Detox Genes: Personalize Your Liver Detoxification

You've read my treatise on the liver, or not, and you're wondering how to make it more relevant to you and what you're known for. You know already that I'm a lover of the 4 "P's" in my medical practice: make it personal, make it predictive of your health, make it aggressively preventive, and make it participatory.

Here it is: details on how to understand more personally your liver and its long, windy, circuitous path to continuous detoxification. I've taken the example of three genes coding for Phase 1 detoxification. Now that you've had the equivalent of mini-medical school on the liver from my previous post, I thought I'd offer a dessert you can eat on this cleanse: more data!

There's a great test offered by Genova that examines your genetic programming for how your liver behaves in its detox job: the DetoxiGenomic Profile. Several other labs offer this type of testing but I like the robust explanations that Genova (formerly Great Smokies Lab) provides.

Keep in mind that your genetic programming can be significantly influenced by your nutrition, lifestyle and environment. More details are available at many online sites, such as Gene Cards. Let me know if you find other good resources in the Comments section.

This test can be particularly helpful to folks who have adverse reactions to drugs, as this is commonly due to a decreased capacity for clearing drugs from the body. Problems with Phase 1 clearance causes toxic overload in the body. Increased clearance of Phase 1 but without increased clearance in Phase 2 can lead to the formation of toxic intermediates, and in some cases, the intermediates are more toxic than the original toxin. Oh, no! Better to be on top of this.

Phase 1 involves the following SNPs or polymorphisms in the genes your inherited from your parents. You have inherited one of three conditions:

1. you inherited the perfect level of the enzyme (homozygous normal - the optimal genomic potential)
2. you inherited one bad allele and one good allele (heterozygous, usually a 30-50% decrement or increase in enzyme activity) 
3. you inherited both bad alleles, one bad one from each parent (homozygous, usually with a 70-90% reduction or increase in the activity of that enzyme).

CYP1A1 - This enzyme detoxifies polycyclic aromatic hydrocarbons such as exhaust fumes and charbroiled meats. Mine sucks - I have a 70-90% reduction in this enxyme. CYP1A1 converts estrogens to 2-hydroxyestrogens, which are protective against breast cancer if methylated, but which
may be carcinogenic if not. CYP1A1 also activates many environmental xenobiotics to pro-carcinogenic intermediates.

A CYP1A1 polymorphism is associated with increased CYP1A1 enzyme activity. Whereas the polymorphism MspI variant has been associated with both decreased and increased risk (in smokers) of breast cancer, the I462V variant has been linked in several studies with increased risk of cancer, especially in smokers and women exposed to PCBs.

CYP1B1 - Important guy for the 4-hydroxylation of estrogen; that is, CYP1B1 takes your garden-variety estrogen and converts it to 4-hydroxyestrogen.  4-hydroxyestrogen is a potent estrogen that may, in turn, be oxidized to carcinogenic compounds. A polymorphism is associated with increased enzyme activity, therefore increased production of these potentially harmful metabolites.

CYP2A6 - Detoxifies nitrosamines and nicotine. Nitrosamines are chemicals that arise from certain reactions such as making bacon, and some of them are carcinogenic. I have a problem with this one too. I don't wig out around smokers because of the how they damage the respiratory lining, kill cilia, and cause cancer; I wig out because I cannot detoxify cigarette smoke and it makes me incredibly anxious. Here's more info from Gene Cards.

This is a review of just 3 of the many gene polymorphisms that affect your ability to detoxify. Contact Genova if you're interested in ordering the test from your local doctor, or if you are a patient or cleanser in our Gottfried Center practice, call Mandy at 510.893.3907.

Happy cleansing - today is day 6. We start our anti-inflammatory shakes on day 8! As always, share questions, concerns, clarifications, corrections, additional info in the Comments section. Thank you!

Thyroid Yoga

You've heard the analogy that your thyroid acts as your body's "gas pedal" by releasing energy hormones that modulate the metabolism of your organs and cells. Your thyroid determines how fast your engine runs.

In previous posts, I've commented on the interdependence of your thyroid with other key glands, particularly your adrenals and ovaries. The adrenals act, as we continue the car analogy, like a steering wheel. Your sex hormones (estrogen, progesterone, testosterone), on the other hand, serve as the ignition -- sparking the life of your engine. I think of the engine as your liver: our livers govern how we metabolize hormones, and the liver in turn is significantly controlled by leptin and insulin.

How complicated. 

