Key Points

  • A recent ANH article defending the principle of enhanced detoxification using natural approaches was flooded with critical comments. After careful consideration, we decided not to post these comments owing to their generally derogatory and unconstructive nature
  • However, several substantive questions or points were raised among the abusive rhetoric – so we have asked Dr Verkerk, our executive and scientific director, to answer them
  • Dr Verkerk’s answers draw from various fields of science and medicine to demonstrate that there is copious evidence that dietary and herbal constituents influence different detoxification pathways in the body
  • Dr Verkerk emphasises that some people’s detoxification capacity could be compromised by polymorphisms in the specific genes responsible for the expression of detoxification enzymes
  • He shows that a wide range of environmental chemicals in food, water and air may cause imbalances linked to excess chemical load that can have serious downstream consequences on health
  • Dr Verkerk also points out that there is an extensive evidence base among practitioners who specialise in detoxification programmes that appears to be widely ignored by mainstream medicine
  • Dr Verkerk stresses that his answers are not, in any way, an attempt to defend particular detox products; rather, they promote the principle of using particular forms of natural therapy to enhance the body’s detoxification system

Shortly after publishing our article on detox last Friday, we received a rash of comments in the moderation queue of our website.  We decided to not publish them because most contained rude and offensive comments that appeared to be based on prejudice against natural approaches to healthcare, rather than engaging in any kind of intelligent debate on the subject. While we are always happy to engage in meaningful debate, we wish to make it clear that we will never respond to abusive rhetoric. And if you think we are exaggerating, we see no reason at all why we should encourage people who call us “stupid and delusional” or “corrupt, evil, selfish sociopath[s]” without addressing a single one of our arguments.

What is a skeptic?

Because many of the comments contained similar objections or views, added to the fact that they were all posted within such a small window of time, it is likely that the individuals behind the comments are linked or syndicated in some way, probably via a skeptic organisation.  Skeptics define themselves in the following way:

“A skeptic is one who prefers beliefs and conclusions that are reliable and valid to ones that are comforting or convenient, and therefore rigorously and openly applies the methods of science and reason to all empirical claims, especially their own.

A skeptic provisionally proportions acceptance of any claim to valid logic and a fair and thorough assessment of available evidence, and studies the pitfalls of human reason and the mechanisms of deception so as to avoid being deceived by others or themselves.

Skepticism values method over any particular conclusion.”

Given the above definition, we are astonished why it is so hard to have any meaningful scientific or clinical debate with skeptics. We are also mystified as to why they continually engage in mud slinging, in a way that is reminiscent of playground bullying. Well, as the old adage goes; “sticks and stones will break my bones, but words will never hurt me.”

However, we are keen to facilitate skeptics’ understanding of this issue as much as possible, so we have asked Dr Robert Verkerk, our scientific and executive director, to answer the key questions that were posted to the moderation queue of our detox article last Friday.  We are of the view that extracting from the dross sent to us last Friday the meaningful questions posed (identifying by username the person posting the comment where this was available), and publishing answers to these questions in a separate article, is the best way of ensuring that our opponents are given a voice. It also gives us a chance to respond in more detail and hopefully goes some way to address complaints made by skeptics, which included our article being “poorly researched”.

Since we are presumably responding to a scientifically interested audience, some of Dr Verkerk’s answers are quite technical, although we believe the language will still be understood by the intrigued layperson.

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Questions and answers

Following is the shortlist of questions, or excerpts from questions, including only those parts we viewed as justifying an answer. Each of the questions below is hyperlinked to Dr Verkerk’s answer.

rosegirl: “As others have asked, if you can name the toxins that can only be removed by detoxing then please publish or be damned.”

Richard Miller: “There [their] evidence base is thin and mostly deal with different topics. For example the NCI Benchmarks article on environmentally induced cancers notes that environmental factors increase the risk of a lot of cancers – well yeah! – but makes no mention of detox as a solution.”

Anonymous: “Equating "the medical establishment" with the "natural health skeptic movement" is paranoid and grandiose to say the least.”

MrRSaunders: “For many people, the root problem is actually disruption of their hormone (endocrine) system", just how many is ‘many’? 5% of people, 10%, 40%? Do you still accept that the problem for MOST people (i.e. more than 50% of people who are over-weight) is that they eat too much and exercise too little?”

Barnie: “So while trying to ridicule Dr Bender, did you not notice that you were actually substantially agreeing with him?”

