pure; advanced dietary interventions for...

PURE; Advanced Dietary Interventions for Detoxification

Kristi Hughes, ND Sydney, Australia June 2014

Gather Organize

©2014 The Institute for Functional Medicine

25 57

Weight Gain/Inc Waist Circ Hypertension Dyslipidemia

Fatigue/Reduce Stamina

50

Electrician; working on construction sites since mid 20s

Weight Gain & Fatigue

Hypertension Incr Chol & LDL

Avid exerciser and runner Reduced exercise

Loves to cook “foodie”

Increased Triglycerides

Incr glucose

Carol’s plan

52 54


Obesity, VAT (Incr WHR) Hypertension Endothelial Dysfunction??? Joint stiffness morning

Mild Testosterone Deficiency??? Insulin Resistance??? Insulin Resistance???

Blood Sugar Elevation HTN and Met Syn???

Occupational Exposure

Fatigue Muscle Soreness

Obesity, VAT (Incr WHR) Endothelial Dysfunction??? Joint stiffness morning

?


Dave’s Initial Therapeutic PlanSupplements On

RisingBkfst Mid

MornLunch Mid

AfternSupper Mid

EvenBeforeBed

DuringNight

What’s Your Plan for Dave?

Nutrition Assessments

PFC-MVP Biomarkers

Gather Organize Re-Tell

Order/Prioritize The ABCDs of

Nutrition Evaluation

Nutrition Therapeutic Interventions


Clinical Nutrition Findings Core Food Plan Elimination Diet Cardiometabolic Medical History Seeking Healthy Diet, All Ages,

Athletic, Pregnancy, Overweight, Overweight, Underweight.

Allergies, Atopy, Asthma, GI Distress, Pain and Fatigue, AI Diseases.

Metabolic Syndrome, Type 2 Diabetes, Hypertension, Dyslipidemia, Obesity

ATMs Antibiotics, Multiple infections, Trauma, Stress, Familial allergies, Mother with Group B strep, Acid Blocking Medication, Maternal use of PPI during pregnancy

Family History, T2DM, CVD, HTN, Obesity, Sedentary Lifestyle, Sleep Disorder (inadequate sleep and Sleep apnea)

Anthropometrics Non-specific Increased BMI, Increased ECW/ICW Incr: BMI, WC, WHR, Fat, Blood Pressure

Biomarkers & Labs Normal screening values Incr. IgG or IgE food reactions, Celiac, Autoantibodies, Dysbiosis.

Incr: HgbA1C, FBS, insulin, hs-CRP, TrigsDecr: HDL

Clinical Indicators fromNutrition Physical Exam

Non-specific Dry Skin, thin eyebrows, Fluid retention, and skin inflammation.

Incr: WC and WHRSkin tags, acanthosis nigricans, peripheral neuropathy.

Diet and Lifestyle Inadequate nutrientsPrepared food

Food Triggers, Allergy Exposures. Excess reliance on one food.

Excess simple sugarHigh CHO intake, GI foods, low protein, excess alcohol, elevated trans fats.

Matrix Patterns Non-specific AssimilationBiotransformationCommunication/Defense and Repair

Structural IntegrityTransportDefend and Repair/Communication

CardiometabolicMetabolic Syndrome, Type 2 Diabetes, Hypertension, Dyslipidemia, Obesity

Trauma, Stress, Familial allergies, Mother with Group B strep, Acid Blocking Medication, Maternal use of

Family History, T2DM, CVD, HTN, Obesity, Sedentary Lifestyle, Sleep Disorder (inadequate sleep and Sleep apnea)

Increased BMI, Increased ECW/ICW Incr: BMI, WC, WHR, Fat, Blood Pressure

Celiac, Autoantibodies, Dysbiosis.Incr: HgbA1C, FBS, insulin, hs-CRP, TrigsDecr: HDL

retention, and skin inflammation.Incr: WC and WHRSkin tags, acanthosis nigricans, peripheral neuropathy.

Food Triggers, Allergy Exposures. Excess simple sugarHigh CHO intake, GI foods, low protein, excess alcohol, elevated trans fats.

