How Nutritional Deficiencies Affect DetoxMelanie Dorion, AGNP

The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.

Lahnor Powell, ND, MPHMedical Education Specialist - Atlanta

Melanie Dorion, AGNP

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How Nutritional Deficiencies Affect DetoxMelanie Dorion, AGNP

The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.

• Understand the interrelationships of toxins and nutritional deficiencies

• Review detox pathways, focusing on glutathione conjugation, methylation and sulfation

• Understand functional nutritional testing

• Apply nutritional therapies to support detox physiology

Objectives

• Background on toxins

• Deficiencies in chronic illness

• Detox overview

• Nutrients and detox pathways – focus on Phase II– Methylation

– Sulfation

– Glutathione conjugation

• Testing

• Management

Outline

About Toxins

• The US permits more than 84,000 chemicals to be used in household products, cosmetics, food and food packaging – Most of these have never been tested for safety

• Personal care products are manufactured with over 10,000 chemical ingredients– Some are known or suspected carcinogens, toxic to the reproductive system or known to

disrupt the endocrine system

• In 2012, “industrial facilities dumped more than 206 million pounds of toxic chemicals into America’s waterways”

About Toxins

https://environmentamerica.org/news/ame/206-million-pounds-toxic-chemicals-dumped-america%E2%80%99s-waterways

https://articles.mercola.com/sites/articles/archive/2015/12/08/toxic-chemical-health-risks.aspx

https://www.ewg.org/skindeep/2011/04/12/why-this-matters/#.WxH-eEgvxPY

• Electrosmog– “Astronomers measure radio waves in units called janskys. A typical star shines at

10 to 100 janskys. The Sun shines at about 500,000 janskys. When you hold a cell phone against your head, you are pumping energy at the rate of about 100,000,000,000,000,000 janskys into your brain.”

– There is now 10 billion times more radiation in our environment than there was in the 1960s

– The whole-body exposure from a smart meter at 3 feet is about 100 times more than that from a cell phone

About Toxins

http://www.cellphonetaskforce.org/cell-phones-questions-and-answers-2/

https://olgasheean.com/wp-content/uploads/2016/07/NO-SAFE-PLACE-Letter-to-Gregor-Robertson-240716.pdf

• The WHO International Agency for Research on Cancer classifies cell phone radiation as “possibly carcinogenic to humans”

• Biological effects– DNA damage, sperm damage, neurological disruption, hormonal changes, cardiac/ECG

changes, increased brain glucose levels, behavioral changes, headaches, sleep disruptions, “brain fog” and fatigue

• Smart meters– “Each wireless smart meter pulses on average 10,000 times per day, creating a dangerous

situation for nearby residents.” Jeromy Johnson

More on Electrosmog and EMFs

http://www.who.int/news-room/fact-sheets/detail/electromagnetic-fields-and-public-health-mobile-phones

https://www.emfanalysis.com/health-effects/

“Generally Recognized As Safe” (GRAS)

– Exempt from the FDA approval process

– Used by food manufacturers to add novel ingredients without FDA oversight

– Include food dyes, heavy metals and artificial sweeteners

https://articles.mercola.com/sites/articles/archive/2015/04/29/flawed-gras-system-foodadditives.aspx

https://www.npr.org/sections/thesalt/2015/04/14/399591292/why-the-fda-is-clueless-about-some-of-the-additives-in-our-food

https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm091048.htm

• May contain any of 3,000+ chemicals– Phthalates and ethanolamines

– Include hormone disruptors and allergens

• 6,578 studies in PubMed include information on the toxicity of these chemicals

• Protected under federal law as “trade secrets” and therefore can remain undisclosed

Fragrance

https://www.beautycounter.com/the-never-list

http://www.ewg.org/skindeep/ingredient/702512/FRAGRANCE/#.WxIBmUgvxPY

Red No. 40 Anyone?

Nutritional Deficiencies in Chronic Disease

Medications Associated with Nutrient Depletion

LaValle, James. (2015). Consequences of Cardiovascular Drug-Induced Nutrient Depletion. 369-404

Prilosec/Omeprazole

www.mytavin.com

Nutrient Prevalence

Vitamin C 35-45%

Vitamin D 80-90%

B12 9-10%

Folate 25%

Iron 13-19%

Nutritional Deficiencies in Obesity

Others

Werbach MR. Altern MedRev. 2000;5(2):93-108

Bennett, P. et al (2010). Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine

Condition Deficiencies/links to illness

SIBO Fat soluble vitamins, B12, iron

IBD Many, many!85% in Crohn’s

68% in UC

CFS/ME Marginal deficienciesB vitamins, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-

carnitine, coenzyme Q10, and essential fatty acids

Prostate CA Lower in take of B6 associated w/ prostate CA

Cervical CA Increased risk w/ elevated homocysteine and inversely associated w/ intake of folate, B12 and B6

Oesophageal and gastric CA Inversely associated w/ folate and B6 intake

• RDA most likely not sufficient to prevent subtle metabolic damage and oxidative stress

• DNA damage and oxidative lesions– Inadequate intake of B12, folate, B6, C, E and Fe

– About half the population may be deficient in one of these

• Mitochondrial damage– Iron and biotin (B7) deficiency

– ¼ of U.S. menstruating women ingest < 50% of the RDA

DNA and Mitochondrial Damage

Bennett, P. et al (2010). Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine

Detox Overview – The BIG Picture

Nutrients

Toxins

Phase I

Phase II

Phase III

Detox As We Know It

It Starts with Nrf2

Bennett, P. et al (2010). Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine

Hodges, R. E, et al. J Nutr Metab. 2015; 2015:760689

Nrf2 ActivationARE

Nutrients

Toxins

Phase I

Phase II

Phase III

Nrf2 ActivationARE

Nutrients

Toxins

Phase I

Phase II

Phase III

Then It Gets Really Complicated …

Image source: SHEICON2017

Image source: SHEICON2017

Methylation

Sulfation

Image source: SHEICON2017

Glutathione

Image source: SHEICON2017

Why Focus on Phase II?

