Dr. Bryan Walsh seriously impressed me in today’s conversation on detoxification. Long story short, you might be wasting your money with detox testing and treatment. Fortunately, you can reduce toxins in your body with a very simple and effective protocol. This is a must-listen episode.
Dr. R’s Fast Facts
Background on Dr. Walsh
- Naturopathic physician
- Research on detoxification began with curiosity about Phase III detoxification
We need to make some serious updates regarding how we think about “detox”
- For example, high dose detox supplements might actually inhibit and worsen detox
- Things like curcumin, quercetin, and catechins are all examples of potential detox inhibitors
Why is detox important?
- We are exposed to chemicals in our day-to-day life
- We all have a certain amount of accumulation depending on a variety of different things
- Genetics, detoxification enzymes, micronutrient sufficiency, microbiome, weight, how much we exercise, exposure
Categories of toxic elements
The common thread to all of these categories is that they all have a mechanism that causes damage
- Heavy metals
- Mercury, lead, arsenic, cadmium, aluminum
- Found in industrial and manufacturing
- Persistent organic pollutants (probably the biggest concern)
- Have to go through Phase I and Phase II detoxification pathways to make them water soluble
- BDP or anything that is polybrominated or polychlorinated or dioxins
- Volatile Organic Compounds
- Generally things you can smell
- Solvents, fumes, gasoline, perfumes, formaldehyde
- Bisphenol A (BPA) and Bisphenol S
Non-monotonic dose response curve
- With the endocrine disruptors, it’s a new concept (research from 2012)
- Low dose of endocrine disrupters is just as physiologically damaging as a high dose
What do the symptoms of this look like, how might someone know it’s affecting them?
- There are some validated questions which could indicate toxicity
- The QEESI questionnaire might be the best
- Assesses both symptoms and sources of exposure
What testing or assessments can be used?
- Levels of toxins might not matter; small compared to large affect one the same way
- “the dose makes the poison” might not be true
- The QEESI questionnaire might be the best test
- Walsh says he would not perform any testing for toxins
- GGT (gamma-glutamyl transpeptidase) might elevate when someone is “toxic”
- Even fat cell biopsies (gold standard) are inaccurate
- There can be various amounts of storage even in the same tissue
- Toxins are also stored in visceral adipose tissue
- Different toxins can be stored in different areas of the body
- Hypocaloric diet can also be a variable
- What the industry recommends and what the literature shows are disparate from one another
- More research and test development is needed
What treatments are available?
- Assess: Start with general lifestyle changes & consider questionnaire
- Healthy diet (including water), exercise, and avoid sources of exposure
- Avoid toxins
- Don’t go crazy, focus on fundamentals
- Water filter, clean household products and body care products
- Optimize your gut health
- Get rid of stuff in the body like infections, reduce the endogenous load
- Remediation of nutritional biochemistry
- Make sure you are getting the basic vitamins, minerals, nutrients you need
- Making sure your bowel habits are correct, PH is balanced, etc.
- Extrinsic detox support protocol – Dr. Walsh protocol
- Exercise for about 30 minutes, then sauna, aim for 30 minutes total in the sauna, get in and out as much as you need to
- Evidence that xenobiotics do come out in sweat
- Only do this when on a hypocaloric diet
- For 6 days go on a hypocaloric diet; decrease 35% below basal metabolic rate, while also intermittent fasting – aim for 6 hours
- Cruciferous vegetables can be helpful also
- Walsh’s program calls for his “detox soup” to be consumed
- Then finish off with a low carb, low protein and high fat diet for 4 days – the fasting mimicking diet – see Dr. Walsh’s program for more
- Bile binding supplements: chitosan, activated charcoal, fiber
Where can people hear more from you?
In This Episode
Prelude … 00:00:39
Episode Intro … 00:04:09
Thinking About Detox Differently … 00:06:39
Categories of toxic elements … 00:14:58
Non-Monotonic Dose Response Curve … 00:18:39
Symptoms … 00:21:40
Testing … 00:22:33
Testing Validation … 00:25:11
Mercury Toxicity … 00:31:55
Treatments … 00:36:26
Extrinsic Detox Support Protocol … 00:45:37
Phase 0-3 Toxification … 00:58:40
Episode Wrap-up … 01:05:00
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Dr. Michael Ruscio: Hey, everyone. Before we get into the body of today’s show, I wanted to talk about how to determine if you should be gluten-free or how gluten-free you need to be, and also a simple protocol for stress and for adrenal fatigue. So, yes, while being gluten-free can be helpful for many people, it’s also an issue, I think, that is shrouded in fear and dogma.
And we’ve talked about this before. And because of this, I think this is one dietary change where it’s very important to get it right. Eating gluten when you should be avoiding it can of course impair your health. However, and as we’ve discussed before, over avoiding gluten can also detract from your health because of the fear, stress, and social repercussions this carries.
In chapter 17 of my book, we will review what the evidence says about gluten and use this to craft an accurate and reasonable set of recommendations. We will also cover how to determine when the problem isn’t actually gluten, but might be something else like FODMAP sensitivity or bacterial overgrowth. And this is very important, because addressing these may allow you to eat gluten again. And that is very nice, and then you can then be devoid of the impediment of that dietary restriction.
We will also review and give you a no-nonsense summary of what the evidence actually says regarding gluten-digesting enzymes. And I think this will be very empowering and enlightening for a lot of people. I think that’s one area where things have been quite a bit over marketed. And there’s a case to be made, and there’s some support evidence there, but there’s also some very far overreaching. And we want to make sure to help you determine if you should be bothering with the gluten enzymes or not, because they are very expensive in many cases.
Also in the book, we discussed a simple protocol for stress and for “adrenal fatigue.” And as you probably have heard me say before, adrenal fatigue is really an antiquated concept that really needs revision. In the book, I make this criticism. But for ease of reading, I also speak in the language that we’re used to speaking. And so I do use the term “adrenal fatigue.”
But in chapter 14, we run through an overview of adrenal fatigue and I think you come away with a few important conclusions. Firstly, there is a very important bidirectional connection between the gut and the adrenals. And thus, second point or conclusion, unresolved gut issues are one of the most common causes of non-responsive adrenal fatigue, absolutely.
A third point or conclusion is adrenal support can actually help prepare the gut. There’s some exciting research we review in that regard. And then fourth and finally and practically important I think is you do not need to perform adrenal testing to use adrenal support, so save your money.
And of course, we wrap all this up in a self-help plan that provides specific recommendations for what adrenal supports to use, when to use them, and how long.
So, all this is detailed in my new book Healthy Gut, Healthy You. And I’m very, very excited about this book. For our audience only, we’re opening up a presale campaign which ends February 2nd. So if you want to know how to use things like adrenal support, low FODMAP diet, gluten-free, gluten enzymes, how to sequence this, how to know what to use when and for how long, my book lays all this out for you. So if you visit drruscio.com/getgutbook, you can learn more and/or pick up a copy. And I hope you will and I guarantee you it will be worth it. Okay, back to the show.
DrMR: Hey, everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with Dr. Bryan Walsh and we are going to be talking about detoxification. And I think this is going to be some different information than people are used to hearing. I don’t know what Dr. Walsh is going to have to say, but I know he came highly recommended from some mutual friends and colleagues, and I’m just really excited to have this conversation.
So, Bryan, welcome to the show.
Dr. Bryan Walsh: I am glad to be here. Thanks so much for having me.
DrMR: You were just saying before we jumped on the recording that what you’ve come away with, in terms of detoxification and how we should be about talking about it, is different than most people are talking about it. And I’m very excited to get there. Just briefly, before we jump there, tell people a little bit about your background and your work with detox. And then we’ll jump in to the rest.
