By Dr. Mercola
Dr. Bryan Walsh is a naturopathic physician extensively trained in molecular biological pathways. In this interview, we discuss detoxification and the food-based detox program he developed. I took his course and believe it's probably one of the best out there.
In today's world, where most of us are exposed to countless toxins on a nearly continuous basis, detoxification is an important issue that needs to be done on a regular basis if you are seeking optimal health. Research even shows that infants are now born with toxins in their cord blood and first bowel movements — toxins absorbed from their mother.
"You can decide that you, in your 20s, want to live this clean lifestyle and be free of toxins, but that doesn't speak to all of the thing that may have been stored from your life even prior to you being born. They are ubiquitous. They are everywhere … everybody's exposed to something," Walsh says.
"I had read the laypeople's books on detoxification. I believed that we were toxic. I thought that detoxification was probably a good idea. But then I was talking to a colleague who told me about this detoxification guru and how he was describing phase 3 detoxification pathways … It didn't jive with what my understanding of phase 3 was."
Starting From Scratch
Walsh decided to investigate further, delving into the scientific literature and eventually coming to the realization that this "guru" was in fact describing that pathway inaccurately. "I have a problem with that, because in functional medicine we need to be accurate with what we're talking about," Walsh says. He also learned there's yet another phase of detoxification that he'd never heard about called Phase Zero.
"The third thing that really bothered me was I read about what's called a biphasic response for nutrients that are commonly used in detoxification programs or formulas. What the biphasic response basically says is that a low dose — choose your herb — stimulates certain detoxification enzymes or pathways, but then a high dose inhibits those very same enzymes.
In English, this means the amounts found in food generally stimulate detoxification enzymes, but the amounts likely found in an isolated form in a capsule or in a bottle of detoxification product might actually inhibit detoxification.
I looked at that and thought, 'Here we go again. We think we're doing all these great things, but in fact, we may be doing the exact opposite of what it is that we're attempting to do, and nobody's questioning this.' Those three things happened, and I was like, 'all right. I've got to start from scratch.'
Just wipe out everything I thought I ever knew or have been taught about detoxification and go to the scientific literature and say, 'What really is being talked about and studied?'
Before even getting into detoxification, answering questions that I thought I knew. 'Are we even toxic in the first place?' Everybody says we are, but I haven't actually looked at the literature. Another one was, 'Is there a synergistic response?' If there are multiple exposures simultaneously, we're told there's a synergistic response. But again, what does the science really say about this?
Another one we hear about is that the dose doesn't matter … that our body has these built-in detoxification pathways to deal with these things, so therefore a low dose is inconsequential, say the detox naysayers. Another one is, 'Are [toxins] stored in us?' Supposedly we're toxic, supposedly they're stored, supposedly there's a synergistic effect, but what does the science say?"
Is Detoxification Necessary?
What Walsh found was that, yes, virtually all of us are toxic and everyone is exposed to a greater or lesser extent and, yes, chemicals are stored in your body and, yes, there is a synergistic effect. What's more, the dose doesn't really matter, because a low dose can be just as damaging as a high dose, especially when it comes to endocrine disrupting chemicals. The next step was to determine the most effective way of eliminating all of these chemicals, which ultimately led to the creation of the Walsh Detox Program.
"In my opinion, if we truly want to detox, then this is the type of program I believe — and we have some evidence on — that will actually do the job," he says. I couldn't agree more. I've looked at many different programs, and this is the best I've encountered. One of the core components of this program is a modified fasting mimicking diet, originally developed by Valter Longo, Ph.D., professor of gerontology and biological sciences at the University of Southern California.
I've become convinced fasting is an exceptional health strategy, and one of the books I'm currently working on is "Keto Fast," which I'm cowriting with Dr. Alan Goldhamer, director of the TrueNorth Health Center, the largest fasting clinic in North America. They've taken 16,000 people through the water fasting process, many up to 40 days.
While Walsh believes regular water fasting has many health benefits, for this program, he uses a fasting mimicking diet instead. "I just don't think we're healthy enough to [water] fast any longer," he says.
"In every mammal study that I've ever looked at, when there's significant calorie restriction or fasting, xenobiotic levels go up in the blood. Toxin levels go up in the blood every single time, no matter what mammal is being studied, which is to say that … we're flooding our body with these xenobiotics.
If we are at all nutrient-deficient, if we have any deficiencies in the biochemical pathways, including the detoxification ones, now we're flooding the body with all these toxins, and we may not be getting rid of them … If we don't take active [steps] to metabolize or detoxify them and then excrete them, then they're more likely to cause damage elsewhere in the body. I love fasting. I just don't think that most of us are actually healthy enough to do it anymore."
Fasting Releases Toxins
The reason toxin levels go up when fasting is because most toxins are fat-soluble and thus stored in fat. When you're fasting or on a low-calorie diet, you're primarily burning fat as fuel. When the fat is being burned for energy, it releases the fat-soluble toxins stored within the fat cells — water-soluble toxins you are hopefully excreting every day through sweat, urine and feces.
