Most people must have heard something about “detox” these days with many health products being commercially marketed to have detox benefits. We can find detox diet, detox supplements, detox programme, detox juices, detox smoothies, detox massage, detox essential oil, detox soap, etc. And the list goes on.  It seems like anything and everything can have something to do with detox.

But, what exactly does the word “detox” mean?

Defining toxins and detox

Detox is an informal word for detoxification, which means “the process of removing toxic substances” as per the Oxford dictionary. Applying in the health context, it refers to the removal of toxic substances (or toxins) and/or their effects from the body. In strict medical definition, toxins generally refer to drugs and alcohol, and “detox” is the process of safe discontinuation from these addictive substances [1].

However, there is now an increased recognition that environmental factors such as air pollutions, heavy metals, as well as chemicals such as pesticides and Bisphenol A (BPA) from plastics can all potentially contribute to chronic diseases such as cerebrovascular disease, cancer, diabetes, metabolic syndrome, obesity, and autoimmune diseases [2].

As such, in the emerging field of environmental medicine, toxins are recognised as any form of chemicals (either from internal or external sources) that can accumulate in the body and potentially cause harm [3] [4]. Detoxification is then the process to eliminate these persistent and potentially harmful chemicals from the human body for disease prevention and health restoration [4].

The detoxification system

The body is such an amazing system that it has built-in mechanisms to transform harmful substances into non-toxic compound that can be eliminated from the body. This detoxification process, which is called the metabolic pathway of detoxification, involves a series of complex biochemical reactions within the cells that modern science is only starting to understand.

In brief, there are two phases in this metabolic pathway. In phase I, a group of enzymes collectively known as cytochrome P450 is responsible for the biotransformation of the predominantly fat-soluble toxins into more water-soluble molecules [5]. It should be noted that such intermediates produced in phase I can be more toxic than the original toxins since they are more reactive and can increase the oxidative stress within the cells. These intermediates must be quickly processed through the phase II reaction to prevent damage to the cells [5].

In phase II, a variety of different conjugation reactions between a second series of enzymes called conjugases and toxic intermediates from phase I take place. These conjugases attach molecules such as glucuronic acid, sulphate, glutathione, glycine, taurine, or methyl groups to the toxic intermediates to render them even more water soluble and non-reactive, effectively “detoxify” these toxic intermediates [5]. The toxins that are biotransformed through these two phases can then be eliminated from the cells and excreted through bile (into faeces), urine, or sweat [5].

Most detoxification processes occur in the liver and the cells lining of the intestine, colon, and appendix. Detoxification can also occur in the brain, lungs, kidneys, and skin, but to a much lesser extent [6]. The liver is thus the primary detoxification organ of the body. However, with the gastrointestinal lining being the first point of contact for ingested toxins, intestine also plays a very important role the detoxification process. Heathy gut microflora not only acts has a physical barrier to the entry of toxic compounds, but also produce compounds that can induce detoxification activities. In the intestine, we can also find enzymes that prevent the toxic compounds excreted in the bile from re-entering the bloodstream, a process which is something referred to as Phase III detoxification [5].

Factors influencing detoxification

While the human body has the inbuilt ability to perform detoxification, there are many factors that can influence the activity of the enzymes involved in this process [5].

• Diet – many foods are known to be able to induce detoxification, e.g. cruciferous vegetables such as broccoli and kale are known to upregulate the Phase I and Phase II activity.
• Lifestyle – lifestyle factors, including smoking and excessive alcohol consumption increase toxic load and stressing the detoxification pathway
• Environment – pollution and frequent exposure to toxic chemicals such as pesticides and herbicides increase the toxic load
• Genetic – production of many of the cytochrome P450 enzymes depends on genetics. Some people are genetically less able to proceed certain enzyme, making them more susceptible to some toxins.
• Age – Generally, as the body ages, the phase I and II detoxification pathways decline in efficiency and effectiveness.
• Gender – Gender also affects the type, amount, and activity of various detoxification enzymes. There are also differences in activity in premenopausal women, pregnant women, and postmenopausal women.
• Disease – In some disease states, detoxification activities appear to be induced or upregulated, but in other conditions, these activities may be inhibited from acting or not produced at high levels.
• Medications – Various medications such as SSRIs, macrolide antibiotics, and H2 blockers (e.g., cimetidine) may inhibit one or more of the phase I enzyme systems, making the body more susceptible to toxic reactions.

