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    Liver Detoxification for Dummies

    February 9, 2020

    Liver Detoxification for Dummies- Why and How to Detox Naturally

    There is a lot of fearmongering, lies, & misleading marketing surrounding the world of “detoxing”. From companies using misinformation to sell “liver cleanses” and “detoxes”, to skinny teas &  supplement sales, the world seems to think that detoxing is something you need to buy something to do! Newsflash- your body can and does it for you! Detoxing of drugs, environmental toxins, hormones, chemicals, water, air, and even the food you eat is performed in your liver, but detoxing also occurs through your digestive tract, kidneys, skin, and lungs! This blog post will dive into what toxification is, how it works, and will hopefully give you clarity on what will and can actually “naturally detox” your system, and save you money!

    Image result for detox 101

    Let’s start with the liver. The liver is critical to maintaining a healthy immune system, metabolism, digestion, and plays the superhero role of detoxification. Without your liver, you can not convert food into energy, make immune system molecules, and process or eliminate medications or environmental toxins. Liver detoxification (or “detoxing” as you hear it) is divided up into two phases, resulting in end products that are sent to other organs for excretion.

    Where is my liver anyway?

    The liver is in the upper right-hand side of the abdomen. It’s snuggled up underneath the ribs (or snuggles!). It’s actually quite large, around 3 pounds. In some cases, it can actually be the size of a large football.

    Doctors will typically physically examination your abdomen in the area of your liver to see if it’s enlarged. This may be a first clue if there’s any true issues going on!

    How exactly does it work?  

    The liver has many different functions. It produces the storage form of carbohydrates, makes specific amino acids needed, it detoxifies products, it produces bile and cholesterol, it manages intermediate metabolites that need to be sent to other cells via the blood. The list goes on. For the purposes of this blog we will be discussing the detoxification system and leave your body’s superhero other work for later.

    It’s important to know that the liver is extremely vascular and receives 25% of the heart’s output each time it beats. This allows the liver to gather particles from the blood. The liver is a jealous organ. It receives all blood and nutrients from the GI tract before they ever make it to the brain.

    Digestion, Intestine, Digestive, Oral, Medical, Anatomy

    When the liver receives blood, it filters and attracts the particles (aka “toxins”) that need to be processed. These can be by-products of other cell processes, foreign chemicals, heavy metals, medicines, hormones, pesticides, or drugs, to name a few. These products enter our body as fat soluble particles, meaning they are dissolved only in fatty or oily substances. This makes it hard for the body to excrete alone, and these particles and “toxins” must be put through phases of detoxification that make them water soluble, so that they can then be easily excreted by the body through water type substances like urine, bile, sweat, and CO2!

    Phase 1 Detoxification

    First, particles must enter phase I detoxification, which consists of a series of oxidation and reduction reactions (cue throwback to chemistry courses). This is a series of extremely complex reactions done by many enzymes that are waiting on the wall of liver cells, called hepatocytes.

    The cool thing about these enzymes is not only their name, but their function. They are called the cytochrome P450 enzyme family. You won’t find these enzymes anywhere else in the body. That’s why they are so important! There are many compounds and drugs that can increase or decrease these P450 enzymes. Below is a table from: https://www.d.umn.edu/~jfitzake/Lectures/DMED/TAA/Q_A/CYP450InteractionTable.htm – that gives a quick overview of a few.

    INHIBITORS, INDUCERS AND SUBSTRATES OF CYTOCHROME P450 ISOZYMES
    remember
    inhibitors and substrates INCREASE the effectiveness of another drug metabolized by that isozyme
    inducers DECREASE effectiveness