Lipolysis is the process of breaking down stored fat, and anything that induces lipolysis is going to mobilize stored fat-soluble toxins. The more lipolysis takes place, such as during fasting or time-restricted feeding (intermittent fasting) or exercise, the more toxins will be mobilized and released from your tissues.
Walsh's fasting mimicking diet is a slight revision of Longo's work, which is based on the idea that by consuming a certain macronutrient ratio in a relatively short period of time, your body is tricked into thinking it's fasting.
"My concern [with Longo's diet], based on studies showing that during caloric restriction or fasting [toxic] levels go up if you were not actively trying to support detoxification pathways, then where are those toxins going? Are they getting metabolized? Are they just going through Phase 1 and not Phase 2 or Phase 3? All these different things. That's my only issue with it."
To address that, Walsh's diet focuses on foods shown to support and improve the detoxification pathways and detox enzymes like glucuronidation or glutathione conjugation. Brassica vegetables such as Brussels sprouts, broccoli, cauliflower and cabbage are excellent for this, as are garlic, onions, leeks and chives.
Detox Pathways 101
Phase Zero, which most people have not heard of, is the entrance of the toxin into the cell. The liver typically gets all the credit for detoxing, as it's part of Phase 1, where the liver makes the toxins available to be water excreted. However, your intestines have the exact same detox enzymes, as do your kidneys and the male testes. So, detoxification actually occurs in a number of organs. Walsh offers the following analogy of the functions of the four pathways:
"Imagine you're in a room that has two doors. The first door is Phase Zero. Somebody walks in through that door. That's the toxin. They come into your room. The room is the cell. And then you start berating them. You say bad, negative things about them. You expose things about them that they didn't want anybody to know about. That's Phase 1. Phase 1 exposes or adds a hydroxyl group [which] makes [the toxin] water-soluble.
But now, you just tore that [toxin] apart. They start wrecking the inside of the cell. Phase 2 is you hand them $1,000 … That's conjugation … [meaning something] is added to it, and now they're not angry anymore.
Phase 2 pathways include methylation, which adds a methyl group to it; sulfation adds a sulfur group; acetylation adds an acetyl group; amino acid conjugation usually will add glycine. Glutathione conjugation is a glutathione molecule; glucuronidation is a glucuronide molecule.
After Phase 2, [the toxin] is still water-soluble, but now it's not angry. It's not going to cause any damage anymore. But it's still inside the cell. This is what's incredibly important. It needs to leave the second door. That second door is Phase 3. If you block Phase 3, which things like curcumin does, and milk thistle, that [toxin] cannot leave, and there are enzymes inside of the cell that can undo that conjugation. So, now they're angry again. Now, they cause damage inside of the cell."
Three Principles of Detoxification
So, for a detoxification program to be effective, the following three principles must be in place:
- Mobilization, which includes calorie restriction or fasting and exercise to engage lipolysis
- Detoxification, which involves stimulating and optimizing all of the detoxification pathways
- Excretion. Fiber is an important binder that enhances excretion from the bowels. You also need to stay well-hydrated to flush toxins out through your urine. A route of excretion that cannot be overstated is sweating. Using a near-infrared sauna, or a far-infrared sauna equipped with near-infrared bulbs is ideal
The Importance of Binders
So, to effectively detox, you first need to mobilize the toxins, then optimize your detox pathways, and finally bind the toxins flowing through your system so that they can be eliminated through your urine, feces or sweat. To do this, you need some kind of binding agent.
"I have specific binders that I've included in the program, some with meals, and some away from meals," Walsh says. "Also, along with the fasting mimicking diet, I also utilize time-restrictive feeding. Try to eat in the smallest window of time to maximize lipolysis, not maximize mobilization …
Now, if you are in the time-restricted feeding period where you're not eating for 16 hours, you're undergoing lipolysis and you're getting this flood, depending on how toxic you are, of toxins, [which] are getting into your gastrointestinal tract on an empty stomach. How are you going to excrete those if you're not eating as much bulk or food as you were prior?
There are some binders that work better on an empty stomach, and then some, like five of them, that work better with food … I use things like chitosan and charcoal, and different types of fibers. There's evidence modified citrus pectin increases excretion of xenobiotics.
It's vital that you not only [get] fiber when eating, but also, when in a fasted state, [you need to] consume these binders, because if your levels of xenobiotics go up in the blood, some of that is leaking into your gastrointestinal tract. If you don't have the bulk that you normally eat in terms of just total calorie content, you're not going to be moving that stuff along as well. That, to me, is a vital piece. It's not just sweating. It's not just drinking enough fluids. You have to bind those things up for excretion."
Beware of Detox Fads
Walsh brings up an important point with regard to detox research. Rodent studies, for example, can be unreliable when it comes to human detoxification, because rodents have more robust detoxification pathways than humans do, are nocturnal, live far shorter lives and have a faster metabolism.
