A Whole-Body Approach To Detoxification
An Interview with Russell Jaffe, MD, PhD, CCN
SARAH COOK: Thanks for joining us to talk about bio-detoxification, Dr. Jaffe. What exactly do you mean by the term “bio-detoxification,” and what are the goals?
RUSSELL JAFFE: I use the term “bio-detoxification” rather than “detoxification” to reflect a more comprehensive, systems-biology approach. Whereas detoxification aims to eliminate toxins from the body, bio-detoxification aims to eliminate toxins and balance the upstream systems that contribute to the toxic body burden.
Bio-detoxification relies on the concept that all body systems interact in synergy. Xenobiotics, metals, persistent organic pollutants, volatile organic chemicals, and other toxic substances in our food, water, and air are anti-nutrients that deplete specific antioxidant cofactors. They disable the body’s remarkable ability to use enzymes and catalysts to nurture, repair, balance, and defend us. They disrupt endocrine, digestive, and neurologic function.
These toxins damage mitochondria, create oxidative stress, and trigger immune reactivity. An overburdened immune system is unable to maintain ongoing repair, and instead responds by releasing cytokines, interleukins, and acute-phase proteins. What is meant to be the immune system’s protective response to stress manifests clinically as chronic inflammation.
The therapeutic goal of bio-detoxification is to restore detoxification, digestive competence, immune tolerance, and neurohormonal balance. This is how we will survive the 21st century. We want to optimize both quality of life and lifespan, or as I like to say, “add years to life and life to years.”
COOK: That sounds like a goal many patients would be interested in. How can clinicians decide what types of patients are good candidates for bio-detoxification strategies?
JAFFE: Because of the association between exposure to environmental toxins and chronic inflammation, bio-detoxification is recommended to reduce the personal and societal impact of many chronic diseases.
Over the last three decades, we have conducted clinical outcome studies, with the support of the Health Studies Collegium, that show these approaches can support patients with diabetes, fibromyalgia, and other diseases associated with chronic inflammation.
Bio-detoxification strategies do not “treat” these diseases, but rather support the healthy structure and function of body systems so that the impact of these diseases will be less. The protocols are also recommended to help reduce the risk of acquiring chronic disease later in life. Most people seeking healthcare in modern times will benefit from taking proactive measures and engaging in healthier habits of daily living.
COOK: Are there any contraindications for bio-detoxification?
JAFFE: The strategies I use to support bio-detoxification are tailored to the biochemical individuality of each patient. Patients who are considered to be “high risk” patients should be managed by more experienced practitioners. Although I believe that these protocols can be safely implemented in almost all patients, modifications may be required in certain cases.
COOK: What is your overarching approach to bio-detoxification?
JAFFE: We are a product of what we eat, drink, think, and do. The overarching approach to bio-detoxification is to modify what we eat, drink, think, and do in a way that will optimize the metabolism and biochemistry of each patient.
To that end, we recommend avoiding toxic exposures, avoiding immune-intolerant foods, optimizing hydration, encouraging detoxification through the skin, replenishing nutrients with food and supplementation, supporting digestion, sleeping in a restorative way, exercising, stretching, and practicing mindfulness.
We begin with patient self-assessments and biomarker testing. Based on those results, we personalize a lifestyle intervention for the patient to follow for six months. We might also do a more focused 30-day multisystem detox program. The goal is optimal outcome measures on self-assessments and biomarker testing. We reassess after six months, and if there is not adequate improvement, we consider additional testing.
COOK: It sounds like testing is an important part of tailoring a personalized protocol. Can you explain the self-assessments in more detail?
JAFFE: We use three self-assessments: transit time, waist-to-height ratio, and hydration status.
Transit time is the interval between consumption of foods and elimination of wastes in the stool. I recommend using charcoal capsules to perform the test. The patient takes the equivalent of 1.5 to 3 grams of charcoal (depending on body weight) with 8 ounces of water, between meals. The results will be most accurate if the patient is able to consume the charcoal immediately after a bowel movement. The patient records the time of ingestion, monitors the stool, and records the time when the stool first becomes black, crumbly, or charcoal-looking. Healthy transit time is 12 to 18 hours. Longer transit time allows digestive toxins and xenobiotics to be reabsorbed into circulation, whereas shorter transit time may not be sufficient for adequate nutrient absorption.
The waist-to-height ratio gives an indication of body fat distribution. A higher waist-to-height ratio is associated with obesity and metabolic disease.
