Environmental Toxicity and the Detoxification Continuum

by Peter Bongiorno, ND 

As a naturopathic doctor living, eating, respiring, and practicing in New York City – there is no doubt that burden of toxic load plays a strong role in the health for many of my patients. More research is amassing showing correlations between toxic exposure with cardiovascular, autoimmune, cancers, neurologic and psychiatric disease. As an emerging field with relative dearth of information available to us to help clearly diagnose and specifically treat environmentally-induced disease, it is a challenge to work with conditions caused by possible toxicity. My aim in this article is to help the integrative practitioner gain awareness of environmental toxicities and review options for treatment. This article will examine typical exposures we all face, and give an overall review how a practitioner may consider ways to lower exposure and appropriately detoxify the individual patient so that his or her body can resume healthy processes to heal.

Categorically, a patient’s toxic exposure can be broken down into those of external origin or internal origin. The most common type of environmental toxins we think of are the external toxins. These toxins, which come from outside the body, are derived from our surrounding air and light, water, foods, household products, and pharmaceuticals. Excess noise also can be an external load. Internal toxins are considered toxic metabolites that are created from body functions that are out of balance. Some practitioners also assign stress an external or an internal toxin.

Airborne toxins are quite prevalent in our country. According to Physicians for Social Responsibility, the U.S. industry releases about 24 billion pounds of toxic substances that are believed to cause developmental and neurological problems. This amount could fill a string of railroad cars stretching from New York City to Albuquerque, New Mexico.¹ Pollution, metal toxicities and other industry related toxins are also well known to increase cardiovascular mortality.² For example, exposure to lead throughout early life is stored in bone and released during aging will increase blood pressure and cardiovascular disease.³ Ozone levels is linked to asthma in six million children.⁴ Other airborne toxins include diesel particulates (the poly aromatic hydrocarbons of burning fuels) which modulate genetically driven modified immune balances to generate reactive oxygen species. These can contribute to cancer and fetal growth problems.⁵ Ubiquitous electromagnetic fields such as the presence of cell phone and electrical wires are suspected to contribute to head⁶ and other cancers. Living conditions can contain high amounts of mold and mildew, a known trigger for pulmonary disorders such as asthma and sarcoidosis.⁷ Finally, most urban areas also live with extreme levels of nighttime light, which will suppress normal secretion of melatonin, a master hormone well-known for its antioxidant and anti-cancer effects. For instance, lowered levels in night-work nurses have shown significantly increased incidences in breast cancer.⁸

Drinking water and food are known carriers of environmental toxins. Water may contain toxins like fluoride, chlorine, and perchlorates which may inhibit iodine uptake and reduce thyroid hormone production, and also carry airborne particulates that have found their way into the ground and water systems. Foods are a well-known source of toxicity, and include preservatives, pesticides and insecticides. Children are especially susceptible to food toxicity due to their immature detoxification pathways. Animals raised for food have increasingly alarming levels of antibiotics and hormones. Animal feed also has other surprising chemicals, like FDA allowed levels of the neurotoxin arsenic, which is used in chicken feed.

Household products are a continuous source of toxins. Off-gassing through evaporation is the letting out of volatile organic compounds while you sleep, eat and breath. Paints, cleaners, rugs, flooring, furniture, and car interiors are the most common culprits. In fact, the environmental Protection Agency (EPA) studies have confirmed that indoor air is often more polluted than outdoor air. The EPA's Total Exposure Assessment Methodology studies found levels of about a dozen common pollutants to be 2 to 5 times higher inside homes than outside, regardless of whether the homes were located in rural or highly industrial areas.⁹ Commonly used plastics have bisphenols and phthalates with an average of 5.5 million tons of phthalate esters produced in the world each year with exposure correlating to low levels of testosterone and corresponding infertility. The Centers for Disease Control and Prevention (CDC) published the results of the Second National Report on Human Exposure to Environmental Chemicals in 2003. This CDC study demonstrated how phthalates were found in more than 75% of urine samples studied, indicating widespread human exposure.¹⁰ Also pervasive are the organotins, which are found in foods, paints, pesticides, wood preservatives, textiles, plastics. These are known to increase masculinization of female fish, and factor into liver toxicity and obesity.¹¹ Hand sanitizers, deodorants, and toothpastes employ triclosan, a chemical similar to dioxin, which is carcinogenic and can contribute to bacterial resistance.

