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Metabolic Tests / The Comprehensive Detoxification Profile
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The Comprehensive Detoxification Profile analyzes saliva, blood, and after-challenge doses of caffeine, aspirin, and acetaminophen in order to assess the Phase I and Phase II functional capacity of the liver to convert and clear toxic substances from the body. This profile includes markers for oxidative stress and important antioxidants. The standard profile analyzes saliva and urine to assess the Phase I and Phase II functional capacity of the liver to convert and clear toxic substances from the body.
In the Comprehensive version of this profile, the urine specimen is analyzed for levels of lipid peroxides. In addition, various oxidative markers are assessed from fasting blood specimens taken the morning after the challenge. These tests are sensitive indicators of biological detoxification status.
Our bodies must be able to detoxify xenobiotics (environmental toxins), endotoxins (gut-derived toxins), endogenous hormones (hormones produced by the body), and other phenolic compounds. This test reflects the degree of toxin exposure and the body’s ability to handle this load. When the two phases of detoxification are out of balance, our bodies are more prone to illness. This test is the only means of assessing this balance. An insufficiency of critical nutrients required for detoxification results in an increased toxic burden on the body and illness. This test can assess the demand upon, and the availability of, these nutrients.
All ingested and microbially-produced toxins are presented to the first-pass clearance system. First-pass clearance involves the biotransformation and clearance of a chemical from the body before it reaches the systemic circulation. This clearance may take place in several organ tissues including the wall of the intestines and the liver.
The liver is the body's primary detoxifying organ. Here, detoxification is carried out in two related processes known as Phase I and Phase II. Phase I serves to break down toxic substances through a process that utilizes what is known as the cytochrome P450 enzymes. This process increases the solubility of molecules and prepares them for Phase II reactions which will further increase their solubility.4-8
The Phase I reactions are necessary for detoxification, but the resulting production of reactive oxygen species can at times be very damaging. Thus, the liver needs to be able to generate oxidation capacity when needed, yet at the same time generate no more than what is needed. Perhaps this is why Phase I systems are inducible by different compounds.
In Phase II, conjugation reactions add a polar hydrophilic molecule to the metabolite or toxin, converting lipophilic (attracting fat) substances to water-soluble forms for excretion and elimination. Phase II reactions may follow Phase I for some molecules or act directly on the toxin or metabolite. Major Phase II pathways include glutathione, sulfate, glycine, and glucuronide conjugations.9 Individual xenobiotics and metabolites usually follow one or two distinct pathways. While the modification of Phase I and II enzyme activities has its basis in the research setting, there is growing appreciation of the clinical applications of such strategies.
Although exhaustive clinical studies have yet to be performed, we have the biochemical and logical basis upon which to recommend interventions in order to help patients with evidence of chemical sensitivity or high exposures to toxic compounds.10-12 It should be noted, however, that nutritional modification of the P-450 and/or conjugation pathways has strong potential to change drug metabolism. Due to this potential metabolic impact, practitioners should use caution and awareness when recommending such strategies in patients taking prescription medications.13
Assessment of the metabolic status of these major detoxification processes assists with our understanding of the body's capacity to detoxify foreign substances. (See Figure 1 below.) 4-8
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