Whoa, hold on there, you say, no need to be insulting – after all, I don’t even know you! More often than not, when I suggest to a patient the possibility that s/he may be a pathological detoxifier, they respond with a puzzled smile, thinking of the more familiar term referring to pathological dishonesty. There are, in fact, similarities between the two conditions. Just as pathological liars are often unaware of their negative behavior (as many really believe their lies to be truth), pathologic detoxifiers have no direct way of knowing of their condition, and both issues only become apparent over time through the cumulative harm caused by these dysfunctions. In contrast, however, while the compulsive dishonesty of the pathological liar eventually becomes clear to those close to them through the corrosive effects of repeated lies, the only evidence of pathologic detoxification may be the gradual development of a confusing array of symptoms and diagnoses, without an identifiable connection or source.
How to Spot a Pathological Detoxifier
What are some hints that pathologic detoxification may be lurking in the shadows, sabotaging your health? Symptoms which come and go, or whose intensity varies can point to this condition. Other red flags are chronic fatigue; malaise; anxiety; depression; sleep issues; unusual sensitivity to smells, particularly cigarette smoke, gasoline, engine fumes, and perfumes; intolerance or sensitivity to medications and even nutritional supplements; generalized achiness (fibromyalgia or migrating joint pains); headaches; “brain fog” or sensations of swelling of the brain; poor focus or concentration; poor response to positive dietary change or detoxification programs (such as an unusually intense or prolonged healing crisis). In addition, both low and high tolerance to alcohol and recreational drugs can indicate pathologic detoxification.
The ’umbrella’ conditions of chronic fatigue syndrome (CFS), multiple chemical sensitivity (MCS), environmental illness (EI), and Gulf War syndrome are all linked with pathologies of detoxification, as are many chronic health conditions, including chronic inflammatory disorders, many neurologic diseases such as ALS (amyotrophic lateral sclerosis), Parkinsonism and Multiple Sclerosis (MS), as well as the spectrum of autoimmune diseases.
Commonly, though, it is the mystifying mix of vague and changing symptoms in a person that most clearly suggests impaired detoxification – in fact, the more murky the diagnosis, the more likely it is that detox pathology is the anarchist operating behind the scenes, quietly and persistently wreaking havoc with your health.
How is it possible that so many symptoms and disease states can be related to this one underlying issue? To understand this, we must first recognize the tremendous power for creating health or disease wielded by the liver, the body’s detoxification clearinghouse.
Your Hardworking Liver
Detoxification is the process by which the body processes and gets rid of toxins (poisons produced by living things) or toxicants (other substances harmful to humans such as chemicals). Both will be referred to here as toxins. The liver is our sophisticated detoxification center: here toxins pass through two primary channels (called Phase 1 and Phase 2) and are transformed, sort of recycled, into less noxious compounds for removal from the body. Some toxins are completely processed by Phase 1, and some entirely by Phase 2; most, however, are only partially detoxified by Phase 1 and are then passed to Phase 2 pathways to complete the process.
Phase 1/ Phase 2 Imbalance=Pathologic Detox
It is this crucial partnership of Phase 1 and Phase 2 which must work well to clear the majority of toxins, and when it doesn’t, we are left with only partially metabolized compounds recirculating through the body like ricocheting bullets, causing damage everywhere they go. Even worse, many of these intermediary metabolites, as they are called, are even more harmful than the original compound. The result? Inflammation, abnormal immune stimulation, a heightened stress response, and direct toxic effects on multiple body tissues. Over time, many poorly metabolized toxins are stored in the body as a way of managing the toxic overload, where they continue do harm over years and decades.
This mismatch between the two phases of liver detoxification can occur because of elevated Phase 1 activity (a pattern often seen with excessive alcohol or drug ingestion), deficient function of one or more Phase 2 pathways, or a combination of the two. Unhealthy lifestyle, poor nutrition, increased toxin exposure (from the external or internal sources named above – or through the release of toxins which occurs with a detoxification program) and genetics can all help to create or exacerbate Phase 1/ Phase 2 imbalances.
Diagnosing Pathologic Detoxification
Fortunately, it is now possible to test for Phase 1/Phase 2 imbalances, through a functional laboratory profile which uses marker substances such as caffeine, acetaminophen, and aspirin to evaluate how well they are cleared through the appropriate pathways. Like sending an unfortunate canary into a mine to test the air quality, we can see how effectively the liver clears these common toxins (yes, they all have toxic effects in the body!), and by identifying the precise pattern of detox impairment for an individual, we can provide the right nutrient support to address imbalances.
It’s even possible to test for genetic factors, defects of which are quite common, which play important roles in detoxification. With this information we can compensate for their negative effects with specific lifestyle and nutritional strategies.