Where can we simplify and just find a little relief? What can I offer when your gas pedal is sluggish or sticky or slammed to the metal of the car floor? When your slow progress toward euthyroidism (normal thyroid labs AND normalized symptoms) is frustrating you endlessly, Yoga comes to mind. Not just because I’ve found yoga to be the best system I’ve encountered for extraordinary living, but because yoga has helped my thyroid provide a smooth ride for 35+ years (I started practicing yoga as a kid, seriously) as well as those of my patients.

We know that yoga provides balance. It is a middle path, and for many of us with lazy thyroids, this is welcome news. We know that most of us seek yoga to manage stress, and that yoga is incredibly effective at balancing stress hormones such as cortisol. It lowers cortisol when it’s high and giving you that tired-wired feeling, and it raises cortisol when it’s low and giving you that “I-need-to-lie-down,-immediately” vibe (provided you don’t have the severest form, called Addison’s Disease).

In the yoga tradition of the past 2500 years, the thyroid is related to the vishuddhi chakra, which is the psychic center that purifies the toxins of the body and turns them into nectar of immortality. Good health of the entire neuroendocrine system is understood to be vital to our higher awareness.

OK, OK, Get Me to the Practical Stuff….

Here’s a Yoga Class, featuring the yoga practices that best balance your thyroid.

Shoulder Stand

If you’ve ever practiced yoga, you probably know that shoulder stand is the mama of all poses (asanas) for healing your thyroid. When you properly come into shoulder stand, you place robust pressure on your thyroid, squeeze out much of the huge blood flow of our little butterfly organ with the chin against your trachea (windpipe), and when released, new and fresh blood infuses your little gland. Old secretions and hormones get washed away, circulation improves, and the nerves are stimulated, reminding the gland to wake up and assume more tasks. In the yoga tradition, you send awareness and prana to your thyroid in shoulder stand, and prana or life force is the vehicle of healing.

Shoulder stand also places robust pressure, in fact the weight of most of your body, onto your little cervical vertebrae in the back of your neck. Make sure you do the pose properly, with an experienced teacher watching your every move until you are safe and skillful at it.

After shoulder stand, we traditionally perform matsyasana or fish pose, to allow all that delicious prana to move into the thyroid.

If daunted, move on first to some of the other asanas described below which are less risky.

Ujjayi Pranayama (“Victory Breath”)

This breathing exercise acts also directs prana to the throat area and stimulates some of the reflex pathways of the through associated with breathing and swallowing. Many call it the “Ocean-Sounding Breath” or more colloquially, “Are you trying to breathe like Darth Vadar?” Learn this from a teacher – it is the basic breathing practice of Ashtanga and many vinyasa classes.

Viparita Karani (“Legs Up the Wall Pose”)

This is a really simple exercise that nearly all of us can do with little experience. Lie on the floor next to a wall. Create an L-shape with your legs up the wall, at a 90-degree angle to your torso, which is on the floor. Lie here for 10 minutes with your eyes closed and allow the pressure to weigh down on your thyroid and breath like Darth Vadar, constricting your glottis as you inhale for 5 seconds and exhale for 5 seconds.

There are many other scrumptious practices for the thyroid such as Nadi Shodhana (another breathing exercise that balances your hormones), Surya Namaskara, Supta Vajrasana, and Jalandara bandha, but that’s all I have time for today.

D4 Group Cleanse: Love Your Liver

We are thrilled to welcome 12 friends to our office last Wednesday for the start of our 21-day Cleanse. We got tasked with clearing out gluten, dairy, caffeine, sugar and alcohol over the next seven days as part of the "Pre-Cleanse" as well as starting the Detox supplements to prepare our liver and gut for the job ahead. Did you start your morning today with a cup of warm, filtered water with a quarter of yummy Meyer lemon? That is your job for the next 21 days.

We start in earnest with our full Cleanse next week, on May 12, and the next seven days allow us to transition off of the toxins we've been using somewhat gradually. While this blog post is primarily aimed at those who have joined our Group Cleanse, you can also join us virtually both on the blog, or on Facebook, and take the supportive supplements (ordering information is below).

Yesterday there was a great question on Detoxification: why bother with detox supplements to support the Cleanse? I thought I'd spend a moment giving the liver's job description and listing the functions of the supplements that support the job. I really believe that you understand the biochemical underpinnings, even in broad strokes, you'll be more motivated and derive a better outcome. First we'll talk about the liver and then I'll fill in the gaps on how the detox supplements help you.