Communication/Defense and Repair

Structural IntegrityTransportDefend and Repair/Communication



RisingBkfst Mid

MornLunch Mid

AfternSupper Mid

EvenBeforeBed

DuringNight

Metabolic Food Plan

MultiVM with Phytonutrients

1

Anti-inflammatory hops extract

1 1

EPA/DHA 3:2 720 mg

2 1

Insulin sensitizing combo

2 2 2

Liver detoxification formula

2

D3 5000 1


O T T G G OG

Gather Oneself & Information

Organize on Timeline & Matrix

Tell the Patient’s Story

Order of your Priorities

Initiate Assessment and Care

Track Progress O I

Lost 34.4 lbs Lost 24.1 lbs of fat Dropped 3.1 L Moved fluid into the cell BP normalized

2 Years Later; Making Progress and Time to Re-evaluation

Lost 34.4 lbs BP normalized Gluc, Insulin, HgbA1C Trig 216 -> 88 Vitamin D improved Testosterone improved

Cholesterol-No Change LDL-no change Apo B/A1 .85

Inflammation VAT (Incr WHR) Low D InflamVascular Risks

Fatigue Muscle Soreness Oxidative Stress

Mild Testosterone Def Insulin Resistance Metabolic Syndrome

Insulin Resistance Blood Sugar Elevation HTN and Met Syn

Occupational Exposure Lead exposure Heavy Metal concern Low Glutathione

Obesity Overweight VAT (Incr WHR) Hypertension Endothelial Dysfunction Erectile Dysfunction Joint Stiffness

Adequate and Restful

Consistent walking and

jogging

Low Anti-oxid Reduced Magnesium Methylation concerns Low B2, B6, B12, Folic Acid

Moving, job satisfaction, excited about change to position for retirement ,

happy in marriage


Pattern Recognition

Undernourished

Reduce Exposures

Ensure a Safe Detox



RisingBkfst Mid

MornLunch Mid

AfternSupper Mid

EvenBeforeBed

DuringNight

What’s Your NEW Plan for Dave?

Dave’s Updated Therapeutic PlanSupplements On

RisingBkfst Mid

MornLunch Mid

AfternSupper Mid

EvenBeforeBed

DuringNight

Detox Food Plan

EFAs 600 (3:2) 1 1

MetaglycemX 2 2

Advaclear 2

Glutaclear (NAC/Vit C) 2 2

D3 5000 1

(Renew) Metallaclear 1 1

Heavy Metal Detox Rotations of oral chelation with EDTA and DMSA

Bowel Motility Ensure daily bowel elimination

Inflammation VAT (Incr WHR) Low D InflamVascular Risks

Fatigue Muscle Soreness Oxidative Stress

Mild Testosterone Def Insulin Resistance Metabolic Syndrome

Insulin Resistance Blood Sugar Elevation HTN and Met Syn

Occupational Exposure Lead exposure Heavy Metal concern Low Glutathione

Obesity Overweight VAT (Incr WHR) Hypertension Endothelial Dysfunction Erectile Dysfunction Joint Stiffness

Adequate and Restful

Consistent walking and

jogging

Low Anti-oxid Reduced Magnesium Methylation concerns Low B2, B6, B12, Folic Acid

Moving, job satisfaction, excited about change to position for retirement ,

happy in marriage


Food Plays a Role in All Phases of Detoxification

Toxins InToxins In

Phase I Phase I SupportPhase I SupportSupport

Phase I Phase I Protection Protection Protection

Phase II Phase II SupportPhase II SupportSupport

Toxins OutToxins Out

FOOD

Sequencing a Detox Program


REMOVE (5R) Detox Foods

1 2

Reduce or Remove •Alcohol & Caffeine •Artificial Sweeteners •Fats & Sugar •High Allergen Foods •Environmental Toxicants •Toxic Habits •Stressors

Therapeutic Intervention Personalize

3 4


Ideas on Eating CleanToxins InToxins In





Food ProductsFood PackagingFood Preparation


Ideas on Eating Clean

Food Products Food Packaging Food Preparation

Organically grown Whole foods Slow, low cooking

Non-GMO No plastic casing No deep frying

No synthetic dyes or additives No metal cans (BPA) No significant browning

Grass-fed, lean meats No cellophane or foil Use intact cookware without scuffs

Wild-caught fish Glass preferred Choose non-toxic pans, pots, skillets

Expeller-pressed, unrefined oils No high heat

Filtered water

Org

anic

& C

lean

Foo

d

Remove Toxic Foods

Food toxins include:

– Petrochemical residues from some farming practices

– Mercury from industrial waste in fish

– Lead in the water – Advanced glycation

endproducts (AGEs) from food preparation (overcooking)

– Polyaromatic hydrocarbons from charbroiled meat

– Trans fats – Naturally-occurring plant toxins

(e.g., aflatoxin)

How to Limit Exposure to Pesticides

• Do not overconsume foods that concentrate pesticides (animal fat, meat, eggs, cheese, milk)

• Buy organic produce • Try to buy local produce in

season • Peel off the skin or remove

outer later of leaves of some produce.

