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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