Dr. Ruscio answers a listener question in this episode of Dr. Ruscio Radio! Are expensive liver detox programs really necessary for overall health or thyroid problems in particular? The doc tells us what the research says, as well as, his past and current approaches to detoxification. He touches on topics such as: the gut-liver connection, iron overload and functional medicine pricing models.
Dr. Ruscio’s previous approach to detoxification…..3:28
Why some people feel better on detoxification programs…..9:10
Velvet rope syndrome…..12:32
Diet and detoxification…..13:14
Toxins and thyroid…..14:13
Iron overload and the liver…..25:00
Functional medicine pricing models…..27:00
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To Detox or Not to Detox
Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine.
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The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.
Now, let’s head to the show!
Hey, everybody, this is Dr. Ruscio.
Just two quick things I wanted to bring up.
The ‘Contact Us’ form on the website wasn’t working for a few weeks, which I just found out about and we just fixed. So, if you’ve tried to reach out, to ask question, or to become a patient through that ‘Contact Us’. portal, and haven’t heard back, please reach out again. And I do apologize – It was a tech error. I’ve lost a little bit of hair on that issue, but I think we are looking good now.
And the second (issue): I’ve had a number of people asked still accepting patients to clinic, and I am. So, if you need help feel free to reach out, and we are more than happy to help however I can.
Dr. Michael Ruscio: Hey folks, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with the lovely Susan McCauley. Hey, Susan. What’s up?
Susan McCauley: Not much. I’m excited today for two reasons: First of all, I have a brisket on the smoker, so…
DR: Ohhh, nice.
SM: Now everybody is jealous. And second of all, our topic today is one of the things, and I’ll let you do the reveal, but one of the things that I get asked a lot of questions about, and I’m pretty passionate about, so I’m really excited for the show.
DR: Cool, cool. Hopefully we have similar opinions on this…
SM: I’m sure we do.
DR: Thank you for saving me the reveal – thanks for not stealing my thunder.
DR: But, yeah. We had a listener question come in, and we will play the question in a minute. But essentially, about detox, about detox for thyroid, and about a pretty pricey detox program. So, I’ve got a lot to say on this from a practical perspective. This isn’t going to be a very reference-heavy episode; it’s going to me a more practical kind of ‘what I’ve seen’ and how to navigate this issue. I think it will hopefully help a lot of people, because I think it’s kind of a pervasive issue out there in functional medicine land.
SM: I think the practical information is super important because, you know, we can delve into the research and that’s also very important. But what happens in the clinic? You know, what happens with clients, you know? We talk about what’s the first line of defense; like, what do you get the most bang for your buck.
SM: So, do you want me to go ahead and play the question?
DR: Yeah, let’s play the question, and then we can dive in after that.
Caller: Hi, Dr. Ruscio. I’ve been enjoying all your podcasts and your information on your website. I really appreciate your sound advice. My sister is seeing a functional medicine doc for some thyroid issues. He is wanting her to buy and commit to a $2,700 liver detox program. I’m really looking for some information about whether this is a good idea or a bad idea. And, I would like to get your opinion. Could you direct me to a source that would give me a sound perspective on a liver detox program? Or give me your opinion on that? I would appreciate it. So, thank you so much, Dr. Ruscio.
DR: Yeah, let’s answer that question, because there are a few really important things there. There is the issue of liver detox, liver detox as it relates to thyroid, and then a $2,700 liver detox…
SM: That’s a price tag. Now that is a price tag.
Dr. Ruscio’s previous approach to detoxification
DR: Right, and I want to come back…I mean, I want to pick into this in more detail. So, you’re giving me a great lead-in to a couple things come back to in just a moment. But before we transition, something I’d like to provided…say you are a practitioner listening to this, and you are doing this, you’re doing these detox cleanses. I would challenge you to experiment and try putting half of your patient group or your client group on the detox and the other half just on the lifestyle interventions – dietary and lifestyle interventions. And see if you can notice an appreciable change in one group to the other. And if you really want to be scientific, you can use something like an SF-12 – Short Form 12, or one of the short forms, which are just different …like a 12-question survey that gives a research validated indicator as to someone’s overall level of health and well being. So, you can have one group…you could have both groups do one of these Short Form 12 assessments before-and-after doing either intervention and see if you notice a significant difference between one group and the other group. That’s if you want to be really scientific. But to be really practically, you could just put half the people on diet and lifestyle, the other half diet and lifestyle with the supplements, and see if you notice a big chance. I would think that, for most people, you’re not going to see a huge change.