• Remove surface pesticide residues, waxes, fungicides, and fertilizers by soaking the food in a mild solution of additive-free soap (pure castille soap, biodegradable cleanser).

• Use scrub brush


Include Clean, Nourishing FoodsEat foods which:

– Nourish the organs of detoxification (e.g., liver)

– Provide substrates and cofactors for optimal detoxification through cellular, hepatic, gastrointestinal, and renal mechanisms

– Modify genetic expression

– Provide phytochemicals that impact cellular signaling


1 2


Therapeutic Intervention Personalize

3 4

Elimination Diet

Features of the Elimination Diet

The Elimination Diet

Reduces Inflammation

Repairs Intestinal

Permeability

Phytonutrients to Heal the Gut

Personalized Diet Approach

Reduces Toxic Burden

No Calorie Restriction

Promotes Body Awareness to

Foods

Identifies Food Triggers


1 2


May Include •Vegetables •Citrus •Protein •Good Oils •Fiber •Water •Herb

Therapeutic Intervention

3 4

Phyto Spectrum Elimination Diet

Personalize

What is the Importance of Phytonutrients in Detox?

Phytonutrient Diversity

The Power of Phytochemical Diversity

“These findings indicate that botanical diversity plays a role in determining the bioactivity of high-VF diets and that smaller amounts of many phytochemicals may have greater beneficial effects than larger amounts of fewer phytochemicals.”

J Nutr.2006 Aug;136(8):2207-12. Dietary botanical diversity affects the reduction of oxidative biomarkers in women due to high vegetable and fruit intake. Thompson HJ, Heimendinger J, Diker A, O'Neill C, Haegele A, Meineck B, Wolfe P, Sedlacek S, Zhu Z, Jiang W.

Carbohydrate = 250 gramsProtein = 100 grams Fat = 60 gramsPhytonutrients = 1.5 grams

We eat less than a teaspoon a day but they make a huge impact!

Walsh et al., Am J Clin Nutr. 2007 Dec;86(6):1687-93.

Fat Phytonutrients

Walsh et al., Am J Clin Nutr. 2007 Dec;86(6):1687


6 Steps to Getting More Phytonutrients



Aim for 9-13 Servings of Plant Foods Everyday



Know Your Phytonutrient Sources



Eat the Rainbow of Colors



Vary Your Choices




Maximize Combinations



Be Creative with Substitutions

Plants as Detox Modulators

68

Liu, Adv. Nutr. 4: 384S–392S, 2013.

• FODMAP • SCD • GAPS • Anti-Candida

Re-introduction Challenge Foods

???

Take Detox Focused Approach


1 2




Therapeutic Intervention •Nutraceuticals •Botanicals •Medical or Functional Food •Liquid Fasting •Chelation Therapy •Hydrotherapy •Homeopathic Drainage

3 4

Phyto Spectrum

Elimination Diet

Personalize

Detox Food Plan


1 2





3 4

Detox Food Plan

Phyto Spectrum

Elimination Diet

Personalize

Introducing the

Detox Food Plan

Tailored to maximize the therapeutic quality of nutrients in all phases of detoxification


Why is Food Important to

Your Patient’s

Detoxification Process?


Food Plays a Role in All Phases of Detoxification

Toxins InToxins In





FOOD


Phase I Nutrients and Food Sources on the Detox Food Plan

Toxins InToxins In





Nutrient Food Sources Riboflavin (vitamin B2) Soybeans, spinach, tempeh, crimini mushrooms, eggs, asparagus, almonds,

turkey Niacin (vitamin B3) Tuna, chicken, turkey, salmon, lamb, beef, sardines, brown rice Pyridoxine (vitamin B6) Tuna, turkey, beef, chicken, salmon, sweet potato, potato, sunflower seeds,

spinach, banana Folic acid Lentils, pinto beans, garbanzo beans, black beans, navy beans, turnip

greens, broccoli Vitamin B12 Choose methylcobalamin for supplemental source, sardines, salmon, tuna,

cod, lamb beef Glutathione Undenatured whey protein, asparagus, curcumin, broccoli, avocado,

spinach, garlic, foods high in vitamin C (e.g., citrus fruits) and selenium (e.g., Brazil nuts)