DrBW: Yeah. So I am a naturopathic physician. I went to the University of Bridgeport. I met the most beautiful, amazing woman in the world there. Together, we have five kids currently under the age of nine. And in terms of naturopathic medicine—or I can’t even say that. In terms of how I approach functional medicine is—the conventional medicine does some really great stuff, quite honestly. And we like to disparage them sometimes in this industry, but they do some amazing stuff. And we really owe much of what we know about the body and how it works and these pathways and mechanisms due to Western science.
DrBW: On the other hand, conventional medicine messes some things up. Now, in the functional medicine/nutritional medicine world, whatever you want to call it, we do some great things too. But we also screw some things up. And so, what I try to do is bridge the two. To say to functional medicine practitioners, ‘We are really good at looking at certain things but we’re completely missing some other things.’ And to talk to conventional medicine practitioners or that world and to say, ‘Listen, what we’re doing—there is some evidence behind what we’re doing nowadays. Let’s take a look at some of these studies because I know you don’t have the time to look at these things. Let me explain these mechanisms and pathways and maybe we can kind of come together.’
So, if anything, I would say I try to be a bridge between the traditional historical natural medicine world, but then blend that and meld that into what conventional medicine does well so that we both benefit from one another and stop making the same mistakes we’ve been making for a long time.
DrMR: Yeah. Well, you are 1000% preaching to the choir. I’m right there with you and I definitely feel the kinship with what you’re saying just in that short, short intro. So, I think we’re definitely getting along great, on the same page.
Thinking About Detox Differently
So, let’s start wading into the topic. I do have some specific questions, but launch us in at a 30,000-foot view. You said we need start thinking about detox differently. So, let’s bring it.
DrBW: It’s actually an extension of what I just said. So I like to—and I know you do this as well—look around. And I think back to our training in our school in the summer as we get to know these things. And when we do those things and we’re new and we don’t know the pathways and we don’t know the physiology, we just kind of take it as rote. And that’s just what you do and that’s what you tell your patients. You say, you have adrenal fatigue or whatever—you have SIBO or whatever the thing is of the year that is the hot topic, or that you’re toxic and you need to detoxify. And as you learn more—and I know you know this—you step back and you start questioning things. And you say, well, is adrenal fatigue real? It’s kind of a funny concept when I really think about it. Let me look in to it.
And that’s what happened with detoxification. I mean, well before I became a naturopath, I was reading the books talking about we’re all toxic and you’re going to die if you don’t detoxify and how horrible these things are and it’s killing us slowly or quickly. And so, just at some point, I take a step back and I was like, ‘Are we toxic? How toxic are we really?’ I heard people in the industry talking about Phase III detoxification, but nobody could seem to agree on what it really was. Some people said it was pH based. Other people said it was binding. There are a variety of different things.
And then I was looking at these detoxification programs that we’re all doing, usually whatever supplement company we like. There are the powders and the supplements and the pills and it’s usually 14 to 21 days. And then you look at the rest of the world and there are footbaths and foot pads and mucoid plaque coming out of people’s butts and lemon juice in the morning detoxifies you and skin brushing and saunas and all this stuff. And I was like, ‘What the…I need to figure this out.’ And that’s what had started me.
And so, then I started researching about detoxification. And honestly, it started with a few things. One was about Phase III. Because I’ve heard about Phase I and Phase II pretty well, I think people that have been in the business long enough have heard about those things. But even to that point I will say, you may be able to list off—and you’re sort of an exception, you may be able to list off all the different Phase II pathways, which we’ll hopefully may be get in to. But for example, glucuronidation, which is a huge pathway, and you need glucose. But that’s kind of all I was taught. I was never taught how can we speed up glucuronidation.
And so, that was fueling me and Phase III was fueling me. Turns out there’s a Phase 0 that was just discovered in 2006 that nobody’s talking about. It was kind of important. And as you know, the more you get into this, the more you read a paper and you’re like, A) I feel like I need to change jobs because I obviously don’t know what I’m talking about anymore. Like the janitor at an elementary school is starting to sound good. And, B) why the heck was I never taught this stuff?
And I’ll just give you just a couple little teasers, but I came into this where most functional medicine practitioners come to detoxification, quite honestly. I used some of the testing that’s available, which turns out most of it’s probably imprecise, waste of money at best. I came in huge on supplements. But this is where I started to get my mind blown is that there’s a Phase 0. But it turns out—and we’ll get in to some of the specific pathways if you want—but there’s a biphasic effect of a number of different botanicals, herbs, different compounds, that if you look at your favorite detoxification formula are probably in there. And this biphasic effect in the literature says that at a low dose, i.e., the amount in food, up regulates certain detoxification enzymes. But at a high dose, i.e., in isolated extract supplement form, inhibits those very same enzymes.
And so, I’m looking at this, I’m going ‘Son of a gun, we don’t know what the heck we’re doing.’ Because I called the nutritional or functional medicine grapevine where people have been doing things for a certain number of years. They teach the next round. They teach the next generation. And it’s just that game of communication and we don’t really have the time to take a look at what’s actually in the literature. And there’s a whole bunch of stuff that’s out there and I really question what it is that we’re doing, especially when it comes to supplementation and these “detoxification supplements.” So I guess it’s kind of a preface to possibly some of your questions.
DrMR: But like a lot of what you’re saying, it sounds very similar to what I’ve uncovered with a lot of things I’ve looked into. And I think you’re right on the mark, where there’s a lot that’s just dogma. And this conversation and these types of conversations, I think, are important to help the field to get better. And I just say that because, yes, most people tend to be open to these things. But every once in a while, you get someone who’s resistant. And in my opinion, being resistant to change and improvement isn’t really helping anybody. And, okay, maybe that change means admitting something that you were doing, some tests you used to be using or a treatment you used to be rendering is no longer valid, accurate, or helpful. But, hey, I mean, if anyone had a perfect model then medicine would be done, right.
DrBW: That had been done a long time ago, too.
DrMR: Because, yes, we would’ve been done, exactly. So this is a natural part of the evolution of healthcare. I am right there with you. And as you’re saying that, a number of thoughts of course go through my mind. But one thing that I found to be helpful is not projecting from a mechanism what a treatment should be. And so, we have the mechanism—and I mean, there can be a time and a place for that, but let me give you the example I’m thinking of.
Phase I and Phase II, you made notes about that. And we can look at a mechanism or mechanisms involved in Phase I and Phase II and certain nutrients that are needed for those mechanisms and then make the stretch, the inference.
DrBW: Huge jump, right.
DrMR: Yeah. A huge jump that because that happens, giving you a high dose of these amino acids or whatever it is will help you detoxify these chemicals. And really, the best approach would be to look at what does the clinical outcome data show in terms of, ‘Okay, we think these people are toxic with compound X. We give them this treatment. Do they get better? Do inflammatory markers decrease? Does cognition improve? Does morbidity improve or what have you?’ And that’s often left out of the equation and that’s, I think, one of the most fundamental tools to help sort through the speculative and oftentimes non-helpful treatments.
And so, it sounds like there’s a bit that occurs in detoxification and I very much so want to get more of your opinion on this. Just briefly for people who may be a little bit newer to the conversation, and Bryan, please to add to this. You hear a lot in natural health about detox. Oftentimes, you hear heavy metals as one category: mercury, lead, arsenic. There’s been urine and blood and even hair tests available for a while, many of which the utility has been questioned.
