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Copyright © 2021 All rights
reserved.
Neither this document nor any
part of it may be reproduced
or transmitted in any form or
by any means
including photocopying, email,
fax, etc. without prior written
permission of the author.
Advanced Clinical Focus:
Detoxification and Biotransformation
Josh Gitalis
Ba(H) CNP RNCP/ROHP
evidence-based clinical nutrition and integrative healthcare
JoshGitalis.com
Advanced Clinical Focus:
Detoxification and Biotransformation
What you will learn...
• Slope of Health • Liver detoxification
• Why this course? • Specific toxins
• History of toxicology • Clinical detoxification
• Toxins defined
• How they damage
• Channels of elimination
Advanced Clinical Focus:
Detoxification and Biotransformation
What you will not learn...
• Protocols
• One-size-fits-all
Advanced Clinical Focus:
Detoxification and Biotransformation
The Slope of Health
Life Slope of Health
Blood tests normal
Heredity M
(inherited factors) Physical signs and symptoms of body out ed
of balance - pain, fatigue, headaches, etc. ica
l(
Poor diet + lifestyle ef
fe
OTC drugs to suppress symptoms ct)
Vitamin + mineral deficiency
Diagnosis of a disease/condition
Li
fe Artificial food additives Surgery to remove dysfunctional
sty body part or stronger meds to
le further suppress symptoms
(ca Pesticides and chemical exposure
us
e) Cancer, tumors, and growths
Environmental pollution
More surgery, chemotherapy,
Digestive problems and internal toxicity and/or radiation
Personal Health Assessment Suppressive medications
Where am I on The Slope of Health?
How did I get there? End stage
How long will it take for me to climb back?
What do you think it takes to get up the slope
back to health?
Copyright © 2013
Advanced Clinical Focus:
Detoxification and Biotransformation
Why This Course?
2.6m 1700s 1940s Present Day
l l l
Homo sapiens Industrial Revolution 80,000+
Chemicals
Chemical experimentation
begins
Advanced Clinical Focus: Detoxification and Biotransformation Why This Course? Advanced Clinical Focus: Detoxification and Biotransformation If Health is The Goal… IN OUT Advanced Clinical Focus: Detoxification and Biotransformation If you’re not detoxifying daily, you’re retoxifying daily.
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• Meet Sandra: Stay-at-home mother of 2 (newborn,
and 4-year-old)
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• She hears her son crying and gets up from her new
“memory foam” mattress.
• Lifts her son David out of his basinet.
• He begins suckling on “the healthiest food”.
• For breakfast she makes pancakes on her teflon pan
for her 4-yr-old Jenny.
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• Then slices strawberries and cantaloupe on top and
adds some syrup. Used to say “ants.
Corrected.
• A piece of strawberry falls to the floor, and ants start to
enjoy it.
• The house is usually sprayed once a year for termites.
The family usually leaves the house for that day.
• Sandra notices a burning smell and realizes the pan is
smoking, and smells more like chemical than pancake.
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• 1 hour later Jenny is dropped off at school, where
about 10 cars are idling.
• As Sandra waves good-bye, Jenny is already playing
on the new pirate ship playground.
• After the drop off, Sandra runs errands:
• Dry-cleaning, David’s moisturizer, hairdresser for
dyed roots, fill up gas, happy meal with toy for
Jenny’s lunch.
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• When Sandra arrives home, the lawn company is
finishing spraying weed killer.
• David and Jenny take a nap on her new bed, while the
dry-cleaning hangs in the nearby closet.
• Sandra calls the dentist because one of her amalgam
fillings is bothering her.
• She manages to get a noodle soup cooked in the
microwave for lunch. It’s in a disposable bowl.
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• She cleans the bathroom while kids are sleeping
because one of the cleaners say “hazardous to
humans and domestic animals”. The fumes make her
feel woozy.
Advanced Clinical Focus:
Detoxification and Biotransformation
Family Health Picture
• Environmentally-minded: recycle, drive hybrid
• “Health-minded”
• Sandra: Raynaud’s disease
• Jenny: eczema, food allergies (dairy and tree nuts)
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• She hears her son crying and gets up from her new
“memory foam” mattress - flame-retardants (PBDEs)
• Lifts her son David out of his basinet - PBDEs
• He begins suckling on “the healthiest food” -
concentrated PBDEs
• For breakfast she makes pancakes on her teflon pan
for her 4-yr-old Jenny - PFOA
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• Then slices strawberries and cantaloupe on top and
add some syrup - pesticide endosulfan
• A piece of strawberry falls to the floor, and ants start to
enjoy it - toxic dust
• The house is usually sprayed once a year for termites.
