whole detox: how to thrive in a toxic world through ... · ... how to thrive in a toxic world...

© 2016 Metagenics, Inc.

Whole Detox: How to Thrive in a Toxic World through Nutrition and Lifestyle

Dr. Tricia Paulson ND St. Croix Falls, WI


Objectives

• Identify patients whom could benefit from a detoxification program.

• Create successful protocols focusing on personalized therapies specific to patient’s individual starting point and health concerns.

• Learn the importance of creating the space to discuss nutrition and lifestyle for health trajectory changes.


Detoxification for Patients with Chronic Illness and Comorbidities


Walking Wounded

Fibromyalgia & chronic fatigue

Generalized joint and muscle aches and pains

Difficulty concentrating

Food, environmental or chemical sensitivities

Irritability, headache

Lethargy, fatigue, weakness

Abdominal pain


Go slow with low doses of nutritional detox support Food first

Hydration

Adequate rest

Gentle movement (stretching, walking…)

Minimize toxins in the environment

Score <50, higher scores in specific organ systems, may be on pharmaceuticals


Case Study

MB: • 39 y.o. Caucasian female • Nurse Practitioner, working full time and completing courses

for Doctor of Nursing Practice • Single, no children • Primary complaint: Chronic fatigue, chronic pain, severe

asthma and allergies, insomnia, RLS, obesity, anxiety and stress • Other conditions: Myasthenia Gravis, Hypothyroid, GERD

(gastric band recently removed), fluctuating stools, migraines, ovarian cysts (some removed), irregular menses


Case Study

Known Toxic Exposures:

• Age 14 job spraying beans (Glyphosate) and pesticides at golf course. Diagnosed with asthma

• History of toxic mold exposure • Adult Toxin Exposure Questionnaire

o Diet: “I don’t know how to eat healthy” o Diet Coke o Alcohol (rum and tequila) o Pharmaceuticals


Case Study

Current Medications:

• Omeprazole 40 mg daily • Levothyroxine 88 mcg daily • Lisinopril/HCTZ 10/12.5 daily • Advair 50/500 1 puff twice daily • Pulmicort 180 2 puff twice daily • Zyflow 1200 mg twice daily • Allegra 180 mg daily • Mestinon 60 mg twice daily • Norco 10/325 mg twice daily as needed • Topamax 100 mg as needed • Maxalt 10 mg as needed • Lorazepam 1 mg as needed • Requip 2 mg daily • Ibuprofen 600-800 mg as needed every 6-8 hours • Zanaflex 4 mg nightly • Additional meds as needed


Ranges: Recommended Diagnostic 9.2.2015

Height 66.5

Total Weight (lbs) 306.6

Bioelectrical Impedance Analysis

Fat (lbs) 143.8

Fat % 22-28 23-34* 46.9

Body Cell Mass (lbs.) 72.1

Body Cell Mass % 25-30% 23.5

Total Body Water (L) 54.5

Intracellular Water (L) 24.3

Intracellular Water % 50-60 44.6

Extracellular Water% 40-50 55.4

Extracellular Water (L) 31.2

Basal Metabolic Rate (BMR) 2303

MDQ <30 81/50

Recommended Diagnostic Ranges 9.2.15

Waist Circumference <35 inches >35 inches 62.5 inches

Blood Pressure 110/70 >130/85 130/85

Fasting Glucose 80-90 mg/dl >100 CMS 95

HgbA1C <5.5 5.5-6 Ins Res >6T2DM 5.6

Insulin, fasting 4-5 >14 uIU/mL 36

GGT 0-40 IU/L 51

CRP <.1 0-8 mg/L 29

SED 0-20 mm/h 17

TSH 1-2 .34-5.1 uIU/mL 2.06

Basic Metabolic Panel normal

Ferritin 50 ng/mL 12-150 ng/mL 10

Homocysteine <10 umol/L 3-14 umol/L 9

CBC normal

ALT 7-55 U/L 48

AST 8-48 U/L 24

Vitamin B12 193-986 pg/mL 634

Magnesium 1.6-2.3 mg/dL 2.1

25-OH D3 50 ng/ml <30 ng/ml 27


Recommended Additional Labs

• Prolactin normal

• Low Testosterone (4 ng/dL)

• Non-detectable progesterone

• Estrogen not tested

• Low DHEA-s (30 ug/dL)

• Vitamin D 27 ng/mL


Recommended Management: Start with Lifestyle

• Food and drink

• Movement

• Joy and leisure time

• Stress reduction

• Quantity and quality sleep

• Environment toxin reduction


Elimination

Known food sensitivities

Sugar

Food additives

Processed food

Trans fats

Alcohol

Caffeine

Source: Metagenics FLT


Crowd Out

• Focus on proteins for blood sugar balancing and adrenal health

• Red foods

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiJhvLnt8rLAhWHs4MKHQGPDU4QjRwIBw&url=http://healthy-organics.com.au/&psig=AFQjCNHnbfXK-LQxu21ap52FR0-HF0HuMA&ust=1458397384305256


Quality Water

½ of your body weight in pounds, in ounces

Add lemon slices

Herbal teas


Recommended Management

Start with Lifestyle

• Food and drink

• Movement





Reference?