But this is one thing that someone may be presented with in a natural provider’s office. There are certain organochlorines and other such compounds that are found in industrial manufacturing and in farming. There’s maybe mold, other similar biotoxins. It’s easy to make a statement that these toxins are not good for you. Yes, I think we can all agree that a too high of an exposure to these toxins can be detrimental. But there’s a big jump between that and then showing that you can take this high dose supplement and have a positive impact.
But maybe for someone newer to this conversation, Bryan, what are some of the important fundamentals in terms of here are some toxins that are often reported to be a problem and here is what is often recommended to be done? Just to get a beginner kind of on the same page with us.
DrBW: The way that I approach that—and we could go through classifications of chemicals, for example. But here’s what I think I found. And I hate to use the word known or like what we know because we often hear people say, “Well, we used to believe this, but now we know. But what we know is not going to be disproven.” So, I hate to use the word know.
Categories of Toxic Elements
There are a few strong assumptions I think that we can make. And one is that we all have exposure, to some degree, of a variety of different things. And they’re going to be different amounts based on where we live and what our lifestyle’s like and where we drive and where we work and some of those types of things.
So you did mention metals—I’ll mention these—and what I was getting to that point was, I actually don’t get caught up in that stuff, because I don’t think we can test for these things accurately. If you showed up with a variety—there’s a variety of different things that you can show up. If you did do testing, then the big question is, where the heck is the exposure coming from? And then that ends up being this huge stress and this, ‘Oh my gosh, I have to cut X, Y, and Z. Where is my phthalates or where they’re coming from?’
And so, I actually take a big step back and say, ‘Listen, we’re all exposed, A) I think we can pretty much say that, B) we all have a certain amount of accumulation.” Now, that’s going to be predicated on a variety of different things like genetics and detoxification enzymes and micronutrient sufficiency and the microbiome and how overweight we might be or how much we exercise or sweat—a variety of different things. We all have exposure. We all have some degree of accumulation. And to what though, we don’t know.
And since there’s no way of testing to answer your question in a roundabout sort of way, I actually don’t get into some of some of those things. I’ll mention some of them, the classifications. But I don’t test for anything for a variety of reasons. I don’t test for them. I don’t “treat for certain ones.” Because when the body’s detoxification pathways are working properly, your body will get rid of whatever it is that has accumulated, whether it’s persistent organic pollutants or DDT metabolites or metals, etcetera.
So to answer your question, just so you don’t think I’m skirting around anything, there’s what I would call toxic elements. And toxic elements are mostly the metals like you said, like arsenic, cadmium, lead, mercury, aluminum. Then there are, in the natural sort of category of things, like aflatoxins. Allergens, for example, I would put into this category, molds, for example. Pesticides could be another category. A big one that people probably hear a lot about is… the big category is persistent organic pollutants.
Then underneath that—and this is a big one, because these ones are the ones that tend to be lipophilic. They really like fat. They get stored in fat. They have to go through these Phase I and Phase II detoxification pathways to make them water-soluble. But these are things that people probably heard about, like DDT and like anything that’s polybrominated or polychlorinated, or dioxins or any of those things, or these huge category of persistent organic pollutants, which, of these, I would say is probably the biggest concern. Then a couple of other ones, there are volatile organic compounds.
So these are the things that tend to be like solvents and fumes and gasoline and perfumes and things that generally you can smell, formaldehyde. And then the last category, if I was to have one, would be plastics. And then those will be the phthalates, for example, or like bisphenol A or bisphenol S. So hopefully that kind of categorizes those a little bit.
The one point I will make about these, again, I don’t get into—well, you could study the mechanisms of each one of these things. But does it really matter? Because you can’t test for it anyways. You don’t know what your levels are. You don’t know what your exposure is. But the thing about these that’s really important to know is they all have a mechanism that they cause damage and they may be different. But it doesn’t matter if you get a little bit in you or a lot in you, it does the same thing to whatever cells it can get a hold of, whether it’s mitochondrial dysfunction or DNA. So, they all have a mechanism that they cause damage.
Non-Monotonic Dose Response Curve
One of the points that I was hoping to cover really quickly is something called the non-monotonic dose response curve. I can go into this more if you want. But specifically, with the endocrine disruptors, it’s a new concept. Some of the first papers were only 2012. But saying that low dose of the endocrine disruptors is just as physiologically damaging as a high dose. When I read that, oh my god, my mind was blown. I was like, ‘Are you kidding me?’ There are plenty of papers that are saying this that you can have a low dose of some of these endocrine disruptors and it’s just as physiologically damaging as the very high doses. They all have a mechanism that they cause damage.
DrMR: That’s really interesting to know. I mean, that actually made so many good points. One of the things, just to reiterate for the listeners, oftentimes, someone is presenting with a certain symptom or condition. I’m overweight, so I have brain fog. I’m tired. And you’ll watch a lecture or you’ll listen an audio file. And they will talk about this toxin affects fat cell metabolism, therefore, it can make you fat. This toxin can get in to the brain, therefore, it can cause problems with memory. Really, that’s all stretch.
And what you just said, I think, wonderfully aims or points to that, which is, those things are a stretch. Unless we can show that those things definitively cause symptomatic problems in those individuals and, better yet, a given treatment will resolve those symptoms, unless we can show that—I’m guessing we’ve been unable to show that in a large part—then all you’re doing is just talking about a problem that has no real solution and a problem that probably doesn’t even exist because what you’re pointing out is there’s some kind of mechanistic association rather than a real-world impact.
So, yeah, I mean I’m right there with you. I find it very interesting that these small dose exposure and the larger dose exposure may have the same impact. That kind of shoots a big hole in the whole “levels” and testing your levels to see if you need to undergo said detox.
DrBW: And in fact, what happens with that is, is you know that adage that the dose makes the poison. Well, it turns out and there are actually papers that use that as a quote and they say, ‘Whoops, that quote doesn’t exist.’ That’s been the quote in toxicology for a very long time. The dose makes the poison. The higher the amount that you have—and they’ll even say, ‘Well, if you have enough water then that can kill you too.’ But it turns out and there are enough papers on this and it’s caused kind of a ruckus within the world of toxicology and, basically, the summary of a lot of these papers is, we didn’t even think this was plausible but it turns out it’s not only plausible but it’s likely. This non-monotonic dose response curve exists with endocrine receptors specifically.
DrMR: Interesting. I’m assuming that there’s not a certain symptom profile that can be connected to this and that people shouldn’t chase or use their symptoms as a justification for doing a heavy metal test or what have you.
But correct me if I’m wrong, are there any symptoms that are more suggestive that a problem with detox might be present?
DrBW: That’s a good question. I was going to interrupt you when you were saying symptoms, I was going to say ‘Anything.’ Because, as you know, you could take a given—I always call them a xenobiotic—a given xenobiotic, a given synthetic chemical, and expose you and I to it, and it will show up as different symptoms. It might show up with you as maybe having some low testosterone symptoms. In me, it might cause neurological symptoms. Even though it has the same mechanism within cells, due to our genetic differences or biochemical individuality, that it can affect us slightly differently.
Certain classes of chemicals may have certain, like I said, endocrine disruptors. So they may likely affect hormones or they may affect the neurological system or some can cause immune system suppression or hypersensitivity, some cause cardiovascular. It’s across the board.
I would say—and this is the way that I approach this—first of all, I don’t think that there’s any valid lab testing for looking at what I’ll call some of these total body burden, how much you have accumulated or stored inside of you.
But what they do have is there are some validated questionnaires out there within the scientific community and they are very symptom-based. And when I say it could be anything, I start to think if somebody may have toxicity issues is when they’re the ones that have a lot of symptoms. They’re fatigued, brain fogged, difficult cognition for example. But this could be a lot of different things. I mean it could be anemia. It could be macronutrient deficiencies.