Then there is the test for hydration status. Elimination of toxins via the stool, urine, and sweat relies on adequate hydration. Also, our cells need to be hydrated for optimal function. A simple test for hydration is to ask the patient to pinch and release the skin on the back of the hand. If well hydrated, the skin will go flat in a fraction of a second. If it relaxes slowly, the patient needs to drink more water.
COOK: Can you explain the biomarker testing in more detail?
JAFFE: Prioritizing functional laboratory assessments can be an overwhelming task, with so many tests available. That is why I have identified just eight “predictive biomarkers” to determine patient risk and response to therapy.
These eight predictive biomarkers meet the following criteria: They qualify as all-cause mortality or morbidity predictors; they cover one or more aspects of epigenetics; they improve outcomes at lower costs (based on clinical outcome studies); and they are applicable to guide therapies for health enhancement and risk reduction.
I will briefly summarize these eight predictive biomarkers for you and touch on interpretation. We interpret values based not on regular lab reference ranges but rather on the best outcome (i.e., least risk).
Hemoglobin A1c (HbA1c) assesses average blood sugar and indicates insulin resistance or diabetic risk when elevated. Studies have shown that higher exposure to endocrine-disrupting chemicals, like polychlorinated biphenyls, organochlorine pesticides, bisphenol A, and phthalates, is correlated with a higher risk of diabetes. HbA1c also correlates with inflammation and free radical oxidative stress. Conditions that affect red blood cell turnover (e.g., hemolytic anemia, blood transfusion, end-stage renal disease) may skew the results of the HbA1c test. In these situations, fructosamine can be measured instead. Fructosamine offers the additional benefit of a one-month half-life, making it a useful biomarker to measure the immediate effect of lifestyle changes. The best outcome-goal value of HbA1c is less than 5 percent.
High Sensitivity C-Reactive Protein (hsCRP) is a standard measure of inflammation. It increases as a cry for help when the immune system is trying to meet unmet repair needs. Xenobiotics and other toxic substances contribute to the immune burden, leading to a cumulative repair deficit and chronic inflammation. The best outcome-goal value of hsCRP is less than 0.5 mg/L.
Homocysteine maintains an intricate balance with methionine, and their ratio informs us about methylation and detoxification in the body. Elevated homocysteine indicates impaired methylation, impaired sulfur metabolism, and impaired detoxification. The best outcome-goal value of homocysteine is less than 0.6 mcmol/L.
Immune tolerance cell cultures lymphocyte response assay (LRA) by ELISA/ ACT identifies individual reactive foods or chemicals that can impair immune function. The LRA measures all three delayed allergy pathways: type II reactivity (IgA, IgM, and IgG), type III reactivity (immune complexes), and type IV reactivity (direct T-cell activation). It is a cell-culture test rather than a serology test, which enables us to distinguish between helpful, neutralizing antibodies and harmful, complement-fixing antibodies. The LRA by ELISA/ACT cell-culture test is reproducible with a variance of less than 3 percent, according to data we collected over 30 years in blind split samples and published in 2016. The best outcome-goal value of the LRA is no reactivity.
First-morning urine pH, an easy self assessment test, gives an estimate of acid excretion and insight into cellular acidosis and mineral reserves. Whereas arterial pH is tightly regulated by the kidneys and lungs, urine pH varies widely in response to diet and lifestyle habits. Lower urine pH suggests a greater need for buffering minerals, particularly magnesium. Urine pH should be measured after six or more hours of rest, after body fluids have calibrated with the contents of the bladder. The best outcome-goal value of first-morning urine pH is 6.5 to 7.5.
Vitamin D (25[OH]D) plays a role in immunity, neurological health, and bone health. Low vitamin D status is associated with exposure to environmental toxins, such as air pollution. Lower-than-optimal values of serum 25(OH)D are associated with an increased risk of obesity. The best outcome-goal value of serum 25(OH)D is 50 to 80 ng/mL.
The Omega-3 index value is a measure of the amount of omega-3 fatty acids—eicosapentaenoic acid (EPA) FEATURE and docosahexaenoic acid (DHA)—as a percentage of total fatty acids in red blood cells. Omega-3 fatty acids are important components of cell membranes and have anti-inflammatory and repair mechanisms. The best outcome-goal value of this needs to be omega-3 index value.
8-oxoguanine (8-OHdG) is an oxidized nucleoside of DNA that is excreted in the urine after DNA repair. Urinary 8-OHdG is a validated measure of nuclear and mitochondrial DNA oxidative stress. The best outcome goal value of serum 8-OHdG is less than 5 ng/mg creatine.
