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Welcome!

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the student program agreement.

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Tracy’s health counseling certification is from Columbia University for the Institute of Integrative Nutrition in New York.

She has completed ongoing training and is working on a certification in understanding the root causes of chronic illness with the Institute of Functional Medicine and on an additional Masters degree in Human Nutrition at Bridgeport University.

She holds a Masters degree in Engineering from MIT and a Masters degree in Management from The Sloan School at MIT.

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Heavy Metal Toxicity

Part 2

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Agenda

Key Reminders and Quick ReviewArsenic, Lead, Cadmium OverviewsDetoxification Plans and NutrientsDetox Dangers:

Timing & ContraindicationsAssessing ToxicityCase studyMore Information

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Optimal Health is Not Complicated

Maximize Put in what’s needed for this unique person

Raw materials your body needs to function and heal Oxygen, Water, Vitamins, Minerals, Antioxidants, Protein, Healthy Fats Belief that the therapy one is choosing is effective and safe

MinimizeTake out what’s harmful for this unique person

Toxins, Infections, Allergens, Stress, TraumaLimiting beliefs, fear, negative expectations

PrioritizeCreate an environment for healing for this unique person

Sleep, Rest, Laughter, Stress ReductionExercise, Stretching, BreathingMeaningful RelationshipsPositive visualizations and associations

And then the body will heal itself – will naturally seek wellness.

Simplifying the face of health can be very calming and inspiring to

your clients.

Of course, we are not very good at doing these three things consistently. The result? Chronic Dis-ease in the body.

This is Why Your Clients and Patients Need You!

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Broad World of Toxins

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Liver detoxification pathways and supportive nutrients

Urine, Stool, Sweat,

Exhalation

Folate (Vit B9)

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Key Detox Tenets Part of the body's innate defense

system – to manage both internally-generated and externally-acquired toxins.

Most body burden of toxins is acquired through chronic, low-level exposure and inability to excrete.

Must convert fat-soluble substances to water-soluble ones that can be readily excreted from the body (e.g. urine, stool, sweat).

Imbalance in Phase 1 and Phase 2 detox is common – and generates oxidative stress and inflammation.

Some variable, heavy metal exposure is largely unavoidable (e.g. arsenic in rice*, HMs in protein powder**, HMs in herbal supplements*** )

We often store toxins in fat which are liberated with weight loss. Being toxic fuels an increase in body fat.

Methylation, & Glutathione conjugation are particularly key Phase 2 processes to clear heavy metals.

Heavy metals interfere with (1) cellular energy production and(2) detoxification, a vicious cycle of chronic fatigue and inflammation.

Avoidance helps. But having strong Detox capability is key for wellness.* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346791/pdf/ehp.1104619.pdf andhttp://www.consumerreports.org/cro/magazine/2012/11/arsenic-in-your-food/index.htm#recommendations ** http://www.consumerreports.org/cro/2012/04/protein-drinks/index.htm

*** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163780/pdf/nihms314148.pdf

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The Experience of Toxicity is Individual

What is toxic to one person is fine for another person. Our toxin tolerance is particularly individual.

Genetics

Toxic Excretion

Environment

Toxic Exposure and Absorption Nutrition

Toxic Retention

Inflammation/Disease

Comfort/Wellness

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Heavy Metal Introductions, Continued

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Toxicity Overload is Common

“Heavy metals” Mercury Arsenic Lead Cadmium Aluminum

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Arsenic (As) #

# http://www.imp.lodz.pl/upload/oficyna/artykuly/pdf/full/Szym1-02-02.pdf* http://www.nytimes.com/2013/10/02/business/fda-bans-three-arsenic-drugs-used-in-poultry-and-pig-feeds.html?_r=0** http://www.ncbi.nlm.nih.gov/pubmed/3956470 and http://www.ncbi.nlm.nih.gov/pubmed/3384494

● Sources: coal plants, smelting, mining waste, volcanic eruptions,car batteries, pesticides (heavy until 1980s; some still today), electronics manufacturing, poultry farming (up until 10/2013*), turkey farming, heavy shellfish intake (largely organic form), and pressure-treated wood (CCA). Apple juice, rice, cotton....

● Most common exposure: contaminated groundwater.● Inorganic form is more toxic than the organic.● Well-absorbed by both ingestion & inhalation, as well as skin

(think child's hand on dewy playground equipment).Binds strongly to keratin in hair, skin, and nails.

