Nutrition

Detoxification
Represented by ACPA Inc 714-606-5859

Dr Carlos Orozco

DETOXIFICATION
What is toxicity?
Toxicity refers to the degree to which a substance is poisonous to our system. Mechanisms of
toxicity include:
Interference with enzymes
Blockages of receptor sites and cellular transport mechanisms
Blockage of nutrient absorption
Oxidative damage
Mimicking of hormones or neurotransmitters

How can we be exposed to toxins?

We can be exposed to toxins via our lungs and skin, but most often it is via the digestive
system. Toxin exposure can be subcategorised into two main groups:
1. Endotoxins: Those toxins produced within the body. A major source of toxicity for
most people is the products and by-products of their digestive systems. A poor diet
consisting of high sugars/fats/preservatives/additives and/or a malfunctioning
digestive system can lead to gut dysbiosis, leaky gut and subsequent entry of a variety
of toxins into the bloodstream and lymph system.
2. Exotoxins: Environmental, industrial and medical toxins directly administered to
the body (e.g. injection) or absorbed through the skin and mucous membranes, inhaled
into the lungs or ingested.
Though an acute exposure to one toxin can cause damage to the body, it is likely that most of
the health burden of toxin exposure comes from multiple, low dose exposures, rather than
single, large doses. The concept of total load describes the sum total of all the influences
that impact on patients physiology.
Contributors to total load include:
Xenobiotics (e.g. insecticides, herbicides, drugs, solvents, metals)
Biological toxins (e.g. aflatoxin, lectins)
Biological inhalants (e.g. moulds, pollen, algae etc)
Physical phenomena (e.g. ionising radiation, electromagnetic fields)
Infection
Hormonal imbalances
Mechanical problems (e.g. spinal alignment, nasal or intestinal obstruction)
Lifestyle choices (e.g. alcohol, junk food, smoking, recreational drugs)
Psychosocial factors (e.g. stress, coping skills, belief systems & trauma)

What protects us against toxins?

Our bodies have several mechanisms to protect us against toxins such as:
Physical barriers: skin
Digestive secretions and mucous barriers
Immune surveillance & enzyme systems (e.g. CYP450 pathways) that process toxins
for excretion (via sweat, breath, urine, bile, faeces)
Storage: if the body is unable to deal with toxins immediately, it will store them in
adipose tissue and bone for later detoxification.

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Detoxification

What happens when this protection fails?

If any or several of these defence mechanisms become impaired (often as a result of being
overloaded by toxic material), levels of toxins can increase in the body with resulting damage
being caused to various systems, including the defence systems themselves (e.g. leaky gut,
liver damage).

Why do some people get sick from toxicity and some dont?
This depends on the toxins the person is exposed to and the way each persons body deals
with it. Some individuals have healthier lifestyles and/or detoxification systems that work
more efficiently than others. General factors that influence detoxification include:
Liver & Kidney function
Bowel function
Nutrient intake & stores
Stress
Digestion & absorption of food
Sleep

What symptoms & diseases are generally associated with toxicity?

Just about any disease process can be aggravated by exposure to toxins. Some symptoms and
diseases strongly related to toxin exposure include:

Symptoms
o Recurrent headaches, infections
o Muscle aching & weakness
o Paraesthesia's (numbness, pins &
needles) & neuralgia (pain nervous system)
o Infertility
o Adverse reactions/sensitivities
o Chronic fatigue & lethargy
o Depression, anxiety &/or mood
swings
o Poor short-term memory &
concentration
o Anaemia

Diseases
o
o
o
o
o
o
o
o
o
o
o
o

Allergies & Asthma

Atherosclerosis
Autism
Autoimmune diseases
Cancer (various types)
Chronic Fatigue Syndrome
Endocrinopathies (diseases
involving the endocrine glands)
Fibromyalgia
Inflammatory Bowel Disease
Multiple chemical sensitivities
Neurodegenerative disorders
Reproductive disorders

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Figure 1: From Metagenics Detox - Patients Manual

Nutrition

Detoxification

Dr Carlos Orozco

How should we go about detoxifying the body?