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjKl8Hv3-nLAhWJRSYKHXq7C9IQjRwIBw&url=https://selfimprovedaily.wordpress.com/2013/02/17/the-importance-of-stretching/&psig=AFQjCNFGSUlvf08Hy1A_p0_W13wE5HCDyQ&ust=1459473261319202




• Food and drink

• Movement





Finding Joy & Simple Pleasures




• Food and drink

• Movement





Stress Reduction and Adaptation




• Food and drink

• Movement






stimulants, food sensitivities, pain,

hormones, neurotransmitters,

stress...

__________________

follow a sleep schedule, spend time

outside, exercise, avoid stimulating activities close to sleep time,

avoid screen watching, create a comfy sleep

environment, brain dump




• Food and drink

• Movement






• Best food storage

• Use chemical-free products in your home (soap, detergents, cleaning products, dryer sheets, natural insect and weed killers, etc).

• Reduce chlorine exposure by attaching filters to your shower heads (Chloroform is released when chlorinated water is heated.)

• Avoid personal products with pthalates and paraben

• Air filter

Every Cell Contributes To Detox

Sweat

Stool

Bile

Urine

Mucous

Tears

Breath

Hair and nails

Reference?

Supportive Therapies

Hydrotherapy — hot and cold showers

Skin brushing

Reference?

Supportive Therapies Detox Baths

EPSOM SALTS

– Opens pores, assists toxin elimination through the skin, supports muscle relaxation which may reduce muscle pain. 1 cup Epsom salts in bath.

APPLE CIDER VINEGAR

– Anti-microbial properties, add 1-2 cups 100% apple cider vinegar to bath.

Reference?

Mitochondrial inefficiency causes fatigue

Mitochondrial function appears to be directly related to fatigue, and when patients experience fatigue, their mitochondrial function is inevitably impaired.

Nicolson GL. The Journal of the American Nutraceutical Association. 2003;6(3):4-10.

Mitochondria are the cell’s powerhouse & housekeeper – producing ~90% of all bioenergy

Energy production - (ATP & oxidative phosphorylation)

Synthesis of useful

compounds

Control of apoptosis

(cell death)

Regulation of cytosolic

calcium

Removal of unwanted

compounds

Reddy PH et al. Curr Alzheimer Res. 2011 June ; 8(4): 393–409.


Mitochondrial stress can impair the conversion of food to energy compromising performance

Early signs

• Fibromyalgia

• Neurodegenerative disorders

• Neuropathies

• Depression

• Liver dysfunction

• Cardiac dysfunction (cardiomyopathies)

• Pancreatic dysfunction (diabetes)

• Kidney dysfunction

Advanced dysfunction

• Weakness

• Fatigue

• Exercise intolerance – slow recovery

• Muscle tenderness

• Low mood – lack motivation

• Poor glucose control

• Difficulty losing weight

• Joint and muscle pain

• Poor hepatic biotransformation

Acta Neuropathol (2012) 123:157–171 Transl Psychiatry (2012) 2, e187; doi:10.1038/tp.2012.107 Exp Med. 2009;2:1-16.


An additional benefit:

Liver mitochondria support

• The liver is one of the richest organs in terms of number and density of mitochondria

• Hub that integrates hepatic metabolism of carbohydrates, lipids, and proteins – distributes energy throughout the body

• Need energy to remove accumulation of damaged mitochondria that influence liver function

• Essential in hepatocyte survival as mediator of apoptosis and necrosis.

Calabrese V., et al. Journal of Nutritional Biochemistry. 2006;17:73–88

Mitochondrial ingredients participate in Phase I and Phase II metabolic detoxification

Liska D et al. Detoxification and Biotransformational Imbalances EXPLORE March 2006, Vol. 2, No. 2 123


L-Carnitine – required for mitochondrial ATP

• Fatty Acid Oxidation Required for the transport of long chain fatty acids from the cytosol across the mitochondrial membrane into the mitochondrial matrix during the breakdown of lipids for the generation of metabolic energy — ß-oxidation.

• Moves waste products such as poorly metabolizable acyl groups from mitochondria to the cytoplasm.

• Possesses antioxidant capacity and protects plasma components against oxidative damage.

Odo S., et al. Food and Nutrition Sciences. 2013;4:222-231. Sahlin K. The Journal of Physiology. 2011:589:1509-1510. Wall BT, et al. The Journal of Physiology. 2011:589;963-973


Carnitine—other possible health effects under investigation

• Defective fatty acid metabolism

• Cardiovascular function

• Stress-induced sarcopenia (cachexia)

• Glucose balance and insulin sensitivity

• Kidney function

• Weight loss

• Ergogenic aid improve exercise performance

Calabresea V., et al. Journal of Nutritional Biochemistry. 2006;17:73–88. Odo S., et al. Food and Nutrition Sciences. 2013;4:222-231. Sahlin K. The Journal of Physiology. 2011;589:1509-1510.


©2001 ACE

Mitochondria

Magnesium, brain, and mitochondrial function

• Magnesium is an essential element that catalyzes more than 300 enzymatic reactions, in particular those involving mitochondrial ATP

• Mitochondrial Mg deficiency

may increase excitatory events in the neuron o Reduced ATP efficiency o Calcium influx o Excess glutamate o Potentiate stimuli that trigger

apoptosis (cell death)

Miller S., et al. Heart. 2005;91(5):618-623. Gums JG. Am J Health Syst Pharm. 2004;61(15):1569-1576.

J Clin Psychiatry. 2000;61(Suppl 12):22-27.