DR: It is, it is. So, thank you for the question. So, my…..I guess, let me give you a little bit of my back story, where, maybe, I’m coming from. I used to do an initial 30-day detox program with most of the patients that came into the office. Now, this program costs $350, maybe $400, so it’s a far cry from $2,700. It was a well laid out detox program, where you got a little booklet, and you had all of these recommendations for diet and lifestyle, and had some detox supplements. And, people got better for doing it.
But, I think it’s really important always be questioning the necessity or the utility of what we are doing, and trying to see if, maybe, we can do things more efficiently. So, after a while I started to say, ‘Geez, everyone seems to be doing better on this, but is it really these supplements that’s doing it? Or is the fact that people are just really tightening up their diet, going gluten free, dairy free, soy free, no processed foods, no caffeine, increased water, more sleep, maybe some exercise or yoga or Epsom salt baths, whatever it is. Because, that’s a pretty large variable that, you know, we have to really take into the equation. So for a while, I just started putting everyone on the autoimmune paleo diet, and I saw the exact equivalent results.
SM: Right. And I think that’s really important because every single detox program I’ve looked at as a practitioner always has included a diet component. So it’s like, what is actually really helping? Is it the diet changes? Or, is it all the supplements? And so, why don’t we start with the diet and save our patients and clients money. And then we can save that money for something down the road, like gut testing.
DR: Precisely. And that’s exactly what I started doing and what I continue to do now, because, really, one of two things happens: People either do that – people either change their diet or their lifestyle, and they are quote/unquote “cured”; all the major ailments go away. Or, they only respond partially, and then we have to do additional follow-up tests to figure out why that is. But either way, the detox supplements didn’t really seemed to be a necessary part of that equation. And so, for me, just like you said, Susan – that was $300-$400 we could put toward additional testing, kind of, at our next step. So yeah, to reiterate that first point my position: My position on this is most of the benefit from these detox programs probably comes from the dietary and lifestyle part.
SM: Yeah, and I think that be the same said for like so-called juice cleanses and juice liver detoxes, because people are cutting out the bad food. It’s not the juice that’s doing it. It’s what they are not eating that’s doing it.
DR: Right, right. I think people may encounter a lot of others out there who are still recommending these detox programs. And to some extent, if you need to think it’s a special detox program to get you to change your diet and to change your lifestyle, then that may not be a bad thing. But, if you’re doing it and you’re taking more than a handful of supplements and you’re incurring a large cost, then I would say is now gone from a potential psychological trigger to get you to be complaint, which is good. But if that comes with a $2,700 price tag attached to it, now I’d say you’re at a strong net-negative, because you’ve really just done a financial disservice to this person.
SM: Yeah, because there is a lot of testing you can have done – gut testing, infection testing – for $2,700. I mean, just a fraction of that, and then the supplements once you figure out…because, we’ve talked about is at the bottom of thyroid is gut, gut issues.
Why some people feel better on detoxification programs
DR: But, let’s pick into this a little bit more. So, why is it that some people…why is it that a lot of people feel a lot better on these programs? And, how does detoxification tie into it? Well, your detoxification system is always running. But, there may be things that impair the functionality of that system. So, one of the things we often see in a detox program or an assortment of different amino acids and protein powders – because, rightfully so, they are used as part of the detoxification process. However, we know that the more inflamed you are, the more altered the use of amino acids becomes. And I’ve put one link in here . There are a lot of them. But, one researcher named Michael Mays has done a fair amount of research showing that when someone is inflamed, for example, tryptophan, one amino acid, goes down this urease pathway, I believe it’s pronounced, which is an inflammatory pathway instead of being used to me make some of your neurotransmitters like serotonin. So, you have a molecule of tryptophan, and that can and become either serotonin or go down this urease pathway to produce inflammatory proteins. So, when you’re inflamed, you don’t use your amino acids, let’s say, effectively or fully for detoxification. You use them for inflammation.