Anonymous: “Instead of this distasteful ad hom attack on Prof Bender (with a poorly veiled innuendo), why don’t you follow the scientific route and write to the journal? You seem to disagree about the science so let’s see a reasoned response with adequate references.”

Matt: So what "Specific Toxins" am I accumulating that I need to detox? If you could name one, and tell me how to identify it so I can prove my levels of it are high, then I could "detox" and watch the levels decrease proving your "Science" once and for all.

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rosegirl: “As others have asked, if you can name the toxins that can only be removed by detoxing then please publish or be damned.”
Dr Verkerk’s answer: We have not said that toxins, or specific toxins, can only be removed by detoxing.  The scientific debate that you are alluding to is actually concerned with whether or not detoxing can increase the rate of internal detoxification – mediated in particular by the liver and gut – over and above the level achieved without detoxing.

We should stress that detoxing does not necessarily involve the use of commercial ‘detox’ products, some of which we know are questionable in terms of their effectiveness or scientific/clinical support. However, it might involve changes to the diet or lifestyle. This doesn’t just mean eating a generally healthy diet and following a healthy lifestyle, because particular components of the diet may increase, decrease or have no effect on enzyme activity associated with Phase I (biotransformation) and Phase II (conjugation) pathways.  Someone who really needs their detoxification system to work optimally — because it is comprised by specific polymorphisms or the effects of excessive environmental chemical exposure — really can benefit from knowing both the status of their on-board detox system, as well as which foods, nutrients and herbs will assist them most.  

As for some examples: toxins for which there is clear evidence for enhancement of detoxification include polyaromatic hydrocarbons (in pesticides), polycyclic aromatic hydrocarbons (in cigarette smoke) and polyaromatic amines found in high-temperature cooked or barbequed meats.  Detoxification of all of these is compromised by polymorphisms in CYP1A1 or CYP1A2 genes expressing cytochrome P-450 (CYP) enzymes in Phase 1 detoxification.  There is a rapidly growing literature on the role of particular dietary constituents and herbal products on expression of CYP enzymes, as well as their effects on Phase II detoxification (conjugation), especially enhancement of the all-important glutathione transferases.  We included some examples of this in our article, and you can check out the peer review literature yourself if you are interested.

There is also detailed information about toxins of particular concern in functional medicine textbooks, such as The Textbook of Functional Medicine, Institute of Functional Medicine (2006), 820 pp., and Biochemical Imbalances in Disease: A Practitioner’s Handbook (2010), Nicolle L, Woodriff Beirne A (Eds), Singing Dragon, 392 pp.

Apart from the examples above, some additional toxins that cause problems for some individuals include: natural food-borne toxins (e.g. aflatoxin, fusarium, penicillium, ergot), drugs (e.g. paracetamol/acetaminophen), caffeine, metals (e.g. cadmium, mercury, lead, arsenic), organic solvents in paints and other industrial chemicals, pesticides, plasticisers (e.g. bisphenol A), synthetic and pharmaceutical oestrogens, petrochemical combustion products, vinyl chloride and drinking water chlorination byproducts.  You might want to check out PubMed for articles on the relationship between specific toxins and the mediation of certain diseases (e.g. a wide range of autoimmune conditions, Gilbert’s syndrome, Alzheimer’s disease, chronic fatigue syndrome, etc.) particularly among those whose detoxification is compromised.  Happy reading!

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Richard Miller: “There [their] evidence base is thin and mostly deal with different topics.  For example the NCI Benchmarks article on environmentally induced cancers notes that environmental factors increase the risk of a lot of cancers – well yeah! – but makes no mention of detox as a solution.”
Dr Verkerk’s answer: Surely, that is a limitation of the National Cancer Institute’s (NCI’s) information.  We are not here to defend all detox solutions and products, but we are arguing that certain detoxification programmes, particularly when managed via a qualified and experienced natural health practitioner, will have a demonstrable effect in improving the rate of detoxification over and above the rate achieved without the programme.

In some cases, compromised detoxification will be diagnosed using commercially available genetic tests that evaluate single nucleotide polymorphisms (SNPs) for particular CYP enzymes, as well as for particular conjugation pathways, such as methylation, acetylation, glutathione conjugation and protection from oxidation.  With knowledge of the genetic background, patient history and chemical exposure, specific programmes can be designed by practitioners using dietary and herbal ingredients, while also modifying occupational or other sources of exposure.  In short, the proof is in the pudding.