And then there’s a sensitivity to like chemical smells. It is sometimes the tip off. If, for example, they totally avoid the perfume area if they walked through a department store, that could be depending on your slant in the nutrition world. It could be something as simple as a molybdenum deficiency or whatever somebody wants to say.
But when you step back and you take a look at this, there are hormone problems and there are cognition issues and there are fatigue issues. And what I’ll say is like multisystemic issues. Many systems are involved. And you look at their lifestyle and perhaps they have a lifestyle that’s more conducive to exposure to these things and that might be somebody that I would consider to have excess exposure.
Interestingly, in the studies, some studies suggest the more overweight somebody is, the more accumulation that they have in adipocytes. But there are other papers that have looked that and suggested that might not necessarily be the case. So it’s tough.
But to answer your question in a short way, I would say there are some validated questionnaires that are available out there today that I think would be the best form of assessment.
DrMR: So, what are a few those and what do they indicate?
DrBW: The one that I like the most, it’s the most sort of robust. It’s fairly long. It actually looks really good graphically. And I think that that’s important to patients. It’s called and I don’t remember—it’s called the QEESI questionnaire. Forgive me I forgot the—I think it’s Q-E-E-S-I. It was a woman that developed it.
At any rate, it is the most compre—I like comprehensive when it comes to symptom questionnaires. It asks, for example, exposure like—basically, your living surroundings or environment, like what’s the school that you teach at like or go to like? What’s your work environment? How much time do you spend in the car? So, it’s not looking at symptoms only. It goes symptoms by system. And it has this really great sort of graphic where you can sort of visually see which systems and maybe the most impacted. But then it also goes fairly deeply into possible areas of exposure that one may not be aware of, if that makes sense.
DrMR: Okay. So, QEESI questionnaire. Is that something if people were to search online, they can probably track that down?
DrBW: Pretty sure. You go to her website. You can download it. And it’s not for commercial use. But you can use it for your own personal use. And I think it’s a fairly easy download.
DrMR: Has that been used—validated in some way? Or what makes you like that questionnaire?
DrBW: Thoroughness. It’s been validated. QEESI, Quick Environmental Exposure and Sensitivity Inventory, that sounds pretty close if I had to take a stab at that.
Yeah. And here’s the thing. So if somebody wants to know, ‘Is toxicity an issue?’ All one has to do is go into the scientific literature. And if there’s a bunch of people that are creating different questionnaires and debating as to which questionnaire is the best to try to look for things like sick building syndrome or multiple chemical sensitivity, there’s got to be something to this. There’s a reason why people are trying to create these questionnaires in the first place.
So, yeah, all the questionnaires that I’ve looked at, I found in the scientific literature were validated and have been used. Now, in terms of their validation, it’s impossible to test for certain chemical exposure. So in terms of their validation, you can’t test or score poorly on one of these questionnaires and then show that there’s a degree of exposure because testing, like I said, it’s terribly imprecise. But they have been validated in the sense that they’re used in research purposes.
DrMR: Got you. So, that naturally begs the question of some of the other testing. And I have a little bit of a prelude in to this question. But we’ve got testing that I’m sure the consumer is going to be confronted with or a clinician a may currently be using. You’ve got blood testing for metals. You’ve got urine testing for metals. You’ve got hair testing for metals. You’ve got blood and urine and maybe even hair testing for other of these volatile organic compounds.
DrMR: There’s a whole bunch of testing, maybe even organic acid testing via the urine to get gauges into this. I’m curious your thoughts on what do we do with those tests. And I’m assuming you’re going to say they’re probably… haven’t been validated yet, haven’t been told to be effective and it’s maybe one area of functional medicine that we need to update, but please go ahead.
DrBW: Yeah. So, I will say that, ideally, you have a test that’s been validated. If there’s a test that looks really good physiologically and it hasn’t been validated yet, I think that that’s okay in some cases in the functional medicine practice. If I can wrap my head around it physiologically and you trust the lab and it seems like they’re doing their due diligence with the way that they’re reporting, then I think that that might be okay.
Now, here’s my problem with all those tests. And listen, you can test fingernail clippings, you can test hair, you can test sweat. Technically, after Phase II and Phase III, it comes out of tears. You can test saliva, theoretically. You could test stool. I’m not going to name labs, but some of these labs look at toxins in blood, in urine, in stool, in hair. You technically can test sweat and saliva and tears if you could cry enough of an amount, I suppose. My problem with all of them—and what the gold standard would be adipocyte biopsy, right, because if that’s where they’re stored, that would be the gold standard. Here’s the problem, even fat cell biopsies are inaccurate. And that’s because, even in the same tissue, there can be various different amounts of storage.
And there was one paper I was reading that talked about intra-abdominal adipose tissue or visceral adipose tissue stores a ton of this stuff. And this is the first time they’ve seen that. And they’re like, ‘Wow, this sucks because we only thought it was subcutaneous.’ Well, it turns out it’s also stored in viscera adipose tissue. So how the heck are you going to access that? Also, that different toxins or xenobiotics can be stored in different areas of the body. Also, they’ve tracked xenobiotics, if you will, following a hypercaloric diet, which I’ll get into, where levels go up in the blood, and then like somebody hypercaloric, it goes into a different site. So, how do you test that?
Here’s my big problem with these, is when somebody goes on a hypocaloric diet—now, every mammalian study, including humans that I’ve seen, that when if it’s hypocaloric state that you increase lipolysis, you increase fat cell breakdown, triacylglycerols, and increasing mobilization of things that were stored in fat. So guess what happens? The blood levels will go up. Like let’s say you and I both head down to the same lab together the same time, we live together, we have the same environment, same exposure, same everything.
We go down there. I decide I want to diet for a few days before I do this lab, you don’t. Now, in my blood or urine or stool, assuming I’m excreting this stuff, it’s going to be way higher than yours, who, let’s say, you’re following a hypercaloric diet. Or let’s say I exercise, let’s say I was on—so, you then you or whoever the practitioner was seeing would see that and be like, ‘Dude, Bryan, you are toxic. You’re so toxic. Look at your levels, they’re through the roof.’ And they would look at you and say, ‘Well, you look good.’ Why? Because yours are all still stored on the inside. Your levels are border— like where do the reference ranges even come from, from these labs in the first place?
DrMR: And Bryan, I wonder if this accounts for you—you sometimes hear people say, ‘You know, I went to see this natural provider. We did a test for toxins. I started in on their protocol and a few months later my levels were even worse.’
DrMR: And they told me it’s because we’re digging deep into the toxic burden. Maybe it’s just because that patient is now on a healthier diet when they’re doing their second test and you’re seeing that the—
DrBW: Healthier diet. Mobilization, actually excreting—there are so many different reasons for that. They have the nutrients so that these different pathways can actually work properly. Maybe they’re on a hypocaloric diet. Maybe they’re exercising a little bit. Maybe they’re doing a sauna, which is going to mobilize a little bit. You don’t know. But that’s the problem is that it’s imprecise. And quite honestly, that’s—some practitioners will say, ‘Listen, if it’s enough to stimulate somebody to actually make some change, then it’s worth it.’ I’m not going to get into that argument.
But I would not waste my money on any of the tests out there period. None of them are perfect. None of them—the reference range is questionable. There are too many variables that have a test that can show up as high or low or normal and does not speak to. And you know this. But when we’re talking about toxicity, we’re not talking about the exposure I’m getting right now. It’s total body burden as they accumulate. How toxic are you? None of the tests show that. And so, then why bother doing the tests?
