Are your patients using pre-packaged detox kits? How are they responding to them? I’ve had many patients come in complaining of fatigue, irritability, headaches and brain fog after trying one of the many OTC detox kits now available.
As health care practitioners we recognize these symptoms as classic detox reactions. But patients are understandably confused. “I thought detox was supposed to make me feel better. Why do I feel worse?”
The detox industry has grown by leaps and bounds in recent years. At first glance this seems like a good thing – until we take a closer look at their messaging. Their advice implies that detoxification onlyhappens when using one of their kits. Further, these standardized kits imply that everyone can safely and effectively use the same detox strategy.
Few patients realize that detoxification is a normal, daily process. Even fewer patients understand the dangers of using an off-the-shelf detox kit that doesn’t consider their own physiology and genetics.
How can you educate patients about the adverse effects of pre-packaged detox kits? And what can integrated geneticstell you about the way their detox pathways function. How you can best support them for overall health?
Let’s take a closer look at phase 1 and 2 detoxification; the genes involved, foods that can help or hinder detox pathways, and how to design personalized detox protocols for your patients guided by integrated genetic analysis.
Quick Review: Phase 1 and Phase 2 Detoxification
Toxins are omnipresent in our environment. Going far beyond food, water, and air pollution we must also consider sources such as personal care products, cleaning products, home furnishings and even some medications.
Although minimizing toxin exposure is a key part of any detox strategy, it will only get you so far. To actively get toxins out of the body, we must look to our phase 1 and 2 detox pathways.
When toxins enter our body, their fat-loving nature allows them to easily infiltrate the fat inside our cells. The longer they remain in our cells, the more damage they can cause.
Once inside a cell, toxins cannot exit in their original shape. This is where the hard-working liver steps in to produce cytochrome P450 (CYP 450) enzymes. This set of enzymes transforms the toxin into a new shape that can leave the cell – a phase 1 substrate. But things get worse before they get better. Because these substrates are usually moreinflammatory and carcinogenic than the original toxin, they need to be removed from the body quickly before they cause trouble. This is where phase 2 enzymes come in; they bind to the phase 1 substrate and promote its excretion.
The Dangers of Targeting Only One Phase of Detoxification
Both phases must be in balance for optimal detox pathway function. But what happens when one phase is faster than another?
Fast Phase 1, Slow Phase 2
Patients with a fast phase 1 can get toxins out of cells quickly. But if phase 2 is slow, these super-toxic, phase 1 substrates remain in the bloodstream too long. This means patients will experience classic detox reactions for longer, and be at increased risk of inflammation and some cancers.
Slow Phase 1, Fast Phase 2
Patients with a slow phase 1 don’t have enough CYP 450 enzymes to remove toxins from cells effectively. The toxins thus remain in the cells for longer, potentially causing widespread damage. A fast phase 2 will clear out any available phase 1 substrates. But with a slow phase 1, there won’t be much to clear out.
Slow Phase 1, Slow Phase 2
These patients are slow to both get toxins out of cells and to remove them from the body entirely. Such patients may carry a heavy toxic burden.
We know that compared to those with ideal processing (moderate phase 1, fast phase 2), the above patients need additional detox pathway support. However, to design truly effective treatment protocols you need to know the rates of both pathways. And genetic analysis is the only way to get this vital information.
Phase 1 Detoxification Genes
The main phase 1 genes are CYP1A2 and CYP3A4. They are both part of the cytochrome P450 group of enzymes. This family has over 50 members, but these two genes are by far the most important. Just as you need to look at both phase 1 and phase 2 genes together, you must also look at the genes withineach phase. Let’s take a look at how these genes differ.
This gene is a key player in getting both xenobiotics and metabolic waste out of the cells in preparation for the phase 2 enzymes to take over and escort them out of the body. Perhaps best known for its caffeine-clearing effects, it metabolizes an astonishing 90% of drugs from our body. With particular affinities for clearing cigarette smoke and aspirin, it may affect the efficacy of some antibiotics and SSRIs.
This gene is one of the most abundant in the cytochrome P450 enzyme family. Responsible for clearing as much as 50% of all pharmaceutical drugs out of our cells, this gene has a particular affinity for oral contraceptives. It is perhaps best known for being strongly affected by grapefruit juice, which can have ramifications on the metabolism of several drugs.
If one of these genes is fast and one is slow, this will moderate the overall phase 1 speed. However, if they are both fast or both slow, this can be potentially harmful.
Phase 2 Detoxification Genes
The main phase 2 genes are GSTP1, SOD2 and NQ01. Let’s look at how these genes work together to pick up where phase 1 left off and rmove toxic phase 1 substrates from the body.
This gene produces Glutathione-S-transferase, the enzyme responsible for manufacturing glutathione. As our master antioxidant, glutathione is highly effective at reducing the overall oxidative damage in our bodies. But when faced with toxic xenobiotics like herbicides, pesticides and some medications, it needs to be produced in greater quantities.