Job: The liver takes harmful (such as alcohol) and more benign substances (such as estradiol, the most common estrogen until about age 50), and converts these substances typically from fat-soluble to water-soluble so that you can remove them in your urine, stool or bile. You have a bazillion enzymes in the liver that act on these substances.

Break it down for me, please. There are two steps to the liver's daily task - Phase 1 and Phase 2. A toxin enters Phase 1 in the liver (the P-450 cytochrome system) and is reduced to smaller metabolites, which then move onto Phase 2, where the are bound to glutathione, glycine and sulfate. This new now non-toxic metabolite can be excreted in the bile, urine or stool.

Phase 1, in other words, either neutralizes a toxin or metabolizes a toxin to an intermediate form that is then neutralized in Phase 2. The mechanism used in Phase 1 include the chemical reactions of oxidation, reduction and hydrolysis, and these processes produce free radicals which may damage liver cells. Antitioxidants (Vitamin D, resveratrol, etc) reduce the damage. If there are lots of toxins and not enough antioxidants, the risk is much higher, and sometimes potentially carcinogenic substances may be made.

Phase 1 and/or Phase 2 detox pathways may be overloaded or otherwise not working well. Particularly bad (aka, perfect storm conditions) exist when an ill person has an overload of toxins coming into Phase 1, and then Phase 2 is inefficient. This can lead to chronic fatigue, fibromyalgia, drug intolerance, and chemical/environmental sensitivities, as well as other not-fun conditions.

A little more info on Phase 1: when it's inefficient or overloaded, you may experience intolerance to caffeine as well as scented products.  Overactive Phase 1 folks will be unaffected by caffeine. Here are things that activate Phase 1 detox:

• food: brussel sprouts, broccoli, cabbage; high-protein diet, oranges/tangerines, charcoal-broiled meats
  
• alcohol, sulfa drugs, nicotine in cigarette smoke, steroids (including estrogen)
• environmental: paint fumes, carbon tetrachloride, exhaust, dioxin, pesticides
• supplements: vitamin C, niacin (B3) 

Phase 2 is also known as the conjugation pathway -- this means that liver cells add a little something (cysteine, glycine, sulfur) to the substance that is coming in. This makes the substance dissolve in water, and then you can get rid of it in urine, bile or stool. For things to work optimally here in Phase 2, you need the amino acids taurine and cysteine as well as additional nutrients (glycine, choline, inositol). This is where the detox supplements come in!

A side note about bile: you make it in phase 2, and normal folks make a quart per day! Bile is the truck that drives the toxins out of your system into the intestines. What's important here is that the bile gets absorbed by fiber and excreted. Low fiber-diets lead to poor binding of the toxins, and the toxins get re-absorbed.  This now helps you understand why we are adding more fiber both with whole foods and a fiber supplement starting on day 8 of our Cleanse.

Take a wild guess at what's in the Detox support packets: potent doses of taurine, cysteine, glycine, inositol, taurine, MSM, Vitamin B6 & 12, Vitamin C, antioxidants, and several other co-factors that help the liver such as biotin, selenium, zinc. These make Phase 1 and Phase 2 Detox pathways operate more efficiently and clear out lingering toxins. We haven't yet talked about the gallbladder, but several additional botanicals such as dandelion root, artichoke and beet extract help both the gallbladder and the liver with detoxification. The twice/daily Detox support packets prepare the liver and gut for the full Cleanse. The supplement helps to minimize damage from free radicals while revving up (or upregulating) the Phase 1 and Phase 2 liver detoxification pathways. You'll also get from the supplements improved digestion of fats and fat-soluble substances. You'll take the Detox supplements for one month. 

If you are interested in joining our Cleanse virtually, call or email our office and order the Detoxification Support Packets ($90 for a 30 day supply). Click here to order online or to visit our website (email us if you need help). Our next Group Cleanse will begin October, 2010.

Detoxification is a very complex biochemical system, and I've oversimplified much of it in the service of making it more accessible. If you have questions, please post them in the comment section.

Week 1: The Pre-Cleanse & Supplements

We were thrilled to welcome 20 friends to our office yesterday for the start of our 28-day Cleanse. We got tasked with clearing out gluten, dairy, caffeine, and alcohol over the next seven days as part of the "Pre-Cleanse" as well as starting the Detox supplements to prepare our liver and gut for the job ahead. Did you start your morning today with a cup of warm, filtered water with a quarter of yummy Meyer lemon? 