So, if we can get rid of inflammation, we really help to restore your natural detoxification function. Along these same lines, if your gut is healthier, of course you are going to be much less inflamed, because the gut is arguably one of the leading sources of inflammation in the body if there is a problem in the gut. But also, you will vastly increase your absorption of amino acids if, let’s say, you were non-celiac insensitivity, or celiac light, or you have some sort of intolerance to gluten that may be causing a little bit of damage to your intestines. If that is happening, then you are likely not going to be absorbing your amino acids well. And those amino acids then cannot power your detox systems. And the same thing could happen with a clinical entity like SIBO (small intestinal bacterial overgrowth), which has been show in some cases to cause similar damage of the intestines that we see in full-blow celiac disease. So to put this in context, really the best thing you can do to allow your detox function to be optimal is to remove any factors that are interfering with that – and inflammation and absorption would be, probably, the two most important. And, by rectifying your gut health by either cleaning up your diet or treating any kind of gut imbalance or infection, you’ll take really large steps in that direction.
SM: Yeah, just the diet and lifestyle piece just curbs inflammation; I’ve just seen it recently in some of my clients. I’m teaching a workshop and a girl with rheumatoid arthritis can almost put her hands together now just from diet and lifestyle.
Velvet rope syndrome
DR: Awesome, yeah. So, not to bring it back to being too basic, but there is always this issue we have to weigh, which is – Do the things that look expensive and seem prestigious or good, always mean they are the best? It’s kind of like the Velvet Rope Syndrome where, if you put a gate or a rope outside of a nightclub, and a bunch of people are in line, and more people will want to go into the club. Sometimes if something is more expensive, and it sounds really quote/unquote “good,” it attracts you to it. But, in a lot of healthcare interventions, the foundational principles, albeit less sexy, really tend to be very effective.
Diet and detoxification
DR: Let’s move on to…I wanted to mention something else about detoxification. To my knowledge, the best data in terms of inventions for detoxification that lead to a positive health outcome – or, again, a dietary interventions. I think the most well studied is looking at the brassica or cruciferous family of vegetables and their ability to prevent cancer. So diet, again, is a really, really important piece. I want to come back to, maybe, how we can sort out using science so as not to get hoodwinked by this.
Toxins and thyroid
DR: But there is something else I think is really worth mentioning about toxins; because, the question again is does my – I think it was here sister – need to participate in this liver detox program in order to get her thyroid healthier. Like we discussed in a previous episode of the podcast – I believe it was one of the iodine series, but they are all starting to gel together at this point. But we talked about, for example, the primary objective with a lot of detox is just stopping exposure to toxins to begin with, right? So that’s really our primary objective, and it doesn’t take $2,700 to do that. Filtered water – and a good water filter. I actually received a pretty nasty YouTube message from someone after I put out the last YouTube video about fluoride in iodine…
DR: …and about how the population that was drinking fluoridated water had higher hypothyroidism than the population that was drinking non-fluoridated water. I got a really nasty email that I didn’t specify you have to use a reverse-osmosis filter in order to clear fluoride from your water. And it’s like, jeez, you know? (laughter) Damned if I do, damned if I don’t. I mean, it was a good point. It’s just…It was a three-minute YouTube video; I can’t cover every detail, A. And B., putting it across with a little more tact would have been lovely. But, anyway.
SM: Yeah, the Internet – There isn’t a lot of tact out there. (laughter)
DR: It’s like, ‘Hey, I’m trying to help you out here. Don’t shoot the messenger.’ So, filtered water, and maybe even, preferably, reverse osmosis – Thank you disgruntled listener. And then things like food and drink: Organic, pesticide-free as much as possible, opting for local forms, of courses things being non-processed. That will go a very long way to limit your exposure to some of the chemicals that have been documented to be thyroid disruptors. Because there are a lot of chemicals that have been documented to be thyroid disruptors. But, just because exposure leads to thyroid disruption doesn’t mean you have to do some kind of crazy detox program to turn that around. Just stopping your exposure to those, in my opinion, is going to be enough for most people. And one third item in terms of limiting exposure to things that could be a thyroid disruptor: water, food, and also things that you put on your skin – lotions, shampoos, soaps – many of those contain different compounds that may have various degrees of thyroid-disrupting chemicals contained within them. And then the last one I should mention also is plastics. Depending on the type of plastic, it may contain chemicals that disrupt thyroid function as well. So, you get a lot out of these basics. That being said, have I ever seen who is hypothyroid start using glass Tupperware instead of plastic and that caused a miracle breakthrough? No. I’ve never seen that. But, certainly, it’s not a bad lifestyle practice to just avoid these sources. And Susan, am I leaving any major ones out there?