There are thousands of practitioners in various disciplines of natural health, ranging from functional medicine and nutritional therapy, through to traditional Chinese medicine (TCM) and Ayurveda, who can provide case report after case report demonstrating rapid improvements in conditions following instigation of detoxification programmes, coupled with minimising exposure to particular toxins.  Allopathic medicine always looks for neat, single-variable problems and solutions, but the issue of toxic chemical load and its alleviation is multi-faceted at every level.  Its popularity among practitioners and patients alike — and the fact that detoxification enhancement remains central to many diverse disciplines — is a testament to the positive results experienced by patients undergoing such treatment.

We hope that, in time, the NCI will learn more about these positive clinical results, as well as about the increasing body of published work relating to enhancement of endogenous detoxification pathways using natural products.

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Anonymous: “Equating "the medical establishment" with the "natural health skeptic movement" is paranoid and grandiose to say the least.”
Dr Verkerk’s answer: You think so?  We submit that a more thorough study of the history of medicine may persuade you otherwise. But perhaps you have also misunderstood what we were saying in our article.  Firstly, we were not saying the two groups are synonymous, as there are elements of mainstream medicine for which we have a great deal of respect.  Having said this, with regard to ‘the medical establishment’, we do generally have a problem with its under-use of particular natural approaches to healthcare, its lack of emphasis on disease prevention strategies that are based on dietary and lifestyle means and its over-use of pharmaceutical products as the primary interventions.

We claimed in our article that the natural health skeptic movement forms a subset of ‘the medical establishment’.  We base this view on the fact that some highly prominent medics and members of allied professions, such as Professors David Colquhoun and Michael Baume, are both self-declared skeptics and long-standing opinion leaders for the medical establishment’s view on so-called alternative medicine. As such, they heavily influence the views of other skeptics and of more neutral members of the medical and allied professions, not to mention the general public.

MrRSaunders: “For many people, the root problem is actually disruption of their hormone (endocrine) system", just how many is ‘many’? 5% of people, 10%, 40%? Do you still accept that the problem for MOST people (i.e. more than 50% of people who are over-weight) is that they eat too much and exercise too little?”
Dr Verkerk’s answer: If only we knew.  You appear to be asking what proportion of the total population experience endocrine system disruption, as opposed to the proportion that turns up at ‘alternative medicine’ clinics and is recommended detoxification. These figures are of course likely to be very different.

The endocrine system can be disrupted in a wide variety of ways.  For example, there is currently very active work looking at gene/nutrient/lifestyle interactions in relation to type 2 diabetes.  A useful summary of recent research on genetic factors (specifically polymorphisms) influencing type 2 diabetes has been published in 2011 by Sunita Singh at the Banaras Hindu University, Varanasi, India in a review entitled The Genetics of Type 2 diabetes mellitus: a review (2011).  This review (which I have quoted here simply because it offers a useful chronology of peer reviewed science in this area) concludes that particular polymorphisms may be associated with the higher predisposition of Asian Indians to the disease. Also, while only 6 loci were implicated in this predisposition up to 2006, more recent research has now revealed about 20, with the most sizable effect from a single polymorphism yielding a 1.37 odds ratio (OR).  Factoring in external influences, including excess oestrogen/xenoestrogen, petrochemical combustion product and other sources of environmental chemical exposure, adds another dimension.

I’m not sure that anyone has yet got a full idea of the precise scale of genetic and environmental dysregulating effects in different populations, sub-populations and age groups. However, practitioners who are members of ANH Collaborating Practitioner Organisations regularly comment to us that they are seeing more and more patients who are unable to lose weight, despite significant calorie reduction and high levels of activity/exercise.  Further testing often reveals endocrine dysfunction that responds to specific functional and botanical medicine interventions, in combination with occupational and lifestyle amendments.  As research and clinical practice evolve, more is likely to be understood both about the genetic and environmental factors that lead to endocrine dysregulation, as well as the most effective ways of dealing with such dysregulation. 

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Barnie: “So while trying to ridicule Dr Bender, did you not notice that you were actually substantially agreeing with him?”
Dr Verkerk’s answer: We are certainly aware that we agree with Dr Bender on certain points, particularly in relation to the massively important role of diet and lifestyle.  However, as we indicated, many people’s situations require considerably more complex advice than simply “eat less and exercise more”.  As you will have gathered, we also disagree strongly that detox is pointless and medically futile, and we are perplexed as to why Dr Bender does not understand the concept of self-healing.  ‘Regression to the mean’ is a familiar concept in medicine and reflects homeostatic and allostatic mechanisms.  In common parlance, I don’t see why it such a stretch to see these mechanisms as self-healing.

