Advanced Metabolic Detoxification Strategies

Kristi Hughes, ND

Based on an interview with Nancy Faass

Detox has become a buzzword in the media. Although detox is now a popular self-help concept, many patients could benefit from professional support for a safer, more effective detoxification experience. Those who are dieting and focused on weight loss, for example, may be unaware that the rapid breakdown of adipose tissue can result in a surge of toxins into the circulation.

As Associate Director of Medical Education for the Institute for Functional Medicine (IFM), a trainer for Metagenics’ international lifestyle programs, and a clinician in private practice, I frequently present on the topic of detoxification for both health care providers and the public. In naturopathic medicine, we consider medically supervised detox a powerful method for removing key obstacles to health and healing. I find that the naturopaths I teach tend to be among the providers most knowledgeable in understanding and applying detox protocols effectively in clinical practice. In conjunction with my work as an instructor on advanced detox principles, I have had periodic discussions with naturopathic physicians regarding lifestyle modification programs. Most report that they had a level of familiarity with about 80% of the course content in FirstLine Therapy, but that the insight they gained from the remaining 20% has made a difference in their clinical management and offered usable clinical pearls.

Candidates for Detox

For many patients, effective, gentle detoxification is one of the first steps in healing. Applying the lens of functional medicine, a sequenced metabolic detox program can provide a systematic approach that lowers the patient’s total body burden, allowing more optimal function. An extended personalized detoxification program that lasts weeks or months can offer greater therapeutic benefit, with the potential for deeper, more lasting impact.

One of the unique features of the functional medicine approach is that we begin the detox sequence by addressing energy dysregulation, targeting oxidative stress, and supporting mitochondrial function. Everyone, in any state of health, can benefit from an increase in their cellular energy processes, enhanced cell membrane integrity and fluidity, integrated nutrition and cleansing foods, improved assimilation and elimination, and a healthier lifestyle to improve their vitality and well-being.

Detox not only helps those with weight-loss goals, but also serves a therapeutic purpose for those at risk of metabolic syndrome, blood sugar and insulin dysregulation, and cardiovascular disease. Clinical management of fatigue and generalized pain using therapeutic detoxification strategies often results in improved energy and tissue repair. A personalized care approach, guided by a comprehensive biotransformation and elimination assessment, can support tissue regeneration and enhanced cellular function. In my own practice, the patients who have responded well to advanced clinical detox programs include those who have:

• Insulin resistance or hypoglycemia

• Need for healthy weight loss to reduce adipose tissue

• Energy deficits

• Chronic aches and pains

• Persistent or recurrent irritability

• Changeable emotional disposition

• Multiple allergies or chemical sensitivities

• Paradoxical reactions to appropriate medication or supplements

• Women’s health disorders such as polycystic ovary syndrome

• Fertility issues or the desire to prepare for healthy pregnancy

• Learning disorders, hyperactivity, or autism

• Chronic illness

PREPARATION FOR DETOX

Rarely is enough forethought and talk time dedicated to the prep for a detoxification program. Yet adequate attention to detail in the setup phase is critical to the success of the entire metabolic cleansing process. In order to provide a patient with the most effective detoxification, an evaluation of their elimination capacity is critical. Care should be taken in noting relevant details collected through history, examination, and laboratory analysis and in organizing the information in a way that informs the therapeutic direction.

The first phase of this entire process involves assessing whether a particular patient is appropriate for a metabolic detoxification program and then preparing him or her for the cleansing process. Initially the goal is to bring patients through a series of lifestyle modifications that move them toward a cleaner lifestyle, making healthier choices. Once those changes begin to take root, patients will reach a stage at which they are able to sustain a three-day cleansing process using entirely liquid foods, nutraceuticals, and protein supplements.

As practitioners consider the various therapeutic interventions and dosing scales, guidance will come from understanding the patient’s total toxic burden and the strength of his or her constitution. The focus of specific supplements, botanical medicines, dietary modification, and lifestyle depends on the patient’s stage of the detoxification journey. Note that similar products are often used throughout all the stages, with the dosing schedule increasing in a more restrictive and therapeutic lifestyle program as patients prep for detox and systemic cleansing.