● Long-term exposure is well-associated with Raynaud'ssyndrome and other vasospasticity syndromes.Circulation improves after exposure reduction. **

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Arsenic (As)

* https://www.dermquest.com/imagelibrary/large/029179HB.JPG and** http://www.researchgate.net/publication/49814484_Mees'_lines/file/32bfe511b77a744232.pdf *** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013823/pdf/nihms-578023.pdf

● Look for hyperkeratosis*, increased warts on soles/palms, skinpigmentation changes, or Mees line formation on nails**. Alsometallic/garlic taste in mouth, low WBC (esp. neutrophils), Raynaud's,hypertension/arrhythmia/atherosclerosis,'milk and roses' complexion.

● Processed in humans via Methylation.Toxic level of arsenic causes tumorsuppressor genes to be hyper-methylated,increasing cancer risk (esp. skin cancer risk).Higher folate intake increases arsenicexcretion via urine and reduces blood levels. ***

● Remember (WS tip): methylation geneticvariants (SNPs) are very common andneed B-vitamin support,especially methyl folate and also B12 andB6.

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Cadmium (Cd)

* http://www.ncbi.nlm.nih.gov/pubmed/9569444 or http://www.sjweh.fi/download.php?abstract_id=281&file_nro=1** http://www.clinchem.org/content/early/2012/02/06/clinchem.2011.167494.full.pdf

● Sources: Mining and smelting, cigarettes, shellfish,spray paint, rechargeable batteries, phosphate fertilizers, artist paints (most types), commercial insecticidesand fungicides, metal alloy in galvanized steel.

● Most common exposure is via cigarettes (4-5x more Cd vs. non-smokers)or contaminated food. Secondarily, contaminated water.

● Can readily replace zinc and chromium in the body.● Binds metallothionein strongly and makes toxic complexes which

inhibits this natural chelating enzyme's ability to protect the bodyfrom other metals.

● Look for kidney dysfunction (e.g. low GFR, high microalbumin)**and recurrent kidney stones.* (WS tip: this can be particularlytoxic in combination with Type 2 diabetes)Long-term exposure: osteoporosis, bone pain (e.g. femur).Also hypertension.

● Processed in humans primarily via glutathione conjugation.Excreted primarily via urine (other heavy metals: primarily stool).

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Lead (Pb)

* http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858639/pdf/nihms190515.pdf andhttp://brain.oxfordjournals.org/content/126/1/5.full ** http://www.ncbi.nlm.nih.gov/pubmed/20807691*** http://www.lead.org.au/fs/fst48.html and http://www.ncbi.nlm.nih.gov/pubmed/15613953 **** http://www.ncbi.nlm.nih.gov/pubmed/8569015***** http://www.ncbi.nlm.nih.gov/pubmed/20628440

● Sources: Households built before 1940 (e.g. paint, pipes, solder), mining and smelting,contaminated soil (prior widespread use of leaded gas), red lipstick,imported painted toys, artist paints, bone meal, hair dye,pottery glaze, chrome-plated faucets.

● Most common non-acute exposure: contaminated food/water and inhaled dust.● Can readily replace calcium and magnesium in the body and, thus, body burden (~95% in

adults) is primarily stored in bone. And passes easily into the brain.● WS tip: look for toxicity as a result of osteopenia/osteoporosis with redistribution to soft

tissues (e.g. brain, liver), especially in postmenopausal women due to hormone changes(reduction in progesterone and estrogen).

● Primary symptoms of slow accumulation are often in nervous system* dysfunctione.g. memory loss, slowed reaction time, cognitive decline, unexplained irritability,restlessness, insomnia, neuropathy, anxiety,paranoia, agoraphobia. ADD/ADHD. Parkinson's.** Dementia.*** Alzheimers. ***

● Most common heavy metal poisoning for children (easily penetrates more permeableblood-brain barrier). Reduces IQ.* Increases delinquency.**** Autism.*****

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Lead(Pb)

* http://www2.epa.gov/lead/protect-your-family** http://www.nsf.gov/eng/cbet/achieve/1440/2012/edwards.htm*** http://www.cdc.gov/nceh/lead/data/national.htm

**** www.atsdr.cdc.gov/HEC/CSEM/lead/physiologiceffects.html

● Organic lead much more toxic than inorganic.Lead emissions have been reduced greatly in developed countrieswhile increasing in undeveloped countries. *

● Drinking water in older municipal buildings is common exposure.**● In the US, lead toxicity affects non-white children

disproportionately more often and more severely.***● “It must be emphasized that there may be no threshold for

developmental effects on children. However, lack of overtsymptoms does not mean “no lead poisoning”. Lower levels ofexposure have been shown to have many subtle health effects****

● Processed in humans primarilyvia glutathione conjugation.