In addition to performing a detox profile and genomic testing for people in whom I suspect pathologic detoxification, I often perform a comprehensive nutritional evaluation for a full range of nutrients, including vitamins, fatty acids, antioxidants, minerals, and amino acids, to more precisely target nutrient cofactor deficiencies and better support balancing of detox pathways.
A Classic Case of Pathologic Detoxification
“Diane S.”, as I’ll call her, came to see me after years of migrating from one healthcare provider to another, none of whom had provided a definitive diagnosis or effective treatment for her growing list of symptoms and ailments. Diane had fatigue, recurrent headaches, difficulty concentrating, joint pains, fibromyalgia, constipation, difficulty sleeping, anxiety, depression – the list went on, and although standard lab tests revealed slight abnormalities associated with autoimmune activation, they did not point to a specific autoimmune disease nor to any diagnosis that could explain her range of symptoms. Like many patients, she didn’t feel right, didn’t know why, and the inability to identify the reason caused great frustration and added to her distress.
I told Diane that my diagnosis for her was “Diane S. Syndrome” –meaning that the underlying cause of her health issues was likely to emerge as a combination of functional systemic imbalances unique to her. Such a situation frequently eludes conventional diagnosis, until health has deteriorated to a point at which diagnostic criteria are met for a nameable pathology. A functional Detoxification Profile told us that Diane had high Phase 1 function and diminished function of two Phase 2 pathways, as well as poor conversion of the amino acid cysteine to sulfate, necessary for the healthy function of the Phase 2 sulfation pathway. Diane was a classic pathologic detoxifier. In addition, genomic testing revealed a genetic trait which causes impaired methylation, an important mechanism of toxin and biochemical metabolism (including the healthy elimination of neurotransmitters which contribute to anxiousness); digestive analysis showed overgrowth of toxin-producing fungal species (yeast organisms); and nutritional testing showed deficiency of multiple B-vitamins, including folic acid and Vitamin B12, the trace mineral molybdenum, magnesium, and certain amino acids. It also showed indications of toxicity relating to heavy metals and styrenes, the chemicals used in production of many plastics and Styrofoam. With appropriate nutritional support, Diane soon began to have better energy, focus, and sleep; her fibromyalgia improved and her joint pains and headaches lessened. When Diane supported her detox pathways with targeted nutrition, she was able to tolerate the work of digestive tract rebalancing, dietary change, and detoxification which were necessary steps to the ultimate resolution of her health problems.
Hope for the Pathologic Detoxifiers
How can Phase 1 and Phase 2 learn to work together in harmony? A number of supplement formulations are specifically designed to provide broad support for Phase 2 reactions. Phase 2 co-factors include amino acids such as N-Acetyl L-Cysteine, Glutathione, Glycine, Glutamine, MSM (Methylsulfonylmethane), Taurine, Ornithine and Methionine; B-vitamins, including folic acid, thiamine, riboflavin, niacin, pyridoxine/ pyridoxine 5-phosphate and vitamin B12; vitamin C; and minerals such as magnesium, manganese, zinc, molybdenum and selenium. No single formulation will provide all these nutrients, so it may be appropriate to augment a Phase 2 support formula with an additional B-Complex or a high-potency multiple vitamin & mineral complex to fill in gaps. Depending on the degree of co-factor deficiency or toxin overload, multiple doses through the day may be appropriate. Essential fatty acids such as those from fish oil and borage oil are used in Phase 2 reactions, so doubling or even tripling your usual daily dose may be helpful; dry skin is often a sign of EFA deficiency, so increase intake if this appears during a detox.
The herbal flavonoids silymarin (derived from Milk Thistle) and curcumin (a component of the spice turmeric) have been found to increase levels of the Phase 2 enzyme glutathione S-transferase, and are excellent additions to a detox supplement program. I recommend phytosomal preparations, which enhance absorption, up to two or three times daily of Milk Thistle (standardized to 80% silymarin) 100 mg. and/ or Curcumin 250mg.
Consulting a naturopathic physician or other functional medicine practitioner experienced in the evaluation and treatment of detoxification impairment and its underlying contributing factors can be the shortest and safest route to healing for the pathologic detoxifier. Because of the many variables which combine to create this condition, there is no one size fits all approach; each person must be evaluated and treated as a unique individual. During the course of treatment, these variables will change, so tracking this dynamic situation can be challenging and adapting the treatment approach to changes as they occur is essential to a full and long-lasting recovery.
Debra Gibson, N.D. practices naturopathic family medicine in her Ridgefield, CT office. She can be reached at 203-431-4443 or at [email protected]. Check out her blog at www.debragibsonnd.com.