Detoxification essentially means converting a toxin to a non-toxic, soluble form that can be
safely eliminated by the body. Though detoxification is a straightforward process, it requires
several steps to complete it effectively. Historically, many Detoxification Programs focus on
liver support (the main organ involved in detoxification), but this is really an incomplete
approach, as the gut, as mentioned, is a major source of toxic exposure for many individuals.
No amount of liver support can help if a patients system is being constantly overwhelmed
with toxic material from the environment or their digestive system. Overall we need to look
at:

A. DECREASING TOXIC LOAD

B. PROMOTING HEALTHY GUT FLORA

C. REPAIRING THE GUT LINING

D. SUPPORT DETOXIFICATION PROCESSES

A. DECREASING TOXIC LOAD:
This is a primary consideration when dealing with toxicity. Reducing exposure to toxins
reduces the risk of aggravations of symptoms during the process, and the chances of the
patient regressing once treatment is complete. Toxic exposure should be assessed when
talking to your patient by considering the following possible sources:
Occupational exposure (e.g. pesticides, organic solvents, radiation etc)
Chemicals at home (e.g. pesticides, cleaning products)
Water supply
Food (e.g. pesticides, lectins. alkaloids, allergens)
Recreational exposure
Medications
As the gut is often one of the main sources of toxins; it can be beneficial to follow a healthy
diet prior to and/or whilst detoxing. For example (see attached Shopping List Guide Also):
Avoid packaged and pre-prepared foods as much as possible
Eliminate foods containing artificial flavours and colours (e.g. Tartrazine: code 102),
other additives (e.g. MSG: code 621) and hydrogenated fats and stabilisers.
Eliminate foods known to cause a reaction, as well as minimizing common causes of
food intolerances e.g. Wheat, dairy.
Purchase fresh seasonal fruit and vegetables if possible. Organic as welleven better.
Minimise high sodium, salt and sugar foods. Aim for less than 15g of sugar per serve.
Fresh vegetable juice can be a great addition. High in nutrients and enzymes to help
digestion.
Prepare easy to digest meals (e.g. vegetable casseroles, soups, stews)
For patients who appear particularly reactive to foods, or where a more restrictive diet may be
thought to be beneficial, some of the following options may be included:
A/B/O Blood Type Diet reduces exposure to inflammatory stimulating lectins
Low salicylate/low amine foods lists (refer to Metagenics Detox Manual Appendix A)
Low reactive/elimination diet (refer to Metagenics Detox Manual Appendix A)
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Dr Carlos Orozco

Detoxification

B. PROMOTING HEALTHY GUT FLORA:

Toxic exposure from the gut can come partly from ingested foods and chemicals, but also
from the gut flora that constitutes a continuous source of metabolites that reach the systemic
circulation.
In our previous lecture on probiotics and the gut, we know there is a variety of beneficial and
harmful microflora throughout the intestinal tract. Metabolites from various harmful bacterial
and fungal species have been found in the urine of patients with many different pathologies.
In addition to harmful metabolites, the cell-wall fragments of bacteria may pass into the
bloodstream. These fragments (consisting of lipopolysaccharides and often referred to as
endotoxins), are potent stimulators of the inflammatory response. They are detected by
Kupffer cells (liver cells) and cause a massive increase in the production of inflammatory
mediators such as Tumour Necrosis Factor alpha (TNF). These can further aggravate preexisting inflammatory or immune conditions.
Some organisms associated with dysbiosis include:
Bacteroides fragilis
Campylobacter jejuni
Candida albicans
Candida tropicalis
Citrobacter freundii