• Proteins– Glycine, glutamate, methionine, serine, cysteine, and acetylcysteine

• Vitamins – B2, B3, B6, B9/folate, and B12

• Minerals– Magnesium, selenium, and zinc

Phase II is Heavily Nutrient Dependent

Methylation

Remember How Enzymes Work

Methylation

Image source: SHEICON2017

• COMT

• MTHFR

• BHMT

• COMT– Magnesium

– B6

– High sucrose diet may inhibit COMT

Methylation

Busserolles J, et al. Life Sci. 2002;71(11):1303-12

https://www.ncbi.nlm.nih.gov/gene/1312

• MTHFR– B12

– FAD (B2)

– NADP (B3)

– Folic acid reduces the activity of the folate pathway

Methylation

Cacciapuoti, F. Journal of Cardiol Ther. 2016;3(4):549-553

https://www.ncbi.nlm.nih.gov/gene/4524

NADP, FAD

• BHMT– Betaine (from choline)

– Zinc

Methylation

https://www.ncbi.nlm.nih.gov/gene/635

Image source: SHEICON2017

Sulfation and Glutathione

• Requires– Sulfur-containing amino acids -

cysteine and methionine

• CBS requires– Serine

– B6

– Iron (is heme binding)

Sulfation

https://www.ncbi.nlm.nih.gov/gene/875

CBS

CTH

GSS

B6, iron

• Tripeptide: glutamate, cysteine and glycine

• Magnesium

• Selenium

• Glycine

• B3

Glutathione

Lu SC. Mol Aspects Med. 2009;30(1-2):42-59

Image source: SHEICON2017

Glutathione

Testing

Standard Lab Testing

• CBC– MCV

• Ferritin

• B2– Whole blood

– G6PD deficiency can mask B2 deficiency

– Hypothyroid and adrenal dysfunction decreases activation of B2 → FAD

• B6– Plasma

• B9– Serum and RBC

– Red blood cells reflects total folate status, while folate in plasma or serum reflects almost exclusively methylated folate

• B12– Serum and methylmalonic (MMA)

– Biotin deficiency could blunt the production of MMA

Standard Lab Testing

• Homocysteine (hcy) (optimal 5-7)– > indicates B6, B9 or B12 deficiency

• Methionine– Plasma Amino Acid Profile

– High w/ low hcy = not converting methionine to SAMe

– Normal w/ high hcy = B6 def

– Low w/ high hcy = deficiency in methyl donors

• Magnesium– Serum and RBC

– 24-H urine: high in urinary loss

• Selenium– Plasma (vs serum or whole blood)

• Zinc– Plasma (vs serum or whole blood)

– Ideal range 70-120mcg/L

Functional Testing

Used with permission of Genova Diagnostics

Functional Testing

• Lipid peroxides: cell membrane damage

• 8-OHdG: DNA damage

Management

NutriGenetic Research Institute 2018

KEAP1 and Nrf2 SupportKEAP1

• Zinc

• Selenium

• Sulforaphane

Nrf2

• Low doses

• Isoflavones

• EPA/DHA

• Turmeric

• Sulforaphane

• Tocopherol

• Remove or reduce sources of toxins

• Adequate hydration– Consider adding electrolytes

• R&R

• Support gentle detox– Lymphatic drainage, magnesium bath, infrared sauna, sweating, movement

• Intermittent fasting

• Support the digestive system

Management

NutriGenetic Research Institute 2018

Treatment Pyramid

Test and Don’t Guess!

• Deficiencies due to– Inadequate intake

– Increased need

– Decreased absorption

• Food first

• “Open” the pathway

• Medical food/meal replacements

Correcting Deficiencies

• SubQ B12 and B complex

• IV’s– Saline with magnesium

– Myer’s cocktail

– High dose vit C with Myer’s B

• Patients may feel exhausted at first

IV, IM and SubQ

Case 1

• Mold illness

• MCAS

• SIBO

• Mold illness

• MCAS

• SIBO

• Mold illness

• MCAS

• SIBO

Case 2

• Lyme

• Bart

• MG

• Lyme

• Bart

• MG

More About Detox and Chronic Illness

To reach me:pentadintegrativehealth.com

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Lahnor Powell, ND, MPHModerator

Melanie Dorion, AGNPPresenter

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July 25, 2018

The GI Effects and NutrEval: Making Clinical ConnectionsStephen Goldman, DC

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The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.

How Nutritional Deficiencies Affect DetoxMelanie Dorion, AGNP

The views and opinions expressed herein are solely those of the presenter and do not necessarily represent those of Genova Diagnostics. Thus, Genova Diagnostics does not accept liability for consequences of any actions taken on the basis of the information provided.