This gene codes for the enzyme Mitochondrial Superoxide Dismutase, a key player in protecting both our mitochondria and our DNA from oxidative damage. Similar to the way phase 1 detox pathways produce toxic substances that must be removed, our mitochondria naturally produce toxic reactive oxygen species (ROS) and superoxide when generating energy. SOD2 is responsible for converting these substances into less toxic forms.
This gene makes the enzyme NAD(P)H-quinone dehydrogenase-1, best known for fully oxidizing quinones to protect against inflammation. With a particular affinity for clearing out benzenes and estrogens, it also plays a key role in vitamin K activation.
Diet and Detox Pathways: When Coffee is Good and Raw Kale is Bad
Foods like lemons and leafy greens have been much-touted in the media as “detox foods”. But did you know that many ‘healthy’ foods can actually be dangerous for your patients? Let’s review some common foods, herbs and beverages to see how they impact our detox pathways.
Your patients may be increasing their intake of veggies like broccoli, cauliflower, cabbage, brussels sprouts and kale to improve overall health. They may even go the extra detox mile and eat them raw.
Raw cruciferous veggies greatly stimulate phase 1 detox. For patients with a slow phase 1, this is ideal. This dietary change will help them get toxins out of their cells faster.
But what if, like me, a patient has a fast phase 1? If they add more raw cruciferous veggies to their diet, they will generate more inflammation. This doesn’t mean they have to eliminate these foods – it just means they have to cook them.
Mint and echinacea are both popular herbs likely to be used by your patients. Both herbs increase the activity of toxic phase 1 substrates. Like raw cruciferous veggies, these should be avoided in patients with fast phase 1 pathways and promoted in those whose phase 1 is slow.
Turmeric (and its main active ingredient curcumin) has gained widespread media coverage for its strong anti-inflammatory action. This herb slows down phase 1. For someone like me with a fast phase 1, this is beneficial and will effectively reduce inflammation. But for patients with a slow phase 1 the result is quite the opposite. Further slowing of phase 1 means toxins will stick around for longer inside the cell, and actually increase inflammation. This is the perfect example of a dietary intervention which, if misapplied, can spell disaster for your patient’s overall health and inflammatory status.
Coffee is often considered ‘unhealthy’. But again, it all depends on your patients’ genetic profile. Coffee slows phase 1 detoxification, especially CYP1A2.
If your patient has a fast phase 1 like me, coffee is beneficial. It can slow and thus balance their phase 1 substrates. In fact, 2 to 3 cups of coffee per day can reduce their inflammation so effectively that it can lower heart attack risk by up to 68%!
For patients with a slow phase 1 however, increased coffee intake will be incredibly inflammatory and toxic.
3 Steps to Optimize Patient Detox Pathways Using Integrated Genetics
You can see how analyzing the genes from only phase 1 puts your patient at risk of accumulating toxic phase 1 substrates in the bloodstream. Conversely, analyzing only phase 2 genes puts your patient at risk of accumulating toxins inside the cells. Both cases result in higher toxic load and increased risk of inflammation, many cancers and a host of chronic diseases.
The key to designing effective treatment protocols to optimize your patient’s detox pathways is examining their genetics. Making supplement, diet or lifestyle recommendations without knowing a patient’s phase 1 and phase 2 status is harmful. You need to know which protocols will effectively improve their detox pathway function and which ones may worsen their health? Here are 3 steps you can take to get started:
Step 1: Just Say No to OTC Detox Kits
Pre-packaged detox kits that claim to support phase 1 and phase 2 pathways imply that they’re covering all the bases. For me personally (and for many of your patients), these kits can often make things worse. They have always made me feel unwell as they boost my already too-fast phase 1 to increase my inflammatory load. OTC kits are directly contrary to the idea of personalized medicine; this one-size-fits-all approach doesn’t fit everyone safely.
Step 2: Do Genetic Testing
We are all unique. And the only foolproof way to know how fast or slow your patient’s detox pathways are, is to test them. Personally, I need to slow phase 1 and greatly increase phase 2. Others may need to speed up phase 1 and maintain phase 2 to find their genetic detoxification balance.
Testing my own genes gave me the information I needed to make effective lifestyle changes like drinking a couple cups of coffee a day, cooking cruciferous veggies and including turmeric in my diet. These changes may seem minor, but for me they have been truly life changing. Don’t you want to provide the same game-changing protocols to your patients to improve not only their detox pathways, but their overall quality of life?
Step 3: Use a Genetic Report That Integrates Gene Analysis
In this article I’ve provided insight into five key detox genes.My GeneRx reportprovides practical information on each of these five genes and their variants. Most importantly, the report will show you how to integrate and interpret these genes. The report includes detailed treatment protocols with diet, lifestyle and supplement do’s and don’ts. GeneRx will help you design truly individualized detox treatment recommendations that work.
Are you ready to use personal genetic testing help your patients say goodbye to toxins and hello to increased energy and vitality? Simply upload your patients raw 23andMe data to start improving patient outcomes right away.
Download a sample GeneRx reportto see how it compares with your current genetic report, or learn more about how GeneRx differs from other reports.