The first four of these predictive biomarkers (HbA1c, hsCRP, homocysteine, and LRA by ELISA/ACT) are the most validated. The second four (urine pH, vitamin D, omega-3 index, and 8-OHdG) deserve further study, but I find them to be clinically useful. These eight tests can be considered an epigenetic biomarker suite and can guide personalized, bio-detoxification protocols.
COOK: The eight predictive biomarkers really make what could be a complicated subject more manageable. Can you talk next about what lifestyle habits support bio-detoxification?
JAFFE: Our lifestyle habits—or what we eat, drink, think, and do—have the ability to bring balance and lower total allostatic and homeostatic load.
The first step is to avoid stressors: caffeine, nicotine, alcohol, nitrates, drugs, pesticides, solvents, and metals. We then add gentle detoxification strategies.
Do not miss the opportunity to clear toxins through the skin. We lose a half-pound of skin cells every day. Exfoliating the skin cells, taking salt- and soda-bath soaks, and using low-temperature saunas are good ways to encourage elimination of toxins through the skin.
Low-temperature saunas encourage elimination of toxins through the oils of the skin. The temperature is 105 to 110 degrees Fahrenheit, which encourages secretion of oils. The time spent in the sauna is 30 to 60 minutes, or until an oily sheen appears on the skin. A shower with glycerin-based soap and a loofah or gentle scrub brush should immediately follow the sauna to wash off any oils released. Ending the shower with cold water will invigorate the body and mind. Saunas can be repeated one to three times per day, three to five days per week.
Additional lifestyle practices to support bio-detoxification include movement, meditation, restorative sleep, and light therapy. Walking, hatha yoga, tai chi chuan, qigong, Pilates, the Alexander Technique, the Feldenkrais Method, and the Trager Method are all good ways to bring together movement and conscious breathing.
Restorative sleep is a time when the body repairs, regenerates, and further detoxifies. Dichromatic color lamps influence brain rhythms to encourage better mood and sleep. Based on the early work of Edwin Babbitt, Dinsah Jadhiali, Faber, Birren, Bhante Dharmawara, and recent studies by Norm Rowenthal and Al Lewy, I recommend sitting in green dichromatic light for 20 minutes, twice a day, ideally in the morning and early evening.
COOK: It sounds like the lifestyle interventions work well in synergy. In addition to these practices, what specific foods support detoxification?
JAFFE: We want people to eat foods they can digest, assimilate, and eliminate without immune burden.
Remove reactive foods from the LRA by ELISA/ACT test results, and include a wide variety of whole foods with high nutrient density and low toxicity. Encourage consumption of at least 2 to 3 quarts of water or herbal beverages to optimize hydration. Also, aim for 40 to 100 grams of prebiotic fibers from plant foods per day to improve transit time and aid in the elimination of toxins via the stool.
Probiotic-rich, fermented foods support digestive and immune balance. I recommend consuming 40 to 100 billion colony-forming units (CFUs) of organisms per day, preferably from food and drinks. Probiotic-rich foods include kombucha, kefir, yogurt, sauerkraut, kimchi, tempeh, freeze-dried microalgae, miso soup, pickles, olives, and natto.
Other foods to support detoxification include sulfur-rich foods and vitamin C-rich foods. Sulfur-rich foods, which support methylation, include cruciferous vegetables, garlic, ginger, onions, brassica sprouts, and eggs. Vitamin C-rich foods, which support antioxidant status, include citrus, strawberries, broccoli, and spinach.
I encourage my patients to eat simple meals that are easy to digest. Liquid-only days can be added to further allow the digestive tract to rest. On liquid-only days, I advise patients to drink 8 ounces of liquid every hour. Options include fresh vegetable juices, vegetable broth, miso broth, fruit smoothies, watermelon juice, ginger tea, lassi, lemon water, and herbal teas. Liquid-only days can be done one day a week for a month.
COOK: Are there any pitfalls practitioners might experience when implementing bio-detoxification strategies?
JAFFE: When we think about detoxification, we need to consider it in the context of the whole body. Environmental toxins disrupt digestive, immune, neurologic, and endocrine function. If we focus solely on the elimination of toxins, we miss the upstream influences, such as nutrient depletion, mitochondrial dysfunction, oxidative stress, impaired glucose tolerance, and dehydration.
We need to evaluate self-assessments and predictive biomarkers to tailor individualized strategies that address all body systems. Bio-detoxification is a proactive approach that is outcome validated. This approach helps patients maintain a high quality of life, a low cost of healthcare, and high functionality through the lifespan.