How to ensure excretion and prevent toxicity.
Kristen Haabala, ND
There is no doubt that obesity is an ever-increasing epidemic in the United States. Roughly 35% of the adult population and almost 17% of kids between the ages of 2 to 19 years are currently obese.1 As the rates of obesity rise, so do the rates of chronic disease, including cardiovascular disease, diabetes, musculoskeletal disorders, hormone imbalances, and cancer, just to name a few. Because of the association between altered body composition and multiple disease processes, it is critical to support our patients in their journey to lose fat and gain healthy body mass.
But with all of the diet programs out there, how do we support our patients and assure that they are utilizing healthy and safe weight loss? The first step is to ensure that the patient’s liver and bowels are ready to endure a fat loss program. The best way to do this is through an initial bowel and liver detox and support regimen.
Research continues to show links between exposure to environmental toxins and syndromes that encompass symptoms of fatigue, muscle weakness, cognitive dysfunction, neurodegenerative diseases, and several types of cancers.2 Furthermore, research is showing that certain chemicals in our environment are acting as “obesogens” and are actually altering a person’s metabolic processes and predisposing him or her to a plague of continued weight gain.1
We are exposed to a wide range of different toxicants from our environment on a daily basis, and our body is constantly working to clear them. The many forms of these toxins include heavy metals, pesticides, drugs, industrial compounds, and food additives.2 The most common way that these toxins enter our bodies is through what we put in our mouths. Unfortunately, toxins are ingested not only by way of the medications we use and the food we eat but also by the sources of the foods we consume and the chemicals with which they are treated.2
Because the toxins are lipid soluble, they are attracted to the lipids in cell membranes. The toxins can then be transported inside cells, where they wreak havoc on our daily function and may be stored for many years.2 Furthermore, because these toxic substances are lipophilic, they are commonly stored in neurological tissue and body fat.3 The fact that the body tends to store these toxins in our body fat is the exact reason it is so important to support detox before a fat loss program. When fat loss begins, these dangerous stored toxins become released back into circulation. It is absolutely critical that they must be properly excreted from the body.
The body’s detox mechanism is similar to a river. At the end of the river is the gastrointestinal tract, where the toxins ultimately get excreted. Should there be any dysfunction in the ability to excrete through the bowel, the toxins risk being reabsorbed and entering back into circulation. At the middle of the river is the liver’s detox pathway. If either phase 1 or phase 2 of the liver’s detox pathway is not functioning properly, the toxins can get backed up and remain in circulation for ultimate redeposition into our cells. Due to the decreased fat mass available, the toxins risk being redeposited into our neurological tissue. All systems in the detox river must be flowing properly for ultimate clearing from the body.
The first step in any detox program must begin with decreasing toxin exposure. This gives the intestines and liver a break in processing new toxins and enhances their ability to focus on past stored toxins. So where do we begin to decrease toxin exposure? Start wit
h foods and products used on a daily basis. Buy more organic foods to limit exposure to pesticides, and eat more whole foods to decrease exposure to additives. Look closely at cleaning products, and opt for natural alternatives. Consider alternatives to the chemical-ridden soaps, lotions, and beauty products used on a daily basis. Finally, be sure the air you breathe and the water you drink are free of contaminants.
The next step in a medically guided program is to cleanse and support the gastrointestinal tract for ultimate removal of toxins. The intestinal mucosa is very active in the processing of toxins. In fact, 25% of the biotransformation activity in our body takes place in the intestines, where the mucosa converts some lipid-soluble toxins into water-soluble molecules for excretion before they are even transported to the liver for processing.2 Ultimately, both toxins that are processed in the intestinal tract and those that come from the liver require healthy fecal production for removal from the body.