Branched-chain amino acids

Whey protein, chicken, fish, eggs

Flavonoids Virtually all plant foods, including apples, apricots, blueberries, pears, raspberries, strawberries, black beans, cabbage, onions, parsley, pinto beans, and tomatoes

Phospholipids Soy, sunflower seeds, eggs


Antioxidant Nutrients and Phytonutrients that Protect Against Overproduction of Phase I Metabolites

Nutrient Food Sources Carotenes (vitamin A) Essentially all red, orange, yellow, and green plant foods Ascorbic acid (vitamin C) All will be higher in vitamin C if uncooked: Bell peppers, papaya, citrus fruits, broccoli,

Brussels sprouts, strawberries, kiwi Tocopherols (vitamin E) Sunflower seeds, almonds, spinach, Swiss chard, avocado, turnip greens, asparagus,

mustard greens Selenium Brazil nuts, tuna, sardines, salmon, turkey, cod, chicken, lamb, beef Copper Sesame seeds, cashews, soybeans, mushrooms (shiitake), sunflower seeds, tempeh,

garbanzo beans, lentils, walnuts, lima beans Zinc Beef, lamb, sesame seeds, pumpkin seeds, lentils, garbanzo beans, cashews, quinoa,

turkey Manganese Cloves, (gluten-free) oats, brown rice, garbanzo beans, spinach, pineapple, pumpkin

seeds, tempeh, soybeans Coenzyme Q10 Meat, poultry, fish Thiols Chives, daikon radishes, garlic, leeks, onions, scallions, shallots Flavonoids Virtually all plant foods, including apples, apricots, blueberries, pears, raspberries,

strawberries, black beans, cabbage, onions, parsley, pinto beans, and tomatoes Silymarin Milk thistle (herb), artichokes Pycnogenol Small amounts in the peels, skins, or seeds of grapes, blueberries, cherries, and plums

Toxins InToxins In






Nutrients for Phase II Conjugation Pathways

Nutrient Food Sources

Glycine Beef, chicken, lamb

Taurine Fish, meat

Glutamine Beef, chicken, fish, eggs, cabbage, beets, beans, spinach, and parsley

N-acetylcysteine Most high-protein foods (e.g., chicken), garlic, cruciferous vegetables

Cysteine Beef, chicken, lamb, fish

Methionine Egg white/whole egg, sesame seeds, Brazil nuts, soy protein, chicken, tuna, beef, chickpea, almonds, pinto beans, lentils, brown rice

Toxins InToxins In





Features of the Detox Food Plan

Therapeutic Dietary Interventions: The Detoxification Food Plan

Reduces Known Food Triggers

Choose Clean and Organic

Foods

Balances Hormone

Metabolism

Fasting and Calorie Options

Phytonutrients for Gut, Liver,

and Kidney

Targeted Anti-oxidants

High Fiber for Optimal

Elimination

Adequate Protein to Aid Detox

Key Features of the Detox Food Plan • Builds on food trigger identification and continues with a

targeted nutrients to support detox pathways • Supports liver function with high-quality protein • Encourages a more specific personalized dietary approach

by targeting hepatic detoxification enzymes and tailoring nutrients to liver-specific needs

• High in phytonutrient density for gut, liver, and kidney • Targeted anti-oxidants to support the reduction of body

toxin burden and impact of incoming toxin load • Fasting and Calorie-specific options or non-calorie plan • Encourages high fiber to create optimal elimination of

toxins and endotoxins • Balances hormone metabolism

Touring Your Patient through the Food Plan

Features of Detox Food Plan High-Quality Protein

• Women 8-10 servings daily/Men 10-12 servings per day• Focus on highlighted foods for detox emphasis• Adequate protein required for detox• Ensure patient can digest protein• Remove allergenic protein sources (may need to be

individualized)• Vegetarian and non-vegetarian options

How Can You Facilitate Phase II

Detox in Your Patient?