Among these factors, there are those that are controllable, including diet and lifestyles. We may or may not be able to control our environment, but genetic, age, and gender are completely not within our control. Our goal should be to minimise exposure to environmental toxins, while maintaining an optimal detoxification ability through diet and lifestyles to prevent disease and avoid medications.

Nutrients for detoxification

The Phase I and Phase II detoxification pathways are complex and energy-intensive processes which require a lot of supporting nutrients to maintain optimal efficacy. The following table provides a summary on the nutrients requires [6]:

[table caption=”Nutrients for detoxification” colalign=”left|left”]
Phase/Process, Nutrients
Phase I, Riboflavin (vit B2); Niacin (vit B3); Pyridoxine (vit B6); Folic acid (vit B9); cobalamin (vit B12); branched-chain amino acids; flavonoids; phospholipids
Phase II, glutathione; amino acids (glycine; taurine; glutamine; ornithine; arginine)
Antioxidants / Protective Nutrients for Reactive Intermediates, Carotenes (vit A); ascorbic acid (vit C); tocopherol (vit E); selenium; copper; zinc; manganese; coenzyme Q10; thiols; bioflavonoids; silymarin; pycnogenol
[/table]

From the table above, we can see that the highly complex processes of detoxification require a whole lot of essential nutrients to function properly. Therefore, it is not reasonable to expect taking only a single food or a substance can be sufficient to promote detoxification of the body.

The best approach for detoxification should be to adopt a healthy, whole-food, complete diet that contains [6]:

• A variety of fruit and vegetables, best to include cruciferous vegetables, coriander, garlic, and citrus fruits.
• Fats and oils with medium-chain fatty acids (Avocado, coconut, olive oil)
• Proteins from lean meat, eggs, and plant-based sources (e.g. tofu, tempeh)
• Complex carbohydrates from grains such as brown rice, quinoa, millet, buckwheat.
• Legumes such as peas, beans, and lentils, which are high in soluble and insoluble fibres.

Detoxification lifestyles

Beside diet, adopting a lifestyle that can minimise exposure to toxins and upregulate the detoxification pathway is equally important. Components of this lifestyle include [6]:

1. Avoid environmental toxins, e.g. heavy metal, persistent organic pollutants, and electromagnetic radiation
2. Mobilise and eliminate toxins through weight loss, use of saunas, exercise, and chelating supplements such as Chlorella.
3. Maintain optimal gut health through diet and probiotics
4. Drink enough water to maintain optimal hydration
5. Reduce emotional stress and maintain relational health
6. Ensure adequate sleep and relaxation

Conclusion

Detoxification is the process to eliminate persistent and potentially harmful chemicals from the human body for disease prevention and health restoration. The body has built-in mechanisms to transform harmful substances into non-toxic compound that can be eliminated from the body. This is done through the 2-phase metabolic detoxification pathway. This detoxification process is highly complex and can be influenced by many factors, including diet, lifestyle, environment, genetic, age, gender, disease, and medication. Nutrition plays an important role in maintaining optimal efficacy in detoxification. Eating a healthy, whole-food, complete diet while maintaining a healthy lifestyle is the best way for detoxification. Which, not surprisingly, is also the recipe for good health.

References

[1]         A.M. Diaper, F.D. Law, J.K. Melichar, Pharmacological strategies for detoxification., Br. J. Clin. Pharmacol. 77 (2014) 302–14. doi:10.1111/bcp.12245.

[2]         M.E. Sears, S.J. Genuis, Environmental determinants of chronic disease and medical approaches: Recognition, avoidance, supportive therapy, and detoxification, J. Environ. Public Health. 2012 (2012). doi:10.1155/2012/356798.

[3]         W.J. Crinnion, Environmental medicine, Part 1: The human burden of environmental toxins and their common health effects, Altern. Med. Rev. 5 (2000) 52–63.

[4]         S.J. Genuis, Elimination of persistent toxicants from the human body., Hum. Exp. Toxicol. 30 (2011) 3–18. doi:10.1177/0960327110368417.

[5]         D. Liska, M. Lyon, D.S. Jones, Detoxification and biotransformational imbalances, Explor. J. Sci. Heal. 2 (2006) 122–140. doi:10.1016/j.explore.2005.12.009.

[6]         J.C. Cline, Nutritional aspects of detoxification in clinical practice, Altern. Ther. Health Med. 21 (2015) 54–62.