In the next phase of detox, patients engage in a process requiring additional nutraceutical support and specific dietary guidelines, often culminating in a liquid nutrition/medical food fast. The entire detoxification journey is usually based on the timing of those fasting days, making sure that the patient’s life schedule around that time creates the proper space for rest and regeneration. A weekend fast with liquid nutrition is not the easiest time to go to a wedding or a major social event. Planning ahead is part of preparing for a successful detox.

Once the deeper detox and cleansing phase is complete, patients “break fast” and begin reducing the therapeutic dosages of their supplements and medical/functional foods. They are encouraged to pay close attention to their symptoms as they reintroduce foods or behaviors that were restricted or avoided in the elimination protocol. The post-fasting detox window is very informative. As patients begin to transition back into a more diverse diet, they are encouraged to observe how their body responds to food, stress, people, sleep, sleeplessness, activity, lack of activity, and more. It is not uncommon for patients to notice that particular foods create immunological or gastrointestinal reactions as they systematically add common foods back into their diet. Usually it is best to dedicate as much as two months for the complete process. This allows the patient the personal flexibility to accomplish a comprehensive detox program on a successful timeline.

Personalized Toxicity Assessment

In-depth assessment and pattern recognition are the first steps in preparing for the detoxification process. The practitioner must first determine whether the patient is a candidate for detox based on his or her clinical presentation. This is achieved through advanced history-taking skills and the use of key questionnaires to gain robust, well-rounded insight into what is unique about the patient’s lifestyle and manifestation of toxicity. The history includes detail on any symptoms of toxicity, as well as potential risk factors or triggers in the patient’s lifestyle and environment.

Questionnaires

Review of symptoms.

One of the most commonly used questionnaires in clinical practice is the MSQ (Medical Symptom Questionnaire). The MSQ is widely recognized as a useful, patient-friendly tool for the review of body systems, associated symptoms, and their intensity. This assessment also provides an opportunity to step back and observe how the patient is expressing the total toxic load. Any area of the questionnaire that scores greater than 10 directs the physician’s attention to a particular system of the body for a more detailed intake or additional assessment. Scores greater than 50 overall indicate the need for a more thorough personalized assessment to determine if there is an excessive toxic load. The higher the score overall, the slower the detox program should be.

Assessing environmental exposures.

When reviewing a patient’s medical history, symptoms, and symptom progression, half the equation involves gathering the right data to identify potential toxic sources and exposures. This is by far the most difficult aspect of the intake, one which requires time and diligence. The more experience a practitioner has in managing complicated toxicity-based cases, the more robust the line of questioning. To evaluate the impact of the patient’s environment, the provider must learn as much as possible about the patient’s exposures, particularly any type of environmental exposure that could be compromising health.

One of the most efficient tools I’ve seen for these assessments is the TEQ (Toxin Exposure Questionnaire) developed for the IFM Advanced Practice Detox Module. The TEQ is an in-depth survey of the patient’s background and history to identify exposures (past or present) in the home, workplace, or community. The questionnaire also explores hobbies and personal habits that may involve a toxicant. This type of analysis has the potential to open a direction of inquiry that could ultimately resolve the patient’s condition. Identifying the primary causes of disease, while uncovering significant details related to exposures and personal detoxification capacity, are the challenges both the patient and doctor face as they move toward becoming more effective medical detectives.

A Personal Note

When my husband and I were ready to begin our family, we bought a plot of land in the country with the idea of settling in a clean environment to raise our kids. We chose a beautiful place with lakes and trees in a forested area of central Minnesota. When I did a search on my zip code at Scorecard.org, a pollution information site, I identified the most common toxicant risks in our area, which led us to do a more robust assessment of our well water. Due to the increased agricultural activity in the area, our water source has the presence of lead, as well as an iron-loving fungus. Some of the abnormalities in the water sample were most likely linked to the presence of local pesticides and herbicides impacting the ecosystem of our well water. I’ve carried three pregnancies since we moved to this property, so I’m deeply concerned about the development of my little ones and have taken additional precautions to minimize their further exposures now that they are all in preschool and grade school. It was a significant disappointment to realize that there are so few places left that have low toxic exposure levels.

Lab Work

Testing for environmental toxins.

