Lifestyle Detoxification Study

Lifestyle Detoxification:
Does dietary detoxification increase measures of wellness?

Cheri L. Soraparu
University of Bridgeport
Research Thesis
Fall Semester 2007


Table of Contents:

Abstract…………………………………………………………………………………3
Introduction……………………………………………………………………………..4
Background……………………………………………………………………………..5
Methods & Materials……………………………………………………………………8
Results…………………………………………………………………………………..12
Discussion………………………………………………………………………………14
References:……………………………………………………………………………...20


Abstract:

There is high exposure to toxins in the environment that pose damage to the human physiology. The human body is equipped with detoxification systems to metabolize, neutralize, and excrete these toxins before damage occurs, however as these systems become overloaded toxins can be stored and the systems can slow, which can lead to many symptoms and even chronic disease. Presently 24 participants went 30 days on a specified detoxification diet which limited certain non-organic food, all processed food, additives, preservatives, and chemicals. Participants also supplemented with a liver cleanse formula and whole food multi vitamin to enhance liver and kidney detoxification systems. A probiotic formula was included to enhance intestinal detoxification systems as well as 60 minutes of exercise induced sweating per week to facilitate lipid toxin release and integument detoxification. All 24 ratings of wellness increased, P > .025, except three, and weight reduced in all participants (mean of 5.16) pounds, with a range of 2-13 pounds), except two. Wellness scores are likely to increase when subjects eat a healthier diet, participate in exercise and loose weight for many reasons in addition to enhanced detoxification. The next step in this research would be to include non-subjective biochemical testing and more extensive subject variables and controls.


Introduction:
Detoxification is defined as “the metabolic process by which toxins are changed into less toxic, or more readily excreted substances” (Webster) and a toxin is basically a poison, or something that is harmful. In our environment, lifestyle, and inherently in our metabolism we are continually exposed to toxins. Some of them are quite potent and can disrupt our biological systems on fist exposure and others are inert in small doses, but become toxic with accumulation. Luckily, we were designed to eliminate and overcome toxic exposure though various systems and organs in our physiology. However, as our environment, food, water, personal products, and lifestyle habits become more polluted our bodies become less efficient at riding these toxins and we then start to feel the poisonous effects in varying manifestations and degrees. Toxins can affect any system or function in the body depending on the degree of exposure and individual differences within persons. Some symptoms of toxic buildup or exposure include but are not limited to: excess weight, diabetes, gallstones, psoriasis, lack of energy, PMS, nervous system disorders, sensitivity to drugs, alcohol and medications, malaise, asthma, digestive complaints, allergies, chemical sensitivities, and constipation (Murry). A relationship between proper detoxification and diseases such as cancer has been investigated. Zbigniew concluded that substances from certain vegetables and fruits enhance carcinogen detoxification and Munday found a relationship between decreased bladder cancer in individuals with higher phase II detoxification induced by brassica family vegetables. Research has also determined that certain individuals or ethic groups are more susceptible to cancer based on genetic differences in detoxification enzymes (Chacko, Kiyohara).
In order to eliminate toxins from the system we have evolved complex processes of detoxification and facilitating these processes by supplying the body with ample required nutrients, co factors, and rest from toxic exposure can only strengthen the process, allow healing, and increase a persons level of wellness.