Clostridium difficile
Escherichia coli
Geotrichum spp.
Klebsiella pneumoniae
Proteus vulgaris

i) Weeding:
Ridding the body of detrimental microbes is often referred to as the Weeding stage. This
may take anywhere from 2-6 weeks to complete, depending on the persons intestinal state
and overall immune system. Various tests (e.g. Indicans, Haemaview, Complete Stool
Analysis, Intestinal Permeability etc.) can be performed before starting and along the way to
ascertain how the intestinal flora and overall patient health is progressing. There are many
herbal medicines that have been shown to have potent antimicrobial actions against these
dysbiotic organisms such as:
Barberry (Berberis vulgaris) root bark
Black walnut (Juglans nigra) green hulls
Chinese wormwood (Artemesia annua) herb
Cinnamon (Cinnamomum zeylandicum) bark oil

Grapefruit (Citrus x paradise) fruit

Olive (Olea europaea) leaf, dry
Oregano (Origanum vulgare) oil
Thyme (Thymus vulgaris) oil

There are various pre-prepared products available in the market to help remove pathogenic
microflora. Some also contain herbs and nutrients to help stimulate digestion and soothe the
gastrointestinal lining. Some examples include:
Parex (Metagenics)
Costat (Metagenics) good for systemic infections
Paracea Forte (Bioceuticals)
Wormwood Complex (Mediherb)
Intestaclear (Orthoplex)
note: Prior to treating with antimicrobial herbal mixtures, many practitioners find that
doing a bowel purge for 1-3 days can be useful in removing a large amount of dysbiotic
organisms from the intestines, thereby helping to speed the overall weeding process.
100-200ml of Aloe Vera Juice taken before bed usually has the desired effect.
2-4 teaspoons of Epsom salts (Magnesium sulphate) followed by a couple of large
glasses of water.
Some patients may require a combination of Aloe Vera juice and Epsom salts.
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Detoxification

Dr Carlos Orozco

Whilst ridding the bowels of detrimental microbes, it is recommended that other nutrients are
included to help prevent the binding of detrimental microbes to the intestinal wall and to help
mop-up the by products of dysbiotic organism breakdown. Some examples include:
Colostrum: provides a source of immunoglobulins that can bind to dysbiotic bacteria
preventing their entry into the bloodstream. It also contains other bioactive proteins
including lactoferrin & lactoperoxidase. note: this product should not be given to
individuals with know milk/dairy allergies/intolerances.
Selenium, iodine and zinc support the function of these proteins
Refer to Prebiotics notes (Wk 5 notes, pages 4-5) for other useful bowel substances
that can help support bowel function.
Again, there are a variety of products on the market that can fill this role. Some examples are:
Ultra Probioplex (Metagenics) contains colostrum so be careful with dairy intolerant
individuals.
Gastro Care Excel (Bioceuticals)- contains colostrum
Gastro AG (Metagenics) Arabinogalactans, dairy free.
When the load of dysbiotic organisms living in the digestive system has been reduced, the
next main step is to:
ii) Seed: re-inoculate the intestines with beneficial (probiotic) bacteria
Refer to the notes on Probiotics and Prebiotics (Wk 5). There is a large range of probiotics
available from reputable companies such as Metagenics (refer to Detox manuals supplied),
Bioceuticals, Orthoplex, Blackmores etc. It is fine to start with one type of probiotic then
move on to another blend as appropriate.

C. REPAIRING THE GUT LINING

There is not much point putting in good bacteria if the environment they arrive in is not
conducive to their growth. For this reason it is also important to:
iii) Feed: feed the good bacteria and support the integrity of the gut lining.
Again, refer to the notes on Probiotics and Prebiotics (Wk 5). It is recommended that this
seed & feed phase should be continued for at least 2 weeks. It is better, particularly for
patients with a history of intestinal complaints to continue this phase for 4-8 weeks. Some
good Prebiotic blends include:
Intestamine (Bioceuticals)
GIT 2 (Orthoplex)
Glutagenics (Metagenics)
It is important to ensure your patient is following their diet well at this stage, as eating the
wrong foods can encourage the wrong gut flora to grow back before the Probiotics can
establish a decent population. It may also be necessary to provide specific digestive support
(e.g. digestive enzymes) to prevent food fermentation in the gut that can lead to bloating and
wind.
It may be useful to do an indicans test again at the end of the seed & feed stage to ensure
decent digestion is taking place.