So, if something works well in a mouse or rat, it doesn't mean it will work as well in us. How they measure detoxification also makes a difference. Typically, researchers will look at enzyme activity or messenger RNA (mRNA), which tells you how the cell is making a detoxification protein.
Walsh cites an in-vitro study that looked at what happened when quercetin was applied to cells. The mRNA went down for certain detoxification enzymes, which suggests quercetin inhibited detox. But when they added a toxin to the mix, quercetin actually increased the toxin excretion. So, even though quercetin appeared to inhibit detox, it still aided excretion of this particular chemical.
One potential reason for this paradoxical finding could be because quercetin inhibits cluster of differentiation 38 (CD38), which is a major consumer of nicotinamide adenine dinucleotide (NAD+), a compound involved in mitochondrial health, cellular redox and energy metabolism. Essentially, quercetin indirectly increases NAD+. There's also the issue of acute versus chronic dosing.
"In most studies, they look at acute dose. They take a cell, they apply green tea (or some other compound), and then they look to see what those enzymes do. Pomegranate acutely inhibited certain detox pathways, but given over a period of two weeks increased those same pathways.
Saying all those things together — choose your nutrient of the month and say, 'Does it help with detox?' Well, was it done in a cell, a rodent or in a human clinical trial? Did they look at mRNA or enzyme activity? What cell tissue were they looking at and does it have different effects? What dose was it, meaning biphasic effects? [and] was it an acute or chronic dose?
Because of all that, you have to be an expert in looking up the research and interpreting the research to say irrefutably that milk thistle is a detoxification nutrient.
I can't say that. Because of that, because of what I've read, I don't have curcumin, green tea, pomegranate or any of those things [in my program], because if you really want to detox, you have to mobilize. You have to open up Phase Zero, 1, 2 and 3, and you have to excrete. Anything that can inhibit any one of those things, I think doesn't have a place in the detoxification program."
For these reasons, Walsh's program includes very few supplements. It's mostly food-based, as you're not likely to harm or create adverse effects on any of the detox pathways with food. As such, it's one of the most pragmatic, safe and relatively inexpensive ways to detox.
How Often Do You Need to Detox?
Considering you're continuously exposed to chemicals and pollutants of all kinds through food, air, water and most household products, how often do you need to detox? Walsh offers the following recommendations:
"The program, as it's outlined, is 10 days. My recommendation is to do the 10-day program. The first six days are calorie restriction, but high-protein. The last four are that modified fasting mimicking diet. What I recommend to people is to do the full 10-day program one month, and then depending on how they do, the next month, do the full 10-day program or just do the four- to five-day modified fasting mimicking diet.
That, for people who are relatively healthy, I think is a good way to go. That's four to five days a month of the fasting mimicking diet portion of it only — all the supplements, all the sauna and all the exercise … For a period of six months or so, doing that once a month is probably not a bad idea for most people, because of the accumulation [of toxins] that we have.
If people want to be somewhat aggressive with this, I would say do two of the four-day fasting mimicking diets a month. Put one in Week 1 of the month, and then do another in Week 3, and then the following month. You can do two of those a month if you really wanted. You mobilize a lot during that."
There are very few absolutes, especially in health. It is likely a six-day, high protein diet would help many, but I think it may not be ideal. My strategy would be to use time-restricted eating to at least eight hours and preferably six. Do this for at least a month and then start the four- to five-day portion of the Walsh protocol.
Why Checking the pH of Your Urine Is a Good Idea
Interestingly, research suggests having urine pH of 7.5 or above greatly increases the excretion of acidic xenobiotics and other toxins. "The pH of the urine dictates whether a xenobiotic on its way out gets reabsorbed or gets excreted," Walsh explains. "It's an incredibly important piece.
If your urine is too acidic, you tend to reabsorb the acidic xenobiotics that have been conjugated and are on their way out. Conversely, the more alkaline it is, you'll tend to reabsorb alkaline xenobiotics, which there are less of. Many xenobiotics are acidic."
To increase excretion of these toxins, all you'd need to do is use a urine analysis strip to measure your pH, and if below 7.5, take some sodium bicarbonate or potassium bicarbonate during the fasting mimicking diet portion of the program, to raise your pH above 7.5. Adding some N-acetyl cysteine (NAC) may also be helpful, as NAC supports glutathione production and calcium D-glucarate to augment glucuronidation.
More Information
To purchase Walsh's detox program, go to MetabolicFitnessPro.com. There are two versions of the program, one for practitioners, which includes nine hours of video delving deep into the science of the detoxification pathways. The other is for patients and nonpractitioners, which includes a less rigorous introduction to the science, along with detailed program instructions.
The practitioner version includes the nonpractitioner version free of charge. You can also find more information about Walsh on DrWalsh.com. If you've been searching for a good detox program, this program is well worth the money. Practitioners can also benefit their patients by understanding the detox process better.