SM: No, I think you hit on all the ones that I do, especially in the microwave with the plastic. If you don’t want to get rid of all their plastic, at least a store stuff in the fridge, and then don’t put it in the microwave. Heated plastic really, really…those on the xenoestrogens can really come out. Our bodies are so smart and our liver is a detox organ, and if we just stop giving it all these things to push through and and and process…drinking is another one – drinking alcohol. When we drink alcohol, our liver says, ‘hold on now, I got to start doing everything else and process alcohol our of the body.
DR: Sure, sure, within reason.
SM: Within reason, oh yeah.
DR: I don’t’ think you’re advocating people never drink ever.
DR: Certainly, we are all going to have a threshold of alcohol we can handle safely, and then if you go over that threshold, you are going to start seeing deleterious effects.
SM: Yes, exactly.
DR: So, to come to the toxin piece in a little more detail: What really needs to be detoxify for thyroid health? There is, potentially, halogens – and we will put the link to the podcast episode where we discuss this (). The halogen family – things like fluoride, chlorine, and bromide – and we discussed this in the previous podcast, and I will refer you there for a more-expanded discussion on this, but, essentially, as long as you are avoiding exposure, you’re going to be OK. And, there isn’t really a need to do a fancy program to detoxify those things. So, that’s for the halogens – again, fluoride, chlorine, and bromide. What about metals?
SM: We just talked about this last week! (laughter)
DR: We will be coming back to this in more detail. And not to rehash the tangent from last week. I would simply say it like this right now: That would be the last, or at least one of the last things I would do if you’re trying to kind of restore your thyroid health. That would be after diet, lifestyle, gut health, and any gut infections – bacterial overgrowth and imbalances. After you do those things, which are sometimes easier said than done, then the metal piece I would potentially consider. But, more on that to come, but, again, not an issue for most people. And that’s based on the research on my experience.
We’ve talked about plastics, which, oftentimes, contain a number of chemicals – a family known as organochlorines. Also, things like perchlorates, which are byproducts of explosives, which find their way into the water supply. But, again, avoidance is probably the primary objective with these. And, I am really unclear about the need for supplements because there’s really not a lot of outcome data. And before this call, I even spent a little while going through PubMed looking to see what kind of data there was in terms of any clinical trials, or even interventionist studies looking at detoxification and thyroid health, and I really couldn’t find any, to be honest with you. I want to make a really important point which is, it is one thing to show an association. It’s another thing to show treatment (that) produces a positive outcome. And that is, I think, one of the keystone issues when it comes to this issue of toxins. There are, admittedly, an alarming amount of association data. But, when it comes to saying, ‘OK, now that we’ve showing the association, the next step is to show treating detoxifying this chemical will lead to an improvement in thyroid health. That is where we have really, really sparse data. Admittedly, this is a mistake that I fell into early in my career, where I went through a period of being really jazzed on toxins. Because I found so much association data. But, again, the association data doesn’t mean we have anything we can really do about that, except the practical principle here of just avoiding exposure. There is a wealth of association data, but we have very, very little showing that, ‘OK, we can give you this amino acid formula that is going to lower your levels of these toxins, and then that’s going to have an impact on your thyroid health in a positive way.’ There is really, really sparse data on that. Working with a lot of thyroid patients, and having had done that, like I mentioned when we opened the call here, I really haven’t seen that shake out to be really important. So, input on that, Susan? Or, questions on that?
SM: I just think it’s fascinating. Because, if anybody is going to find it in the research, you are. Because you’re digging in there all the time. There really is no research that shows that, for this condition, this liver detox…you know, there’s never been randomized controlled trials, or any intervention studies. I think that’s pretty powerful.
