Detoxificatio

ns
Quang Bui
Touro University. April 2009
Preceptor: Victor Chirkin, Pharm
D.
Filed as: QB Herbal
 The Body 1

• The body accumulates toxins over time

• Metals, pesticides, etc.

• The body undergoes stress

• During digestion process

• Natural detoxifiers in the body

• The gastrointestinal tract (GIT)
• The liver
• The kidney

. Naturaldatabase: Detoxification
 Detoxification
• Goal: remove toxins and prevent illnesses

• Methods:
• Special “detox diet” regimens1
• Aka Diet Detox, Fad Diet, Juice Fasting, Starvation Diet,
Water Diet, Water Fasting, etc.
• Herbals remedies
• Supplements2-4
• SAMe (1200 mg/day) – antioxidant and increases bile flow
• Soy Phosphatidylcholine (900 mg/day) – removes fatty
deposits in liver
• Lecithin found in eggs, liver, organ meats, soya beans, nuts &
wheatgerm
• Naturaldatabase: Detoxification
•
•
• Colonic irrigations
Healthnotes: Liver Cirrhosis. Accessed 4/1/2009
http://www.thehealthierlife.co.uk/natural-health-articles/weight-loss/liver-detox-shift-pounds-00985.html
• Berardi RR, Kroon LA, McDermott JH, et al. Handbook of Nonprescription Drugs: An Interactive Approach to Self-
 Liver-Loving
Lifestyle 1

• Eat well
• Vegetables (esp. Brassica family)
• Broccoli, cabbage, cauliflower, Brussels sprouts
• Caraway and dill seeds
• Avoid toxins
• Prefer organics, no alcohol or smoking
• Avoid chemicals
• From household cleaning products & lawn/garden
supplies
• Avoid acetaminophen and ibuprofen

• Sweat well
• Regular physical activity increases phase 1 liver
hite LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387
 Herbal Remedies for
Liver Detoxification 1
Herbal Reasons Typical Dosages
Remedies
Milk thistle Liver protector and healer • 70-210 mg silymarin capsules 3
(Silybum times daily
marianum) • ¼ - 1 tsp milk thistle tincture 3
Dandelion root Enhance liver function (increase bile • 1 cup of tea 3 times daily
times daily
• Simmer
(Taraxacum production & improve gallbladder 1 tsp dried root + 1 cup
officinale) func.) water for 10 mins
Has choline (form of Vit B) for
normal liver function • Cook with turmeric 3 times weekly
Turmeric Antioxidant properties
(Curcuma longa) Nearly double bile ouptu & increase • 250-500 mg capsules 2-3x/d with
bile solubility to prevent & treat meals
gallstones • 1/8 to ½ tsp tincture or glycerite
3x/d
• Take with bromelain (enzyme in
Bupleurum Chinese herb that stimulates the • ½ - 1 tsp tincture 3 times daily
pineapple)
• 1 cup tea for better abs
(Bupleurum immune system. Beneficial studies 3 times daily
chinensis) in treatment of viral hepatitis. • Simmer 1 tsp root + 1 cup water
10-15
• Up tomins
Schisandra Berries with antioxidant effects six 580 mg capsules daily
(Schisandra Has mild adaptogen (gradually • 1/8 – 1 tsp tincture or glycerite up
chinensis) improves over help) so helpful in to 3x/d
chronic stress • 1 cup tea 3 times daily
• Simmer 1/3 – ½ tsp dried fruit + 1
cup water for 10-15 mins
hite LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387
 Milk Thistle 1

• Milk thistle (Silybum marianum) as main herb

• Approved by the Commissions E of German
BGA & WHO monographs2-3
• Recommend 12 – 15 g/day = 200 – 400 mg
silymarin4