In order to check for specific chemicals and toxins, Metametrix provides a series of panels in serum or whole blood that practitioners can use to effectively identify increased toxicant levels. One of their more common panels includes assessments for whole PCBs and volatile solvents; persistent organophosphates (which have been directly linked to diabetes); herbicides and pesticides, including chlorinated pesticides such as DDT, HCB (hexachlorobenzene), and other commonly used agricultural chemicals. Patients who grew up on a farm or who live near a farming community are good candidates for this type of testing if they are symptomatic. These panels are among the most up-to-date evaluations available for assessing risks and needs for personalized detox.

Metametrix also provides testing for phthalates, parabens, and BPA in urine. Most of us are exposed to these compounds in small amounts on a constant basis. As a result, we may be unaware of the body’s tipping point—the level at which the overall body burden can begin to cause chronic irritation and oxidative stress, resulting in symptom expression. Few people are fully aware of the extent of these toxic exposures. Few realize, for example, that women on average apply more than 120 different chemicals on their skin before they leave the house in the morning (due to compounds contained in their personal care products) or that the number one source of BPA exposure occurs when we touch printed receipts.

Heavy metals can also be an important factor, and additional tests for the presence of heavy metals are an option, especially if the onset of symptoms includes neurologic issues such as mild tremors, paresthesias or mild numbness, intermittent or transient pain syndromes, or petit mal or grand mal seizures. Not all patients can be tested for heavy metals. Assessing for an immunologic reaction to metals through MELISA (Memory Lymphocyte Immunostimulation Assay) can inform the work of functional dentists and practitioners who want a more comprehensive dental assessment to determine if the oral cavity is contributing in any way to the toxic load. The test also provides information useful in deciding if existing amalgams can be safely removed, and whether oral or IV chelation therapy may be indicated to support personal detoxification.

Evaluating liver function.

A hepatic panel is still considered relevant in identifying the status of principle liver enzymes. Even high normal values will be of concern to the practitioner. When assessing patients I often request testing for an additional biomarker for toxicity: the liver enzyme termed GGT (gamma-glutamyl transpeptidase). When elevated, this enzyme helps to identify a higher demand for glutathione due to excessive exposure to toxins or lifelong accumulation of toxicants. These can include over-the-counter and prescription drugs, alcohol and other habitual substances, environmental compounds, and xenobiotics. Research has shown that patients who are obese with high normal levels of GGT (between 40 and 60, depending on the reference range) may be experiencing an increased toxic burden, resulting in an elevated demand placed on glutathione production. Obese patients with elevated normal ranges of GGT levels have a higher association with diabetic risk. Laboratory testing for GGT is provided by mainstream labs such as LabCorp; however, the test is not included in a standard hepatic panel and needs to be specifically requested as a stand-alone evaluation.

Genetic testing.

The detoxigenomic panel from Genova is one of the most comprehensive available to evaluate the impacts of genetic predispositions on detoxification functions and to support clinical guidance on lifestyle modifications. This panel reviews four of the six primary phase II conjugation pathways and identifies SNPs (single nucleotide polymorphisms) for the most common cytochrome P450 enzymes. The test report includes an extensive review of substrates that are processed or metabolized via each specific pathway. This provides insight for patient management, such as prescription medications the patient should avoid in order to reduce the risk of overdose or adverse side effects, and dietary modifications that could improve the functionality of specific detox-related metabolic pathways.

In some cases, patients may not produce adequate levels of phase I enzymes, compromising their ability to process certain chemicals or compounds. Other patients have an increase in the activity level of these enzymes, creating oxidative stress through an elevated burden of reactive oxygen intermediates. Inadequate support for phase II conjugation can also have an impact on the detox process. Metabolic byproducts of detox can place further demand on the body’s endogenous systems. Genetic testing enables us to move beyond general recommendations to make more specific suggestions that address the patient’s unique needs and support individualized healthy lifestyle choices.

Pulling together the details: benefits of the Functional Medicine Matrix.

The Functional Medicine Matrix can assist the provider in organizing the medical case history, identifying repeated symptom triggers or triggering events, and ascertaining the primary underlying causes of the patient’s health concerns. In my own work, before I began using the Matrix and applying a system’s biology approach, I often struggled with detoxification because the topic is so vast, with so many variables. The Matrix provides indications of where to begin as we initiate care, and looks at a range of other considerations, including familial or genetic trends that are the most relevant. Using the FM Matrix, practitioners can identify patterns to more effectively guide them through the detox sequencing.