• Protein/Amino Acids– Sulfate– Methyl groups– Glucuronic acid– Glutathione

• Compounds to stimulate glutathione production

Toxins InToxins In





Features of Detox Food Plan Legumes:• 2-4 servings per day• Focus on highlighted foods for detox emphasis• Good protein source for vegetarians• Encourage variety in colors for broad array of

phytochemical support• Source of fiber

Legumes

Features of Detox Food Plan LF Dairy Alternatives:• 2-4 servings daily (not required, may sub for other

proteins/carbs at practitioners discretion)• Focus on highlighted foods for detox emphasis• Eliminate dairy-containing foods to reduce potential

allergenic load and toxin storage in animal fat• Seed milks conducive to liver detox pathways• Coconut milk as good energy source during detox• Ensure unsweetened varieties of all products

Low-FatDairy

Alternatives

• Unfiltered, cold-pressed, organic preferred, non-GMO• 4-8 servings daily on average• Quality of oils is key• Reduction of processed, inflammatory, high-omega-6 oils• Spectrum of short-, medium, and long-chain fats• Omission of dairy-derived fats• Note oils to cook with and not cook with

Features of Detox Food Plan Fats & Oils

Therapeutic Foods: Fats & Oils

• Avocado • Clarified butter (ghee) • Coconut oil • Extra virgin olive oil • Flaxseed oil • Rice bran oil • Sesame oil

Features of Detox Food Plan Nuts & Seeds

• Up to 4 servings daily (based on other protein amounts)• Focus on highlighted foods for detox emphasis• Include in smoothies for added protein• Provides fiber and healthy fats for detox• Soaked, sprouted or lightly roasted for patients with

impaired digestion• Watch for inclusion of poor-quality oils• Remove allergenic peanuts/peanut butter

Therapeutic Foods: Nuts & Seeds

• All of the nuts, seeds and their respective butters or pastes

• Special focus on sesame seeds and flaxseeds for detox

Features of Detox Food Plan Non-starchy Vegetables

• Recommend consuming 8 or more servings daily• Focus on highlighted foods for detox emphasis• Ensure servings from specified categories for additional detox support• Source of fiber for proper elimination• Phytochemical variety essential• Stimulates healthy bile flow

Therapeutic Foods: Non-Starchy Vegetables

• Brassicales • Detoxifying Leafy Greens • Thiols • Liver & Kidney Support

High dietary intake of vegetables and fruits result in a reduced

dietary net acid load (and improved alkalinization) and

indirectly improves detoxification processes.

Proudfoot et al. J Tox Clin Tox 2004Remer and Manz, J Am Diet Assoc. 1995; 95:791-797.

Features of Detox Food Plan Starchy Vegetables:• Up to 1-4 servings daily based on Metabolic Concerns• Focus on highlighted foods for detox emphasis• Encourage variety in colors for broad array of

phytochemical support• Source of fiber• Eliminate corn to reduce potential allergenic load• Consider GI specific Plan options (FODMAP)

Starchy Vegetables

Therapeutic Foods: Starchy Vegetables

• Beets • Celeriac

Features of Detox Food Plan Fruits:• 2-4 servings daily of unsweetened fruits based on other GI

considerations, may help with sugar cravings• Focus on highlighted foods for detox emphasis• Ensure variety for colorful spectrum of phytochemicals to

support detox process• Watch for grapefruit if reduced CYP3A4 activity• Antioxidants to reduce Phase I production of reactive

metabolites• Source of fiber and water for healthy excretion

Fruits

Features of Detox Food Plan GF Grains:• Ideally limit servings daily to no more than 2• Focus on highlighted foods for detox emphasis• Ensure variety for colorful spectrum of phytochemicals to

support detox process• Eliminate gluten to reduce allergenic load and potential

inflammation, consider GI specific Plan (FODMAP)• Antioxidants to reduce Phase I production of reactive

metabolites

Gluten-Free Grains


1 2Therapeutic Intervention

3 4Personalize

May Include •Food challenges •Re-introduction •Assess Reactions •Ongoing Support

•Bowel Support •Kidney Support •Liver Support

•Dental work

Food Plan That You Love


1 2





3 4

Detox Food Plan

Phyto Spectrum

Elimination Diet

Personalize

May Include •Food challenges •Re-introduction •Assess Reactions •Ongoing Support

•Bowel Support •Kidney Support •Liver Support

•Dental work

Our Mission:To inform people about toxicity and inspire them to healthy solutions

Led by Deanna Minich, PhDin collaboration with

Our Mission:To provide individuals with a 21-day transformational detoxification experience for the purpose of cultivating health, wellness and vitality in body, mind and spirit


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August 4-10, 2014


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