Background:
There are many routes of toxic exposure. Our human biochemistry is the very first. The colon houses many forms of bacteria for protection and metabolism; a byproduct of this bacterial metabolism is essentially toxic to our system and needs to be changed into a less toxic form to be excreted. Also in the colon as a function of frequent antibiotic use and chronic exposure to sugars our protective bacteria can die off and harmful bacteria can overgrow. This, in addition to chronic exogenous toxin exposure and food allergy, can cause a more permeable colon wall, resulting in these toxic bacteria and other toxic substances that are taken in, penetrating into the systemic body (Galland).
Environmental exposure is the biggest source of toxin buildup. Our produce crops are sprayed with pesticides, herbicides, and fungicides. Livestock are fed these crops and then administered hormones and antibiotics. The food is then processed, preserved and packaged with more chemicals. Chlorine and other chemicals are added to our water supply as a means to prevent bacterial infection, however sometimes in larger amounts than necessary. (Kilburn, Holistic Health Tools). Heavy metals and coal produced from industry are released into the air which we then breathe, or are deposited back into the soil and water. We also use personal products that contain chemicals, use cleaning chemicals and live in homes and work in buildings which emit fumes from carpets, paints and other building materials and scents (National Institute of Building Sciences). We consume alcohol, caffeine, drugs and medications, all of which are considered toxins and must be detoxified by our systems.
All of this exposure cannot and need not be avoided because the skin, liver, intestinal system, and kidneys work hard at detoxification and elimination. However, when there is chronic exposure and no rest for these organs they can become overloaded and weakened, especially when combined with advancing age and stress. Toxins will then accumulate and are stored in lipids and may cause detrimental effects to the neurological, integumentary, immune, and metabolic systems (Murry).
There are four major routes for detoxification and elimination in the human physiology. The skin, intestinal tract, kidneys and liver all function to either make toxins less harmful to the body or to excrete them out of the body, or both.
The skin’s primary function is as a barrier to toxic substances entering the body, but also allows the release of waste material in sweat (Murry).
The intestinal tract’s main function is that of elimination. This occurs with three mechanisms: bile excretion, direct elimination by fiber binding to toxins, and certain strains of friendly bacteria which help with the metabolism of nutrients but also have detoxification functions. (Avdanced Nut., Ibrahim). On the contrary the intestines can be a source of toxic exposure if intestinal transit time is delayed and the toxins contained in the feces remain in the body for longer periods of time.
The kidneys are one of the main routes for the elimination. They function to excreting waste and toxins into the urine and out of the body after processing by the liver.
Lastly and most importantly the liver has a the major role in detoxification. All blood is filtered through the liver which primarily removes any large substances. Secondarily toxins enter the cytochrome p450 detoxification system. Within this system there phase I and phase II. Phase I neutralizes toxins directly, or changes them into a different form which can actually end up being more toxic, but now easier to excrete. Phase II takes phase I metabolites and makes them either water soluble so they will enter the kidneys and be excreted with urine, or makes them fat soluble so they can enter the bile circulation to be excreted in feces (Liska). There are six different components of phase II detoxification, each with specificity for certain types of compounds. All systems must be working efficiently for proper detoxification to occur and numerous things can hinder their functioning, including: lack of exercise, nutrient deficiency, genetics, and heavy toxic burden (Murry). Fortunately much can be done through dietary and lifestyle measures to facilitate and engage these detoxification systems in order to help rid the toxic burden,
The concept of detoxification is not a new one. The Bible makes references to fasting and other cleansing practices as a means to facilitate detoxification (Reid) and animals as well as primitive cultures restrict food to the ill as a means of healing. There is scientific evidence that fasting practices elongate life and wellness (Reid).
The current research speculates that healthy adults who went through a thirty day detoxification utilizing a diet that eliminates ninety percent of exposure to chemicals, drugs, preservatives, alcohol and hormones, while combined with lipotropic nutrients, adequate detoxification co-factors and probiotics to facilitate detoxification and elimination, would show improved subjective wellness scores and weight loss after only a one month period.


