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How Nutritional Deficiencies Affect DetoxMelanie Dorion, AGNP
The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.
Lahnor Powell, ND, MPHMedical Education Specialist - Atlanta
Melanie Dorion, AGNP
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How Nutritional Deficiencies Affect DetoxMelanie Dorion, AGNP
The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.
• Understand the interrelationships of toxins and nutritional deficiencies
• Review detox pathways, focusing on glutathione conjugation, methylation and sulfation
• Understand functional nutritional testing
• Apply nutritional therapies to support detox physiology
Objectives
• Background on toxins
• Deficiencies in chronic illness
• Detox overview
• Nutrients and detox pathways – focus on Phase II– Methylation
– Sulfation
– Glutathione conjugation
• Testing
• Management
Outline
About Toxins
• The US permits more than 84,000 chemicals to be used in household products, cosmetics, food and food packaging – Most of these have never been tested for safety
• Personal care products are manufactured with over 10,000 chemical ingredients– Some are known or suspected carcinogens, toxic to the reproductive system or known to
disrupt the endocrine system
• In 2012, “industrial facilities dumped more than 206 million pounds of toxic chemicals into America’s waterways”
About Toxins
https://environmentamerica.org/news/ame/206-million-pounds-toxic-chemicals-dumped-america%E2%80%99s-waterways
https://articles.mercola.com/sites/articles/archive/2015/12/08/toxic-chemical-health-risks.aspx
https://www.ewg.org/skindeep/2011/04/12/why-this-matters/#.WxH-eEgvxPY
• Electrosmog– “Astronomers measure radio waves in units called janskys. A typical star shines at
10 to 100 janskys. The Sun shines at about 500,000 janskys. When you hold a cell phone against your head, you are pumping energy at the rate of about 100,000,000,000,000,000 janskys into your brain.”
– There is now 10 billion times more radiation in our environment than there was in the 1960s
– The whole-body exposure from a smart meter at 3 feet is about 100 times more than that from a cell phone
About Toxins
http://www.cellphonetaskforce.org/cell-phones-questions-and-answers-2/
https://olgasheean.com/wp-content/uploads/2016/07/NO-SAFE-PLACE-Letter-to-Gregor-Robertson-240716.pdf
• The WHO International Agency for Research on Cancer classifies cell phone radiation as “possibly carcinogenic to humans”
• Biological effects– DNA damage, sperm damage, neurological disruption, hormonal changes, cardiac/ECG
changes, increased brain glucose levels, behavioral changes, headaches, sleep disruptions, “brain fog” and fatigue
• Smart meters– “Each wireless smart meter pulses on average 10,000 times per day, creating a dangerous
situation for nearby residents.” Jeromy Johnson
More on Electrosmog and EMFs
http://www.who.int/news-room/fact-sheets/detail/electromagnetic-fields-and-public-health-mobile-phones
https://www.emfanalysis.com/health-effects/
“Generally Recognized As Safe” (GRAS)
– Exempt from the FDA approval process
– Used by food manufacturers to add novel ingredients without FDA oversight
– Include food dyes, heavy metals and artificial sweeteners
https://articles.mercola.com/sites/articles/archive/2015/04/29/flawed-gras-system-foodadditives.aspx
https://www.npr.org/sections/thesalt/2015/04/14/399591292/why-the-fda-is-clueless-about-some-of-the-additives-in-our-food
https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm091048.htm
• May contain any of 3,000+ chemicals– Phthalates and ethanolamines
– Include hormone disruptors and allergens
• 6,578 studies in PubMed include information on the toxicity of these chemicals
• Protected under federal law as “trade secrets” and therefore can remain undisclosed
Fragrance
https://www.beautycounter.com/the-never-list
http://www.ewg.org/skindeep/ingredient/702512/FRAGRANCE/#.WxIBmUgvxPY
Red No. 40 Anyone?
Nutritional Deficiencies in Chronic Disease
Medications Associated with Nutrient Depletion
LaValle, James. (2015). Consequences of Cardiovascular Drug-Induced Nutrient Depletion. 369-404
Prilosec/Omeprazole
www.mytavin.com
Nutrient Prevalence
Vitamin C 35-45%
Vitamin D 80-90%
B12 9-10%
Folate 25%
Iron 13-19%
Nutritional Deficiencies in Obesity
Others
Werbach MR. Altern MedRev. 2000;5(2):93-108
Bennett, P. et al (2010). Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine
Condition Deficiencies/links to illness
SIBO Fat soluble vitamins, B12, iron
IBD Many, many!85% in Crohn’s
68% in UC
CFS/ME Marginal deficienciesB vitamins, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-
carnitine, coenzyme Q10, and essential fatty acids
Prostate CA Lower in take of B6 associated w/ prostate CA
Cervical CA Increased risk w/ elevated homocysteine and inversely associated w/ intake of folate, B12 and B6
Oesophageal and gastric CA Inversely associated w/ folate and B6 intake
• RDA most likely not sufficient to prevent subtle metabolic damage and oxidative stress
• DNA damage and oxidative lesions– Inadequate intake of B12, folate, B6, C, E and Fe
– About half the population may be deficient in one of these
• Mitochondrial damage– Iron and biotin (B7) deficiency
– ¼ of U.S. menstruating women ingest < 50% of the RDA
DNA and Mitochondrial Damage
Bennett, P. et al (2010). Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine
Detox Overview – The BIG Picture
Nutrients
Toxins
Phase I
Phase II
Phase III
Detox As We Know It
It Starts with Nrf2
Bennett, P. et al (2010). Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine
Hodges, R. E, et al. J Nutr Metab. 2015; 2015:760689
Nrf2 ActivationARE
Nutrients
Toxins
Phase I
Phase II
Phase III
Nrf2 ActivationARE
Nutrients
Toxins
Phase I
Phase II
Phase III
Then It Gets Really Complicated …
Image source: SHEICON2017
Image source: SHEICON2017
Methylation
Sulfation
Image source: SHEICON2017
Glutathione
Image source: SHEICON2017
Why Focus on Phase II?