We start in earnest with our full Cleanse next week, on Jan 20, and the next seven days allow us to transition off of the toxins we've been using somewhat gradually. While this blog post is primarily aimed at those who have joined our Group Cleanse, you can also join us virtually both on the blog, on Twitter, and take the supportive supplements (ordering information is below).

Yesterday there was a great question on Detoxification: why bother with detox supplements to support the Cleanse? I thought I'd spend a moment giving the liver's job description and listing the functions of the supplements that support the job. I really believe that you understand the biochemical underpinnings, even in broad strokes, you'll be more motivated and derive a better outcome. First we'll talk about the liver and then I'll fill in the gaps on how the detox supplements help you.

Job: The liver takes harmful (such as alcohol) and more benign substances (such as estradiol, the most common estrogen until about age 50), and converts these substances typically from fat-soluble to water-soluble so that you can remove them in your urine, stool or bile. You have a bazillion enzymes in the liver that act on these substances.

Break it down for me, please. There are two steps to the liver's daily task - Phase 1 and Phase 2. A toxin enters Phase 1 in the liver (the P-450 cytochrome system) and is reduced to smaller metabolites, which then move onto Phase 2, where the are bound to glutathione, glycine and sulfate. This new now non-toxic metabolite can be excreted in the bile, urine or stool.

Phase 1, in other words, either neutralizes a toxin or metabolizes a toxin to an intermediate form that is then neutralized in Phase 2. The mechanism used in Phase 1 include the chemical reactions of oxidation, reduction and hydrolysis, and these processes produce free radicals which may damage liver cells. Antitioxidants (Vitamin D, resveratrol, etc) reduce the damage. If there are lots of toxins and not enough antioxidants, the risk is much higher, and sometimes potentially carcinogenic substances may be made.

Phase 1 and/or Phase 2 detox pathways may be overloaded or otherwise not working well. Particularly bad (aka, perfect storm conditions) exist when an ill person has an overload of toxins coming into Phase 1, and then Phase 2 is inefficient. This can lead to chronic fatigue, fibromyalgia, drug intolerance, and chemical/environmental sensitivities, as well as other not-fun conditions.

A little more info on Phase 1: when it's inefficient or overloaded, you may experience intolerance to caffeine as well as scented products.  Overactive Phase 1 folks will be unaffected by caffeine. Here are things that activate Phase 1 detox:

• food: brussel sprouts, broccoli, cabbage; high-protein diet, oranges/tangerines, charcoal-broiled meats
  
• alcohol, sulfa drugs, nicotine in cigarette smoke, steroids (including estrogen)
• environmental: paint fumes, carbon tetrachloride, exhaust, dioxin, pesticides
• supplements: vitamin C, niacin (B3) 

Phase 2 is also known as the conjugation pathway -- this means that liver cells add a little something (cysteine, glycine, sulfur) to the substance that is coming in. This makes the substance dissolve in water, and then you can get rid of it in urine, bile or stool. For things to work optimally here in Phase 2, you need the amino acids taurine and cysteine as well as additional nutrients (glycine, choline, inositol). This is where the detox supplements come in!

A side note about bile: you make it in phase 2, and normal folks make a quart per day! Bile is the truck that drives the toxins out of your system into the intestines. What's important here is that the bile gets absorbed by fiber and excreted. Low fiber-diets lead to poor binding of the toxins, and the toxins get re-absorbed.  This now helps you understand why we are adding more fiber both with whole foods and a fiber supplement starting on January 20 (day 8).

Take a wild guess at what's in the Detox support packets: potent doses of taurine, cysteine, glycine, inositol, taurine, MSM, Vitamin B6 & 12, Vitamin C, antioxidants, and several other co-factors that help the liver such as biotin, selenium, zinc. These make Phase 1 and Phase 2 Detox pathways operate more efficiently and clear out lingering toxins. We haven't yet talked about the gallbladder, but several additional botanicals such as dandelion root, artichoke and beet extract help both the gallbladder and the liver with detoxification. The twice/daily Detox support packets prepare the liver and gut for the full Cleanse. The supplement helps to minimize damage from free radicals while revving up (or upregulating) the Phase 1 and Phase 2 liver detoxification pathways. You'll also get from the supplements improved digestion of fats and fat-soluble substances. You'll take the Detox supplements for one month. 

If you are interested in joining our Cleanse virtually, call or email our office and order the Detoxification Support Packets ($90 for a 30 day supply). Click here to order online or to visit our website. Our next Group Cleanse will begin March 17, 2010.

Detoxification is a very complex biochemical system, and I've oversimplified much of it in the service of making it more accessible. If you have questions, please post them in the comment section.