DrMR: Well, I mean that’s a very important aspect of a test that the test actually shows you something that’s clinically meaningful, actionable, and can help you do something that you would not otherwise be able to do. So, yeah, I’m in complete agreement with you there.
Something I just want to add in, and I’ve mentioned this a few times in the podcast. The one area I have dove deeply into is mercury toxicity. And this is the first inkling that I got that what much the field recommends and what the literature actually shows are incredibly disparate from one another.
DrMR: And I found an amazing amount of data showing that people who have mercury exposure have no change in mortality or morbidity whatsoever.
DrMR: And in some of these studies, we’re talking about tens of thousands of people who were assessed and broken down into categories of those with two or less mercury fillings, those with four or more mercury fillings, those with six or more, and those with 10 or more mercury fillings.
So, we have some pretty impressive data that would be able to sniff out if mercury fillings and the leeching that accompanies those has any deleterious effect on health. And that was a huge eye-opener for me. And you also see, when I was digging into this literature, that some of the companies that offer some of this urine testing have been called out on the carpet. And there’s been litigation against some of these companies. And it’s not because—I can see the conspiracy theorist coming out and saying, ‘Oh, this is because conventional medicine is afraid, underlying cause of disease is going to be found here, and it’s going to cost them money and so they’re trying to shut this lab down.’ It could be.
But when there’s no association between the thing that you’re claiming to test and any disease state, then it’s more likely that you’re manufacturing a disease with a fictitious test. And yeah I think that’s definitely happened with the heavy metal piece. And so, it’s nice to hear you say that. That seems to hold true for many other tests.
DrBW: When you were looking into that, did you come across this term called speciation when it came to mercury?
DrMR: I can’t recall if—it’s about two and a half years ago when I went through this.
DrBW: So, this is part of it for me. And I haven’t gone deeply into any of this because, quite honestly, it doesn’t interest me enough to just focus on one particular compound or xenobiotic or metal. But yeah, so I was reading about mercury and this concept of speciation. And basically what it is, is that, as you know, there’s all these different forms of mercury and that it can enter in the body as one type and then our biochemistry can manipulate it into another type. There are so many different types of both organic and inorganic.
And so then testing even that. I was reading about this and I was like, ‘Well, who the heck knows actually how to test mercury properly such that it’s actually looking at these levels?’ And then there are all the other pieces to this too and the challenge testing and all this stuff. And so where I land is where I said earlier that we all probably—we all have exposure, that we all have some degree of accumulation, which there’s a variety of different factors that will determine how much accumulation we have. But then the big question is, and getting back to some of the papers that you were just talking about mercury, is can mercury exposure to one person cause an issue? Absolutely. But in these major papers that you were suggesting, is that, globally, it doesn’t seem to have any problems.
So, the question is, if somebody has a lot of symptoms, might they want to do some kind of evidence-based detoxification program to try to enhance the removal of some of these things and to see if there’s some positive benefit? So, anyhow…
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DrMR: Perfect. And that’s actually the next question that I wanted to ask, which is what treatments are available? And I always like to ask along with that, because I am developing a pretty sensitive BS meter unfortunately—because the field now is just so littered with it—what research supports any of those treatment interventions that you would recommend? I’m sure you’re going to have a great answer to that, so please.
DrBW: Just so I’m clear on the question. Are there any detoxification treatments or modalities that have been shown to lower total body burden or toxicity levels? Is that your question?
DrMR: Yes, and/or to improve the health of or symptom profile of a person.
DrBW: So, the first answer is no. There’s no paper anywhere that I’ve ever seen that shows that any given modality actually decreases toxicity levels. Because it’s so hard to measure in the first place and most of them don’t. The second part is, in terms of symptoms, you have to wonder why the symptoms have improved.
So for example, there’s one paper that I found. It was done in South Korea that used the term, I think, detoxification diet within the title. And it said something to the effect of detoxification diet can—it alluded to the fact that it might be lowering toxins in somebody. And it was a 21-day diet. Basically, it was like chicken, non-antibiotic chicken—I forgot—seaweed and polished rice they used I think it was—or, no, it wasn’t polished rice, brown rice maybe—it was brown rice and white fish and vegetables and fruits and that was kind of about it. Not much of a detoxification diet. It’s just kind of a whole food sort of traditional South Korean diet I would think. And the marker that they used was GGT, because GGT in the literature has been suggested that if it’s high normal can be a marker of toxin exposure in certain types.
And what they found was is that GGT went down in these people over this course of three weeks. But if you take someone and put them on a healthier diet than they were following over a period of three weeks, GGT might go down anyways. And it didn’t ask them their symptoms, if I remember correctly, so I don’t think there’s a whole lot out there in terms of different sort of protocols.
Now, sauna has been used or heat therapy—let’s just call it that—has been used. You’re probably familiar with the L. Ron Hubbard detoxification program
DrMR: The same L. Ron Hubbard from…
DrBW: Yes, Dianetics.
DrMR: Okay, thank you.
DrBW: Yeah. It’s like clear body, clear mind or something like that in his whatever you want to call it, religion, cult. I’m not going to get into that. It’s a purification program and they do this. And it’s like five hours of sauna a day and high-dose niacin and all those stuff. There are a few really, really weak papers on that suggesting—really bad papers—that it may decrease toxins or people feel better and they’ve used it on firemen that had exposure to a variety of different things. But the short answer is nothing really compelling has been shown to decrease toxins or consistently greatly improve symptoms. It’s just too complex of a topic.
DrMR: Now, when I was digging into the mercury literature—and the reason why I chose just one was because it felt overwhelming to try and tackle the topic at large. So I said, let me use one. And then what is helpful for me is sometimes to pick one issue and use that as a proxy for others. So, if I found a ton of compelling literature on mercury, I would have started using that evidence in the clinic and then started researching other therapies that were helpful. This is why I research so heavily into the gut, because there’s good research there and that research is clinically impactful.
That’s why I haven’t dug too deeply into toxins, because the deeper I dug the less I found. So I didn’t really move on to other things. I’m certainly open if someone presents the right evidence for another type of toxin, but it sounds like you’ve done some of that digging and you haven’t seen anything.
But one thing I just want to mention really quick is that there was one study notably, and there may have been more than one similar to this, but one that essentially took two groups of patients that had “high” levels of mercury in the urine after a provocation test, so a test where you give a flushing agent. And almost everyone will show higher levels because you’ve given an agent to flush this out.
DrMR: Both groups were—so, they were treated but one was given a sham detox. They’re given like sugar pills or something. And the other group was given actual detox support. And they showed identical improvements in their symptoms. Now, those improvements were probably due to, in part, surprise, largely placebo effect, which is why having a placebo arm in this trial is so important. Because if you give someone something and they’re expecting to feel better, most likely they are going to report that they’re feeling better. So when you have the placebo versus a treatment group, you isolate out for that.
So the one mercury detox study that looked at mercury detox treatment versus a sham treatment showed identical responsiveness in terms of patient outcome. So it’s definitely important to keep these things in mind. And so, Bryan, would you recommend in terms of—I know you said there’s an evidence-based detox protocol, is that mainly avoidance like lifestyle and dietary things, like getting exercise, avoiding toxins or what does that look like?
