Environmental APM Flashcards
phase I: bioactivation
oxidation, reduction, hydrolysis
metabolites are more polar, may activate inert compounds
CYP450 - heme/iron dependent
phase II: conjugation
metabolites are metabolically inactive, water-soluble, excreted through bile or urine
- glucoronidation (UGT)
- sulfonation (SULT)
- glutathione conjugation
- methylation
- amino acid conjugation
- acetylation
Gilbert’s syndrome SNP
UGT
Gilbert’s syndrome presentation
jaundice after fasting (due to inability to conjugate bilirubin with glucuronic acid)
which drug harder to metabolize in Gilbert’s
acetaminophen
food group that is supportive in Gilbert’s
cruciferous
body burden
quantity of exogenous substances or metabolites that accumulate in individual
enterohepatic recirculation
cycling of drugs, xenobiotics, metabolites after excretion into biliary system, which are then reabsorbed in intestine
does fasting impact phase I or II more?
phase II
it can decrease sulfonate and glucuronidation
lab tests to reveal toxicity
CBC - leukopenia, anemia
8-OH DG - indicates damaged DNA
blood lead, arsenic, cadmium, mercury
GGT (also AST, ALT) - xenobiotic exposure
lab measures of antioxidant status
GSH, GSH peroxidase, SOD RBC Zn, Mag, Se EFA coQ10 (total and reduced) retinol tocopherols
biomarkers of susceptibility in stool/GI
decreased diversity, dysbiosis, IP, elevated beta glucuronidase
lab measures of oxidative stress
8-OHDG TBARS ORAC - oxygen radical absorbance capacity lipid peroxides F2 isoprostanes oxLDL
testing for heavy metals
blood is best for recent exposure (4-6 weeks) or recent mobilization
blood and urine can both be used for acute or chronic
hair best used WITH blood and urine
heavy metal found in hair of those with ASD
Antimony, Lead, Mercury, Arsenic
heavy metal found in hair of those with ADHD, ODD
Manganese, Lead, Mercury, Aluminum
heavy metal found in hair of those with depression
lead
utility of fecal samples of heavy metal
elimination of mercury DURING therapy (children, elderly)
Supportive nutrients for phase I
B2 B3 B6 folic acid B12 GSH phospholipids Mag, Zn, Cu iron (CYP450s) Mb flavonoids
Supportive nutrients for phase II
cysteine Sulfate N-acetylcysteine Methionine, serine glycine, taurine glutamine, proline ornithine, arginine Riboflavin Vitamin A Methyl donors (folate, choline, TMG, SAMe) Phytonutrients
SMART
Safe Mercury Amalgam Removal Technique
pre-tx with ingested charcoal + chlorella rinse nasal air supply for patient dental dam + nitrile gloves saliva ejector under dam eye protection for pt "clean-up" suction devices PPE and Hg-sp masks for dental team
oral health preventative strategies
Diet - Avoid allergies/intolerances, nutrient to support detox, Detox Food Plan
physical biofilm disruption
BPA free dental materials
eliminate toxic oral health products (SLS, triclosan, propylene glycol, fluoride)
probiotics
4 primary amino acids in phase II aa conjugation
glycine, taurine, arginine, glutamine
phytochelators
inulin modified citrus pectin oat fiber taurine wheat and rice bran chlorella
estrogen phase I support
I3C, DIM, soy, lignan
estrogen phase II COMT support
Mag, SAMe, folate/B12, choline, TMG (trimethylglycine)
estrogen phase II SULT support
genistein, vit A and E, Se, cruciferous
estrogen phase II UGT support
Mag, curcumin, quercetin, calcium d glucurate, probiotics
green tea
inhibits certain phase I and induces certain phase II enzymes
oral health antecedent examples
root canal, jaw osteonecrosis, xerostromia, mercury amalgams
oral health trigger examples
removing mercury, periodontal dz, root canal tx/failure, extraction/implants
oral health mediator examples
mercury amalgams, oral/jaw infection, mixed metals, jaw osteonecrosis
PURE
Pattern Recognition - mouth/dental exam, ID toxic exposure, pt sensitivity, autoimmune/CVD/DM
Undernourished - esp vit D, K2, C, E, B vitamins, Se, CoQ10, Zn, Ca
Reduce Exposure - from food, remove amalgams before chelation
Ensure a Safe Detox