Cellular energy and ATP production Electron transport chain co-factors


o Vitamin C

o Selenium

o N-Acetylcysteine (NAC)

o Taurine

o -Lipoic Acid

o CoQ10

o Vitamin E

o Polyphenols

Scavenging Reactive Oxygen Species (ROS) Stimulating Cellular Antioxidant Pathways

Manji H, et al. Nature Reviews Neuroscience 2012; 13, 293-307

Nutritional support for GST: • N-Acetylcysteine • Selenium • Niacinamide • Vitamin C Johnson and coworkers (Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood

cell glutathione in healthy adults. Am J Clin Nutr 58:103-5, 1993) found that blood glutathione levels rose nearly 50% in healthy individuals taking 500 mg of vitamin C daily.

• Silymarin (Silymarin not only prevents the depletion of glutathione induced by alcohol and other toxins

(Chrungoo VJ et al. Indian J Exp Biol. 1997 Jun;35(6):611-7.), but can increase the level of glutathione n the cells of the liver (hepatocytes) (Valenzuela A et al. Planta Med. 1989 Oct;55(5):420-2.), and possibly by up to 35%.

• Cruciferous vegetables, I3C (Traka M, Gasper AV, Melchini A, Bacon JR,

Needs PW, et al. (2008) . PLoS ONE 3(7): e2568. doi:10.1371/journal.pone.0002568; Hawkey et al. Am J Clin Nutr 2005;82:1283–91.

• Alpha lipoic acid (Alt Med Rev 1998; 3(4):308.)

• Whey protein (Micke et al., Eur J Clin Invest 2001; 31(2):171)

Promote healthy levels of GST

Antioxidant function Detoxifying function

GSH

GSH GSSG

G R

Neutralized counterparts

G P x

Free radicals, H2O2

organic peroxides

NADP+ NADPH

GSH

X

G S T

Further breakdown and excretion

GSH = glutathione; = glutathione disulfide; = xenobiotics

GST = glutathione S-transferase; GPx = glutathione peroxidase; GR = glutathione reductase

GSSG X

X

Glutathione: Antioxidant and detoxifying function

Personalized Supplementation (Mitochondria Support)

Supplements On Rising

Bkfst Mid Morn

Lunch Mid Aftern

Dinner Mid Even

Before Bed

L-Carnitine, Malic Acid, Taurine for Mitochondrial Support

1-2 scoops in water, sip throughout the day

NAC, Broccoli Seed Extract Glutathione Support

1 1

Magnesium as bis-glycinate

2 2

Iron Blend for Red Blood Cell Support

1

Liquid Vit. D 2 ds


Genus, Species and Strain Characterization

LACTOBACILLI

L. bulgaricus

B. infantis

B. lactis

B. longum

L. rhamnosus

L. casei

L. plantarum

L. acidophilus

BIFIDOBACTERIA

SACCHAROMYCES

S. cerevisiae

B. adolescentis

GENUS

SPECIES

STRAIN DDS 1 685 1195

299V NCFM HN001 CR14

33200

HN019 17930

837

B734

15708

15706 25962

15705

BI07

S. boulardii


L. acidophilus NCFM

B. lactis BI-07

• Well researched strains for overall GI health

• Studied in the management of IBS

• NCFM is one of the only probiotic strains whose DNA has been completely mapped and characterized

The probiotics (L. acidophilus NCFM and B. lactis BI-07) have been studied clinically in numerous models of bowel distress

The similar efficacy, in treating pain, of orally administered L. acidophilus NCFM and a standard dosage of morphine suggests that specific modulation of intestinal flora may be a … treatment for abdominal pain, a prominent symptom of irritable bowel syndrome”

“These observations suggest that inoculation with probiotics can effectively prevent bacteria-induced colitis by limiting enteric bacteria infection and promoting mucosal protective regulatory immune responses.” Pediatr Res. 2005 Dec;58(6):1185-91.

Nat Med. 2007 Jan;13(1):35-7. Epub 2006 Dec 10


Bkfst Mid Morn

Lunch Mid Aftern

Dinner Mid Even

Before Bed


1-2 scoops in water, sip throughout the day


1 1


2 2

Iron Blend for red blood cell support

1

Liquid Vit. D 2 ds

Probiotic blend of NCFM® & Bi07

1-2 1-2

DGL Chew 2 before each meal and as needed for GERD

Personalized Supplementation (Mitochondria and Gut Support)


• Organic

• Grass Fed

• Free range


DIRTY DOZEN™ www.foodnews.org

1. Celery

2. Peaches

3. Strawberries

4. Apples

5. Blueberries

6. Nectarines

7. Bell Peppers

8. Spinach

9. Cherries

10. Kale/Collard & Greens

11. Potatoes

12. Grapes (Imported)

Buy these organic:

CLEAN 15™ www.foodnews.org

1. Onions

2. Avocado

3. Sweet Corn

4. Pineapple

5. Mangos

6. Sweet Peas

7. Asparagus

8. Kiwi

9. Cabbage

10. Eggplant

11. Cantaloupe

12. Watermelon

13. Grapefruit

14. Sweet Potato

15. Honeydew & Melon

Lowest in pesticides Ok to eat conventionally grown

In a sample of three types of produce, those grown without pest fighting chemicals had between 19 and 160 percent more of the cancer fighting compounds known as

flavonoids than conventionally grown produce.