The family leave the house for that day - termiticides
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• 1 hour later Jenny is dropped off at school, where
about 10 cars are idling - carbon monoxide,
formaldehyde, benzene, polycyclic hydrocarbons
• As Sandra waves good-bye, Jenny is already playing
on the new pirate ship playground - phthalates
• Drycleaning - PERCs, David’s moisturizer - parabens,
hairdresser for dyed roots, fill up gas - benzene,
happy meal with toy for Jenny’s lunch - BPA
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• When Sandra arrives home the lawn company is finishing
spraying weed killer - atrazine
• David and Jenny take a nap on her new bed, while the
dry-cleaning hangs in the nearby closet - PBDEs, PERCs
• Sandra calls the dentist because one of her amalgam
fillings is bothering her - mercury
• She manages to get a noodle soup cooked in the
microwave for lunch. It’s in a disposable bowl - leached
phthalates
Advanced Clinical Focus:
Detoxification and Biotransformation
How did we become contaminated?
• She cleans the bathroom while kids are sleeping
because one of the cleaners say “hazardous to
humans and domestic animals”. The fumes make her
feel woozy - ammonia
• Tally: PBDE, PFOA, pesticides, termiticides, carbon
monoxide, formaldehyde, benzene, polycyclic
hydrocarbons, phthalates, PERCs, parabens,
benzene, BPA, atrazine, mercury, ammonia
Advanced Clinical Focus:
Detoxification and Biotransformation
Chemical Synergy
1 + 1 + 1 =
x 3
Nakazawa, Donna Jackson. Autoimmune Epidemic. 2008.
Advanced Clinical Focus:
Detoxification and Biotransformation
Chemical Synergy
1 + 1 + 1 = 6-9
Nakazawa, Donna Jackson. Autoimmune Epidemic. 2008.
Advanced Clinical Focus:
Detoxification and Biotransformation
Chemical Synergy
#6 IN A SERIES
Chemicals combine in
our bodies, but are rarely
tested that way.
Why?
A study at Tufts University tested the
effects of 10 pesticides which mimicked
estrogen in the body. At low levels,
none of the pesticides alone had an
effect on human tissue. But in various
combinations, there was a strong
estrogen-mimicking effect ... even at
low levels.
In a study at the University of
Wisconsin, mice showed no effect
when exposed to atrazine or aldicarb,
two pesticides commonly found in
drinking water in the Midwest. When
mice were exposed to both chemicals,
as humans often are, the combination
therefore, that smokers exposed to
Multiple exposures pose produced immune system impairment.
asbestos would have 15 times the
unknown risks. risk of getting lung cancer. In fact,
What We Can Do
they face 55 times the risk. A powerful
interaction. Parents should limit their children’s
A good pharmacist will alert you that exposure to pesticides, both in and
a newly-prescribed medicine may We know that the tissue of nearly outside the home. Organically
adversely interact with some other every human on earth contains produced foods should be purchased
medicine you’re already taking.That is, detectable levels of a range of whenever possible. The use of paints,
two medications that are individually chemicals called persistent organic solvents, and cleaning products
benign can cause problems in pollutants or POPs.We find POPs in containing toxic and volatile chemicals
combination. Careful studies have pesticides, industrial chemicals, indeed should be limited. There are more
been undertaken to identify those in a broad range of products introduced suggestions on our website.
drug interactions. over the past sixty years.We know that
occupational exposure to PCBs, dioxin, But we must do more. Of the thousands
But when it comes to toxic chemicals of synthetic chemicals on the market,
in everyday products, there is and other POPs has been linked to
several cancers and to a broad range relatively few have been tested for
surprisingly little information available safety. And even fewer have been
about how they behave in combination. of reproductive problems, including
birth defects in offspring. Clinical tested in combination with other
How, for example, are our bodies chemicals. For our health, for our
affected when the chemicals in paint and epidemiological studies suggest
that non-occupational exposures to children’s health, such testing should
thinners interact with those in dark hair be in place for all chemicals.
dyes, or when we are exposed to one POPs at much lower levels may also
pesticide on a fruit, and another from cause significant harm, especially to A summary of the supporting
our neighbor’s lawn? developing fetal organs. And the little scientific evidence, and a list of
we know of exposure to a multiplicity scientific endorsers, can be found
of these chemicals should cause concern. at www.childenvironment.org.
