Hepatoprotection, Estrogen metabolism, Elimination

Question 1

Hepatoprotection

Milk thistle (Silybum marianum):

Answer 1

• A liver tonic that has strong antioxidant properties and has been shown to help protect the liver from the damaging effects of phase I metabolites.
• It is suitable for hepatoprotection e.g., high alcohol intake, pharmaceutical drugs and hepatitis.
• However, milk thistle at high doses can inhibit phase III.

Question 2

Hepatoprotection

Mycotherapy:

Answer 2

• Shiitake and maitake are hepatoprotective.
• Cordyceps — hepatoprotective and supports detoxification by increasing glutathione (phase II).

Question 3

Key oestrogen liver genes:

Answer 3

• CYP1A1 is crucial because it converts oestrogens into 2OH oestrogens, which are neutral or even beneficial for the body.
• CYP1B1 converts oestrogens to 4OH oestrogens and can promote the synthesis of harmful molecules called quinones, which damage DNA and potentially initiate cancer. Variations on CYP1B1 are associated with increased production of 4OH oestrogens.
• COMT is involved in the methylation of 2OH and 4OH before detoxification of these oestrogens occurs.

Question 4

Oestrogen elimination:

Answer 4

• Oestrogens are then detoxified by sulphation and glucuronidation. SULT / UGT SNPs increase the risk of hormone-related cancers e.g., breast cancer.
• Oestrogen enters the bowel (in bile), where certain gut bacteria ‘deconjugate’ it, allowing recirculation via beta-glucuronidase enzymes. Excess activity can lead to increased levels.
• Raised beta-glucuronidase is often due to an overgrowth of bacteria such as E. coli and Clostridium perfringens. Detected on a CDSA.
• To combat this: Optimise gut flora and ↑ glucuronic acid-rich foods, mung bean sprouts, orange peel (infused tea), apples, broccoli.

Question 5

How to optimise oestrogen metabolism:

Answer 5

• Increase intake of:

‒ Cruciferous vegetables, and focus on broccoli sprouts due to the high I3C content.

‒ Fibre (elimination), organic fruit and vegetables, filtered water.

Avoid: Dairy, excess alcohol and caffeine, non-organic meat and eggs, water from plastic bottles (due to BPA), anti-perspirants, hormonal contraceptives.

• Address dysbiosis (e.g., weed, seed, feed protocol). Calcium D-glucarate has been shown to inhibit beta-glucuronidase.

Question 6

Support bowel elimination (‘clean up the GIT’):

Answer 6

• Remove anything damaging the GIT (e.g., alcohol, NSAIDs).
• Ensure good hydration.
• Eat foods rich in mucilage, which swells and lubricates the bowel (linseed, chia seeds, psyllium seed / husk). Always take with plenty of water.
• Maximise fibre intake (soluble and insoluble) to aid transit through the GIT, increase stool bulk and provide prebiotics.
• Ensure a healthy intestinal microflora:

– Eradicate pathogens / SIBO with antimicrobials, e.g., berberine.

– Repopulate the flora with probiotic foods (e.g., kimchi, sauerkraut, kombucha and kefir) and / or probiotic supplements. Increase prebiotic foods (e.g., chicory, garlic, asparagus, onions).

• Support the intestinal mucosa, e.g., quercetin, bone broth, cabbage juice (glutamine), N-acetyl glucosamine (e.g., in shellfish). Slippery elm and / or marshmallow root (1 tsp powder in water — drink 3 x daily between meals).

Question 7

Support kidney function:

Answer 7

• The kidneys play a vital role in elimination, filtering undesired products of metabolism such as uric acid, creatinine, hormone metabolites and phase II metabolites.
• Stop drugs that damage the kidneys, esp. NSAIDS, paracetamol.
• Avoid table salt and protein (esp. animal) diets as they increase the metabolic load on the kidneys.
• Good intake of filtered water to aid waste removal via the kidneys.
• Address GI dysbiosis and intestinal permeability due to the impact of circulating endotoxaemia on the kidneys.
• Celery seed, nettle and dandelion leaf taken as herbal infusions support renal blood flow, increase urine output and encourage removal of conjugated toxins and acidic wastes.
• Nettle and dandelion leaf are alkalising (rich in minerals) helping the kidneys to release toxins.
• Beetroot juice is especially rich in organic nitrates, which are converted to nitric oxide in the body = vasodilation and improved microcirculation. 250 ml x 2 per day.
• Blueberries protect the kidneys from gut-derived endotoxins.

Question 8

Skin support:

Answer 8

• Toxin avoidance — especially anti-perspirants (to avoid inhibiting skin elimination).
• Saunas — increase the elimination of toxins (incl. heavy metals, BPA and phthalates) by promoting cutaneous vasodilation and increasing perspiration. Every 2–4 days.
• Wraps / poultices (i.e., rock salt, clay, mud) increase heat, which opens pores; the alkalinity absorbs acid wastes.
• Epsom salt / seaweed baths combine warm water (opens pores) and alkalinity (draws out acid wastes).
• Burdock root (tea daily) — ‘re-conditions’ the skin.

Question 9

Optimise lymphatic flow:

Answer 9

• The lymphatic system plays a vital role in elimination, filtering and removing harmful substances.
• Exercise helps to mobilise and shift toxins and wastes. Mini trampolining is especially good!
• Dry skin brushing (gently brushing the skin from the bottom of the feet and palms of the hands toward the heart).
• Massage i.e., manual lymphatic drainage.
• Abdominal breathing exercises (promote thoracic duct drainage).
• Cleaver’s tea (especially in the spring and summer months).

Question 10

General detoxification support in clinic:

Answer 10

1. Reduce toxin burden — avoid dietary and environmental toxins.
2. Assess GI integrity — ‘weed, seed, feed’ for dysbiosis, heal gut mucosa if indicated.
3. Support eliminatory channels as outlined.
4. Regular consumption of foods that support detoxification — brassica veg, allium veg, fibre-rich foods.
5. Eat a rainbow of phytonutrients to ensure optimal antioxidant status.
6. Good quality protein to provide adequate conjugates for phase II.
7. Ensure optimal intake of B vitamins.
8. Regular saunas — ↑ toxin excretion e.g., heavy metals, PCBs.

Question 11

Water fast

Answer 11

• Wholefoods only (mainly steamed veg) for several days prior to decrease toxin load.
• 2–3 litres of filtered water daily.
• Rest, limit exercise (gentle only).
• No vitamins, herbs, herbal teas.
• Limit medication to those needed.
• Reintroduce food with easy-to-digest soups and broths.

Question 12

Fasting mimicking diet (5‒10 days)

Answer 12

• Low complex carbohydrate (no refined sugar).
• 500‒800 kcal a day.
• 0.8 g protein / kg body weight.
• 8‒10 portions of liver-supporting vegetables esp. cruciferous veg, onions and garlic, mung bean sprouts (glucuronic acid).
• Natural fats from plant foods.
• Reduced eating window — 8 hours
• Ensure good intake of filtered water.