● Lead and mercury impair the enzymesecretions needed for Methylation whichis then needed to make Glutathione.

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Damage from Heavy Metals

● Indirect e.g. an inflammatory reaction from the immune system reacting tothe metal as a foreign invader (e.g. damaging the endothelial lining of an artery ortriggering an autoimmune reaction)– Removing mercury amalgams reduces the autoimmune

reaction in Hashimotos thyroiditis*● Direct e.g. intra- or extracellular dysfunction

(e.g. microtubule neuron degeneration in responseto mercury exposure**)– Lead can replace calcium in key enzymes,

negatively affecting cognitive transmission ***● All can penetrate the blood-brain barrier using a variety of transport

mechanisms.****● Toxins cause inflammation which can damage mitochondria, rendering us less

able to make cellular energy (ATP): “Tired'n'achy”. Chronic fatigue? Fibro?● Can negatively affect the function of nearly any tissue in the human body.

But as with all other toxins, the dose-response can vary substantiallydepending on absorption and detoxification capability.

● Heavy metals impair detox processes needed to get rid of heavy metals.* http://www.ncbi.nlm.nih.gov/pubmed/16804512** https://www.youtube.com/watch?v=lCzT1yuau_4 *** http://www.ncbi.nlm.nih.gov/pubmed/10227691 **** http://pharmacy.mc.uky.edu/faculty/files/jad.pdf

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True Root Causes?

● Consider the body as intelligent strategist vs. environmental victim?

from “Mercury Toxicity and Systemic Elimination Agents”, posted as a handout in the Course documents

Dr. Klinghardt believes that “most, if not all chronic infectious diseases are not caused by a failure of the immune system but are instead

a conscious adaptation of the immune system to an otherwise lethal heavy metal environment.

Mercury suffocates the intracellular respiratory mechanism and can cause cell death. So, it is speculated that the immune system makes a compromise: it cultivates fungi and bacteria that can bind large amounts of toxic metals. This allows the cells to breathe. However, the system is compromised, as it has to provide nutrition for the microorganisms and contend with toxic metabolic by-products (“toxins”).

These organisms, especially Candida, can frequently grow uncontrollably. When this occurs, the patient experiences the so-called “die-off effect” (sometimes severe crisis a patient can have in the initial stages of aggressive antifungal or antibacterial treatment). This may often be due in part to acute heavy metal toxicity-metals released from the cell walls of dying microorganisms. “

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Supporting Detoxification

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Detoxification Flow: Simplified

Toxin Absorption

Toxin Polarization

Toxin Conjugation

Toxin Excretion

Oxidize toxin and make it more “sticky” (& more toxic!)

“Cytochrome P450” enzymes (CYP)* are catalysts (57)

Detoxification steps: Phase 1 Phase 2 Phase 3

Free Radical Damage

Bind toxin to a water-soluble “escort” (less toxic)

NrF2 activates Phase 2 enzymes (6)

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Methylation

http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/figure9_1.html

Methyl Groups

Vitamin B6

Vitamin B12

Folate

Methionine

Conjugates Lead, Cadmium, Aluminum, Mercury

Nutrition

Nrf2

Nrf2

Cruciferous veggies, Curcumin, Hops,...

Toxin Excretion through

stool, urine

Glutathione

Glycine

Glutamine

Glycine

Glutamine

SeleniumSelenium

Conjugates Arsenic

Glutathione s-transferase

& Glutathione

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Daily Detox Nutrition

Daily “complete” protein intake– Glycine, Cysteine, Glutamine (or Glutamic acid), and Methionine (theoretically

the only “essential amino acid). Cysteine and Glycine are often rate-limitingfor glutathione production. Whey protein is very high in cysteine. Collagenhigh in glycine. Either can be supplemented directly with free amino acids

B Vitamins– All B vitamins required for activation of various CYP (Phase 1) enzymes.

Folate, B12, and B6 are particularly key for Phase 2 heavy metal detoxprocesses. Real B12 comes only from organism sources (e.g. fish, algae).Folate from predominantly fruits and vegetables. If supplement, choosemethyl-B12 (not cyano-) & real folate (max 400mg/day folic acid).