    INHIBITORS INDUCERS SUBSTRATES INHIBITORS INDUCERS SUBSTRATES
    CYP1A2 CYP3A4
    cimetidine
    ciproflxacin
    enoxacin
    erythromycin
    ***fluvoxamine
    grepafloxacin
    isoniazid
    mexiletine
    norfloxacin
    tacrine
    zileuton
    barbiturates
    carbamazepine
    charcoal-broiled foods
    lansoprazole
    omeprazole
    phenytoin
    rifampin
    smoking
    amitriptyline
    caffeine
    clomipramine
    clozapine
    cyclobenzaprine
    grepafloxacin
    imipramine
    mirtazapine
    olanzapine
    propranolol
    riluzole
    ropinirole
    R-warfarin
    tacrine
    theophylline
    zileuton
    amiodarone
    amprenavir
    clarithromycin
    cyclosporine
    danazol
    delavirdine
    diltazem
    efavirenz
    erythromycin
    ethinylestradiol
    fluconazole
    fluvoxamine
    grapefruit juice
    indinavir
    itraconazole
    ketoconazole
    nefazodone
    nelfinavir
    quinine
    ***ritonavir
    saquinavir
    Synercid
    troleandomycin
    verapamil
    zafirlukast
    barbiturates
    carbamazepine
    dexamethasone
    efavirenz
    ethosuximide
    griseofulvin
    modafinil
    nafcillin
    nevirapine
    oxcarbazepine
    phenytoin
    primidone
    rifabutin
    ***rifampin
    rifapentine
    St. John’s wort
    alfentanil
    alprazolam
    amiodipine
    amprenavir
    atorvastatin
    bepridil
    buspirone
    carbamazepine
    cerivastatin
    cisapride
    citalopram
    clarithromycin
    clomipramine
    corticosteroids
    cyclophosphamide
    cyclosporine
    dapsone
    delavirdine
    diazepam
    diltiazem
    disopyramide
    dofetilide
    donepezil
    doxorubicin
    efavirenz
    erythromycin
    ethinylestradiol
    etoposide
    felodipine
    fentanyl
    finasteride
    ifosfamide
    imipramine
    indinavir
    isradipine
    itraconazole
    ketoconazole
    lansoprazole
    loratadine
    losartan
    lovastatin
    methadone
    midazolam
    mirtazapine
    montelukast
    nefazodone
    nelfinavir
    nicardipine
    nifedipine
    nimodipine
    nisoldipine
    paclitaxel
    pimozide
    quetiapine
    quinidine
    quinine
    repaglinide
    refabutin
    ritonavir
    saquinavir
    sertraline
    sibutamine
    sildenafil
    simvastatin
    sirolimus
    sufentanil
    tacrolimus
    tamoxifen
    testosterone
    tolterodine
    toremifene
    triazolam
    troleandomycin
    verapamil
    vinblastine
    vincristine
    R-warfarin
    zaleplon
    zileuton
    zolpidem
    zonisamide
    CYP2C9
    amiodarone
    cimetidine
    cortrimoxazole
    fluconazole
    ***fluvoxamine
    isoniazid
    ketoconazole
    metronidazole
    zafirlukast
    barbiturates
    carbamazepine
    rifampin
    rifapentine
    St. John’s wort
    carvedilol
    celecoxib
    diclofenac
    flurbiprofen
    fluvastatin
    glimepiride
    ibuprofen
    irbesartan
    losartan
    montelukast
    naproxen
    phenytoin
    piroxicam
    tolbutamide
    torsemide
    S-warfarin
    zafirlukast
    CYP2C19
    felbamate
    fluoxetine
    fluvoxamine
    modafinil
    omeprazole
    oxcarbazepine
    None amitriptyline
    citalopram
    clomipramine
    diazepam
    imipramine
    lansoprazole
    phenytoin
    omeprazole
    R-warfarin
    CYP2D6
    amiodarone
    chloroquine
    cimetidine
    clomipramine
    diphenhydramine
    fluoxetine
    fluphenazine
    haloperidol
    paroxetine
    perphenazine
    propafenone
    propoxyphene
    quinacrine
    quinidine
    ritonavir
    sertaline
    terbinafine
    thioridazine
    None amitriptyline
    carvedilol
    chlorpromazine
    clomipramine
    clozapine
    codeine
    desipramine
    dextromethorphan
    dihydrocodeine
    donepezil
    flecainide
    fluoxetine
    haloperidol
    hydrocodone
    imipramine
    loratadine
    maprotiline
    methamphetamine
    metoprolol
    mexiletine
    mirtazpine
    nortriptyline
    oxycodone
    paroxetine
    perphenazine
    propafenone
    propanolol
    risperidone
    ritonavir
    thoridazine
    timolo
    tolterodine
    tramadol
    trazodone
    venlafaxine

    Foods and dietary components, including teas and supplements, can also influence this enzyme.