DrBW: Based on all those research, and I have over I think 300 references to date just on this one topic. I’ve been spending a while on this. I’ll jump to the end, basically, say that I have, based on what I read in the literature, put together what I am extremely comfortable with as a detoxification program. Has it been proven? Big fat no on that. I thought about ways of doing it, but the problem is that testing is so imprecise. Even controlling for some of the variables that I talk about, I really want to test this. I’ll be honest with you. I think it’s really good. I’ll just say this, as a practitioner, I think of my family first. Would I be willing to do something like that, or if I thought my family had a specific problem like toxicity issue, what would I do? I wouldn’t just throw some powders and pills at them and say, ‘Oh this is going to detoxify because this is what I was taught in naturopathic school.’ I would want to make it something that I would comfortable giving it to my wife or my kids, and I’ve come up with that. I’ll tell you why and I’ll tell you how in just a second.
But so here’s the thing, number one, you have to assess. There’s no lab test that I currently know of. There’s one that I’m curious about but I won’t get into that now. But you can’t test, so to do a questionnaire, to do like the QEESI questionnaire for example. See how you score and if your symptoms may be due to some kind of chemical exposure. You have to assess first, I think.
Then the second one that I recommend is avoidance, to clean up your life as much as you can. And you know this as a practitioner, people have a finite amount of money, time, attention, and resources to put towards this. There are some people that I think are a little crazy when it comes to this, quite honestly. But I mean they have chemical-free everything and purifiers here and there. I mean, out of control. So you do what’s comfortable. I mean there are plants that have been shown by NASA to help clean up the air a little bit. Water purifier, I’m not going to get into the splitting hairs on that either. It’s not a bad idea if all you’re drinking is tap water. Organic food probably is a better idea than processed, although processed organic food is questionable. So, cleaning up your life. And there’s a lot of resources that—I’m not going to get into that. That’s not my thing. A lot of ways that you can try to avoid certain things.
And the third one is if somebody’s truly interested in detoxifying their body or seeing if toxins are causing a problem, number one is assess, number two is avoid, number three is to get rid of any of the stuff going on in the body. And this is not an exciting list. You find what I call extrinsic detoxification is last. It’s not jumping to the detox program.
One is assess. Two is avoid. Three is if you have any kind of infections, gastrointestinal infection, you got to reduce what I call the exogenous or endogenous load. Do you have like lipopolysaccharides from your gastrointestinal tract and intestinal permeability? Do you have excess reactive oxygen? You have to get the body working a little bit if it’s going to feel comfortable releasing and mobilizing and getting rid of potentially stored toxins or xenobiotics.
Fourth step is, I call it remediation of nutritional biochemistry. There’s no sense in doing a detoxification program of any type if you lack the basic vitamins and minerals and nutrients and micronutrients to run these pathways effectively in the first place. Phase 0, Phase I, Phase II, and Phase III. Then I call it intrinsic detoxification and that’s making sure your bowel habits are correct, your pH is close enough. And there’s interesting research in pH in the kidneys and how it re-absorbs toxins. But you have to be hydrated, you have to be moving your bowels regularly, have the raw materials for things like glutathione to make sure that—so, that’s intrinsic detox. Getting the stuff primed and ready.
And then finally, finally the last step would be to employ an extrinsic detoxification.
Extrinsic detox support protocol
DrMR: So, what about the extrinsic protocol, I’m sure people—but I mean, before we even go there, important to emphasize that we’re not going right—you’re putting what most people would probably consider the most important thing, the supplements, as the last thing. So, I want to just reiterate that. I think that’s a really sound approach.
DrBW: Or they say that their favorite celebrity is promoting some juice cleanse. They’re like, “Well, it’s time for me to cleanse.” Cleanse what? I mean, you eat a horrible diet. You’re using cosmetics and cleaning products and living in a toxic environment, whatever, rubbing these lotions on your body, whatever it might be.
You’re not taking the multi—you might be nutrient deficient. You’re not even eating a good diet in the first place. You’re pooping once every three days. Yeah, go ahead and do a detox, that sounds fantastic.
Because, again, every single paper I’ve looked at, if somebody goes, animals or humans alike, becomes hypocaloric, their blood levels go up. They do release these things. And if you’re not set-up to get rid of those things, what are they going to do? They’re going to cause problems. There’s one really interesting paper that I looked at. It talked about an additional role of adipocytes or fat cells is actually—I mean we saw this for a long time—but it’s actually to store and help get rid of xenobiotics, things that could otherwise damage the body.
So, then the extrinsic detoxification and this is—I will tell you what’s not evidence-based, if that’s okay. So, sauna, there are some pretty cool studies on sauna therapy. In fact, there are some xenobiotics chemicals that are excreted in sweat and doesn’t seem to be excreted in other ways as well. That said, there are things that aren’t secreted in sweat. Here’s a great one. There’s a couple of papers that looked at blood, urine, and sweat, and they look for certain xenobiotics, depending on the study. It could be metals. It could’ve been persistent organic pollutants. But this is why the testing is horrible. It didn’t show up in the blood. It didn’t show up in the urine. But it did show up in the sweat. That tells you that it’s in them.
And so, you could do your—I’m not going to name a lab—but you can do that test and it shows up as normal and your practitioner says you’re not toxic, but then you sweat it out. Where did that come from? It’s accumulated and there’s a few papers on that.
DrMR: And does it matter if you sauna, steam room, or it’s exercise that induces the sweat? Does what induce you to sweat matter?
DrBW: So, I told you before, I have a program that I’ve created. I’ll give you a little bit of it, but there’s far more detail. Here’s what I would do. If I thought I was toxic, this is what I would do based on a lot of reading of a lot of the literature and I feel very, very comfortable with this protocol. One is I would exercise for about 30 minutes, probably a combination of some high intensity, which has no evidence. There’s evidence that exercise can increase some detoxification enzymes like glutathione conjugation enzymes. It definitely heats the body up. You definitely sweat. And there’s a bit of lipolysis. And that’s what we’re going for. And so ask me a question if you want, because this is wholly done very mindfully.
So, about 30 minutes of exercise, a little bit of high intensity, a little bit of steady state cardio for about 30 minutes. Then hop directly into a sauna. Now, you’re already heated up. You’re going to be sweating a little bit and then the sauna is going to be probably more effective. I would say this is somewhat evidence-based. On the papers that used saunas, for reasons of possible toxicity, do about 30 minutes, as hot as you can manage, and get in and out as frequently as you need to. So, I say crank it up as high as you can, get in there. If you have to take a break after 10 minutes and cool off for two and hop back in, that’s fine. But make a goal for being in there about 30 minutes. The purpose of the sauna is to heat. There is plenty of evidence that certain xenobiotics do come out in the sweat. Now, that you’ve exercised and hopefully increased lipolysis and mobilization, you’ve increased circulation, and you’ve increased like I said mobilization and heat, then you get into the sauna and continue that.
Now, I would only do this, by the way, if you’re only following a hypocaloric diet. The program that I came up with—so, then the hypocaloric diet, the way that I’ve done this, it’s only 10 days. It’s a 10-day program. And now how much—and go ahead, feel free to question me, as skeptical as you want to be. I come from the same brand, man. But like I said, I am really proud of and comfortable with this program based on all the stuff that I read. Ten days is cool. Now, is there any evidence that 10 days is better than 21 or less or more? No. I have people following a hypocaloric diet, a certain—it was a great study. We didn’t even get into Phase III yet. There is one study on rats that showed that lowering calories 25% below their basal metabolic rate increased Phase III, which is specifically was P-glycoprotein, but increased Phase III detoxification.
So just decreasing calories seems to not only increase mobilization based on studies, but as well as might actually facilitate Phase III, which is the exit route getting out of the cell. So, I have people drop down their calories about 35% from their basal metabolic rate. Calculated, it’s not ideal, but at least you get a ballpark. And then a certain macronutrient ratio, kind of higher in protein, lower in refined carbohydrates, a little bit of fat so you can keep bile moving along. So, do that hypocaloric diet for six days. And also, I don’t know if you’re familiar with some of the papers on time-restricted feeding.