• Main uses:
• Dyspepsia: acid reflux, cramp, nausea and
vomiting
• Liver health
• Alcohol-related liver disease, hepatitis B or C
1. Naturaldatabase:•MilkAmanita
Thistle mushroom poisoning
2. Tyler VE. Herbs of choice: the therapuetic use of phytomedicinals. Pharmaceutical Product Press. NY. 1994. pp 63-65
3. Boncompagni E • Toxin-induced
and Lugli liver
A. Aboca, the evoluation damage
of phytotherapy. ABOCA USA Inc. CO. 2007. pp 116-117
4. Blumenthal M, et al. The Complete German Commission E Monographs: Therapuetic Guide to Herbal Medicines. 1998.
 Milk Thistle
• Has 4 flavonolignans in the seed makes us
silymarin1-3
• Silibinin (silybin) makes 70% of silymarin
• Isosilybinin, silichristin (silychristin), and
silidian

• Silimarin undergoes enterohepatic

recirculation & has higher hepatic conc.
• Changes liver cell membrane & prevents toxin
penetration

• Antioxidant3
• Free radical scavenger & inhibitor of lipid
1. Venkataraman peroxidation
R, Ramachandran V, Komoroski BJ, et al. Drug Metabo Dispos. 2000;28:1270-3
2.
3.
• Decrease insulin resistance, blood sugar, and
Boerth J and Strong KM. J Herbal Pharmacotherapy. 2002;2:11-7
Hume AL and Strog KM of Berardi RR, Kroon LA, McDermott JH, et al. Handbook of Nonprescription Drugs: An
lipidto levels
Interactive Approach in Ed.
Self-Care. 15
th
patients with diabetes
Ch 53. pp 1108-1109
4. Flora K, Hahn M, Rosen H, Benner K. Am J Gastroenterol. 1998;93:139-43
 Milk Thistle vs. Drugs
• TNF inhibition1
• TNF is a cytotoxic, inflammatory, and an apoptosis
inducer

• Inhibit P-glycoprotein transporter2

• May decrease drug resistance of cancer cells

• Antifibrotic, anti-inflammatory, &

immunomodulatory effects3
• Decreased activity of organic anion transporting
polypeptide (OATP1B1) & inhibit breast cancer
resistance protein (BCRP)4
•  inhibit “statins” transport into the liver [mild
1. Manna SK, Mukhopadhvay
interaction]A, Van NT, Aggrawal BB. J Immunol. 1999;163:6800-9
2. Maltrelean M, Comte G, Barron D, et al. Bloorg Med Chem Lett. 2000;10:157-60
3. AHRQ evidence report/technology assessment: number 21. Avail at:
http://www.ahrq.gov/clinic/epcsums/milktsum.htm
4. Deng JW, Shon JH, Shin HJ, et al. Pharm Res. 2008;25:1807-14
 Milk Thistle vs.
Drugs 1
• Inhibits beta-glucuronidase
• Enzyme that turn glucuronides into toxic
metabolites in liver & intestine
• Protective against liver injury & colon cancer
• Theoretically increase Estrogen clearance2
[mild interaction]

• Estrogenic effects3
• Avoid in hormone sensitive conditions

• Protective kidney effect4

• Vs. nephrotoxic drugs such as
acetaminophen, cisplatin, and vincristin
1. Naturaldatabase: Milk Thistle
2. AHRQ evidence report/technology assessment: number 21. Avail at:
http://www.ahrq.gov/clinic/epcsums/milktsum.htm
3. Eagon PK, Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept
Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8-11
 Milk Thistle vs. Drugs
• Affect drug metabolism
• Phase 1 drug metabolism
• May not inhibits CYP2C91-3
• Amitriptyline, diazepam, verapamil,
warfarin, zileuton, etc. [moderate
interaction]
• Phase 2 drug metabolism
• Inhibits uridine diphosphoglucuronosyl
transferase (UGT)4-6 [moderate
•
•
interaction]
Beckmann-Knopp S, Rletbrock S, Weyhenmeyer R, et al. Pharmacol Toxicol. 2000;86:250-6
Piscitelli SC, Formentini E, Burstein AH, et al. Pharmacotherapy. 2002;22:551-6
• Gurley BJ, Gardner SF, Hubbard MA, et al. Clini Pharmacol Ther. 2004;76:428-40
• Budzinski JW, Foster BC, Vandenhoek S, et al. Phytomedicine. 2000;7:273-82
• Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R, et al. Pharmacol Toxicol. 2000:86:250-6
• Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Drug Metabo Dispos.
 Milk Thistle Dosing
• Hepatic cirrhosis:
• 420 mg/day of silymarin extract
(Legalon)1