    Image result for cytochrome p450 foods

    Image result for phase 1 detoxification

    After a good fight between the particles and the enzymes, particles (our “toxins”) come out modified and partially water soluble. The new products are called toxic intermediates and sometimes can do more damage to the cells than they can do in their original state. They can create free radicals that cause oxidative damage if not excreted & put through phase 2, which can cause oxidative stress, inflammation, premature again, and increase risk for chronic disease. This is where antioxidants are VERY important! They help combat the intermediates.

    Speaking of antioxidants, there are a variety of nutrients that are extremely important for the enzyme processes to continue. If you are lacking in these nutrients, phase I liver detoxification cannot run at full speed. This means any toxic products will continue disturbing, can build up, and cause damage to the body. If one was to try and “detox” without these nutrients, they may do more harm than good.

    The nutrients that are of importance for phase I detoxification processes are:

    • B2, B3, B6, B12
    • Folate
    • Glutathione
    • Flavonoids

    Phase II Detoxification

    Image result for phase 1 detoxification

    (photo sourced from https://wildcraftmedicine.com/21-day-detox-program/)

    After phase I comes phase II. This is the final step in transformation of the toxins, where they go from being less lipid soluble, to becoming more water soluble through what is known as conjugation -which includes sulfation, glucuronidation, and more (see above image!). Depending on the molecules, they undergo these 1-or more- of 6 reactions that conjugate (aka ADD another substance such as sulfur, cysteine, or glycine) to the particle or “toxin” to make it less harmful and be able to be excreted.

    It’s important to note that phase II pathways require different nutrients than phase I. This is why variety in the diet is important! If the body lacks of any of these nutrients,  the process will slow down immensely, just like in phase I. This can mean reductions in your body’s detoxification (and a HUGE reason why those on poor diets with micronutrient deficiencies see benefits from “detoxes”- they finally get their needed nutrients & feel better with reductions in inflammation and free radical damage! (Plus they may get a large bowel movement… “detox” teas tend to stimulate the GI tract and are really just a laxative- yes I said it).

    Nutrients that are importance for phase II detoxification include:

    • Glutathione
    • B5, B12
    • Multiple Amino Acids- including taurine, glutamine, cysteine, methionine, glycine
    • Sulfur Containing Compounds like MSM & Sam- E
    • Magnesium
    • Vitamin C
    • Choline
    • Carnitine

    Final Excretion

    After phase 2, finally, these the transformed particles & “toxins” are excreted. Some are returned to the blood to go to the kidneys and eventually out of the body through urine. Other products are attached to bile, which then go into the intestines and are passed through the stool. Others leave your body via sweat or breathing out of CO2. Along with getting in all the required nutrients to go through each phase, it’s important to stay hydrated and to have regular bowel movements to rid your body of the final form of toxins- FOR GOOD! A happy poop life can mean a happy detoxification life!

    Critical factors for final excretion include:

    • Adequate fiber intake
    • Adequate water intake

    Lack of excretion or alterations in phase 1 & 2 detoxification can lead to a build up in the body of some particles- which is commonly seen when drugs are not metabolized correctly can be seen in estrogen dominance or high sex hormone binding globulin levels.

    Okay we discussed detoxification- What does and can my liver store?

    Your liver is a crafty organ. As mentioned before, the liver receives most of the blood and nutrients first. This allows for swift processing and storage. It stores many of the fat-soluble vitamins and minerals. Specifically, it stores Vitamin A, D, E, K. Vitamin B12 is also stored in the liver. Last, two minerals, iron and copper have their stores in the liver. Many animal liver’s store the same vitamins and minerals. This makes animal liver is a nutrient dense food. It’s important not to eat too much though, because the fat-soluble vitamins can become toxic at high doses.

    Even though the liver stores all of these vitamins and minerals. It does not store many of the critical nutrients mentioned above for the detoxification pathways. Many of these are protein (stored in muscle) or water-soluble vitamins, (directly excreted if not utilized). Therefore, having a wide variety of foods in the diet should be first priority.