Methods & Materials

Subjects were recruited through e-mail contacts and a sign-up sheet in one Naturopathic Clinic. An initial e-mail was sent out with preliminary study information and a request to forward the e-mail to any and all persons that they could. A follow-up e-mail was sent out a few days later going into greater detail about which foods would be allowed for the detox and which foods would have to be avoided. In addition, information was included regarding physical activity, supplementary protocol and the support that was going to be included. At the bottom was an agreement form that those who were willing to participate and whom could be compliant, were to fill out and return. The agreement form stated that they, the subjects, voluntarily were participating in a detoxification study and agreed to the specified diet, supplements, and exercise for 30 days. They were also made aware of some potential minor unpleasant effects, such as, but not limited to, acne, loose stool, and fatigue. There were 29 subjects that agreed to participate. They ranged from 20 -57 years of age, six men and 23 women. When the agreement forms were received, participants were entered into a data base. A group e-mail address was set up and five days prior to the start date (October 8th – 20th 2007) the initial questionnaire, study guidelines, acceptable foods, foods to avoid, deviation tracking sheet, sample menus, recipes and places to shop were sent out and detailed instructions were provided. The questionnaire consisted of three sections. The first section was provided to obtain current diet data. A table was provided with food categories and subjects were to fill in the number of servings of each food category they ate per week. Serving guidelines for each food group were provided as a reference. The next section contained 15 questions regarding general daily wellness and current weight. The questions were short and direct as to avoid any interpretation or confusion. The questions were as follows:

My energy level usually is…………………………….

My motivation is………………………………………

My quality of sleep usually is………………………….

The frequency I wake feeling refreshed is……………..

The frequency I fall asleep easily is……………………

The quality of my digestion usually is…………………

The frequency of my elimination usually is…………….

My fatigue level is………………………………………

The frequency of a positive mood is …………………..

The quality of my short term memory is……………….

The frequency that my mind feels foggy is……………

My craving for sugar is………………………………….

My headache frequency is………………………………..

My allergy level is………………………………………..

The severity of any other condition I have is……………
Instructions were provided to rate each question on a scale of 1-5 as follows.

Generally Speaking Rate the Questions Below on a scale of 1 – 5.

1 2 3 4 5
Low Somewhat Low Moderate/Average Somewhat High High

The last section of the questionnaire had subjects rate how their favorite shirt and pants fit on a scale of: loose, somewhat loose, just right, somewhat tight, and tight. These ratings had corresponding numerical values of 1-5 respectively. This measure was included to asses weight or fat loss as a better indication than just a scale weight because of daily fluctuations.
A Yahoo Group was set up for participants to share recipe ideas, questions, and concerns. There were recipes and/or menu ideas posted weekly. There were also occasional group e-mails answering questions from individual participants as well as acceptable organic restaurants, places to shop and label reading instructions. All participants were invited to a Pot Luck where recipes were provided, by the researcher, which they could make and bring. This was an attempt to demonstrate to participants various cooking and preparation methods that could be used during the study. It was also an opportunity for the participants to gather with the researcher and ask questions and network with other participants. Only 5 participants attended. There were two subjects who lived out of state and could not attend. Others may have been too far to reasonably drive, but mostly subjects claimed lack of time as reasoning not to attend.
All participants were instructed generally to eat only organic meat and certain organic foods as specified by the Environmental Working Group as the most highly toxic. They were to avoid all processed grains, sugars and foods with preservatives and chemicals added. No alcohol was allowed. The only dairy that was allowed was raw milk and raw cheese and plain organic yogurt (see appendix for specific food lists).
Participants agreed to exercise 60 minutes a week strenuously enough to sweat and to track their deviations up to a maximum of 15 and were to pay $10 for each deviation to at charity. The donation was an attempt to decrease deviations by having a financial incentive.
Three supplements were required to be taken regularly. Vita Lipotropic by Eclectic Institute, Alive – iron free by Nature’s Way, and Primadopholus Bifidus by Nature’s Way. Two Lipotropic in the morning and two in the evening. One Primadopholus and one Alive in the morning and evening.
The liver detoxifications systems would be enhanced through the dietary supplement Vita Lipotropic by Eclectic Institute. This supplement contains sulfur amino acids to promote phase II detoxification, as well as cofactor nutrients needed for phase I and II systems. Sylmarian is also included in the supplement to enhance liver repair and oxidant protection. The lipotropic nutrients promote the flow of fat to and from the liver.
A multi-vitamin and mineral supplement called Alive by Nature’s Way was included to ensure all subjects had the proper nutrient levels need to sustain detoxification function and glutathione and other antioxidant supply. Alive was chosen because the company tests their products for absorption (Nature’s Way), includes “green foods” which also provide enhanced detoxification (Hwang) and the price is reasonable for most.
The probiotic formula, Primadopholus Bifidus, was chosen by the same company, Nature’s Way, with five strains of bacteria at a dosage of one million strains per capsule to ensure growth of beneficial bacteria in the hopes to eliminate any harmful bacteria overgrowth.
Subjects were given permission to e-mail or call a cell number at any time if they had questions, concerns or needed help with something. Occasionally a few calls and e-mails were received and action was taken immediately.
At week two a short questionnaire was sent to all participants asking about the number of deviations, exercise minutes, organic choices, vegetable servings and questions or concerns (all of which were addressed). Then at week four a study end questionnaire was sent out for all participants to fill out and send back. This was to be completed by their end date and a follow-up questionnaire will be sent out one month after the end of the detox period. The end questionnaire consisted of the same questions and ratings as the beginning questionnaire and specific instructions were provided to use the same scale and weight at the same time of day and to use the same clothing for the fitting. The end questionnaire also included an additional section for commentary, concerns, question, and additional information. They were asked to list the number of deviations they had and a percentage for their adherence rate. Participants were asked to be thoughtful, truthful and careful with their answers. Participants were given instructions about how to end the detox by slowly incorporating avoided foods back into the diet and to only consume these foods in moderation and infrequently.