Heavy vegetable intake– To supply B-vitamins, minerals (esp. potassium), and sulfur-containing

compounds, especially cruciferous veggies, onions, garlic. Use handoutto educate clients about creative intake (e.g. daikon radish “cracker”).

Antioxidants– To protect against Phase 1 byproducts and tissue damage from

toxin circulation. Tannins (esp. from green tea), quercetin, citrusflavonoids, alpha lipoic acid, Vitamin C, Vitamin A, etc. Heavy veggieintake with appropriate fruit or at least Juice Plus and/or 'greens' food)

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Daily Detox Nutrition

Magnesium– One of the top American nutrient deficiencies. Required by every cell in

the body to make energy (ATP). And ATP is required to make every detoxenzyme. Potent food sources include seeds, nuts, and legumes, especially almonds,tahini, pumpkin seeds. For general body sufficiency, I recommend an amino acidchelate form of magnesium e.g. glycinate, malate.

– Insufficient levels often cause constipation – a block in Phase 3 detox.For constipation, I recommend magnesium citrate e.g. Natural Calm.

– Increases cellular uptake of potassium which makes cellular pH morealkaline, promoting greater cellular release of toxins.*

Probiotics– Beneficial bacteria to nourish colon lining (by making SCFA esp. butyrate)

and to keep immune system calm in the face of toxic threats. Potential rolealso in binding and detoxifying heavy metals directly. ** Either supplementor naturally-cultured foods (e.g. kefir, natural sauerkraut, kombucha).

Water– To flush toxins and reduce risk of kidney inflammation. To bulk up fiber and form a

complete, easy-to-pass stool. Plain, clean, filtered water. Not carbonated.

* http://www.ncbi.nlm.nih.gov/pubmed/15083932 ; http://www.metadocs.com/pdf/publications/0707_minich.pdf** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426676/pdf/zam6397.pdf

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Daily Detox Boosts

Key Mineral CoFactors – must be Balanced!– Molybdenum, Zinc, Copper, Iron

Cholagogues – Artichoke, dandelion, turmeric, beet, yellow dock

– Promote bile formation and secretion in the liver.

Silymarin– Extract of the herb milk thistle

– Promotes liver tissue regeneration, protecting organ function from toxins

Epsom Salt Baths– Magnesium sulfate, yields sulfate to promote toxin binding

Nrf2 Boosters – Cruciferous vegetables, curcumin, hops, green tea, piperine (fr. black pepper),

resveratrol, capsaicin (fr. cayenne pepper), ….

– Trigger Phase 2 enzyme synthesis

Increase sweating -but not stress hormones (e.g. sauna, moderate exercise)

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Chelation#

Mobilization. Forming a “claw” around a toxin. Strong bonds between binding agents and metal or metalloid ions or molecules.

Body naturally makes some chelating agents, e.g. metallothionein but can be overwhelmed (e.g. cadmium/metallothionein complexes)

Common Chelation Agents– Algae* – such as chlorella and alginate extracts (e.g. Alginate Plus).

Needs to be “broken cell wall” for effective digestion and absorption.– Pectin – soluble fiber, usually from citrus fruits or apple. “Modified” pectin

is much smaller and penetrates cellular membranes (e.g. EcoNugenics MCP)– Cilantro** - fresh is much more effective than dried/encapsulated.

Unusually, penetrates blood/brain barrier very effectively (as does DMSA)– Charcoal – absorbs toxins from GI tract to impair absorption (e.g. Solaray)– Alpha Lipoic Acid– DMSA, DMPS, Ca-EDTA***

Chelation agents are not toxin-specific. What chelates heavy metals will also typically chelate zinc, calcium, magnesium, and copper. WS tip: mineral supplement post-chelation (and during, if extended) is critical for general wellness!

# http://www.hindawi.com/journals/tswj/2013/219840/, also posted as a Course document – an excellent overview of chelators.* A Course document is posted on “Mercury Toxicity...” which includes details on many chelators, including references forefficacy and usage guidelines – a very practical and helpful treatise from two physicians' clinical experience specifically with Hg.** http://www.ncbi.nlm.nih.gov/pubmed/8686573 *** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1519187/pdf/envhper00359-0076.pdf (more detail on pharmaceutical chelators)

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Chelation Cautions

“More and Faster” is almost never Better. Chelation is usually done in “cycles” (e.g. 3 days on and 11 days off).