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Nutrition

Detoxification

Dr Carlos Orozco

D. SUPPORT DETOXIFICATION PROCESS

Now the load on the bodys waste removal systems has been reduced, the final stage of
detoxification is to enhance the capacity and function of these systems. This step will take 24 weeks (possibly more) depending on the chronicity and severity of the patients condition,
and the organ reserve available for detoxification. Depending on the toxic load of the body,
patients can often feel a little unwell during this stage as toxins are released. It is important to
go steadily and include nutrients to help support the body and the fall-out of the
detoxification process. A single detoxification will likely not remove all the toxins from a
patients body. Several gentle detoxification cycles are much better for the patient than a
harsh all at once approach.
In summary, the body has 3 major detoxification systems that work mainly through the liver
and intestine:
1. Phase 1 detoxification
2. Phase 2 detoxification
3. Phase 3 antiport system lining the intestine
Phase 1 Detoxification: This system is mainly comprised of the cytochrome P450
(CypP450, CYP450) super family of enzymes (refer to handout on CYP P450s for more
detail). It is the first enzymatic defence against foreign compounds, particularly steroids,
drugs and exogenous toxins.
These enzymes either add or expose a functional group to the substrate (toxin); most
commonly a hydroxyl group (OH), which then opens up a reactive site that allows the toxin to
be conjugated to a substance in phase 2. In general they utilize oxygen and NADH (Activated
B3) as follows:
NADPH + H+ + O2 + RH

NADP+ + H2O + R-OH

RH denotes parent drug and R-OH is the oxidized product

The reaction above may actually make the toxin highly reactive, and it can now act as a free
radical, potentially damaging proteins, DNA and RNA and causing cellular damage. It is
important that the Phase 2 reactions act on this reactive intermediate as quickly as possible to
reduce the time available for it to do damage. Therefore, it is critical for effective
detoxification that Phase 2 keeps up with Phase 1, so that there is no accumulation of these
reactive intermediates.
It is important to realize that Phase 1 Detoxification occurs in various tissues throughout the
body. For example CYP1A1 & CYP1B1 in breast tissue; CYP1A2 and CYP3A4 in the liver.
Xenobiotic-metabolising CYPs however, are largely expressed within the liver where they
play a crucial role in hepatic metabolism, although lower levels have been found in
extrahepatic tissues including the lung, kidney, gastrointestinal tract and nasal epithelium.
CYPs expressed within these extrahepatic tissues can contribute to overall drug clearance
from the body. For ease of explanation however, we will be referring to the liver when
discussing detoxification pathways from here on.
Human CYPs responsible for metabolism of pharmaceuticals and environmental toxins are
largely concentrated within the CYP 1-3 families, and to a lesser extent the CYP4 family.
CYP450 enzymes can either be induced or inhibited (refer to diagram on detox handout).
Most patients initially presenting to you will likely have an induced Phase 1 cycle happening
due to the intake of coffee, alcohol, nicotine as well as increased levels of stress in their lives.

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Nutrition

Detoxification

Dr Carlos Orozco

For this reason it is often useful to first:

Inhibit Phase 1 detoxification in order to reduce the amount of highly reactive
intermediates being produced. (refer to list of Phase 1 inhibitors on Detox handout,
and Appendix 1 of these notes)
Help protect the liver (i.e. use Hepatoprotectants such as Silymarin & Bupleurum)
Include high levels of Antioxidants in the diet (broad range supplements suggested)
to help deal directly with and minimize free radical damage from the high levels of
reactive intermediates produced.
Support and increase Phase 2 detoxification to help rid the body of the harmful
intermediates (refer to list of Phase 2 support & enhancing nutrients, Detox handout
and Appendix 1 of these notes)
Phase 1 activity should only be induced after Phase 2 has had a chance to catch up.
Phase 2 Detoxification: The processing of reactive intermediates into water soluble, nontoxic compounds requires two steps:
A conjugating substance
An enzyme to catalyse the reaction
Conjugation Reactions
Acetylation
Amino acid conjugation