Anonymous: “Instead of this distasteful ad hom attack on Prof Bender (with a poorly veiled innuendo), why don’t you follow the scientific route and write to the journal? You seem to disagree about the science so let’s see a reasoned response with adequate references.”
Dr Verkerk’s answer: It is unfortunate that you saw this as an ad hominem attack and a thinly veiled innuendo.  In all sincerity, the innuendo you suggested hadn’t crossed any of our minds — probably because we all abhor oppressive or discriminatory behaviours and attitudes to any minority group.  In the subtitle to the section that you and others have taken offense to, we were just making light of the fact that a Professor called Bender believes that detoxing after going on a ‘bender’ (i.e. abusing alcohol) is medically futile.  Anyway, I hope you will be pleased to know that we have made a submission to The Biologist.

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Matt: So what "Specific Toxins" am I accumulating that I need to detox? If you could name one, and tell me how to identify it so I can prove my levels of it are high, then I could "detox" and watch the levels decrease proving your "Science" once and for all.
Dr Verkerk’s answer: Are you really asking us to identify specific toxins in your own body? If you are, no can play; we have no data on you other than your name.  But I presume you are actually asking us what toxins may be present in some individuals that may cause problems — and how these can be measured and monitored.  Your detoxification system may, of course, be functioning sublimely and you may be perfectly able to rid yourself both of endogenously produced toxins (metabolic byproducts) and environmental chemicals to which you have been exposed.  Unfortunately, many are not so lucky, and herein lies the concept of ‘total chemical load’ as opposed to hunting down individual toxins.

Someone with a genetic predisposition to chemical hypersensitivity, because of particular genetic defects or polymorphisms that effect detoxification enzymes, may experience a wide range of effects from a given chemical load that others – such as yourself, perhaps – can tolerate with no discernable problems. In recent years, the role of environmental chemical exposure has been associated with a diverse range of diseases or conditions, ranging from cancer, asthma, Alzheimer’s disease, rheumatoid arthritis, other autoimmune conditions, cognitive or behavioural impairment and birth defects through to chronic fatigue syndrome (CFS) and fibromyalgia.  Different individuals may be exposed to a given toxic burden at some stage in their lives (e.g. sheep dippers) that then can cause them to become chemically hypersensitive for the remainder of their lives. Clinical experience informs us that such people benefit massively from carefully managed detoxification programmes, coupled with lifestyle modification. 

Examples of toxins that some individuals are affected by are given in answers above, especially the one to rosegirl.  You could also consult the textbooks that I mentioned in the same answer, or do a simple PubMed search as also indicated in the answer to rosegirl.  In terms of testing, depending on the toxin and its solubility and degradation/detoxification pathways, it may be analysed in blood, fat biopsies, urine, stool, etc.  As indicated above, there are a wide range of commercially available genetic tests that can determine whether someone’s detoxification capacity is compromised to any extent because of a single nucleotide polymorphism (SNP) that would affect the detoxification enzyme activity associated with either Phase I or II pathways (see above for some examples).  Furthermore, there are a wide variety of tests that can be conducted for responses to environmental stressors.  See this list of analytical methods compiled by the Centers for Disease Control (CDC) in the USA.

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Conclusion

We hope these answers go some way toward illuminating and even raising the quality of the debate that has raged for several years between detox protagonists and skeptics.

We would like to end this piece by making one point clear — and this point will serve to demonstrate that there is perhaps a small area of agreement on at least one issue.  Our defence of the principle of enhancing detoxification using specific forms of natural therapy is just that.  Nothing more and nothing less.  It doesn’t pretend to be a defence of detox products on the market, because these are very diverse, vary in quality, applicability, and so on. In fact, we’ll be the first to agree that there are a few commercial products out there that appear to have no scientific basis for their claimed effect.  Ironically, the products that might fall into this small category are typically ones for sale in outlets that are very accessible to the public, namely supermarkets, pharmacies or the Internet.  However, most countries have adopted legal provisions or trading rules that prevent companies from making claims that cannot be substantiated. Over time, this regulatory mechanism tends to remove most of the products containing claims that cannot be supported with scientific evidence.

The EU’s Nutrition and Health Claims Regulation, on the other hand, goes to the other extreme, almost as if it were a tool fabricated by the skeptics for their benefit.  Let’s face it, if unequivocal, causative proof of benefit were to be applied to medical treatments generally, the majority would have to be removed from the market. This view is based on the fact that BMJ Clinical Evidence considers that, of around 3,000 medical treatments evaluated, only 11% have been proven to be beneficial.

We look forward to your meaningful and scientific comments.  

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