• Proteins– Glycine, glutamate, methionine, serine, cysteine, and acetylcysteine
• Vitamins – B2, B3, B6, B9/folate, and B12
• Minerals– Magnesium, selenium, and zinc
Phase II is Heavily Nutrient Dependent
Methylation
Remember How Enzymes Work
Methylation
Image source: SHEICON2017
• COMT
• MTHFR
• BHMT
• COMT– Magnesium
– B6
– High sucrose diet may inhibit COMT
Methylation
Busserolles J, et al. Life Sci. 2002;71(11):1303-12
https://www.ncbi.nlm.nih.gov/gene/1312
• MTHFR– B12
– FAD (B2)
– NADP (B3)
– Folic acid reduces the activity of the folate pathway
Methylation
Cacciapuoti, F. Journal of Cardiol Ther. 2016;3(4):549-553
https://www.ncbi.nlm.nih.gov/gene/4524
NADP, FAD
• BHMT– Betaine (from choline)
– Zinc
Methylation
https://www.ncbi.nlm.nih.gov/gene/635
Image source: SHEICON2017
Sulfation and Glutathione
• Requires– Sulfur-containing amino acids -
cysteine and methionine
• CBS requires– Serine
– B6
– Iron (is heme binding)
Sulfation
https://www.ncbi.nlm.nih.gov/gene/875
CBS
CTH
GSS
B6, iron
• Tripeptide: glutamate, cysteine and glycine
• Magnesium
• Selenium
• Glycine
• B3
Glutathione
Lu SC. Mol Aspects Med. 2009;30(1-2):42-59
Image source: SHEICON2017
Glutathione
Testing
Standard Lab Testing
• CBC– MCV
• Ferritin
• B2– Whole blood
– G6PD deficiency can mask B2 deficiency
– Hypothyroid and adrenal dysfunction decreases activation of B2 → FAD
• B6– Plasma
• B9– Serum and RBC
– Red blood cells reflects total folate status, while folate in plasma or serum reflects almost exclusively methylated folate
• B12– Serum and methylmalonic (MMA)
– Biotin deficiency could blunt the production of MMA
Standard Lab Testing
• Homocysteine (hcy) (optimal 5-7)– > indicates B6, B9 or B12 deficiency
• Methionine– Plasma Amino Acid Profile
– High w/ low hcy = not converting methionine to SAMe
– Normal w/ high hcy = B6 def
– Low w/ high hcy = deficiency in methyl donors
• Magnesium– Serum and RBC
– 24-H urine: high in urinary loss
• Selenium– Plasma (vs serum or whole blood)
• Zinc– Plasma (vs serum or whole blood)
– Ideal range 70-120mcg/L
Functional Testing
Used with permission of Genova Diagnostics
Functional Testing
• Lipid peroxides: cell membrane damage
• 8-OHdG: DNA damage
Management
NutriGenetic Research Institute 2018
KEAP1 and Nrf2 SupportKEAP1
• Zinc
• Selenium
• Sulforaphane
Nrf2
• Low doses
• Isoflavones
• EPA/DHA
• Turmeric
• Sulforaphane
• Tocopherol
• Remove or reduce sources of toxins
• Adequate hydration– Consider adding electrolytes
• R&R
• Support gentle detox– Lymphatic drainage, magnesium bath, infrared sauna, sweating, movement
• Intermittent fasting
• Support the digestive system
Management
NutriGenetic Research Institute 2018
Treatment Pyramid
Test and Don’t Guess!
• Deficiencies due to– Inadequate intake
– Increased need
– Decreased absorption
• Food first
• “Open” the pathway
• Medical food/meal replacements
Correcting Deficiencies
• SubQ B12 and B complex
• IV’s– Saline with magnesium
– Myer’s cocktail
– High dose vit C with Myer’s B
• Patients may feel exhausted at first
IV, IM and SubQ
Case 1
• Mold illness
• MCAS
• SIBO
• Mold illness
• MCAS
• SIBO
• Mold illness
• MCAS
• SIBO
Case 2
• Lyme
• Bart
• MG
• Lyme
• Bart
• MG
More About Detox and Chronic Illness
To reach me:pentadintegrativehealth.com
Questions?
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Lahnor Powell, ND, MPHModerator
Melanie Dorion, AGNPPresenter
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July 25, 2018
The GI Effects and NutrEval: Making Clinical ConnectionsStephen Goldman, DC
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The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.
How Nutritional Deficiencies Affect DetoxMelanie Dorion, AGNP
The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.