DR: Yeah, I think it’s something that is really important, especially (for) healthcare consumers to be aware of. Because, what you sometimes see is a case being made for using a detox cleanse system, whatever it is, based upon all this association data. But, we really need more than that, right? And now, again, if we want to (prescribe) a detox program, and add in a few supplements to get you to commit to changing your diet and lifestyle – get off the couch, put down the crap food, what have you – then that may not be a bad compromise. But, if people are going to be spending really whopping amounts of money, then you need to have some outcome data showing that this is going to have a positive effect. I’m really, really tenuous about that. This all being said, the liver is definitely important, right?
SM: Oh, it’s very important.
DR: I don’t want to discount the importance of the liver, but, again, it’s not to say that your liver is not working properly unless you do this fancy program and then your liver will be fixed forever. Again, the most important thing: avoidance.
DR: Now a couple other factoids regarding the liver: Remember that the liver filters everything from the gut. Everything from the gut drains via a vein called the portal Vein to the liver to be filtered. So, as your gut goes, your liver goes, because, again, there is this strong gut-liver connection, where, again, the gut filters through the liver. So, the worse your gut health is, and the more garbage you’re putting into your mouth, the harder the job is for the liver.
Iron overload and the liver
There is another condition that people may want to be aware of. There are a few, but another one that I think is more common and potentially more relevant is iron overload.
SM: Oh, yeah, that’s a good one.
DR: Yeah. Iron overload can cause elevation of liver enzymes. The worse an iron problem is, the higher the likelihood that an elevation of liver enzymes is going to occur. When liver enzymes go high – essentially, these enzymes should only be in the liver; if the liver is too inflamed, you can think of the liver getting little cuts, so to speak, to really give a crude analogy – and then the liver enzymes are spilling out into the bloodstream, and now you see elevated liver enzymes on a blood test.
SM: And that’s on, what is it, the complete metabolic profile?
DR: Yes, yeah, metabolic panel, exactly.
DR: So, that’s something to be aware of, especially…let’s say someone has a really hard time with iron overload, and then they have what’s called hemochromatosis, which is a somewhat genetic predisposition to accumulate iron, then seeing elevated liver enzymes is part of the diagnostic criteria for diagnosing that. So, certainly that is something to be aware of. But that, again, would not be…even then, even hemochromatosis, doesn’t have this super fancy, expensive program…
SM: No, it’s simple.
DR: Maybe easiest is to do periodic blood draws. Along with that, you can eat a lower iron diet, and maybe use one or two natural compounds that – like curcumin, for example – that bind to, and help you excrete iron more effectively. You are looking there at minimal cost, right? Maybe $50-$150 per month on supplements. And that’s for a diagnosed condition that is known to have strong liver implications.
Functional medicine pricing models
DR: So, maybe that’s a good segue to go into the price issue.
DR: And, again, as someone who, for a short while actually used to use packages – like a care package – I’m not criticizing whoever is doing this, or if anyone is doing this. I think a lot of clinicians, especially if they don’t go into the conventional insurance model, graduate a little bit lost in terms of ‘What do I charge?’, and ‘How do I take care of the billing?’ Because, you don’t really get a ton of education about that in school…about the non-insurance way of doing this. So, I understand if people find some kind of practice management group that advocates packages. As someone who, for a short while, did it myself. But, I have to say that I was only doing that for a very, very short time, I quickly learned, ‘How can I possibly put everyone on the same package?’
SM: Right. Everybody is different.
DR: Yes, and so some people come in and they didn’t need the full package. They changed their diet and their lifestyle and they were good. And then I felt terrible (laughter): ‘Well, I guess we better just do all of the other stuff because you already paid for it.’ Very quickly I said, ‘OK, this is…something here is wrong.’
And then, on the other side of the coin, some patients really needed a lot more than the package provided. Then I was in this weird situation where they thought everything would be solved with the package. And then, when it wasn’t, you’re kind of left like, ‘Ah, so, anyway…’
SM: ‘So now this is what we need to do next, and this is how much it’s going to cost.’