DrMR: In terms of detox or just in general?
DrBW: Just in general.
DrMR: Yeah, yeah.
DrBW: Yeah. So, also, because you’re trying to maximize lipolysis, if we’re trying to get rid of lipophilic fat-loving, stored in adipocytes, you want to maximize lipolysis. So I try to have people keep a window of about six hours when they’re eating this 35% below their basal metabolic rate. Now, what they eat during that six days—so, you’re familiar with Panchakarma in Ayurvedic medicine?
DrBW: Vaguely, okay. And they have this thing, this dish called kitchari. Now, I’m not trying to bastardize Ayurvedic medicine or say that I know better than—
DrMR: Is that the rice curry and like—
DrBW: Rice and mung bean, yeah. So this is evidence based. There are some papers that have very specific amounts largely of cruciferous vegetables and a variety of them that have shown that it increases glutathione conjugation enzymes as well as glucuronidation enzymes in human trials. The gold standard, for me, was human trials, if I could. There are a lot of animal studies on some of these things, but I want to try it on human. And so, things like—any of the cruciferous vegetables as well as onions and leeks and chives.
And so, I have a specific amount, based on these papers, that people would use on a daily basis. Sprouted mung beans, it turns out, have something called glucaric acid. And glucaric acid is nature’s answer to calcium D-glucarate, which as you know decreases beta glucuronidase activity, which essentially—and this is getting a little technical—that essentially speeds up or makes glucuronidation itself more effective because it’s not getting undone by beta glucuronidase. So, cruciferous vegetables and sprouted mung beans are really high in glucaric acid, which, like I said, is a beta glucuronidase inhibitor.
So, basically what people eat for six days, man, I made this as simple as possible. They make a big pot of this. I didn’t know what to call it, so right now it has a horrible name, just a detox soup. It’s horrible. I realize it. You can feel free to make whatever—
DrMR: Simple words.
DrBW: Replace you want. But I couldn’t come up—I’m not creative when it comes titles. So, it’s this big pot. What you eat every day is a certain amount based on the calories that you calculated. A certain amount of sprouted mung beans, a certain amount of cruciferous vegetables and onions and leeks and garlic and some protein and that’s what you. And you do it within about six hours. The design is to make sure that you’re hypocaloric and in the time-restricted feeding that you’re in mostly a state of lipolysis.
Now, to ensure that somebody maintains the hypocaloric state, because the body can kind of change its metabolic rate, is you’re probably familiar with the fasting mimicking diet as well. So, for the last four days, I really like the papers and the concept of the fasting mimicking diet. I love it. The problem I have is, if somebody does that diet and that’s really low calorie and they have stored or accumulated xenobiotics, those are going to go up. But as you know in the fasting mimicking diet, he just gives macronutrient recommendations. It doesn’t say what to eat. So people might be eating rice and avocados, for example, but that’s not, by any means, going to help stimulate these different phases of detoxification.
DrMR: It’s essentially low carb, correct?
DrBW: Actually, it’s really low protein, super low protein. Protein is like below 10%. But it’s to mimic fasting. And that would make sense. Because if you’re going to go through autophagy and breaking down some of these old proteins. If you’re eating proteins, your body is not going to do that. So, it’s mostly fat and carbohydrates, but really low calorie. Time-restricted feeding. Do it again within about six hours. Your body thinks it’s fasting, which I’ll just as a quick statement, I don’t think we should fast anymore because I don’t think we’re healthy enough to—I think we’re too toxic in the first place. I don’t think most of us are healthy enough to actually deal with the exposure that, that might be causing if we do fast.
So anyways, the last four days is the fasting mimicking diet, but I recommend very specific foods like cruciferous vegetables to meet those macronutrient requirements for the fasting mimicking diet to make sure that you’re pushing glucuronidation enzyme and sulfation and glutathione conjugation, for example. And so, then there’s the exercise component, sauna component. It’s basically a food-based program and I do have a few supplements that I recommend as well, but that’s—do you have any questions so far? That was kind of long.
DrMR: No. I mean that’s great.
DrBW: I love it.
DrMR: One thing that I wondered about was, okay, you’re going to do said nutritional company’s detox-in-a-box program. It might be 21 days. It might be 10 days, whatever. I always wondered, does the hypocaloric diet, the lots of water, the recommendation to sweat induce saunas, is that where most of the benefit is coming from instead of the $300 of amino acids and whatever else? And it sounds like that’s pretty much the case, where we can probably get enough support for detox with diet and lifestyle factors. And what you’ve laid out I think is beautiful. Stimulate metabolism with a low-calorie diet, stimulate sweating circulation, get some food that supports you in there and works synergistically. And yeah, I think this is brilliant. I really like it.
DrBW: If I can add to that, to use foods that in human clinical trials have been shown to stimulate or up regulate certain Phase II detoxification enzymes.
DrBW: And they had very specific amounts in these things, like 1.33 cups of leeks was used in one study of all things. So these were specific rules. I forgot what it was, like two tablespoons of chives or… I don’t remember. There are a few of them. But I feel and I think that, again, you and I come from sort of the same brand. I’m very skeptical of a lot of things. I mean, I’ll say proud—I’m not a very prideful person—proud of but comfortable with this as an evidence-based as much as possible—and I’m happy to put an asterisk next to anything that’s not—program that I would follow if I wanted to try to lower my total toxic burden.
It hasn’t been proven. I thought about ways that I can. I’m still thinking about ways that I can, because I think it’s a really good program. I will say, too, so who tested it out originally was my wife and I. Dude, we loved it. The fact that you get to eat for the first six days, it’s the same thing for six days. That might turn some people off. But it turns me on, because it’s the same darn food and you just make. And it’s, like you said, curry based. It’s turmeric and there are spices in this thing. My kids ate it.
DrMR: That’s a good gauge.
DrBW: All of them did. Yeah, one of them was one year old. They all ate it. And what ended up happening, it’s such an easy program to follow. The next month after—it’s only 10 days. My wife is like, “You know, I feel like I want to do that again.” And it’s because like we felt good. I’m not saying there’s anything great about the diet, but it’s just a really clean, pretty awesome diet.
Then, I won’t get into details. I’m sure we’re probably getting close on time here. But in terms of supplements, I try not to use supplements on this. It’s food-based. But as you know, with your focus on the gut or your knowledge of the gut, bile gets recycled 14 to 17 times, including anything that was attached to it unless it gets excreted. Now, something you might find interesting is there are some papers on, you know cholestyramine?
DrBW: That old cholesterol—bile acid sequestrant drug. There are papers that say that there are certain persistent organic pollutants that are really hard to get rid of because they’re attached to bile and it goes to this enteropathic circulation. But in the group that took cholestyramine, they had more excretion of this. And so, I have a number of things that don’t promote detoxification, per se, but rather things like chitosan, which I hate as a sort of fat loss thing. But chitosan, there’s papers on. Activated charcoal, believe it or not, there’s a couple of interesting papers on. Fiber, just loads of fiber, in fact, more fiber than one would probably want to take.
DrMR: Is it soluble that you’re using, I’m assuming?
DrBW: Both. Yeah. You want to try to get—and I know that we’re already past time and—
DrMR: That’s all right. We can coast for a bit. We’re on a roll.