Results

The statistical analysis used is the t-test for paired differences. The null hypothesis is, there are no differences between the wellness scores before the detox diet and after the diet (Ho:µd=0). The alternative hypothesis is that the wellness scores will be higher after the detox diet (Ho: µd>0) at a P value of .025. Out of the original 29 participants 26 completed the study, but two did not turn in a completed end questionnaire in time. Using an Excel spread sheet each of the 24 participants beginning and end wellness scores were plotted and the mean differences (µd) and standard deviations (s) were calculated for each value measured. The standard error (s / √n) was then calculated by hand as well as the test statistic (t- score = µ d / standard error) (Rumsey). The t-scores were compared to a t-distribution table at the 97.5th percentile with 23 degrees of freedom. P > .025 for all measures except severity of foggy mind, headache frequency, “other” condition, and shirt fit in shoulders. The null hypothesis is rejected.
In other words the subjective wellness scores of participants in the categories of: energy level, quality of sleep, waking refreshed, falling asleep easily, motivation, digestion, elimination, positive mood, and short term memory were generally increased while the measures of: sugar cravings, fatigue level, allergy level, shirt fit overall, pants fit overall, and weight were decreased.
In addition to the statistical results, generally speaking all subjects were pleased with the results of the 30 day diet and were thankful for the opportunity. Subjects were asked to comment on any result not covered in the questionnaire and a few notable responses were that a type 1 diabetic was able to decrease the baseline insulin dose due to better insulin release and many subjects reported decreased gas and bloating. All subjects reported a 90% or higher compliance rate and 15 or fewer deviations, except one who reported 75% and 20 deviations.