DR: It’s not something I’d really recommend. I say this with all respect to anyone who is doing this, but my personal feeling on this is: If someone is charging you a package, I would run out of that office and never look back, because I don’t know how you can reconcile those issues that I just mentioned about some people vastly overpaying, and other people really underpaying. And, I just don’t know how you can really be a clinician that is putting the patient first and having that really work for you. Then, the $2,700 is…holy cow, that is extreme.
SM: It is really high. And I’ve seen some of the programs that are out there from some of the large natural medicine supplement company, and I’ve never seen one that is $2,700. I’m not sure what all that could include.
DR: Now, we don’t know all the back story here. So, we have to provide our commentary with a grain of salt. But I am assuming a few things: I’m assuming that this person is fairly early on in their process; I am assuming that this is a standard, canned kind of program.
DR: If that’s the case, this just screams being financially shady to me.
SM: Right. And, even if it included some testing and the visits, it still seems like a lot of money.
DR: Yeah, and I completely agree with you on that.
SM: I tried to Google around to see if I could find out more information, just by putting ‘$2,700’ and ‘liver detox’, but nothing really came up. (laughter)
DR: That’s extreme. It really is extreme. I should maybe just mention here – not to make this sound like I am pointing a finger too much – but I’ve had patients complain no matter what. I find some patients…I remember one or two patients in particular, they did two visits and then they complained. “This costs a lot and it didn’t work.”
SM: People want things to work right away, they want a magic pill.
DR: And, I’ve had patients complain about supplements being too expensive, when we always use what the lab suggests, in terms of ‘Here is the price that the clinic should charge for these things.’ We always follow what is called the Manufacturer’s SRP.
DR: But, there are some people who will come in not knowing there is this world where you may have to incur some out-of-pocket expense. So, anything above a $25 co-pay to them is a lot.
DR: Right? Or, people that always get their vitamins from Costco. They are used to buying a jug of multivitamins for $11. So, sometimes no matter what you do, you can’t make everybody happy. That being said, $2,700 is a lot of money.
SM: I just keep coming back to that. You know, that is a lot of money. You and I, we live in, like, the most expensive place in the country. And that still seems like a lot to the both of us.
DR: Right. Exactly.
SM: So, if you lived somewhere like Boise, ID, that would be like…and that’s not where this person is from, so…that would just be like an inordinate amount of money.
DR: Yeah, this is extreme. Now, there are a couple of exceptions for where I do think a…I don’t even want to say a program. I do think there are some exceptions where doing the detoxification work would help. But I would feel most comfortable as a patient with a doctor that took some time to get to know me through history and examination. And then potentially did some testing, and based upon testing, had some recommendations that seemed to make sense to me.
DR: And it would be on a per-visit basis, which is exactly what we do in the clinic.
SM: Yeah, per visit, and then you pay for you supplements, and your labs usually go through insurance or you can pay the lab directly, correct?
DR: Exactly. We try to use insurance, in my office, anyway, as much as we can for labs. But, not every patient’s insurance will contract with those labs or bill those labs. And, not every lab accepts insurance. Some of them, (the) more progressive functional medicine labs, don’t have insurance billing options. That’s not to say that those labs are the best – like we’ve discussed, sometimes those labs are not the best.
DR: But the exceptions would be, as we’ve discussed a little earlier, if someone is already addressed diet, lifestyle, gut health, and any other obvious kind of low-hanging fruit that may be an issue for that person, right? Let’s say they are, maybe….I mean, this would fall under lifestyle, but let’s say they have a relationship that is toxic.
SM: Oh. That’s stress management, yes.
DR: Right, so some of these foundational principles, if they’ve all been addressed, then here are a few causes where I would say it would make sense. If someone has a known exposure, either previously or currently, to mold…
SM: Oh, yeah, mold.