[Please include the Functional Medicine Matrix (image 2) somewhere in this area]

(Looked great when you ran it in the spring.)

SEQUENCING THE METABOLIC DETOX

Stage 1. Preparation for Metabolic Detox and Adequate Support

In order to adequately prepare for a safe and healthy detox, patients must reduce daily toxic exposures due to food, personal products, and environmental chemicals. Major goals include an emphasis on specific healthy food choices and inclusion of adequate phytonutrients to support systemic detox. It is also important to improve hydration status while gently shifting the diet in preparation for a supported liquid fast. The fast can last for one to five days, and often includes the use of a medical food to provide balanced detoxification, macronutrients, and calories.

Reducing toxic exposures.

The first step involves reducing and removing primary toxins to which the patient has been exposed. Detox could focus on clearing alcohol, caffeine, artificial sweeteners, or unhealthy fats and sugars in the diet. It might mean identifying and eliminating highly allergenic foods or environmental toxins. Stress is also a toxin, and the patient may have toxic emotional relationships—people in his or her life who feel toxic from an energetic perspective.

Hydration.

In a healthy weight-loss program, it is helpful to determine hydration status and to assure that the patient is consuming adequate clean water. This may involve the use of bioimpedance technology to evaluate the patient’s total body water and fluid distribution both within and outside the cells. We can certainly ask patients how much water they are consuming and encourage them to drink about half their weight (in pounds) in ounces of water. For example, a 200-pound person should drink 100 ounces of water, which is about 12 cups (8 oz. servings) a day.

Fiber.

During this step in sequencing it is important to provide adequate dietary fiber in conjunction with high volumes of water while encouraging the body to flush using a purified food approach. Healthy bowel elimination will be essential once we start to increase the liver and kidney detoxification pathways through nutrition. Healthy bowel excretion is necessary to avoid auto-toxicity.

Juice fasts.

Fasting and liquid nutrition are appropriate; however, it is always wise to use these approaches in conjunction with supportive medical foods or emulsified or juiced fruits and vegetables. Water fasts are no longer recommended from a nutrition perspective because they do not provide adequate protein intake for the patient to fuel phase II detoxification enzymes.

Protein.

Balanced amino acids and quality protein sources are key requirements frequently overlooked in detoxification. Protein is now recognized as necessary for a sustained state of fasting. Fad diets that emphasize low fat have a tendency to lower protein intake as well. Naturopathic protocol incorporates adequate protein levels to support the physiology of the detox organs. This approach is in contrast to radical fasts and rapid weight-loss diets, which carry the risk of caloric deficiencies, macronutrient deficiencies, and hydro-nutrient deficiencies.

Health care providers need to be aware of potential side effects that can occur with fasting or detox, particularly an excessive release of toxins if the body burns fat deposits too rapidly. It is important to prescribe adequate calories and nutrients to support ATP (adenosine triphosphate) production given the high energy requirements and dependence on ATP during phase II detox in which compounds are packaged and removed. This is particularly important in patients with exhaustion or chronic fatigue and those with genetic risks or polymorphisms involving the detox systems.

Adequate phytonutrients.

One of the simplest, most beneficial approaches to improve detox status is to encourage the patient to eat a colorful array of fruits and vegetables every day, sometimes described as “eating a rainbow” of food choices. Foods in red or green hues are often very beneficial in supporting the release of key antioxidants because they provide phytonutrients that improve detox enzymes. Delicious fruits such as cherries, pomegranates, and raspberries, and greens such as broccoli, kale, and spinach are at the top of the list of healthy detox foods.

Stage 2. Clearing Toxins Completely Rather than Quickly

Effective detoxification is not about how fast the detox occurs; rather, the clinician must assure that there is adequate time to sequence detox and to support the detoxification pathways. Naturopaths are well trained in sequencing patients safely through excretion and elimination, mitochondrial rehabilitation, and liver detoxification to ensure effective release of toxins, while minimizing the risk of re-toxifying the body. These are all considerations before starting a patient on a weight-loss program.

Excretion and elimination.