Even with natural agents, “low, slow, and cautious” is smart strategy. Use a low (e.g. 500mg chlorella or 1 cap modified citrus pectin) for first ~4 days to assess aggressiveness of toxic surge. Increase slowly, holding each dose step for several days before moving on.

Tissue damage occurs with chelation that the body needs time to heal (with food and rest!). Pulling toxins out into circulation at a faster rate than the body can detoxify and excrete them risks substantial inflammation and oxidative damage.

IV chelation is particularly aggressive and high-risk. But avoids the impact on the gut for sensitive individuals.

Chelation agents are not toxin-specific. What chelates heavy metals will also typically chelate zinc, calcium, magnesium, and copper. WS tip: mineral supplement post-chelation (and during, if targeted detox more than a week or two) is critical for general wellness!

Caution!

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Targeted Detoxification

Can be done intensely for 5-15 days or moderately for 2 months. Then take a break for at least a month and allow the body to heal and refortify!

I recommend a three-pronged approach, implemented one at a time (dosages are for the moderate approach)

– Support Phase 2. My top picks: Metagenics UltraClear Renew orXymogen's OptiCleanse (build up to 1 full dose daily of either).

● If severe toxicity or known glutathione SNPs, first addin supplemental glutathione.

– Upregulate both Phase 1 and Phase 2. My top picks:Metagenics Advaclear or Xymogen's Medcaps DPO(build up to one full dose twice daily with food).

– Chelate. My top picks: EcoNugenics Modified Citrus Pectin (build up to3 caps 2x/day, empty stomach) OR Mercola Chlorella (build up to 2 grams 2-3x/day)

Heavy intake of cruciferous vegetables, garlic, onion family...Sulfur! Anti-inflammatory support up to 3x/day as needed

(e.g. Meriva curcumin, high-quality fish oil, boswellia)

Be sure to continue to follow all Daily detox guidelines as well (e.g. water, bowel movements, water).

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Glutathione (GSH)

Arguably the most important antioxidant and detoxifying molecule in the modern human body.

Produced by all cells but especially in the liver and the brain

Responsible for clearance of many toxins and damaging substances (oxidative stress, solvents, pesticides, steroids, polycyclic aromatic hydrocarbons, and heavy metals including mercury and lead)Helps to recycle other antioxidants in the body. Small tripeptide chain of three amino acids: cysteine, glycine, and

glutamic acid.This is why N-acetyl-cysteine (NAC) is given as an antidote to acetaminophen (Tylenol) overdose in the emergency room.

Cysteine has a Sulfur group which binds to toxins directly.

Activating enzyme in GSH formation is dependent on selenium, a common mineral deficiency (brazil nuts!)

Also required by T4 thyroid hormone conversion to bioactive T3

Can be reused for internal toxins (e.g. oxidative stress) but must exit the body for exogenous toxins (e.g heavy metals).

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Glutathione Dysfunction

Critical for survival! Mice with genetically-induced loss of GSH synthesis only in the liver die within 1 month of birth Reduced glutathione activity increases the risk of chronic disease (e.g.

cardiovascular disease* SNPs are common genetic variations that occur in at least 1% of the population. Genetic weakness in the ability to generate glutathione impairs the

ability to clear toxins and increases the likelihood of chronic disease.Many different SNP types in several GSH-related genes (e.g. GSTM1, GSTP1)

Increased mercury retention in the body**

Increased risk of prostate cancer ***, lung cancer****, breast cancer*****

Increased incidence of autism ******

*http://www.nejm.org/doi/full/10.1056/nejmoa030535** http://www.ncbi.nlm.nih.gov/pubmed/21967774*** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777237/**** http://www.niehs.nih.gov/research/supported/sep/2002/gslungca/index.cfm***** http://cebp.aacrjournals.org/content/8/10/843.short****** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188290/

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Alpha Lipoic Acid

A sulfur-containing fatty acid present in every human cell (present in very small amounts in food & also synthesized in the body from other fats). Aids directly in using blood sugar for fuel, antioxidant in both watery and fatty

part of the body (thus excellent for nerves and neurological inflammation needs), reduce arterial inflammation, penetrates blood/brain barrier, induces Phase 2 liver detox, chelates heavy metal toxins, and recycles glutathione for ongoing use*Dosage recommendations

100mg/day for general detoxification maintenance

300mg twice daily for active detoxification or inflammatory disease (e.g. Alzheimers, Parkinsons, MS, cancer, various neuropathy)

500-600mg twice daily for Type 2 diabetes (or pre-diabetes)

Ideally, choose one with only the “R” fraction isomer (e.g. Jarrow, Swanson, GNC) Take on an empty stomach for best absorption. As with all supplements that can enhance detoxification, begin with

low dose (100mg/day) and increase gradually to allow body time to process toxins Also, be sure diabetics monitor their blood sugar carefully to avoid hypoglycemic episode.

