzorno's book is an important educational tool. Pizzorno makes the case that elimination of toxic chemical exposures and dietary modification must be undertaken before any detox program. The strategy of cleaning up the gut, and then detoxifying the liver, and then the kidneys makes sense. There is no reason to detox if the systems needed for detoxification are incapacitated and dysfunctional.

Shade and Decker on a "Push-Catch" System that Enables Effective Detoxification

Pizzorno's Toxin Solution book offers an overview of the problem with toxicity and a do-it-yourself detox program for the patient to undertake at home. Christopher Shade, PhD, and Carrie Decker, ND, examine the physiology of detoxification in this issue of the Townsend Letter. Pizzorno's premise that one needs to detoxify the gut, liver, and kidney makes sense, but what mechanisms are involved in these organ systems? Shade and Decker note that we generally talk about two states of detoxification: Phase I is involved with biochemically metabolizing the toxins through the cytochrome P450 enzyme system. Phase II "conjugates" the toxin metabolites forming water-soluble chemicals. However, we often fail to discuss Phase III of detoxification concerned with the transport and elimination of these metabolites and chemicals though cell membranes. While there are important limiting steps in Phase I and Phase II aspects of detoxification, it is often Phase III where detoxification becomes severely impaired if not incapacitated.

Shade and Decker examine closely the proteins that are critical in Phase III detoxification. When these proteins are impaired, the ability to detoxify mold toxins, such as Ochratoxin A, a mycotoxin commonly found in food and water, is impaired and its accumulation shuts down Phase III detoxification. Endotoxins from gut bacteria enter the system because of leaky gut syndrome and further inhibit Phase III detoxification. Additionally, endotoxins contribute to the stasis of bile, inhibiting the transport of conjugated toxin metabolites from the liver into the intestines for elimination. Indeed, cholestasis may be the major factor why toxins are not effectively detoxified while also damaging kidney functioning. Shade and Deck refer to cholestasis as toxistasis.

How do we experience cholestasis/toxistasis? We recognize the right upper quadrant abdominal pain or epigastric tenderness. Pruritus and stool changes are not uncommon. Lab testing not infrequently reveals abnormalities in AST, ALT, and GGTP. What can be done to enable liver detoxification. Shade and Decker offer a "push-catch" strategy to enhance liver detox. The "push" part refers to employing nutraceuticals to support Phase I,II, and III detoxification as well as stimulating bile flow. The "catch" part is done 30 minutes (!) later with toxin binders sequestering the toxin metabolites before they are able to reenter the body from the gut.

How this is accomplished is for you to read about in this issue.

What's New in Women's Health?

In addition to detoxification, this issue focuses on women's health. One of the surprising medical reports in 2017 was a large population study of women using birth control pills in Denmark. The December 6th study, published in the NEJM and written by lead author Lina S. Morch, found that the use of birth control pills (BCP) had a small but significant increase in the incidence of breast cancer. (1) The researchers examined national prescription and cancer registries of 1.8 million females in Denmark following them for more than one decade. Compared to women who have never used birth control pills, users experienced a 20% increased risk of developing breast cancer. Like most adult cancers, breast cancer incidence increases with increasing age. Statistically, it is estimated that for 100,000 women, birth control pill users experienced 13 additional cases of breast cancer compared to non-users; among contraceptive users there were 68 cases of breast cancer annually compared to 55 cases in non-users. The study did not find protective benefit from lower dose birth control pills; furthermore, the use of IUD delivery system of hormone did not reduce risk. On a positive note, the use of BCP decreased the risk of ovarian and endometrial cancer. The study did find there is a corresponding increase in risk in women above age 40 who used contraceptives as a younger adult. Also of note, progestins, synthetic progesterone compounds, also yield an increased risk of developing breast cancer.

The US Preventive Services Task Force published a recommendation statement for the use of hormone therapy for the primary prevention of chronic conditions in postmenopausal women in JAMA on December 12, 2017. (2) Although the task force did find 18 studies considered to be of fair-good quality, the Women's Health Initiative was the only study considered to be large enough to adequately assess the effectiveness of hormone therapy for primary prevention of chronic conditions. Unfortunately, the WHI based its results on women using Premarin/Provera (equine estrogen/progestin) combined or Premarin alone (equine estrogen). As expected, the task force found very limited benefit in prevention of fracture, diabetes, colorectal cancer but no benefit for prevention of breast cancer, pulmonary embolism, stroke, cognitive impairment, gall bladder disease, urinary incontinence, and all-cause mortality. The US Preventive Services Task Force concluded that there is no justification for the use of estrogen/progestin or estrogen alone treatment as a primary prevention for chronic conditions. Of course, the task force did not assess the use of bio-identical estrogen or progesterone.

Corina Dunlap, ND, on PCOS in Disguise

Think you know all you need to know about PCOS? Not so fast. Yes, our antennae come up when we see a woman who is not ovulating and shows evidence of excess testosterone. But what about a lean individual who is anovulatory with low testosterone? Indeed, such an individual may have PCOS. Another scenario that is frequently seen is the individual who has quit using birth control pills and does not resume normal menstrual cycles. If this woman is not ovulating, she may very well have PCOS, even though she is not showing evidence of hyperandrogenism. In this issue, Dr. Corina Dunlap discusses these variations of PCOS.

Bonnie Nedrow, ND, on Endocrine Disruptors: Our Cover Story

Much of this publisher letter has been devoted to our exposure and accumulation of toxins and how we should go about detoxifying. One of the unfortunate consequences of elevated toxins is male and female infertility. In this issue, Bonnie Nedrow, ND, focuses on infertility in the woman and why metal and chemical toxins play an outsized role in its cause. The reason that toxins are so problematic with fertility is that they mimic hormones and activate hormone receptor sites. This activity leads to endocrine disruption, a definite interference in successful reproduction.

Discovering the sources of toxin exposure and eliminating those exposures is fundamental to the detoxification process. As discussed earlier removing the chemicals, "depuration," is key to undertaking detoxification and vital to removing the endocrine disruption inhibiting a successful pregnancy.

(1.) Morch SL, et al. Contemporary hormonal contraception and the risk of breast cancer. NEJM. 2017; 377: 2228-2239.

(2.) US Preventive Services Task Force. Hormone therapy for the primary prevention of chronic conditions in postmenopausal women. JAMA. 2017; 318 (22): 2224-2233.
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Title Annotation:detox therapy
Author:Collin, Jonathan
Publication:Townsend Letter
Article Type:Editorial
Geographic Code:1USA
Date:Feb 1, 2018
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