Pharmaceutical medications, when properly used, are toxic enough to be the fourth leading cause of death in the United States behind cancers, heart disease and stroke.¹² Many pediatric experts also cite vaccination use as a catalyst of autistic, spectrum and development disorders. Clinically, I have witnessed a number of my senior patients complain of typical symptoms of toxic exposures after receiving the flu vaccine, which, according to a recent British report, is not shown to help ward off flu mortality.¹³

Internal toxins are varied and can be due to the presence of unwanted organisms such as candida, parasites, bacterias or viruses. Candidal and bacterial dysbiosis can be encouraged by the use of antibiotic therapies. Excess viral load can be due to poor nutrient intake and immune deficiencies not allowing the patient’s body to clear these. Internal toxins may also be related to by products of poor digestion and immune dysregulation, both of which can increase free radicals in the body. The bacterial, fungal, and parasitic infections are typically heralded by digestive symptoms which may include bloating, gastrointestinal distress, and the non-specific symptom of fatigue.

So, as a practitioner, what is a reasonable plan to deal with these onslaughts and chemical insults? Although each patient is unique, and may have individual needs, a general plan I follow is to:

1. Take a detailed history to learn about symptoms, as well as possible past exposures and current sources of toxicity and consider testing if needed.
2. Limit Current Exposures
3. Identify and Support Detoxification Pathways
4. Detoxify in a Patient-Specific Manner

In my experience, many patients do quite well with a host of conditions by simply lowering the current toxic load and then giving individual support in an effort to let the body’s vital force start clearing out.

1) Take A Detailed History and Consider Testing: At the initial intake, a practitioner needs to spend time with a patient to specifically assess where a patient toxic load may reside. Was there childhood exposure or proximity to industry? Does he or she have a history of working with toxic exposures?  Detailing a person’s level of happiness with life relationship, goals, and work, and asking about stress levels and causes is also a must. It is important to ask about hobbies. I have recently begun working with one patient who is a business man that developed multiple myeloma in his late 60’s. At the end of the intake, there was no obvious toxic history until I asked about hobbies. His reply “well, I have worked on my farms in New Jersey for many years plus I enjoy blacksmithing, and I never wear a mask. My wife is constantly on me about that.” Knowing that regular exposure to agricultural chemicals and heavy metals are factors in multiple myeloma,¹⁴ we will be specifically addressing this issue when creating a detoxification protocol.

Beyond the scope of this article, there are numerous methods to test for toxins, including provocative urine tests, blood and hair analysis, kinesiology, fecal tests, breath tests, etc… Some may prove useful, and my general thought is to start with basic less expensive methods first, if needed at all, and bring in further testing if satisfactory results are not experienced using basic history and detoxification methods.

2) Limit Current Exposures: For the second step, I encourage patients to help minimize their environmental exposures. A good place to start is to purchase air filters for their place of work and home, including the area and sleeping areas. Higher quality air filters will have separate filters for particulate matters and volatile compounds. Plants such as ficus, mums, ivy, spider plants and golden pothos may be useful, but require a high density of these varieties to be effective. Water filters should be able to remove arsenic. Reverse osmosis filters may be valuable although these may use up to five gallons of water for each gallon filtered and might not be suitable in a conservation-sensitive area. Perfumes and household chemicals should be traded for non-toxic choices, and organic foods should replace non-organic as much as possible. Especially in children, organic foods are imperative for children have been shown to have minimal urinary output of pesticide metabolites when given organic foods.¹⁵ Non organic meats and certain produce (peppers, apples, berries, grapes) are especially known for higher levels of hormones, pesticides and/or antibiotics and should have a greater level of exclusion. By suggesting occlusive blinds and dampening light sources, you can help your patient create dark sleeping area to avoid any inhibition of melatonin secretion. A rule of thumb would be to if a patient could see his or her had a foot in front of the face, there is too much light.  Excess sound can also be resulting in a chronic sympathetic response and require dampening. Finally, assessment of a patient’s medication needs, to see if there are any drugs that might be able to safely decrease dosage, or forego entirely. Sometimes speaking to the other practitioners involved to create a team approach may be necessary to achieve this goal. Overtime, as you work with your patient’s vitality, medication discontinuation may become more realistic.

