D
uring global industrialization over the past century, the manufacture, use, and release of xenobiotics, including synthetic chemicals and metals, into the environment has increased exponentially. As a result, exposure to persistent bioaccumulative toxicants (PBTs) by humans has increased. Exposure to certain PBTs has been associated with adverse health effects, including endocrine disruption,
1 neurological
2 and reproductive effects,
3 as well as cancers
4 and cardiovascular diseases.
5 Examples of chemicals associated with diseases and disorders include organochlorine pesticides, phthalates, bisphenol A, and polybrominated diphenyl ethers. Comprehensive indices of chemical–disease associations are available online from advocacy groups,
6 independent research organizations/networks,
7 and the federal government.
8 Over 80,000 chemicals are registered for use today in the United States, with an estimated 2000 new ones coming to market annually, many of which have not been studied for adverse health effects.
9Human biomonitoring is the process of measuring the amount of chemicals that exist within the body (blood, urine, adipose, cord blood, breast milk, etc.) coming from various environmental sources, such as soil, air, water, dust, or food.
10 The concentration of these chemicals, assessed by biomonitoring, is commonly referred to as the “body burden.” Studies increasingly suggest that the human body burden of several chemicals, at physiologically relevant levels, is a real threat to human health, including fetal and neonatal health.
11–15The term “detoxification” has become common in today's society, generally referring to weight loss, addiction recovery, or a panacea for numerous nonspecific ailments. Approaches to detoxification are highly variable, nonstandardized, and often controversial. The clinical definition of detoxification is less vague. The Centers for Disease Control and Prevention's Agency for Toxic Substances & Disease Registry defines detoxification as “the process of removing a poison or toxin or the effect of either from an area or individual.”
16 Clinical toxicology books define detoxification as conversion of “toxic parent compounds to nontoxic metabolites,” or “all reactions, enzyme-catalyzed or not, that consume toxic metabolites without producing injury.”
17,18 There are virtually no standardized clinical practice guidelines or textbooks in the field of detoxification. Within complementary and alternative medicine (CAM), there may be a large variation between CAM practitioners' use of detoxification therapies, depending on schooling, subsequent training, or individually developed protocols. It is unclear what methods are used by CAM practitioners on a regular basis for the purpose of detoxification (for diagnosis or treatment).
To the authors' knowledge, no comprehensive assessment of clinical detoxification practice in the United States has ever been conducted. However, limited data on specific detoxification protocols are available in the literature. For example, detoxification using a medical food supplement (UltraClear
© and UltraClear SUSTAIN
©) in combination with a modified elimination diet was found to improve Metabolic Screening Questionnaire scores, and increase Phase I and II metabolism markers, although not all findings were statistically significant.
19,20 A review by Crinnion summarizing a case series spanning over 10 years of practice with patients undergoing a detoxification protocol indicated that 83% of people who had undergone these treatments self-rated their results as “good” or “great.” These questionnaires were filled out by patients 0–10 years after completion of the protocols, and therefore serve as a subjective means of rating efficacy.
21 One of the most frequently cited programs, the Hubbard Purification Program,
22 is currently being used at a high-profile clinic in Manhattan to treat World Trade Center rescue workers. The multicomponent program is centered on graduating doses of niacin, as well as sauna, exercise, nutrient supplementation, and electrolytes. While methodological descriptions of the program lack specificity, particularly regarding rationale, medical monitoring, and poor characterization of endpoints, it has been shown to decrease serum and adipose levels of lipophilic chemicals, including polycholorinated biphenyls and 1,1,1-trichloro-2,2-bis(
p-chlorophenyl)ethane.
23–25 In addition, its strong association with L. Ron Hubbard and the Church of Scientology has drawn some criticism.
The few previous studies on detoxification, while providing promising data, have had important methodological limitations, including lack of peer-review, lack of randomization, lack of control groups, poorly characterized methodology, and small sample sizes. With the body burden increasing for a number of synthetic chemicals, and increasing research suggesting possible or probable adverse human health effects from these exposures, there exists an urgent public health and clinical need for research on methods of decreasing body burden (detoxification). Before rigorous clinical trials can be conducted, there is need for a better description of the current detoxification treatments used by CAM clinicians. Naturopathic doctors are an excellent resource for this information because they are provided clinical training in detoxification methods, although this training may be more based on biochemical rationale and anecdote than evidence based. The purpose of this survey was to obtain information from licensed naturopathic doctors (NDs) practicing in the United States on the use of detoxification treatments and outcome measures assessed in their practices.
1,2 Melissa Montalto, MS,1 Jennifer Lovejoy, PhD,3 and Wendy Weber, ND, PhD, MPH4