* http://www.ncbi.nlm.nih.gov/pubmed/19664690

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Supplementing to Make Glutathione

Amino Acid precursor supplements increase serum glutathione levels

Typically GSH synthesis is cysteine-limited (body makes cysteine primarily from methionine, an essential amino acid in food, especially animal proteins)

N-acetyl-cysteine (NAC)** I recommend at least 300mg/day maintenance or 500- 1000mg twice daily for active detoxification or raising very low GSH.

Whey protein powder *** 20-40 grams daily. Choose a non-denatured brand (e.g. Immunocal, Natural Factors, PaleoMeal, Whey Cool, Dr. Mercola)

Alpha-Lipoic Acid **** I recommend at least 100mg/day for maintenance or up to 300mg twice daily for active detoxification.

Pine Bark extract (aka Pycnogenol)***** and Bilberry ****** (e.g. Market America's Isotonix OPC-3 includes both of these)

Quercetin ******* I recommend 500mg twice daily to raise low GSH

Selenium. 200-300mg/day selenomethionine.

* http://www.ncbi.nlm.nih.gov/pubmed/1362956** http://www.ncbi.nlm.nih.gov/pubmed/8299004*** http://www.ncbi.nlm.nih.gov/pubmed/11168457**** http://www.ncbi.nlm.nih.gov/pubmed/1418040***** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203267/****** http://www.ncbi.nlm.nih.gov/pubmed/18690680 and http://www.ncbi.nlm.nih.gov/pubmed/16800777******* http://www.sciencedirect.com/science/article/pii/S0891584901008127

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Supplementing With Glutathione

Oral glutathione tablets or capsules generally are not shown to increase serum (or liver) GSH significantly or longer than 2-3 hrs. Liposomal glutathione is encapsulated in tiny fat globules (absorbed into

the lymph system largely intact). Demonstrated to increase cellular glutathione significantly* and decrease oxidative stress markers by ~40%.**

Always increase glutathione slowly, as the liverin particular will increase detoxification rapidly.

I use 400-500mg liposomal glutathione once or twice daily (empty stomach) for clients with low serum glutathione (well down in lower half of TRR).

* http://www.ncbi.nlm.nih.gov/pubmed/20535554** http://www.ncbi.nlm.nih.gov/pubmed/17588583

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Detoxification Cautions

Detoxification is an “expensive” process for the body, energy-wise. Enhance detoxification from a position of strength. WS tip: Maximize nutrition,

support the adrenal glands, boost energy production, and heal the gut FIRST. Don't boost detoxification in someone who is recovering from surgery, emotionally

unstable, stress-ridden, struggling with regular inflammation, has poor kidney or liver function, or who is actively trying to get their disease “under control”.

Don't boost detoxification in someone who is already inflamed. Generally, detoxification temporarily increases inflammation. For someone without an effective anti-inflammatory regimen, this can be very debilitating. WS tip: Reduce inflammation first (triage). Detox from a place of stability.

Work with your client to ensure Detox Readiness: – Consistent healthy eating habits ?– Deep, restful sleep ?– Daily, easy-to-pass bowel movements ?– Plentiful intake of plain, fresh water ?– Sufficient adrenal and thyroid hormone status ?– Availability in life to 'take a time out' and allow body to rest ?– Supportive personal relationships ?

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Detoxification Considerations

Common detox symptoms include fatigue, headache, joint pain, muscle tightness, skin breakout, diarrhea, intestinal bloating, stomach cramp, and irritability.

During any detox program, be in touch with your clients frequently. Again, start cautiously and revise plans (or stop) is client is suffering.

Consider at least twice yearly “cleanses” - periods of 5-15 days of targeted detoxification to help prevent toxic build-up. Ease into them.