     What foods should I eat to help my liver and detox naturally?

    A healthy liver needs a well-rounded diet with a variety of fruits, vegetables and proteins. In this case, remembering to eat the rainbow will help you get all the nutrients you need for a healthy liver!

    Red beets, tomatoes, cherries, cranberries, raspberries, strawberries, red bell peppers, red apples
    Blue/Purple eggplant, grapes, blueberries, plums, pomegranates, purple potatoes
    Orange/Yellow: oranges, bananas, guavas, peaches, yellow squash, carrots, sweet potatoes
    Green kiwi, collard greens, swiss chard, celery, green beans
    White cauliflower, garlic, turnips, potatoes, onions, mushrooms
    Don’t forget your protein!* legumes (beans), poultry, beef, eggs, soy products, pork

    *Protein provides essential amino acids for liver detoxification.

     

    Why do I not need a liver cleanse?

    There are many companies out there trying to sell liver cleanses, detox teas, or “liver supplements”. They are sold under a false pretense that your liver stores toxins. As we learned earlier, the liver will store these toxins in excess fat outside the liver, because many of these toxins are fat loving molecules. That is only if the phases are not running at optimum capacity.  If, through diet and lifestyle, the toxic load is more than the liver can handle even at optimum capacity- toxins will get stored in fat until the liver can process them. So, contrary to popular thought, your liver does not directly store toxins. Therefore, you do not need a liver cleanse! What you do need to handle toxins is to be physically active, poop daily, ensure optimal nutrients required for each pathway, and to sweat!

    The body never stops working and neither does the liver. Through all these miraculous enzymes and nutrients, the body can keep running at optimum level, without a need to buy a “detox”. It’s important to keep a consistent dietary intake of all the required nutrients to support the liver. Unless you have specific medical conditions inhibiting absorption or digestion of nutrients the best way to make your liver happy and processing is to eat the rainbow! Taking supplements that help provide the body with required phase nutrients MAY help if someone is deficient, has a compromised liver, or genetic mutation affected detox pathways, but unless you work with a health care provider, avoid any supplements to “help detox” reagrdless, and some may do more harm than good.

    Authors: Lacey Dunn, MS, RD, LD & Chelsea Macias, Dietetic Intern

    Ballantyne S. What Does Our Liver Do Anyway? Detoxification Explained. The Paleo Mom. https://www.thepaleomom.com/what-the-heck-does-our-liver-do-anyway-detoxification-explained/. Published July 8, 2019. Accessed January 31, 2020.

    Cline JC. Nutritional Aspects of Detoxification in Clinical Practice. Alternative Therapies. 2015;21(3).

    Lautt WW. Overview Hepatic Circulation. Hepatic Circulation: Physiology and Pathophysiology. https://www.ncbi.nlm.nih.gov/books/NBK53069/. Published January 1, 1970. Accessed January 31, 2020.

    Percival M. Phytonutrients and Detoxification PDF. 1997.

    Speller J. Storage Functions of The Liver – Carbohydrates – Vitamins. TeachMePhysiology. https://teachmephysiology.com/gastrointestinal-system/liver/storage-functions-liver/. Published June 3, 2018. Accessed January 31, 2020.

    Tucker I. Your Body’s Detoxification Pathways. The Great Plains Laboratory, Inc. https://www.greatplainslaboratory.com/gpl-blog-source/2016/6/6/your-bodys-detoxification-pathways. Published June 6, 2016. Accessed January 31, 2020.

    Additional resources:

    www.ncbi.nlm.nih.gov › pmc › articles › PMC4488002Modulation of Metabolic Detoxification Pathways Using Foods …

    www.ncbi.nlm.nih.gov › pubmedNutritional aspects of detoxification in clinical practice. – NCBI

    www.ncbi.nlm.nih.gov › pmc › articles › PMC4014033Pharmacological strategies for detoxification – NCBI

    www.ncbi.nlm.nih.gov › pubmedAntioxidant and detoxifying enzymes in the liver and … – NCBI

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