While the initial phase of sequencing focuses on hydration status, the next phase emphasizes effective internal cleansing through excretion and elimination. We want to assure that the patient is moving their bowels, and that bile is effluxing properly from the liver. It is also important that the patient is sweating to discharge toxins through their skin and that their urinary system is working ideally—in short, that all the systems involved in eliminating metabolic byproducts are working efficiently.

Supporting bile production.

Once toxins are processed and packaged within the liver, those toxins are effluxed with the bile, released into the upper portion of the small intestine (controlled by the sphincter of Oddi), and excreted in the stool. We want to keep the bile flowing, releasing toxins into the small intestine and eliminating them. To support both bile production and release, patients need to include small amounts of healthy fats in their diet, which may seem counterintuitive in a weight-loss program. My approach has been to follow the metabolic mentors in this field, who train providers that the key to healthy weight loss is to reduce metabolic toxicity through effective diet and exercise-related decisions. Loss of excess adipose tissue continues to be an important aspect of healthy metabolic balance.

Preventing toxin resorption.

Patients dealing with sluggish bowel elimination may experience enterohepatic recirculation, placing them at risk of re-toxifying the body if toxins are introduced back into the bloodstream. An effective binding agent, such as bentonite clay or charcoal, will retain toxins in the gastrointestinal tract to support effective elimination in the stool.

Stabilizing the mitochondria.

Many patients with fatigue, chronic pain, fibromyalgia, or multiple chemical sensitivities suffer from mitochondrial insufficiency, since the mitochondria play an imperative role in cellular cleansing and overall detox capacity. A naturopathic functional medicine approach helps patients jump-start mitochondrial function—an important step in detox preparation that may be overlooked in the clinical setting. Support for the mitochondria means stabilizing the inner membranes of mitochondria through healthy fats in the diet such as DHA (found in fish oils), coconut oil, and olive oil to balance membrane content and reduce inflammation in the tissues.

Key supplements for cellular energy production.

Liver detox relies on the energy capacity of the mitochondria. The efficiency of these energy centers to support cellular detox serves as an essential foundation for a broader systemic detox, and key essential fatty acids are provided to improve mitochondrial energy production. Other important nutrients to support the mitochondria include CoQ10, lipoic acid, and a specific, highly focused B-complex formula designed to support Krebs cycle intermediates of the mitochondria in a rehabilitation program. Adequate magnesium and proper electrolytes should be included, particularly for patients with various fatigue syndromes.

Mitochondrial rehabilitation.

These recommendations are customized to the specific health conditions and needs of the patient. For the patient with prediabetes or diabetes we recommend a mitochondrial rehabilitation protocol described by Dr. Stephen Sinatra in his book Metabolic Cardiology. This approach supports healing in cardiovascular and metabolically compromised patients, providing specific details and dosages for the rehabilitation of the heart muscle and the myocardial sites.

Supporting detox with nutrients and medical foods.

Frequently clinicians use combination detoxification formulas developed to enhance and balance the multiple pathways of the cytochrome P450 enzymes with the conjugating pathways of phase II detox. Both medical and functional foods are increasingly available in the nutraceutical market to fulfill the need for more advanced nutritional support. Many of these combination formulas also integrate key botanicals that can further aid and improve liver or detox function, such as milk thistle, dandelion root, andrographis, rosemary, or turmeric.

Stage 3. Therapeutic Interventions for Detox

In my practice, the preparation and sequencing of a structured, medically supported detox program takes approximately two to three months on average. Very rarely do patients come to our clinic so incredibly healthy that they can go through a ten-day detox and feel great. Most patients need time to prepare: to go shopping, change products, read labels, etc. Patients with more involved chronic conditions often require lower doses of metabolic detox support and a slower-paced detox, enabling them to gradually eliminate various toxic insults from their environment. For patients with more severe conditions, the smallest lifestyle changes frequently have the greatest impact.

Advanced phytonutrient support.