Healthy fecal production can be supported through dietary fiber. Fiber has also been shown to actually bind some toxins for removal from the body before they are even digested and absorbed into circulation. Along with dietary fiber comes the necessity of adequate water intake to help maintain healthy kidney functioning and processing of toxins already in circulation.2
In supporting the functional integrity of the gastrointestinal mucosa, there are 4 important questions to ask yourself in your patient assessment (the 4 Rs of a functional medicine approach to gastrointestinal restoration). (1) The first important question is “What may need to be removed to support healthy gastrointestinal function?” This may be an underlying infection of pathogenic yeast, bacteria, or protozoa. There may also be a history of chronic exposure to a particular food or additive to which the patient is intolerant. Your full history will give clues to any of these issues. (2) After this question is addressed, you can move on to the second important question: “What may need to be replaced?” Consider the possibility of digestive enzymes, bile salts, or stomach acid supplementation. (3) Then, the third important question is “Does there need to be reinoculation with probiotics and/or prebiotics?” (4) And last, the fourth important question: “Is anything needed for regeneration or repair of the mucosal layer?” This can be supported through tailored nutrition therapy, as well as by gastrointestinal supportive botanical medicines.4
Once the toxins reach the liver, there is an intricate process of detoxification that involves 2 phases. Both phases must be in balance, or further damage can be done. During phase 1 of bioactivation, a reactive site is generated on the toxin, so it can be further processed by phase 2. One major concern is that after phase 1, the reactive intermediate is often even more reactive and potentially more toxic than the original toxin molecule. This new molecule can act as a reactive oxygen species and has the ability to bind to DNA, RNA, and proteins, causing irreversible damage to cells. The intermediate must move into phase 2 of the detox process. It is in phase 2 where the reactive toxin becomes conjugated into a nontoxic and water-soluble molecule to be flushed out of the body. There is potential for a huge problem if phase 1 is working overtime and phase 2 is lagging behind, leading to a buildup of large quantities of reactive toxins.2 As practitioners, we have the opportunity to design personalized programs to support both phases of the detox process. This can be done through the use of targeted nutritional therapy in the form of diet, supplementation, and herbal formulations tailored to support each phase.
Once this process has been completed, it is safe to address weight loss concerns. After an appropriate bowel and liver cleanse, the patient may have already begun to see changes in his or her weight and body composition. When designing a weight loss program for a patient, it is of utmost importance to do so in a personalized way to address any possible underlying factors that may be influencing the body composition. For example, if the patient has insulin resistance, hypertension, or food allergies, these conditions must be taken into consideration when designing a food plan. A staple of all food plans for weight loss should be an emphasis on providing optimal nutrition through whole foods, while limiting caloric intake. The diet and exercise plan should be designed with the goal of maintaining or increasing lean body mass, while decreasing fat mass. In order to do this, resistance along with cardiovascular exercise should be added to the plan. Lean body mass increases the body’s calorie-burning capacity and decreases the likelihood of fat mass returning after a weight loss program.5 Of course, the ultimate goal as a holistic practitioner is to teach our patients how to eat and live to maintain the weight loss for the rest of their lives.
Kristen Haabala, ND received her doctorate in Naturopathic Medicine from the National College of Natural Medicine (Portland, Oregon). Prior to attending NCNM, Kristen received her bachelor’s degree in Biomedical Science from St. Cloud State University. Additional post-doctorate education includes training in the areas of Functional Medicine, Frequency Specific Microcurrent, and Lifestyle Medicine with certification as a First Line Therapy health care practitioner. She completed her residency work under Dr Kristi Hughes. Dr Haabala is now the owner of Midwest Natural Medicine in Alexandria, Minnesota. Her practice is focused on educating patients on the power of living a healthy lifestyle, offering natural healthcare solutions to today’s complicated medical conditions. She strives to create a personalized treatment program for each patient with a supportive environment for improving holistic health.
References
Holtcamp W. Obesogens: an environmental link to obesity. Environ Health Perspect. 2012;120:a62-a68. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279464/. Accessed March 13, 2013.
Liska DJ, Rountree R. The role of detoxification in the prevention of chronic degenerative diseases: a summary. Adv Nutr Publications. 2002. http://www.optinutri.net/detox_article.html. Accessed March 13, 2013.
Jandacek RJ, Tso P. Factors affecting storage and excretion of toxic lipophilic xenobiotics. Lipids. 2001;36(12):1289-1305.
Clinical approaches to gastrointestinal imbalance. In: Jones DS, ed. Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine; 2005. Chapter 28. http://www.functionalmedicine.org/content_management/files/TOM%20-%20Chapter%2013%20-%20Stress.pdf. Accessed March 13, 2013.
Lerman RH, Liska DJ. Body composition and optimal health: a summary. Adv Nutr Publications. 2002. http://integrativewellness.org/Documents/BodyCompositionandOptimalHealth.pdf. Accessed March 13, 2013.