Ensure sustainable, ongoing daily detox-supportive habits. Explore and reduce ongoing sources of toxins. Start with low-hanging fruit and

changes which are easy-to-control:– Smoking (e.g. stop)– Pesticide- and chemical-laden food (e.g. choose organic, only wild seafood)– Home chemical use, especially insecticides, fertilizers, fungicides, household cleaners,

personal hygiene products. Consider investigating detoxification SNPs (e.g. MTHFR, GSTM1) If client is interested in mercury amalgam removal,

caution them to insist that it be completed with full protection protocol by a dentist specializing in removal**

* A course handout is posted with some IAOMT guidelines as reference.** http://www.ncbi.nlm.nih.gov/pubmed/8914687

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Assessing Toxicity

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Bothersome Barriers to the Truth

By definition, every type of heavy metal testing is inaccurate and limited regarding chronic low-level toxicity. But some testing can be useful.

Remember: we are exposed to toxins daily. The question is do we readily get rid of them or store them?

Other than immediate (and especially acute) exposure, the body sequesters heavy metals quickly. When they are stored away from circulation (e.g. fat/brain or bone), they cannot be measured in the blood or the urine or the stool or the hair.

Use symptoms, client history, and client intuition as powerful tools! Some clients are anxious to learn everything they can about their body and want to

spend money on all types of testing. Others would rather put their funds into detoxification to begin to feel better more quickly.

There are many more toxins than heavy metals. A targeted detoxification that supports Phase 1 and all Phase 2 processes can have a powerfully positive impact on both short-term and long-term wellness.

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Testing Options

Serum toxins. Reflects recent exposure or weight loss or current detoxification. Concern: may be reflection of one-time or short-term issue (e.g. big shrimp dinner).

RBC toxins. Reflects more typical ongoing exposure past 3-4 months. Concern: again, may reflect recent exposure or weight loss or current detox effort. Does not reflect stored levels. Helpful to gauge success in removing ongoing exposure.

Hair toxins. Can show longer-term circulation. Concern: Still does not reflect stored levels. Low Hg in hair may still be high storage in fat/brain tissue. High toxins in hair may reflect successful mobilization and detoxification. Hair care products can impact data

Urinary toxins.* Ideally measured pre- and post-provocation to assess a relative (not specific) body burden level. Excellent tool for gauging progress of detox effort.

– Will be inaccurate for those with mineral deficiencies.– Should involve collection of at least 6 hours (urinate prior to taking provocation agent).– Provocation test is usually done with 500mg DMSA (after separate, single 50-100mg test dose to

ensure tolerance – very important).– Be sure to shake the urine collection container before selecting the sample.– Urinary nutrient element data from a provoked sample is not useful.

● Urinary Porphyrins** Assess the level of impact a toxin has on heme biochemistry. Verygood impact assessment, specific to particular heavy metal. Concern: Doesn't reflect stores.

* Specific instructions from one of the testing companies:http://www.greatplainslaboratory.com/home/eng/instructions/DMSA%20Challenge%20Test%20for%20Heavy%20Metal%20Poisoning.pdf ** http://www.ncbi.nlm.nih.gov/pubmed/8723034

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Urinary Toxic/Nutrient Elements

● Available from nearly all functionalmedicine physicians.

● From Genova Labs, Doctor's Data, GreatPlains Labs

● Ideally pre- and post-provocationtesting.

● Substantially difference reference rangesfor unprovoked vs. provoked samples.

Provoked

Not Provoked

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Meet Trisha

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Progress!

Eliminated grain flours from her diet. Started key supplements

– 400mg magnesium glycinate once daily; after 2 weeks increased to twice daily– Xymogen's Methyl Protect (B-complex targeted for homocysteine – high folate)– Metagenics Mega-10 fish oil blend, one cap twice daily– 100mg ubiqinol form of CoQ10 (depleted by beta blockers) once daily

After 4 weeks, typical blood pressure was down from 145/85 to 125/75. Lost 8 lbs. Muscle cramps gone!

Now what?

Trisha stopped eating all seafood for 5 full days and then did a provoked urinary challenge test (500mg DMSA)

Started two months of targeted detoxification: UltraClear Renew and Advaclear

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Getting to the Root

Three weeks into detox, Trisha started getting dizzy. Blood pressure 105/68. Doctor suggested cutting both medications in half.

About five weeks into detox, issue persisted. Stopped diuretic entirely first. Two weeks later, weaned off beta blocker.

Four weeks post-detox and medication removal, typical BP 118/72. Woohoo!

Pre-Detox Post-Detox

Not a chelated reference range

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Heavy Metal Toxicity

Part 2

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