Crowd Out

Focus on foods to support detoxification: Artichokes, asparagus, broccoli, Brussels sprouts, cabbage, celery, greens, kelp, seaweeds, onion, garlic


Foods for Targeted Detoxification

54

Almonds Brazil nuts Egg Leek Onion Potato Scallops Spinach

Glucuronidation Sulfation

Glutathione Methylation

Almond Apple

Broccoli Carrot

Chile pepper Cocoa

Cranberries Halibut

Pumpkin Sweet potato

Turmeric

Banana Beans Beets Broccoli Brussels sprouts Cabbage Cauliflower Eggs Legumes Potato Soy foods Spinach Sweet potato

Apples Artichoke hearts

Asparagus Cruciferous vegetables

Eggs Green tea

Oats Pomegranate Red peppers

Sprouted lentils Turmeric

Yogurt

Source: The Detox Prescription, Woodson Merrell, MD, 2013


Case Study

MB: 8 weeks on protocol • Breathing is best it has ever been • Still tired • Mild sinus and nasal congestion continues • Off omeprazole, uses DGL as needed for situational GERD • Regular bowel movements, digestion “is good” • Off all pain medication and sleep medication (although sleep is

not great) • No migraines in past 14 days • Has postponed school • Is actively looking for a new job and new house

Daily Detox Support

Daily Detox Support

Daily Detox Support

You’re finished. Continue to slowly reintroduce foods 1 at a time and wait 24-48 hours to see if you note a reaction. Ask your healthcare provider about ongoing nutritional support for detoxification and other simple foundational health programs to keep you feeling better long term.


Personalized Supplementation (Detoxification Support)


Bkfst Mid Morn

Lunch Mid Aftern

Dinner Mid Even

Before Bed


As needed


1 1


2 2


1

Liquid Vit. D 2 ds

Probiotics NCFM™ & Bi-07 1

DGL As needed for situational GERD

Powdered nutritional product for metabolic detox and alkalinization

½ scoop 1-2 times per day, gradually increase to 1 scoop 2 times per day



Bkfst Mid Morn

Lunch Mid Aftern

Dinner Mid Even

Before Bed


As needed


1 1


2 2


1

Liquid Vit. D 2 ds

Probiotic blend of NCFM® & Bi-07

1


Gradually increase to 1 scoop 2 times per day

Methylated B12 and folate, Sylymarin, Artichoke leaf extract, Watercress, Ellagic Acid, NAC

1

1



Bkfst Mid Morn

Lunch Mid Aftern

Dinner Mid Even

Before Bed


Goal is to increase to 2 scoops twice daily


2 2


1 1

Daily Detox Support

Daily Detox Support

Daily Detox Support



Ranges:

Recommended Diagnostic 9.2.2015 9.30.2015 2.9.2016

Height 66.5 66.5 66.5

Total Weight (lbs) 306.6 307.6 250.2


Fat (lbs) 143.8 144.6 113.3

Fat % 22-28 23-34* 46.9 47 45.3

Body Cell Mass (lbs.) 72.1 71.9 60.2

Body Cell Mass % 25-30% 23.5 23.4 24.1

Total Body Water (L) 54.5 54.5 44.5

Intracellular Water (L) 24.3 24.2 20.1

Intracellular Water % 50-60 44.6 44.6 45.2

Extracellular Water% 40-50 55.4 55.6 54.8

Extracellular Water (L) 30.2 30.3 24.4

Basal Metabolic Rate (BMR) 2303 2306 1938

MDQ <30 81/50 47/46

Over-Worked and Weary

Depleted reserves resulting in:

Endocrine imbalances Digestive issues

Cardiovascular risk Immune suppression

Neurotransmitter imbalances Sleep difficulties

Reference?

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi4p9Tbwd7LAhUMNiYKHSpXDlAQjRwIBw&url=http://www.lingerconference.com/weary-wanderer/&psig=AFQjCNFFr3psVjhDJGgLr6vuwPyBm_jlBA&ust=1459087212345116

Nutritional focus on specific organ system(s)

Leisure time and joy

Movement


Score >50, higher scores in specific organ systems, may be on pharmaceuticals


Case Study

AS: • 31 yo Caucasian female • Administrative full time work • Engaged, no children

• Primary complaint: Fall seasonal allergies, prescribed Augmentin and steroid drops for eyes. Hives all over body, vaginal yeast infection. Told allergic reaction to antibiotic, prescribed prednisone (cleared returned prednisone cleared returned steroid “shot”). Told “it’s your pets” get rid of your cat and dog.

• Other conditions: Tired, muscle stiffness, Pain in stomach, “food sits like a rock”, flatulence, constipation, difficulty losing weight,

66


Case Study

Known Toxic Exposures:

• Stress • Dysbiosis


Case Study

Current Medications:

• Claritin and Singulair daily because “on the brink”.