Enzyme
N-acetyl transferases
Amino acid transferases

Glucoronidation
Glutathionation
Methylation

Glucoronyl transferases
Glutathione transferase
N & O-methyl transferases

Sulfation

Sulfotransferases

Conjugating substance
acetyl-CoA
Glycine, taurine, glutamine,
arginine, ornithine
Glucoronic acid
Glutathione
Methyl groups (mainly SAM: Sadenosylmethionine)
Sulphur containing compounds,
taurine, glutathione

Phase 2 reactions are more vulnerable to defects, as they require both an adequate supply of
conjugants (amino acids and other nutrients), plus adequate enzyme function. Phase 2
pathways are also down regulated by inflammation. Typically then, many patients will
present with elevated Phase 1 activity and reduced Phase 2 activity, leading to an
accumulation of reactive intermediates, with consequent tissue inflammation and damage.
This is a major factor in how toxicity drives disease processes.
Studies performed in the UK have proved a link between a deficiency in the sulphation
conjugation pathway of patients with Parkinsons, Motor Neurone Disease and Alzheimers,
indicating toxic stress as a major predisposing factor in degenerative disease of the nervous
system. Similarly, 50% of the general population and 80% of chemically sensitive people are
slow acetylators (Referenced from Get a Life website).
As mentioned before, always include an antioxidant mix in any detoxification protocol. There
are a variety of prepared mixes available that support the appropriate balance between Phase 1
& Phase 2 detox. Some of these include:
Phyto Pro (Metagenics)
Thermo Phase Detox (Metagenics)
RejuvenX (Bioceuticals)
XenoClear (Bioceuticals)
LM1 (Orthoplex)
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Nutrition

Detoxification

Dr Carlos Orozco

Phase 3 Antiporter Intestinal Detoxification System:

As the gastrointestinal tract represents the first barrier met exogenous compounds of food or
orally ingested drugs and toxins, it is not surprising that intestinal cells have a coupled
detoxification system known as the antiporter.
The antiporter is an energy dependent efflux pump that pumps xenobiotics out of the cell into
the intestinal lumen, thereby decreasing intracellular concentration of xenobiotics. This
activity seems to be co-regulated with the intestinal phase 1 Cyp3A4 enzyme.
The maintenance of the gut mucosal integrity is essential for this antiport system to work, so
all the more reason the clean up the gut before continuing with the Phase 1 & 2 detoxification.
A compromised gut mucosal barrier will allow xenobiotics to migrate into the circulation
without the opportunity for detoxification.

Additional Notes of Interest:

Chelation: for patients with significant toxic metal or chemical exposure, adding one or both
of chelating agents Lipoic Acid or Glutathione during detoxification may help to reduce their
symptoms and significantly increase toxin excretion.
Nutrients to Support Kidney Excretion:
Water: needed to keep substances in solution and able to be excreted. Avoiding
dehydration is essential.
Vitamin A, B6, C, Lipoic acid, magnesium and potassium help the kidneys operate
more efficiently during waste removal.
Options for helping the body excrete toxins during a detox:
Dry skin brushing remove dead cells to allow better toxin excretion through skin
Spa treatments encourage waste excretion through sweat, detox wraps etc.
Lymphatic drainage massage mobilise toxins into and out of the lymph system
Exercise:
Help get the blood and lymph moving to move toxins to sites for excretion. (Not too
much earlier on in the detox when the persons body is already under strain coping
with excess toxins being processed).
Avoiding toxins in the environment and emotions:
Reduce chemical exposure by limiting pesticide use, antiperspirants, bad foods etc
Minimise toxic thoughts and individuals from your life. Stress and unhappiness can
release many toxins in the body.
Bibliography
Henry Osiecki (2006) The Physicians Handbook of Clinical Nutrition (7 th ed) Bio Concepts, Eagle Farm,
Qld, Australia
Metagenics Detox Key Clinical Concepts booklet, Healthworld Limited, Qld, Australia
Metagenics Detox Recommendations for a Successful Detox booklet, Healthworld Limited, Qld, Australia
Get a Life (n.d.) Liver Stress and How to Correct It Part 2, viewed at:
http://getalife.net.au/mag/lstress2_html
Nicole Yvonne Marden (2006) Transcriptional Regulation of the Human Cytochrome P450 2J2 Gene by
Activator Protein 1 PhD Thesis, School of Medical Sciences, Faculty of Medicine, The University of
New South Wales, viewed at: http://www.library.unsw.edu.au/~thesis/adt-NUN/uploads/approved/adtNUN20060607.114151/ public/02whole.pdf