Discussion

The goal in this research was to determine whether decreasing the amount of toxins consumed while facilitating detoxification systems would increase a person’s wellness. Wellness was defined by energy levels, motivation, quality of sleep, waking refreshed, level of fatigue, quality of digestion, frequency of elimination, positive moods, weight loss, and clothing fit. These parameters were subjectively rated by the participant prior to the beginning of the study and again at the end of 30 days on the detox diet.
Participants were given dietary guidelines to facilitate detoxification and healing in the body. They were asked to consume only organic meat or meat that did not contain hormones, antibiotics, preservatives, additives or other chemicals. They were also given a list of produce that had to be organic (see appendix) because of high toxic residue as specified by the Environmental Working Group. These specifications were in force as a means to decrease the toxins entering the body. Other guidelines enforced to decrease the toxic load were: avoidance of alcohol, over the counter medications as much as possible, reading labels and avoiding all consumption of products with additives, chemicals, food colorings, and preservatives including gum, mints, dietary supplements, dressings, sauces, spices, etc. These products were allowed if completely natural without the additives listed. By decreasing the toxins consumed the liver can rest as it is not continually detoxifying exogenous substances and can rid the body of stored toxins. Rest will allow energy to be spent healing if necessary. Other guidelines enforces were avoidance of refined grains and sugars. This was enforced along with riding the consumption of toxins to free up energy and work for the liver. There is only so much energy available for use at one time and two opposing processes cannot occur at the same time (Gropper). Therefore, if excess carbohydrate is consumed the liver must transform it into storage forms and there will be less energy for healing. The excess carbohydrate will also tax blood sugar control mechanisms which can release compensatory hormones like epinephrine and cortisol (Gropper) causing stress in the body. During stress the body is not repairing or healing. Dairy products were not allowed, except for raw milk and raw cheese, because some authorities believe the pasteurization process causes the proteins to be altered and digestibility is hindered leading to inflammation in the body, which turns the systems energy usage away from healing and detoxification. This diet inherently contained large amount of fiber from vegetables, legumes and whole grains, which is necessary to increase intestinal transit time and toxic binding in the colon.
Sixty minutes of sweating from exercise was required as an achievable amount for everyone, it is under the guidelines suggested by the American Heart Association and the American College of Sports Medicine. Sweating allows toxin release form the body into the sweat and exercise will burn lipids and release stored toxins.
The supplements were used in addition to the diet and exercise program to facilitate detoxification and healing. The liver supplement Vita Lipotropic contains B6, magnesium, choline, insoitol, methionine, freeze dried beet, freeze dried artichoke, grape root, and milk thistle which all enhance cytochrome p450 phase I and II detoxification (Murry, PCC). This supplement also contains freeze dried and dandelion to facilitate urine flow (PCC). The multi-vitamin Alive was included to ensure all participants had adequate co-factor nutrients required for detoxification process (zinc, copper, manganese, niacin, ascorbic acid, B12, folic acid, riboflavin) and anti-oxidant reactions (A, C, E, selenium, copper, zinc, manganese). The probiotic was used to ensure proper beneficial bacteria in the colon for detoxification and elimination.
Employing these guidelines helped participants bodies excrete stored toxins from the body in the initial weeks providing a cleaner less stressed body at the end of the study, which was demonstrated by increased wellness in the measures taken. It is interesting to note that after the first week or two of the study several participants noted increased fatigue, acne, elimination activity, and malaise, which can be contributed to toxin release. All of these complaints subsided (as demonstrated by the end questionnaire) except the elimination activity, with increase feelings of wellness.
There are various other factors that could have increased the participants wellness scores in addition to or instead of a decreased toxic load and increased detoxification, the first being a placebo effect. It is generally known, due to increased public heath campaigns that vegetables and whole grains are good for health and that sugar and processed foods are not good for health. Also in an effort to recruit compliant subjects it was stated that a detox diet could make one feel better and facilitate weight loss and lasting well-being afterward. The subjects may have assumed from the beginning of the study that they were going to feel better and that their scores were going to increase. Therefore, they could have subconsciously increased their scores based on the placebo effect, however, weight as a non subjective measure decreased in every subject except two and clothing fit decreased in all subjects. In addition, the questionnaire asked that the participants take time to fill out the questionnaire as honestly and thoughtful as possible.