What We Know
Here is an analogy: Compared with Dutch scientists have documented that
non-smokers, cigarette smokers have when PCBs, at a non-toxic level, are Center for
ten times the risk of contracting lung mixed with dioxin, at a level that
Children’s Health
cancer. We also know that workers produced only minor liver damage,
exposed to asbestos have five times the the combination produced 400 times and the
lung cancer risk compared with those the damage of the dioxin alone. Environment
never exposed. You might think,
Box 1043, One Gustave Levy Place, New York, NY 10029 • www.childenvironment.org
https://home.comcast.net/~carlislepag/images/ad6big.pdf
Advanced Clinical Focus:
Detoxification and Biotransformation
Chemical Synergy
Lung Cancer Risk
Smoking
Asbestos
10x
5x ↑Risk
↑Risk
55x ↑ Risk in Lung Cancer
History of
Toxicology
Advanced Clinical Focus:
Detoxification and Biotransformation
Paracelsus (1493-1591)
• Father of toxicology
• Attributed illness to
external factors
• Established concepts
of acute and chronic
toxicity
Advanced Clinical Focus:
Detoxification and Biotransformation
Paracelsus (1493-1591)
All substances are poisons;
there is none which is not a
poison. The right dose
differentiates a poison from a
remedy.
Advanced Clinical Focus:
Detoxification and Biotransformation
Key Definitions
• Toxic: Capable of causing injury or death, especially
by chemical means; poisonous
• Toxin: A toxic substance that is produced by a living
organism (e.g. plants, animals, fungi, bacteria)
• Toxicant: A type of poison that is made by humans
or introduced into the environment by human activity
• Xenobiotic: A chemical compound that is foreign to
or not normally produced by the body
• Persistent Organic Pollutant (POP): Substances
that persist in the environment, bioaccumulate
through the food chain, and pose a risk of adverse
effects to human and environmental health.
Advanced Clinical Focus:
Detoxification and Biotransformation
Liver Detoxification Words
• Words used for “liver detoxification”:
• Hepatic
• Detoxification
• Biotransformation
• MetabolomicsAdvanced Clinical Focus:
Detoxification and Biotransformation
Toxicology
• The study of poisons or the adverse effects of
chemical and physical agents on living organisms
• Historically, toxicology has been concerned with the
amount of a poisonous substance that would be fatal
(LD50), not subtle or long-term effects.
Advanced Clinical Focus:
Detoxification and Biotransformation
LD50
Advanced Clinical Focus:
Detoxification and Biotransformation
Lethal Dose of Common ChemicalsAdvanced Clinical Focus:
Detoxification and Biotransformation
Principles of Toxicology
• Hazard identification: describing an agent’s toxic
potential
• Dose-response: identifying concentration above
which an environmental agent induces toxic effects
(NOEL)
• Exposure assessment: evaluation of concentration
in relevant medium
Advanced Clinical Focus:
Detoxification and Biotransformation
NOEL- based risk assessment for synthetic
chemicals
• NOEL = No Observable Effect Level
• Typically based on short-term observations
• Assumes linear dose-effects
• Assumes individuals biochemically similar
• Ignores windows of vulnerability
?
Advanced Clinical Focus:
Detoxification and Biotransformation
NOEL- based risk assessment for synthetic
chemicals
• Discounts potentially cumulative effects of low-dose
• Discounts toxin synergy
• Fails to account for trans-generational effects
?Advanced Clinical Focus:
Detoxification and Biotransformation
NOEL- based risk assessment for synthetic
chemicals
http://www.michiganscience.org/12811
Sources of
Toxins
Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• In a study conducted
by the EPA, benzene
derivatives were found
in 98% of subjects
Hill RH Jr, Ashley DL, Head SL, et al. p- Dichlorobenzene exposure among 1,000 adults in the United States. Arch Environ Health 1995;50:277-280.Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• The average woman
uses 12 different
personal care products
per day
• This exposes them to
160 chemical
ingredients daily
Ken Cook - Environmental Working Group President
Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• 75% of all brand-name
cosmetics contain
phthalates, chemicals
that have been strongly
linked with hormone
disruption
Decaon, Gillian. There’s Lead in Your Lipstick. 2011.
Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• There are over 75,000
chemicals approved in
the US
Strashem, Connie. Defeat Cancer. 2011.Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• Low-level lead
exposure can result in
serious mental and
behavioural problems
• Lead’s most insidious
effects is its poisoning
of the developing
nervous system
3. Needleman HL, Schell A, Bellinger D, Leviton A, Alfred FN: The long-term efects of exposure to low doses of lead in childhood; An 11-year follow-up
report. New Engl J Med, 322: 2, 83-88, 11 January 1990.