After reducing and removing toxins, the emphasis shifts to repletion, replacing nutrients through diet and nutraceutical supplementation. Applying a whole-food approach, naturopaths and functional medicine providers work with patients to increase the array of fruits and vegetables consumed in support of specific detox pathways. Nutrient-rich choices include cruciferous vegetables (glucosinolates such as bok choy, broccoli, broccoli flowers, brussels sprouts, cabbage, cauliflower, collard greens, and kale) which support the sulfation detox pathway. Traditionally we also recommend detoxifying leafy greens such as beet greens, dandelion greens, cilantro, and spinach. Greens can be taken in a salad, provided in various detox smoothies, or in hydro-nutrient smoothies. Liver function is strengthened through foods such as artichokes and beets. Other elements that aid detox pathways are provided in red and purple fruits and dark blue fruits such as blackberries and blueberries.

Hydrotherapy.

Water therapies can be highly effective in pumping the blood and supporting microcirculation. A detox regimen is an opportune time to invoke the power of hot and cold to move and redistribute the blood supply. This could be as simple as the use of hot and cold showers or it might include saunas or detoxifying baths with Epsom salts or organic apple cider vinegar. Hot and cold stimulation can also be used to encourage the process of sweating. These are effective means of enhancing the elimination of toxins through the skin.

Managing leaky gut syndrome.

It is imperative to repair the permeable gut before mobilizing stored toxins and moving them into the GI tract. Otherwise the patient is at a higher risk for auto-toxicity. Naturopathic providers are experienced in managing intestinal permeability/leaky gut, which is one of the principle causes of systemic toxicity. Consider the appropriate use of colon cleansing in this phase of elimination with various types of nutrients that support and repair the intestinal tract, particularly if there is any sign of inflammation. Supplements well recognized in the repair of intestinal mucosa include pre- and probiotics, plant fibers, nutrients such as L-glutamine, arabinogalactan (extracted from Western larch bark), and soothing extracts such as aloe vera and deglycyrrhizinated licorice root (DGL). These are effective ways to lower inflammation in the gut and manage leaky gut, so the patient is no longer dealing with endotoxicity or byproducts of their own immunologic food reactions.

Maintenance of healthy lifestyle modifications.

The final stage of detox moves patients into a maintenance plan that will allow them to continue aspects of the program for life. A customized transition plan includes repeated testing to track the initial areas of concern, updating body composition results, and identifying unresolved health concerns.

Functional Medicine Detox Sequencing: PURE

Both the art and science of metabolic detoxification programs have evolved significantly in the last two decades. Clinicians are now able to offer their patients supervised detox that can be individualized to their specific medical needs. This is a paradigm shift in clinical practice that will involve educating consumers. Safe, effective medical detox requires far more than simply ordering a “Cleanse in a Box” kit or fasting with grapefruit juice.

In order to improve the clinical approach to metabolic detox, the faculty of the IFM provides a module on advanced practice detox. The module includes the acronym PURE to support clinical implementation of advanced detoxification programs.

[INSERT ART – PURE Acronym about here.]

Pattern recognition.

For most patients, symptoms of toxicity are general and diffuse, developing slowly over time, which makes the patterns more challenging to identify for both provider and patient. We need to recognize when the patient is toxic by observing body composition, taking a good history, providing the TEQ and MSQ questionnaires, and evaluating lab results. Clinical management begins with this process of pattern recognition, by identifying the tissues that are most susceptible or experiencing the greatest impact. Patterns of toxicity that have been identified by Dr. Kenny Bock, described in his book Healing the New Childhood Epidemics, include mitochondrial toxicity, metabolic toxicity, neurodevelopmental toxicity, and immunotoxicity, to name a few. Since the total toxic burden cannot be fully quantified in all patients due to limitations in laboratory testing and/or financial constraints, pattern recognition is often an essential aspect of clinical strategy.

Undernourished.

Patients tend to under-consume adequate protein and healthy fats in their diets, affecting their ability to detoxify. Inadequate levels of key nutrients can result from either insufficient dietary intake or enzymatic concerns secondary to epigenetic influences. Effective coaching on a detox diet starts by encouraging patients to consume a wide colorful array of phytonutrient-dense foods, coupled with an elimination diet while emphasizing detox-focused foods such as onions and garlic, broccoli and cauliflower, berries, greens, and green tea.

Reducing exposures.

To reduce the toxic load, patients are encouraged to read labels, evaluate their personal beauty products, make wiser choices in terms of bottled water, and become aware of other significant sources of exposure in their environment. The goal is to reduce overall toxic load by buying more organics, and when animal protein is consumed, selecting free-range poultry and animals with less exposure to hormones, pesticides, and other contaminants.