Another, possible explanation for the increased wellness measures is that everyone had an increased nutrient level due to a generally increased nutrient dense and fibrous diet, and use of a multi-vitamin. The detox diet inherently is a healthy diet composed of whole foods which contain many more nutrients and fiber than a diet of processed foods and refined sugars. An attempt to control for this factor was made by having all participants fill out a table listing their general weekly consumption of certain foods based on serving size, which were provided for each food category. The average refined sugar servings per week for the participants was 6.2 servings per week with a range of 0-36 and a mode of 3, and the average processed grain servings per week was 4, with a range of 0-10 and a mode of 0. Vegetable serving average was 12 per week, with a range of 6-24, and whole grains were 6 per week, with a range of 0 - 27. There can be much interpretation as to whether this group of participants is considered healthy, but given the large range it would seem there are some with a healthier diet and some with an unhealthier diet, and those in-between. This study seems to have a fairly representative sample of healthfulness and un-healthfulness with slight favor toward healthfulness. Since wellness measures increased in those participants already consuming a healthful diet containing vegetables and whole grains it can be assumed that another variable is responsible than solely a consumption of these foods. Multi-vitamin use could be a factor. Participants were not questioned as to current supplement use or not. The multi-vitamin was necessary for proper levels of cofactor nutrients for detoxification process, but the increased nutrient intake could have increased wellness measures.
The next variable that could have accounted for some increased wellness measures is a stabilized blood sugar level in participants. The consumption of whole grains and vegetables containing fiber with the elimination of refined sugars can stop increases or decreases in blood sugar and subsequent side effects of compensatory hormone release.
The last variable that could account for some of the increased wellness scores in addition to the weight loss was the requirement of 60 minutes of sweating per week. This was required as a means to facilitate detoxification through the skin, and to burn fat cells, which contain stored toxins. Exercise alone can increase energy levels, lead to weight loss, facilitate quality sleep, increase mood (American College).
There were many limitations to this study. The participants were asked to be truthful; however no tracking was done for their diet other than a simple questionnaire. Assumptions were made that the group was reasonably honest because they had some personal knowledge of who the researcher was and how important honest data was for the proper completion of the study.
Participants also were left to determine the quantity of their deviations and the percentage in which they adhered to the dietary guidelines. Instructions were given and measurement guidelines for what counted as a deviation, but consistency between subjects in reporting and remembering all the small details can not be accounted for. Also, each person has a different idea of how well they followed the diet; one person’s 90% could be another’s 75%. A limit of 15 deviations was suggested, which was estimated to equal a 90% adherence rate based on the assumption that people generally eat five times a day (three meals and two snacks). A calculation of eating 5 times a day multiplied by 30 days was 150 meals/snacks. 150 divided by 10% (the maximum amount of deviation) equals 15.
Another limitation was that collection of the sample was not representative of the population and not done randomly, participants had to have some skill to cook and sufficient time to prepare meals therefore only those who knew they could handle it agreed to participate. Some may argue that most of the participants were assumed to be “health conscious” because of where the participants were recruited (Naturopathic clinic and friends or friends of friends of a Nutritionist). This can be looked upon both ways, as a limitation and as an advantage. If among the health conscious, effects were seen, then the population that is not health conscious would definitely benefit. However, the type of lifestyle changes recommend would be very hard to follow for those not somewhat accustomed and would need to be modified or more support would need to be given.
To improve this research, an inclusion of: a more varied subject pool, objective measures like blood lipids or liver enzyme tests, a longer follow-up period and a more extensive and detailed questionnaire could be employed. There also could be controls set for prior health issues and exercise quantity among participants.
Toxins are found widely distributed in our environment and we can only limit our exposure to a certain degree. This is why enhancing detoxification systems in the body are crucial for protection against chronic disease, but also to increase and maintain wellness and feeling optimal in day to day life. The present study found significant mean increases in wellness ratings in individuals undergoing a 30 day detoxification program, but smaller lifestyle changes including incorporating more organic foods, more fresh green vegetables, exercise and decreased sugar and alcohol consumption can all help keep detoxification systems working to protect us.

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