Pre

con

cep

tio

n

Current Concerns

Antecedents

Triggers or Triggering Events

Signs, Symptoms or Diseases Reported

Pre

nat

al

Bir

th

•Microbes •Toxins •Allergens •Foods •Stress

Pre

con

cep

tio

n

Current Concerns

Antecedents

Triggers or Triggering Events

Signs, Symptoms or Diseases Reported

Pre

nat

al

Birth

0-6 31

Fatigue

15

Tonsillectomy, Seasonal allergies

Dad smoked in the house, chronic tonsillitis and ear infections, lots of antibiotics,

Hypoglycemia, IBS, GERD

Allergies, skin issues, pain/ stiffness

cholecystectomy

7

Menarche, many tests, inconclusive

30

Weight gain

20


Ranges: Recommended Diagnostic

Height 58

Total Weight (lbs) 151.4


Fat (lbs) 60.1

Fat % 22-28 23-34* 39.7

Lean Dry Mass (lbs.) 20.6

Lean Dry Mass % 13.9-18.3 13.6

Total Body Water (lbs) 70.7

Intracellular Water (lbs) 37.2

Intracellular Water % 50-60 52.7

Extracellular Water% 40-50 47.3

Extracellular Water (lbs) 33.4

Basal Metabolic Rate (BMR) 1429

MDQ <30 165

Recommended Diagnostic Ranges

Waist Circumference <35 inches >35 inches 36 inches

Blood Pressure 110/70 >130/85 125/80

Fasting Glucose and 2 hr 80-90 mg/dl >100 CMS 101 and 132

HgbA1C <5.5 5.5-6 Ins Res >6T2DM 5.6

Insulin, fasting and 2 hr 4-5 >14 uIU/mL 18 and 45

Cholesterol <200 >200 282

Triglycerides <100 >150 173

HDL >50 <50 81

LDL 178

GGT 0-40 IU/L 32

hsCRP <.5 0-3 mg/L

SED 0-20 mm/h 10

TSH 1-2 .34-5.1 uIU/mL 2.64

Basic Metabolic Panel normal

Ferritin <400 mg/dL 193-507 mg/dL 48

Homocysteine <10 umol/L 3-14 umol/L 8

CBC normal

25-OH D3 50 ng/ml <30 ng/ml 23

H. Pylori Stool Antigen

Formatting,


Comprehensive Parasitology


• B1 deficiency

• B12 deficiency

The 5R GI Restoration Program

A systematic approach to managing GI dysfunction through individualized therapies for gut restoration

5R GI Restoration Program 1. Remove

2. Replace

3. Reinoculate

4. Regenerate

5. Retain

“Get rid of what you don’t need, get what

you do need”. Sydney Baker M.D.



• Food and drink

• Movement





Personalized Supplementation (5 R Program)


Bkfst Mid Morn

Lunch Mid Aftern

Supper Mid Even

Before Bed

Medical Food for IBD 2scp 2scp

EPA-DHA 300mg 1 1

Green tea catechins, methylcobalamin, biotin, chromium, chinese cinnamon bark powder

2 2 2

Vitamin D 5000IU 1

Concentrated berberine formula 1-2 1-2

Lipotropic formula with artichoke leaf extract and Chen Pi 5:1 extract

2 2 2


2 2

Probiotic blend of NCFM® & Bi-07 1

Ranges: Recommended Diagnostic 11.14.12 12.12.12

Height 58 58

Total Weight (lbs) 151.4 144.6


Fat (lbs) 60.1 57

Fat % 22-28 23-34* 39.7 39.5

Lean Dry Mass (lbs.) 20.6 19.9

Lean Dry Mass % 13.9-18.3 13.6 13.7

Total Body Water (lbs) 70.7 67.7

Intracellular Water (lbs) 37.2 36.2

Intracellular Water % 50-60 52.7 53.5

Extracellular Water% 40-50 47.3 46.5

Extracellular Water (lbs) 33.4 31.4

Basal Metabolic Rate (BMR) 1429 1376

MDQ <30 165 89

Ranges: Recommended Diagnostic 11.14.12 12.12.12 1.21.13

Height 58 58 58

Total Weight (lbs) 151.4 144.6 137.8


Fat (lbs) 60.1 57 53

Fat % 22-28 23-34* 39.7 39.5 38.5

Lean Dry Mass (lbs.) 20.6 19.9 19.3

Lean Dry Mass % 13.9-18.3 13.6 13.7 14

Total Body Water (lbs) 70.7 67.7 65.5

Intracellular Water (lbs) 37.2 36.2 47.5

Intracellular Water % 50-60 52.7 53.5 53.1

Extracellular Water% 40-50 47.3 46.5 53.6

Extracellular Water (lbs) 33.4 31.4 46.4

Basal Metabolic Rate (BMR) 1429 1376 1332

MDQ <30 165 89 75


Case Study

AS: 9 weeks on protocol • Allergy symptoms gone • Bowel movements daily, digestion improved, no yeast

symptoms • No hypoglycemia, less cravings and hunger • Would like more energy, less brain fog • Life continues to be stressful


Daily Detox Support

Daily Detox Support

Daily Detox Support


Personalized Supplementation (5 R Program)


Bkfst Mid Morn

Lunch Mid Aftern

Supper

Mid Even

Before Bed


As per 28 day Detox schedule

EPA-DHA 1 1

Vitamin D 5000IU 1


1

Lipotropic formula with artichoke leaf extract and Chen Pi 5:1 extract

As needed, only with solid food


A per 28 Detox schedule

Ranges:

Recommended Diagnostic 11.14.12 12.12.12 1.21.13 2.28.13

Height 58 58 58 58

Total Weight (lbs) 151.4 144.6 137.8 131.4


Fat (lbs) 60.1 57 53 45.4

Fat % 22-28 23-34* 39.7 39.5 38.5 34.5

Lean Dry Mass (lbs.) 20.6 19.9 19.3 19.2

Lean Dry Mass % 13.9-18.3 13.6 13.7 14 14.6

Total Body Water (lbs) 70.7 67.7 65.5 66.8

Intracellular Water (lbs) 37.2 36.2 35.1 35.7

Intracellular Water % 50-60 52.7 53.5 53.6 53.4

Extracellular Water% 40-50 47.3 46.5 46.4 46.6

Extracellular Water (lbs) 33.4 31.4 30.4 31.1

Basal Metabolic Rate (BMR) 1429 1376 1332 1345

MDQ <30 165 83 75 39

A systematic approach to managing GI dysfunction through individualized therapies for gut restoration

5R GI Restoration Program 1. Remove

2. Replace

3. Reinoculate

4. Regenerate

5. Retain

“Get rid of what you don’t need, get what

you do need”. Sydney Baker M.D.


The 5R GI Restoration Program

• Diet

• Supplements

o Probiotic, Digestive enzymes, Multi with phytonutrients, EPAH/DHA


o Adrenal support

• Movement

Retain patients’ lifestyle for lasting relief of gastrointestinal

complaints. Determining the triggers or lifestyle habits that may have lead to the core issue.

5. Retain

Lost 37.2 lbs

28.3 lbs Fat Loss

Over 13 months…

Managing Patients After Detoxification: Next Steps

Sustainable healthy lifestyle behavior change post

metabolic detoxification

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjXp5Hjut7LAhWDOiYKHburBXMQjRwIBw&url=http://www.emilynachazel.com/events/2015/6/4/detox-to-retox-dc&bvm=bv.117868183,d.eWE&psig=AFQjCNHA6nDeUlEuTMHFrg7RQu3IfSXDPg&ust=1459085367149405


What is Lifestyle Medicine?

The evidence-based practice of assisting individuals and families to adopt and sustain healthy behaviors that can improve quality of life.

Lianov L, Johnson M. JAMA. 2010;304:202-203

FLT Way of Living & Eating

The FLT Menu Plan

Personalized Supplementation

Physical Activity

Transforming Stress

Behavior Change Firs

tLin

e Th

erap

y


Modified Med Food Plan—Real, whole, fresh food, created by nature.

The most well-studied “diet”

1,670 citations on Pubmed for “Mediterranean Diet”

Data accessed 12/21/12 Pubmed

Serra-Majem et al., Nutr Reviews, Feb 2006: S27-S47.

Increasing Scientific Publications on the Mediterranean DietCal

Mediterranean Diet (MD)

Metabolic Syndrome & Insulin insensitivity

Diabetes

Coronary Heart Disease

Heart Rate Variability

Cognitive Decline

Immune function


The effect of Mediterranean Diet on metabolic syndrome and its components

A meta-analysis of 50 studies and 534,906 individuals

“The present meta-analysis, performed in 50 studies, with an overall incorporated population of approximately one-half million subjects, revealed the beneficial effect of the MD, with regard to not only the MS but also its individual components, namely waist circumference, HDL cholesterol levels, triglyceride levels, blood pressure levels, and glucose metabolism.”

Kastorini et al. J. Am. Coll. Cardiol. 2011;57;1299-1313

Esposito et al., Mol Nutr Food Res 2007; 51:1268-1274.

Dietary Effects

Medication Effects

Effective Resolution of Metabolic Syndrome with Diet

At 18 months, patients receiving the MED treatment had a significantly lower antihyperglycemic drug therapy requirement (12%) than the patients treated with a low-fat diet (24%; P<0.01). By the end of the 4-year study, only 44% of the MED group required antihyperglycemic drug therapy, compared with 70% of the patients on the low-fat diet (P<0.01).

Esposito et al., Ann Intern Med. 2009 Sep 1;151(5):306-14. Reisen, Curr Hypertens Rep; 2010 12:56–58

The benefit of the Mediterranean Diet in type 2 diabetes


The Mediterranean Diet improves heart rate variability

“After adjusting for energy intake, other nutritional factors, shared genes, and common environment, a 1-unit higher score was significantly associated with 3.9% to 13% higher time and frequency domain HRV parameters.” Dai J. et al. Circ Cardiovasc Qual Outcomes. 2010;3:00-00

The Mediterranean diet and cognition Higher adherence to the MeDi is associated with a trend for reduced risk of developing MCI and with reduced risk of MCI conversion to AD.

Scarmeas et Arch Neurol. 2009 Feb;66(2):216-25 l. Arch Neurol. 2009 Feb; 66(2):216-225.


Mediterranean diet associated with decreased disease and all-cause mortality

• Large cohort studies suggest that a high degree of adherence to the Med-Diet is associated with a reduction in both total and CHD mortality

• Clinical trials show Med-diet improves glycemic control, weight and blood pressure

• Med-diets typically contain high amounts of fruits, vegetables, whole grains, and olive oil which contain antioxidants, minerals and phytonutrients

Estruch R. Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study. Proc Nutr Soc. 2010 Aug;69(3):333-40.