Ensuring a safe detox.

Today we have access to extensive detoxigenomic and toxicant testing that was not available in clinical practice a few years ago. Factoring in details from an extensive patient case history with results from lab tests and relevant genomic studies, clinicians are provided with a deeper understanding of the biochemically unique needs of the individual patient, enabling them to create a more personalized approach to reduce the body burden. These emerging assessment tools, in combination with advanced nutraceuticals, will help us manage detoxification protocols more safely and effectively, particularly for our most sensitive and vulnerable patients.

NATUROPATHIC MEDICINE AND THE FUNCTIONAL MEDICINE PARADIGM

As many of you know, key leaders in naturopathic medicine were instrumental in the creation and evolution of functional medicine more than twenty years ago. Currently, many naturopathic providers are involved in the global expansion of functional medicine, both in clinical practice and in the dissemination of advanced clinical strategies to other health care professionals. The therapeutic partnership taught in naturopathic medicine is congruent with the patient-centered approach of functional medicine. Today naturopathic physicians are leading the way in providing advanced detoxification and personalized programs for patients as they master the art and science of detox medicine.

Resources

Institute for Functional Medicine.

IFM provides a philosophical and scientific framework in metabolic medicine that focuses on the underlying causes of disease, and supports early diagnosis and effective early intervention to improve patient outcomes. www.FunctionalMedicine.org

Metagenics.

Metagenics’ FirstLine Therapy is a clinically driven approach focused on well-defined protocols, nutritional products, and real-world case histories. These functional medicine interventions are now being disseminated around the globe. www.Metagenics.com

Metametrix.

A clinical laboratory recognized in the development of metabolic, toxicant, microbial, and nutritional testing. www.Metametrix.com

Genova.

Functional laboratory testing that supports personalized medicine, including panels of individual genomic evaluations. www.gdx.com

Environmental scorecard.

A website that enables consumers to check the sources and severity of toxic exposures in their own community by zip code. www.scorecard.org

Books.

Healing the New Childhood Epidemics: Autism, ADHD, Asthma, and Allergies by Dr. Kenneth Bock effectively describes the impact of toxins on our children, including gut-induced endotoxicity, environmental factors, methylation defects, and resulting neurotoxicity. Additional resources include The Sinatra Solution: Metabolic Cardiology by Stephen Sinatra, MD; Textbook of Functional Medicine 2010 published by the Institute for Functional Medicine; Detoxification and Healing: The Key to Optimal Health by Sidney MacDonald Baker, MD; and Advancing Medicine with Food and Nutrients, 2nd ed., Ingrid Kohlstadt, MD, MPH, editor.

Dr. Kristi Hughes, ND

Dr. Hughes serves as Associate Director of Medical Education for IFM, where her role includes the development and supervision of teaching teams in the Functional Medicine Certification Program and the Functional Nutrition Course. She is also the developer of the Functional Medicine Matrix for IFM and co-developer of the FirstLine Therapy Certification Program for Metagenics. As a trainer on lifestyle and functional medicine, she has lectured internationally for more than a decade and has been instrumental in providing functional medicine resources for clinicians and nutrition professionals in South Africa.

Founder and director of the Dynamic Healing Centers in Minnesota, Dr. Hughes manages an integrated team of health care providers. Her clinical sites also support preceptors, host a naturopathic residency program, and model the integration of functional medicine with a naturopathic foundation. Through the centers she provides distance consulting to physicians and to patients in conjunction with their physicians’ participation, with an emphasis on therapeutics such as supervised detox.

Dynamic Healing Center

507 N Nokomis St Ste 201

Alexandria, MN 56308

(320) 762-4295

Editorial

Our thanks to Jerry Stine, NC, Director of the Lifespan Institute (www.Lifespan-Institute.com) for technical support.

Nancy Faass, MSW, MPH, is a writer and editor in San Francisco who has worked on more than 40 books for publishers that include Elsevier, McGraw-Hill, Mosby, and others. Director of the Writers’ Group, she also provides articles, white papers, and writing for the Web via www.HealthWritersGroup.com.