3) Identify and Support Detoxification Pathways: This is critical before implementing any kind of detoxification. If the body’s ability to move substances through is not active and effective, any detoxification attempted will only ‘stir up the pot’ and make patients feel worse as these toxins settle back into the tissues. It is key for the practitioner to first use a thorough review of systems, getting specific detail about the digestive tract, eating habits, bowel movements, lung function, urinary tract, integument and lymph systems. If any of these systems are compromised, the practitioner must first address and help correct these before embarking on a detoxification protocol. Having a patient perform regular bowel movements (preferably once or twice a day) is a must.

4) Detoxify In A Patient-Specific Manner: Once the above steps are in place, we can think about an actual detoxification regimen. Detoxifications can be quite gentle, using only foods and exercise – or more aggressive, by using provactive oral and intravenous chemicals. Generally, I try to use methods that are least invasive first, unless there is great sickness and urgency, which would require more heroic measures.

Supporting a patient’s vital ability to heal by hydration, cleaning up the diet, beginning an exercise regimen, and nutritional support, relaxation, combined with instituting regular sleep can bring amazing results in most cases.

If a patient has chronic or acute anxiety, boundary and relationship issues, unhappiness with his or her place in life, etc..., planning ways to work on ‘detoxifying’ these may prove the most crucial to allow the body to disengage from sympathetic mode back to a parasympathetic response which allows for better digestion and elimination. In my experience, any detoxification program absolutely requires a spiritual and psychological cleansing in addition to the physical and is often more important than the physical detoxification. Eliminating uneccessary stressors, active counseling or other feedback therapy, mediation, qi gong or tai qi and acupuncture can aid in this process.

Water alone is a powerful ally to clean and purify. According to the Rig Veda “water has a unique curative property which is not found in any other liquid. Adequate intake drives out the toxins from our body and makes the body healthy.” Given our nation’s Standard American Diet (SAD) and hectic lifestyle, bringing back the basics to health is imperative. It is important and probably the greatest challenge to help each patient learn how to institute these into their own life in a realistic and lasting way. Teaching long term lifestyle changes will also avoid the “retox” that can occur once a patient finishes a detox program.

Beyond the fundamentals, I then consider fasting and/or food allergy elimination with emphasis on support for liver phase I (biotransformation) and II (conjugation) detoxification pathways. Protein intake is important for best liver support. If a patient is deficient, I am cautious not to use a fast or purgative botanicals for concern of depleting him or her further. Skin brushing may help the integumentary movement of toxins outward. Colon hydrotherapy can be employed in most plans with respective replacement of bowel flora. Saunas and thermal chambers can and movement of fat and encourage lipolysis. Naturopathic constitutional hydrotherapy and baths have been shown to help increase immune function and aid detoxification efforts.¹⁶ If there is a strong history of certain toxins, oral chelation methods such as DMSA may be employed in conjunction with proper urinary and blood monitoring. If a patient’s digestive system is severely impaired, nutrients may not get adequately absorbed. In this case, intravenous therapy may be most effective with care to replace any lost essential nutrients and minerals. With any of the above methods, specific foods and nutrients can aid in the detox. Favorites of mine include cilantro, garlic, onions, milk thistle, dandelion, licorice, curcumin, boswellia, ginger, artichoke, parsley, glutamine, glutathione, quercetin, and green tea. Homeopathics specific for your patient may also aid your patient’s vital energy. There are many other supplemental choices, and these will depend on the organ systems on which you focus and patient needs.

As a cautionary note, it is also important always pay attention specific medical conditions and how your patient is feeling. Detoxifications may untowardly affect the clearance of medications or the condition itself. For instance, when I instituted a detox with a Type I diabetic patient of mine, I learned quickly that this required extra careful blood sugar monitoring and food intake adjustment to create a new balance that worked effectively with her insulin administration. At the same time, you will need to remind your patient that detox reactions such as local rashes, eczema, short term headaches and malaise may be normal, and suppression with pharmaceuticals should be avoided.

As you can see, there are many choices on the continuum of detoxification. We are still learning how to identify and work with removing toxins to restore the body’s ability to heal. It is key to understand the possible toxins involved, and then learn the patient’s physiologic and environmental circumstances and needs when deciding on a specific plan. I encourage my fellow practitioners to publish and share your experiences so that we may learn together how to most effectively help our patients.

References

To hear more about this topic first-hand, attend Homeopathic Medicines in the Treatment of Environmental Toxins: What Research Teaches Us about Homeo at the 2009 Integrative Healthcare Symposium. Integrative Practitioner members get 15% off Symposium registration when they enter discount code7470.