DR: …that may be an issue. And I want to thank Chris Kresser for informing (me) about something that I thought was interesting. When we were at PaleoFX, we got breakfast together one of our mornings there. We were talking about different things we are both researching. And he’s looking into mold quite intensely right now. And, he mentioned that one of the theories for why people don’t recover after mold is because some people have a hard time clearing mold; instead of mold getting filtered by your liver and then processed out of the body, it keeps recirculating and causing this chronic immune reaction. This is a very controversial area, so I just want to let people know that I don’t know if there is super-solid science, and that’s one of the things we were discussing – This is a hard area to make definitive conclusions on it, because there’s not a lot of solid science. But, this is one of the theories from one of the more preeminent and respected mold experts. These people may need to do…it’s a program that essentially helps the body bind these mold toxins and excrete them, amongst some other things. So, that would be one population. Potentially, also with Lyme. I am not a Lyme expert, but I know for some of these people, certain detoxifications can be very helpful in conjunction with treating Lyme because of biotoxin accumulation. If someone’s had a high level of exposure – let’s say they worked at a smelting plant and got exposed to a high level of, let’s say, cadmium or something like that- then they are most likely going to be followed up with routine medical treatment for that. But, just in case that they weren’t, if someone has a known high exposure to a dangerous chemical, then that would, potentially, make a lot of sense. Also, potentially someone who has identified some kind of functional detoxification impairment, like on an organics acid profile or methylation function profile. But, again, remember that should only be done after everything else.
SM: Right, I was going to say. This is, like, the last stages of ‘All the other things don’t work, you might want to look at these things.’
DR: Exactly, exactly. So, not the first step…
DR: …but, you’ve done everything else and you’re not all the way there, then, maybe consider these things then.
SM: And you would throw the heavy metals in there as well, at those later stages?
DR: Yes. That kind of falls underneath known previous exposure.
DR: But yes, definitely I would also include heavy metals in there. And I’d also include gene polymorphisms in there because the genes don’t mean you will have a problem with said gene function.
SM: That’s very, very, very important. (laughter) A lot of people get the 23andMe and they think they have to take a million supplements. But they aren’t testing and talking to a doctor and finding out if these polymorphisms are expressing.
DR: Precisely, yep. So, I think that’s the basic rundown.
DR: And, again, to give the 30,000-foot reiteration here, that is ridiculously expensive. The fact that it is in a package, if it’s the type of package we are thinking it is, that would really make me question the provider. And also, the need for a detox plan is highly questionable. And, there are some cases where specific clinical detox therapy, treatment, and testing might be needed, but that would be on a case-by-case basis with clinician who is familiar with the case, and is going to be custom-tailoring it to the patient.
SM: And I think one other good point maybe to make at the very end is to say, if you do go to a functional medicine provider and they do give you this $2,000-$2,700-$3,000 package, you can get a second opinion. There are other functional medicine providers, and you can go see what another one might recommend, instead of just going to one and doing whatever they say.
DR: Exactly. I mean, this gal could do a phone visit with office and pay 1/8th…(laughter)…for the initial exam and my follow-up interpretation and prognosis. I’m guessing they’d get a heck of a lot more useful information than just doing some pre-canned detox program.
SM: Any last-minute words of wisdom, Dr. R.?
DR: I think that’s pretty much it. This was just a great question…
SM: I loved it.
DR: It’s very real world. Everybody has heard me say multiple times that I think functional medicine needs to make some reforms, and this is a perfect example of that. I think this is really wasteful – if this is what we think it is, you know? We could be misinterpreting, but I’m pretty sure we got this…
SM: We are just going off the information we’ve been given, which, like we said, isn’t a lot. Everybody heard the recording. That’s the information we had, so…
DR: Right, right. If this is what I think it is, then this is something that I think really needs to stop happening in the functional medicine community, because it does a lot of disservice to the name ‘functional medicine.’ If this person went and did this and felt no better, she would probably be livid. She would probably have some very nasty things to say about functional medicine. Eventually, she might complain to the medical board about functional medicine. And, if that happens enough…
SM: It makes everybody look bad.
DR: Well, it not only makes everyone look bad, but all of a sudden the medical board is going to start cracking down on functional medicine providers. We are not going to be able to do this. And we will be stuck practicing within the standard of care. Ten-minute visits, here’s your proscription, see you later. So please, if you’re a provider and you are doing this, maybe have a second thought. Because, I think you may be doing more damage than you realize.
SM: OK. I think that’s an episode.
DR: Yeah, I think that’s a wrap.
SM: OK. Thanks, everybody. Talk to you next week.
DR: All right. Thanks, guys. Bye-bye.
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