4. Needleman HL, Gatsonis CA: Low Level Lead Exposure and the IQ of Children: A Meta-analy- sis of Modern Studies. JAMA, 263: 5, 673-678, 2,
February 1990.
Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• People who have
trouble detoxifying are
more prone to cancer
Murray, Michael and Pizzorno, Joseph. Encyclopedia of Natural Medicine. 1998.
Advanced Clinical Focus:
Detoxification and Biotransformation
FACT
• The average American
has 91 chemicals in
their body
http://www.ewg.org/sites/bodyburden1/findings.phpAdvanced Clinical Focus:
Detoxification and Biotransformation
Sources of Toxins
Endogenous
Advanced Clinical Focus:
Detoxification and Biotransformation
Sources of Toxins
Endogenous Exogenous
Naturally-Occurring
Synthetic
Advanced Clinical Focus:
Detoxification and Biotransformation
Endogenous
• By-products of intestinal
microorganisms - endotoxins,
LPS
• Intermediary metabolites
• Non-end-product metabolites
• Hormonal overload
• Free radicals
• Toxic emotions/memoriesAdvanced Clinical Focus:
Detoxification and Biotransformation
Exogenous - Naturally Occurring
• Ionizing radiation
• UV light
• Radioactive elements (radon, uranium)
• Oxidation (free radicals)
• Animal and plant mycotoxins
• Products of combustion
• Heavy metals
Advanced Clinical Focus:
Detoxification and Biotransformation
Exogenous - Synthetic
• Pesticides, herbicides, • EMFs
etc.
• Skin products
• Industrial chemicals
• Cleaning products
• Food toxins
• Plastics
• Drugs
• Inhalants
Advanced Clinical Focus:
Detoxification and Biotransformation
Chronic Low-Level Toxicity
• Effects of toxicants are not linear
• Chemical sensitivity varies
considerably, depending on:
• Species
• Life stage
• Biochemical individuality
X
• Toxin synergyAdvanced Clinical Focus:
Detoxification and Biotransformation
Disease Risk
Cumulative
Toxic Potency x x Susceptibility
Exposure
Advanced Clinical Focus:
Detoxification and Biotransformation
Total Toxic Load (Body Burden)
• Over long periods of time, small daily doses of
multiple contaminants have cumulative detrimental
effects on physiological pathways that can eventually
impair and cause disease.
Advanced Clinical Focus:
Detoxification and Biotransformation
Total Toxic Load Terminology
• Chemical body burden: the quantity of an
exogenous substance or its metabolites that has
accumulated in an individual or a population
• Total toxic load: the total body burden of
exogenous chemicals, heavy metals, and toxic
exogenous compounds
• Exposome: combined exposures from all sources
that reach the internal environmentAdvanced Clinical Focus:
Detoxification and Biotransformation
Spectrum of Vulnerability
Permitted
exposure Average threshold
of harm
Number of Margin of safety
people for for average
whom individual
indicated
exposure is
the threshold
of harm Individuals harmed
by permitted
exposure
more sensitive less sensitive
individuals Increasing Exposure to Toxicant individuals
Advanced Clinical Focus:
Detoxification and Biotransformation
Limits of Certainty and Under-
Recognition of Toxic Threats
Gene-environment interactions
80,000 chemicals
Billions of mixtures
Unknown Effects Known
Effects
Long latency effects
Windows of vulnerability
Advanced Clinical Focus:
Detoxification and Biotransformation
Dr. Richard Horton (editor-in-chief @ Lancet)
We must act on facts, and on the most accurate interpretation
of them, using the best scientific information. That does
not mean we must sit back until we have 100% evidence
about everything. Where the state of the health of the people
is at stake, the risks can be so high and the cost of corrective
action so great, that prevention is better than cure. We
must analyze the possible benefits and cost of action and
inaction. Where there are significant risks of damage to the
public health, we should be prepared to take action to
diminish those risks even when the scientific knowledge is
not conclusive, if the balance of likely costs and benefits
justifies it. Lancet. 1998;352(9124):251-52Advanced Clinical Focus:
Detoxification and Biotransformation
Innocent Until Proven Guilty?
=
—
Advanced Clinical Focus:
Detoxification and Biotransformation
Silent Spring:1962
Advanced Clinical Focus:
Detoxification and Biotransformation
Functional Toxicology
ANTECEDENTS
predisposition
TRIGGERS Chronic
TOXINS
the tipping point Disease
MEDIATORS
perpetuate current stateYou can also read
