How Liver Detoxification Works: the natural phases of detox
Updated: Sep 24, 2020
A chiropractic mentor of mine, Dr. Robert Silverman, likened detoxification, and the phases of it, to taking out the garbage and it has always stuck with me. He describes Phase 1 as the bagging of trash, and Phase 2 is throwing the bag into the trash can for sanitation engineers to pick up. And I would add that the sanitary truck taking the rubbish to the dump (pun intended 💩) can be an analogy for "Phase 3" elimination.
More scientifically put: 75 percent of detoxification takes place in the liver. The other 25 percent takes place in the gut. The liver houses Phases 1 & 2 of detoxification; otherwise known as the cytochrome P450 and the conjugation pathways. The gut is responsible for what I like to refer to as Phase 3 detoxification, which is the elimination of waste (bowel movements). Elimination can also occur via urination and the kidneys. In order for toxins to be removed from the body, they first have to be made water-soluble. Most toxins are fat-soluble, so this is where the liver comes into play. In Phase 1, the cytochrome P450 enzymes of the liver break down toxins via oxidation, reduction, hydrolysis, dehalogenation and various other processes. This transforms the toxin into a reactive intermediate--these are highly dangerous to the body. However, Phase 2 saves the day by attaching water to the intermediate via glutathione trasferase, quinone reductase, glucaronidation, sulfation and various other conjugation pathways. Now that the toxin water-soluble, the intestines or kidneys can go to work at eliminating it.
Essentially, the detoxification process is an assembly line. With any assembly line, it is important to watch for the rate limiting step. Unfortunately, often times, Phase 2 happens to be the rate limiting step in us humans. When Phase 2 is moving slower than Phase 1, we end up with an excess of those harmful reactive intermediates that aren't getting neutralized fast enough. All too often, this issue is exacerbated by juice cleanse, skinny teas and other incomplete detox programs--they induce Phase 1 breakdown of toxins, or increase Phase 3 elimination while failing to support Phase 2 neutralization of toxins. In fact, often times they restrict or call for elimination of protein, which is essential for Phase 2. In effect, they can leave the consumer more toxic than they were to begin with.
So how do we properly support the detoxification process? With NUTRIENTS! A.k.a. food and supplementation. Phase 1 requires B vitamins, folic acid, glutathione, and flavonoids. Which can be found in many fruits, vegetables, herbs and spices. Phase 2 nutrient requirements include B vitamins, folic acid and glutathione, but also amino acids, vitamin C, magnesium, and choline which can come from fruits, vegetables, and protein sources. In some cases, a blood test may be recommend to asses for deficiencies of any of these micronutrients. When a deficiency is present, mega-dosing said nutrient (via supplementation with the guidance of a medical professional) can be necessary to boost levels to the optimal range. Once a functional level is reached, food sources may be sufficient for maintenance.
In the absence of any clinical level micronutrient deficiencies, food sources are excellent tools to capitalize on for supporting detoxification. The best part about food sources? So many of them act as bifunctional modulators--meaning they temper Phase 1, while inducing Phases 2 & 3. They help all of the phases of detoxification to work efficiently together, AND many of them act to protect the body from those pesky reactive intermediates as well.
There are SO many food sources that are beneficial for supporting your liver, intestines and kidneys in detoxification. Entire books have been written on this topic alone. As a general rule of thumb, eat whole foods (no packaging or labels), mostly plants--chose organic fruits and vegetables when you can, shoot for fresh and local. When it comes to protein, look for wild-caught, grass-finished, and antibiotic-free sources. I will detail a few of my favorite food for detoxification below, but know that the complete list is MUCH longer and which foods are most beneficial will be different from one person to another.
Green Tea. Okay, so tea might not be a "food," but it is a beverage and herb that is in huge support of detoxification. It inhibits over-induction of CYP450 Phase 1 enzymes, enhances induction of glutathione-s-transferase (GST) and quinone reductase enzymes of Phase 2. At just one cup per day it has shown to improve liver enzyme levels (27% reduction in AST, 29% reduction in ALT). And at just 1 cup per day a 5% reduction in cardiovascular disease mortality and a 4% reduction is all-cause mortality were observed.
Beet Root Juice, to stay on the trend of beverages. Beet root juice inhibits CYP450, 1A1 and CYP2E1 enzymes of Phase 1 while induces quinone reductase and GST of Phase 2. It is also protective against xenobiotics (substances foreign to the body) because it reduces DNA damage by helping antioxidant enzymes keep their vitality. It is high in nitrate and thus increases nitric oxide in the body to effectively increase endurance and stamina.
Dietary Fiber. All forms of fiber (soluble, insoluble and functional) work to enhance all three phases of detoxification. They decrease enterohepatic circulation of toxins (merry-go-round of toxins from and back to the liver) and increase fecal excretion. Dietary fiber also enhances microbial balance in the intestines to improve genomic expression in support of detoxification. Sources of soluble fiber include: legumes, rice, oats, berries, apples, pear, and psyillium. Insoluble fiber can be found in whole grains, avocado, flax and lentils. Inulin, pectin and resistant starches are examples of functional fiber. The average American consumes 14g of fiber per day. Ideally, we would be consuming 14g of dietary fiber per 1000kcal we consumer per day.
Cruciferous Vegetables. Dr. Kylie's favorite! We're talkin' 🥦 broccoli, cauliflower, cabbage, brussel sprouts, horseradish, radishes, watercress... These beauties induce metallothionine, glucaronidation, sulfurotransferases of Phase 2. They also induce Nrf-2, the nuclear factor that protects against oxidative stress and the associated free radical damage that contribute to aging symptoms. Cruciferous veggies promote detox of potentially harmful estrogen metabolites (in women AND men) and xenoestrogens (consumed from a poor diet). Aim to consume 6-8+ servings of non-starchy vegetables per day, and have a goal of at least half of them being cruciferous!
There are many other foods and supplements that can serve the liver and body well. When it comes to deciding which might be most beneficial for YOU, consider working with a functional medicine professional. Addressing the body as a whole, diving deep into your unique history, and accounting for your specific lifestyle will be the best way to reach optimal function.
If you have any questions, do not hesitate to reach out to Dr. Kylie at Pivotal Health Chiropractic 715.204.4223
Show your body a little extra love today with some bifunctional phytochemical modulators 🥦 🍏 🍵