The FLT Food Plan— beyond the Mediterranean Diet

Higher F&V intake

Increased phytonutrient density - modulation of

signal transduction pathways, antioxidant and anti-inflammatory properties, hormonal

balance

Lower in grain-based, gluten

containing, high-glycemic carbohydrates

improves post-prandial glucose

response, reduces cravings and overeating

Healthy fat spectrum

focused on achieving essential fatty acid balance

Personalization

individual assessment

emphasizes food selection based on

need


The FLT Menu Plan


Physical Activity

Transforming Stress

Behavior Change Firs

tLin

e Th

erap

y

Behavior Change

Tweaking the environment trumps will power every time

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLrJv-T5_MgCFQfmYwodFDcKBA&url=http://www.trendpolice.com/4627/travel-tips-to-jot-down-for-your-motorcycle-diaries/&bvm=bv.106923889,d.cGc&psig=AFQjCNHbkqD-IzEbBvtBpJHqk4AV08oohw&ust=1446938920471228

Behavior Change

Have the patient leave with a very specific plan based on their health goals and body composition

Healthy Weight Loss Program

Glycemic Food List

Gluten Free Glycemic Food List

High Protein Phytonutrient Food List

Metabolic Detoxification Food List

10 food categories support color, phytochemical diversity and density, balance and wholeness

1. Protein (animal & vegetable)

2. Legumes and beans

3. Dairy and dairy alternatives

4. Seeds and nuts

5. Vegetables that grow above the ground (category 1)

6. Vegetables that grow below the ground (category 2)

7. Fruits

8. Grains

9. Healthy fats

10. Medical foods

Weekend Warriors

Eat relatively healthy Monday thru Thursday Eat out a little too often Drink alcoholic beverages a little too often Exercise a little too little Stress a little too much

Each year gain a few extra pounds of body fat, lose a little energy, gain a little joint pain, lose a little mental endurance

More energy and less fatigue

Less foggy brain

Less coffee dependent

Less sugar cravings

Less water retention

An annual “Re-set” button

Score <50 non-specific issues, no pharmaceuticals


Weekend Warriors

10 day detox Annually to quarterly

Participate in a group detox Additional targeted nutrition for

acute/mild symptoms


10-Day Clear Change Options

Comprehensive personalized options

• Choice of nutritional powder formula and flavor

• Dietary supplement to support balanced metabolic detoxification activity and provide antioxidant protection

• Comprehensive program guide

• Online support options include a free webinar, additional recipes, FAQs, and daily motivational emails

Daily Detox Support

Daily Detox Support

Daily Detox Support



Body Composition

• It takes three times longer to accumulate BCM as to deplete it

• To increase BCM you must remove catabolic factors (stress, anxiety, sedentary behaviors, insulin resistance, etc.), increase protein calories, and introduce resistance training

Constipation

Talk to your clients about the importance of regular elimination. Add Magnesium Citrate 200mg-600mg at night before bed as needed.

Personalized Supplementation (Constipation)


Bkfst Mid Morn

Lunch Mid Aftern

Supper

Mid Even

Before Bed

Powdered nutritional product for metabolic detox, heavy metal metabolism and alkalinization


EPA-DHA 1 1

Magnesium Citrate 2-6

Methylated B12 and folate, Silymarin, Artichoke leaf extract, Watercress, Ellagic Acid, NAC

A per 10 day Detox schedule

Personalized Supplementation (Constipation/Gas/Bloating)


Bkfst Mid Morn

Lunch Mid Aftern

Supper

Mid Even

Before Bed

Powdered nutritional product for metabolic detox, heavy metal metabolism and alkalinization


EPA/DHA 1 1

Mag Citrate 2-6

Digestive support (with solid food)

2 2 2


A per 10 Day Detox schedule


Quality Water

½ of your body weight in pounds, in ounces

Add lemon slices

Herbal teas


Case Study

JL: • 36 yo Caucasian female • Administrative full time work • Married, 2 daughters

• Primary complaint: New Years resolution to clean up eating… poor follow through

• Other conditions: Poor concentration , acne, dry/rough skin



Bkfst Mid Morn

Lunch Mid Aftern

Supper

Mid Even

Before Bed

Powdered nutritional product for metabolic detox and alkalinization mixed with low-allergy-potential soluble/insoluble fiber blend

As per 10 day Detox schedule 1-2 scoops Fiber as needed

EPA-DHA 1 1

Magnesium Citrate 2-8

Lipotropic formula with artichoke leaf extract and Chen Pi 5:1 extract (with solid food)

2 2 2




6

Height 65.5 65.5



Fat (lbs) 48 45

Fat % 22-28 23-34* 31.9 30.5

Body Cell Mass (lbs.) 50.9 49.4

Body Cell Mass % 25-30% 33.8 33.5

Total Body Water (L) 32.8 32.8

Intracellular Water (L) 17.6 18.1



Extracellular Water (L) 15.2 14.7


MDQ <30 43 9


Case Study

CJ: • 38 yo Caucasian male • Sales full time work • Married, child free

• Primary complaint: Gained 10 lbs. over past year, beer drinker, unsuccessful paleo “diet”, suspects asthma

• Other conditions: Mild digestive symptoms



Bkfst Mid Morn

Lunch Mid Aftern

Supper Mid Even

Before Bed



Men’s vitamin vitality daily packets

1 pkg

Stomach acid support featuring betaine HCl & Pepsin (with solid food)