Phase 0-III toxification
DrBW: So, Phase 0 is bringing a toxin into the cell that needs to get detoxified. Inside the cell, Phase I and Phase II do their thing, which I go into more if you want. And then Phase III is excretion out. It’s efflux out of the cell. Now, the efflux out of the cell, if that ends up in bile, bile ends up in the gastrointestinal tract and that ends up going out as poop, if it’s bound up to something. If not, it’s going to probably be recycled. So, activated charcoal, the chitosan, both types of fiber is designed to bind onto as much as humanly possible, assuming that Phase III has opened up, which I have to comment on something, but Phase III has opened up so that you pull all that stuff out when you do go poop, if that makes sense.
So, I have a lot of binders in there, intentionally, to try to pull things out that are evidence-based. And if you’re interested in some of these papers and the program I put together, there’s—I was surprised actually to find papers that showed that things like modified citrus pectin or activated charcoal actually did something. I was expecting that I wasn’t going to find anything.
DrMR: Now, I’m assuming many of these same agents that had been shown to help lower cholesterol like guggul? Has guggul come up in this also?
DrBW: Yeah. I didn’t look at guggul. No, that was a good question. I didn’t look at guggul. That’s a really good question.
But the last piece I want to say is, so think about your favorite supplement company’s detoxification powder or products, and ask yourself if things like quercetin are in there or catechins are in there or, everybody’s favorite right now, curcumin is in there. All of these things—we’re totally out of time—have been shown to inhibit potently Phase III.
The analogy I use is, you have a room and it has two doors. So door number one, or I should say door zero. The entrance door is when a toxin comes in to the room.
Then you have different enzymes—here’s the way I put it, you open up a door then your toxin comes in, this fat-soluble toxin. Phase I puts a sticky note on it, right on it’s forehead. And after Phase I, it makes it kind of anybody that has a sticky note on the forehead is going to be kind of upset, kind of irritated, kind of angry because they have the sticky note on their forehead and they feel embarrassed. After Phase I, these toxins can become more toxic or can become a reactive oxygen species and, therefore, are more damaging to the body. And this last concept is really an important one, so we’ll just wrap it there.
Then Phase II takes this upset xenobiotic that has a sticky note on its head and hands it something. That Phase II is a conjugation reaction. It adds something to it. So methylation can add a methyl group to it. Sulfation has the sulfur group or glucuronidation has the glucuronide to it. And now, it’s happy, and as long as the third door is open, then it can leave, leave the cell and go as water-soluble compound, be urinated out, be pooped out in the form of bile, be sweat out, salivated out, or tear ducted out, if that makes sense.
Okay. Now, here’s the problem. Curcumin is an incredibly potent Phase III inhibitor, as is silymarin, or milk thistle actually inhibits Phase III a little bit. And that’s in every detoxification program. Quercetin, because of its anti-inflammatory effects, is in every single one of them. Catechins from green tea inhibits Phase III. And in fact, cruciferous vegetables do to some degree also. So you maybe wondering, well, why do these things inhibit Phase III? And this is a really important concept. Here’s why they don’t belong in a detoxification program though is, once Phase II handed that xenobiotic whatever was handing it, like beta glucuronidase, it can take away what was given and become what it was after Phase I again, which is this really pissed off, angry reactive oxygen species or more toxic metabolite and can cause damage because it couldn’t get out of the room.
So, I suggest, and we started out this by saying, I think we need to have a very different conversation that we’re having about if something’s truly a detoxification program. Based on what I’ve read—by the way, turmeric enhances Phase III. Curcumin, part of turmeric, inhibits Phase III. That goes back to that biphasic effect I was talking about. That green tea by itself probably doesn’t inhibit Phase III, but isolated catechins do, if that makes sense. I don’t think that quercetin or green tea extracts or curcumin has any place in the detoxification program. Because if you’re trying to get rid of stuff, why would you shut the door on the way out. Does that make sense?
DrMR: It makes complete sense. It reminds me of what Dr. Kara Fitzgerald said in the podcast about methylation. She said, “You can over methylate and cause problems of over methylation by taking some of these methylation supplements.” And so, it’s tempting to say, ‘Oh, this might be good for this pathway,’ and then try to overly goose that pathway and actually make yourself worse in the process. This is a little different than that, but it kind of is similar in the concept of more is not better in terms of higher doses and more stuff. And sometimes less is more, especially when these things are targeted and well thought out as this protocol seems to be.
DrBW: And it’s contextual. So, you may say curcumin I’ve heard is good for you, which is questionable. But how about cruciferous vegetables, right? They’re anti-cancer. Well, here’s how it works. This is so awesome. That cruciferous vegetables, first of all, it’s not one compound. They have a bunch of things in it. Cruciferous vegetables actually inhibit Phase I a little bit, which is good, because after Phase I, it’s more toxic to reactive oxygen species. They enhance Phase II and then they may close the door to Phase III a little bit, as does curcumin. And we’ve heard green tea extract is fabulous, right? Anti-cancer as well. But it’s because they close Phase III that causes them to be anti-cancer or have the benefits they do inside of the cell, because they don’t get in and out, if that makes sense.
So, in terms of cancer… And in conventional medicine, guess what they’re trying to find? They’re trying to find Phase III inhibitors, on purpose. Because they want to keep the chemotherapeutic drug inside the cells so that it can do what it does better and so it doesn’t just leave the cell. And so they’re looking to inhibit that.
But it’s all contextual. If you want to reduce your risk of cancer, those things are great, but they’re probably not going to detoxify you very much and, therefore, don’t belong in the detoxification program. So take them out as much as you want. But if you want to detoxify, I say, don’t take them. And then when you’re done detoxifying, go ahead and take them again. So it’s all contextual. It’s what’s the goal, what’s the purpose, instead of just taking these things willy-nilly.
DrMR: I like it. No. I’m really resonating with pretty much everything you’ve said today. And you’ve given people some great things to maybe start on, but you did mention the program that I know you put a lot of time and effort into and clearly passion.
So, where can people find out more about that program and also follow you if they wanted to.
DrBW: Sure. Yeah. I’ve done a lot of educational programs over the years. This one, honestly, it’s my favorite one. It is so good. I mean, I should say most humble person. I’m horrible at self-promotion. But it is so good. It’s a program I wish I had. My main website is drwalsh.com, just D-R-WALSH dot com. There are links to various things from there. It’s not a really active site, I will say, but that’s where they can find me.
This program is one of a few at metabolicfitnesspro.com. It’s just metabolicfitness-P-R-O dot com. Specifically this detoxification program, it’s nine hours of video lecture. I lecture in front of a whiteboard. It’s more interesting than narrated PowerPoints, in my opinion. But I flash on the screen papers as I’m referencing them, for example, and call out boxes and graphics and stuff. So it takes everybody through how toxic are we, is there a synergistic effect, a low dose non-monotonic dose response curve I mentioned earlier, the mechanisms of damage. I go into a little bit of detail as to what is Phase 0, Phase I, Phase II, Phase III. And then, of course, at the very end is more details about this program that I put together and the sort of the references that go behind.
DrBW: So, that’s it.
DrMR: I love it, my man. Hey, thanks for taking the time to talk about this. This is a topic that I think is, like you said, is very important and I think we, as a whole, in terms of clinicians trying to help people, have only been using the information in terms of testing and detox protocols wanting to help people. But I do think that this is an area where we could maybe trim some fat from the care model, save some expense, save some cost, certainly save some worry, and stir people towards a more effective and also cheaper and less worry-prone interventions. And it sounds like this course is hopefully going to be a keynote piece to help people navigate that.
So, thank you for taking the time to put the course together and to talk with us.
DrBW: Listen, it was a lot of fun. I really appreciate you having me.
DrMR: My pleasure. Bye. Thanks again. Bye.