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Nutrition

Detoxification

Dr Carlos Orozco

Appendix 1: Substances that Effect Phase 1 & 2 Detoxification

Taken from Tuberose.com website, Liver Cleansing and Support Products:
http://www.tuberose.com/Liver_Detoxification.html

Substances that activate Phase I detoxification

Drugs: alcohol; nicotine in cigarette smoke; Phenobarbital; sulfonamides; steroids
Foods: cabbage, broccoli, and brussels sprouts; charcoal-broiled meats; high-protein diet;
oranges and tangerines (but not grapefruits)
Nutrients: niacin; vitamin B1; vitamin C
Herbs: caraway and dill seeds
Environmental toxins: carbon tetrachloride; exhaust fumes; paint fumes; dioxin;
pesticides

Substances that Inhibit phase I detoxification

Drugs: benzodiazepines; antihistamines; cimetidine and other stomach-acid secretion
blocking drugs; ketoconazole; sulfaphenazole
Foods: naringenin from grapefruit juice; curcumin from turmeric; capsaicin form chili
pepper; eugenol from clove oil; quercetin from onions
Botanicals: curcuma longa (curcumin); capsicum frutescens (capsaicin); eugenia
caryophyllus (eugenol); calendula officianalis
Other: aging; toxins from inappropriate bacteria in the intestines

Nutrients needed by phase II detoxification enzymes

Glutathione conjugation: Glutathione Precursors (Cysteine, Glycine, Glutamic Acid,
and co-factors), Essential Fatty Acids (Black Currant Seed Oil, Flax Seed Oil, EPA),
Parathyroid Tissue
Amino acid conjugation: Glycine
Methylation: Methionine, Co-factors (Magnesium, Folic Acid, B-12, Methyl Donors)
Sulfation: Molybdenum, Cysteine and precursor (Methionine), Co-factors (B-12, Folic
Acid, Methyl Donors, Magnesium, B-6/P-5-P), MSM
Acetylation: Acetyl-CoA, Molybdenum, Iron, Niacinamide, B-2
Glucuronidation: Glucuronic acid, Magnesium
Glycination: Arginase Enzyme, Glycine, Gly Co-factors (Folic Acid, Manganese, B-2, B6/P-5-P)

Inducers of phase II detoxification enzymes

Glutathione conjugation: Brassica family foods (cabbage, broccoli, Brussels sprouts);
limonene-containing foods (citrus peel, dill weed oil, caraway oil)
Amino acid conjugation: Glycine
Methylation: Lipotropic nutrients (choline, methionine, betaine, folic acid, vitamin B12)
Sulfation: Cysteine, methionine, taurine
Acetylation: None found
Glucuronidation: Fish oils, cigarette smoking, birth control pills, Phenobarbital,
limonene-containing foods

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Nutrition

Detoxification

Dr Carlos Orozco

Inhibitors of phase II detoxification enzymes

Glutathione conjugation: Selenium deficiency, vitamin B2 deficiency, glutathione
deficiency, zinc deficiency
Amino acid conjugation: Low protein diet
Methylation: Folic acid or vitamin B12 deficiency
Sulfation: Non-steroidal anti-inflammatory drugs (e.g. aspirin), tartrazine (yellow food
dye), molybdenum deficiency
Acetylation: Vitamin B2, B5, or C deficiency
Glucuronidation: Aspirin, probenecid

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