2-4 2-4 2-4


1 1




Height 73.5 73.5



Fat (lbs) 38.5 27.8

Fat % 13-20 11-22* 19.4 14.7

Body Cell Mass (lbs.) 83.6 85.8

Body Cell Mass % 35-40% 42.1 45.4

Total Body Water (L) 53.4 53.5

Intracellular Water (L) 32.3 33



Extracellular Water (L) 21.1 20.5


MDQ <30 17 5

2016 Spring Clean Your Body Metabolic Detoxification

This program is a progressive 4 week, food first metabolic detoxifcation program with focus on well-researched nutrients, vitamins and herbs to balance and optimize the body’s detoxification pathways

2016 Group Detox Program


Week #1:

Withdrawal Week

• Eliminate all addictive food and drink

o Alcohol, caffeine, sugar, saturated fat, white rice/potato/bread

• Eliminate all chemically enhanced food and drink

o Artificial color, flavor, MSG, anything processed

• Macronutrient balancing

o Following the Glycemic Meal Plan

• Blood sugar balancing

o Following the Glycemic Meal Plan


Week #2:

Modified Elimination

• Food Elimination Week – Foods that are hard to digest

– Foods that are common food allergies

– Foods that are inflammatory

• Introduction to powdered nutritional product for metabolic detoxification, heavy metal metabolism and alkalinization

• Eating better quality proteins, the importance of organic

• Detox Powder and Fiber Supplement o Gives the digestive

system a “time out”

o Promotes phase I and phase II liver detoxification

o Promotes optimal elimination

o Balances the pH of the body

o Restricts body to minimal calories to shrink the fat cell and release toxins

o Environmental toxin elimination

o Additional detox modalities

Week #3:

Liquid Fast Week

Week #4

Food reintroduction week

• How does food affect you?

o Signs and symptoms to look for

• Return to week #1wtih focus on specific foods

• Motivation to not RETOX!

• How’d you do? Repeat BIA


Food Reintroduction Order

• Return to modified elimination diet o Protein, fruits, vegetables, nuts and seeds, legumes, gluten

free grains

o Can add as many foods as desired on one day

o If any reaction remove foods and add one at a time on a daily basis

o ALL Metabolic Detoxification common foods should be introduced first

o Use any left over detox powder as a protein replacement

o Return to macronutrient balancing (week #1 food groups and portions)


Potential Symptoms

Immediate

• Shortness of breath, throat swelling

• Rash or itchy skin

• Light headedness

• Heart palpitations

• Nausea, vomiting, diarrhea

• Sinus congestion, nasal drainage

• Headache

• Mood swings

Delayed

• Fatigue

• Foggy brain

• Sinus congestion, post nasal drip, mucous production

• Stiffness/achy joints and/or muscles

• Headaches

• Mood swings, inability to concentrate

• Constipation/diarrhea

• Nausea

Reference?


Reference?

Week #1

Week #2

BIA BIA BIA

BIA

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwie7Y6jk-LLAhXEWSYKHY09AdoQjRwIBw&url=http://www.free-printable-calendar.com/april-2016-calendar.html&psig=AFQjCNHdk2CWrZWeEpH1ctLfuc_qi-xz5Q&ust=1459212216971352

Mom’s day

Week #3

Week #4

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.freeallpictures.com/blank-may-2015-calendar-to-print.html&ei=GtgNVeWcFJSfyAT-5YDICA&bvm=bv.88528373,d.aWw&psig=AFQjCNGK-QnEeGLvfSg7RhOvoaMC_Je8bw&ust=1427057017552699

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiAgv-FlOLLAhUKLSYKHRZ2BW0QjRwIBw&url=http://www.free-printable-calendar.com/may-2016-calendar.html&bvm=bv.117868183,d.eWE&psig=AFQjCNHHP7j8Igw3lx5w693i7rUnglS-ew&ust=1459212424860482


How Much Does This Cost?

• Detox powder x3

• Fiber x1

• Magnesium citrate

• EPA-DHA 300

• Blender bottle

• Cook Book

• 2 boxes meal bars

• 2 Body composition tests

• 4 weeks of information that will change your health trajectory

Optimal Health & Vitality

Declining Health

Poor Health

Progressive & Chronic Disability

Age

% V

ital

ity

Age 10 20 30 40 50 60 70 80 90

LifeSpan

HealthSpan

Shape & Direction of The Health Trajectory

What is Our Health Trajectory?

And in the end, it’s not the years in your life that count. It’s the life in your years. —Abraham Lincoln

Fries J. NEJM. 1980; 303:130-135. Vita AJ, et al. NEJM. 1998;338:1035-1041.

100 90 80 70 60 50 40 30 20 10

0


How Much Does This Cost?

• Detox powder x3

• Fiber x1

• Magnesium citrate

• EPA-DHA 300

• Blender bottle

• Cook Book

• 2 boxes meal bars

• 2 Body composition tests

• 4 weeks of information that will change your health trajectory

$400

MSQ score <50

Accelerated Program: 10 Day Program

• A unique program targeted for those patients with a low level of symptomology

• Lack of a serious chronic disease or symptoms

• Medical Detox Questionnaire (MDQ) score under 50

• Self-assessed stress level mild-moderate


Conclusions

• Everyone can benefit from targeted nutritional detox therapies or programs, but there is not one protocol that suits everyone

• Factors including genetics, environmental exposure, endotoxins, diet and lifestyle must be considered to create effective personalized detoxification protocols

• Ensuring adequate mitochondrial and gastrointestinal function prior to a more aggressive detoxification program can results in better outcomes.

whole detox: how to thrive in a toxic world through ... · ... how to thrive in a toxic world...

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