• Chronic active hepatitis:

• 240 mg silibinin (Silibide) twice daily2

• Dyspepsia:
1.
• 1 mL of product Iberogast 3 times daily x
Ferenci P, Dragosics B, Dittrich H, et al. J Hepatol. 1989;9:105-13
2.
3.
4 wks
Buzzelli G, Moscarella S,3-5
Giusti A, et al. Int J Clin Pharmacol Ther Toxicol. 1993;31:456-60
Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial
on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg
Digestive Disease Week. May 1999
4. Madisch A, Holtmann G, Mayr G, et al. Digestion. 2004;69:45-52
 Milk Thistle Dosing
• Diabetes:
• Silymarin 200 mg 3 times daily as
additional x 4 mos1-2

• Amanita phalloides mushroom

poisoning:3
• 20-50 mg/kg over 24 hrs, divided into 4
infusions of 2 hrs period each
• Given 48 hrs after ingestion
• Intravenous silbinin not available in US
1. Velussi M, Cernigol AM, De Monte A, et al. J Hepatol. 1997;26:871-9
2. Huseini HF, Larijani B, Heshmat R, et al. Phytother Res. 2006;20:1036-9
3. Hruby K, Csmos G, Fuhrmann M, Thaler H. Hum Toxicol. 1983;2:183-95
 Milk Thistle – Side
Effects
• Well-tolerated. Contributory laxative
effects1

• Less common GI effects2

• Nausea, diarrhea, dyspepsia, flatulence,
abdominal bloating, fullness or pain, and
anorexia

• Allergic reactions1-2
• Likely to occur if sensitive to
Astreraceae/Compositae family
• Boerth J and • Ragweed,
Strong chrysanthemums,
KM. J Herbal Pharmacotherapy. 2002;2:11-7 marigolds,
• AHRQ evidence report/technology assessment: number 21. Avail at:
daisies, etc.
http://www.ahrq.gov/clinic/epcsums/milktsum.htm
 Colonic Irrigation 1

• Aka “putrefication of the stools” or

“autointoxification”
• Purpose: remove toxins from the colon
• Not to be confused with purgatives (for constipation of
≥ 72 hrs)2

• Method:
• Infuse large quantities of liquids and other substances
into colon via tube3

• Coffee Enema4-7
• Unsafe. At least 3 deaths
• Electrolyte abnormalities
• Naturaldatabase: Colonic Irrigation
• • Polymicrobial
Lewis WH and Elvin-Lewis septicemia
MPF. Medical Botany: plants affecting man’s health. John Wiley & Sons. NY. 1977. pp 280-284
• Jarvis WT. Avail at: http://www.ncahf.org/articles/c-d/colonic.html
• Margolin KA, Green MR. West J Med. 1984;140:460
• Green S. JAMA. 1992;268:3224-7
• Shils ME, Herman MG. Bull N Y Acad Med. 1992;58:323-39
• Brown BT. JAMA. 1993;269:1635-6
 Kidney Cleansing 1

Eat proper fruits & vegetables, esp. organics

• Healthy water intakes (8-10 cups per day)2
• Take foods rich in magnesium & Vitamin B63
• Mg rich food: avocados, legumes, whole grains, dark greens
veggies, nuts, seeds, soy, dried apricots
• B6 rich food: avocados, legumes, whole grains, Brewer’s yeast, egg
yolks, fish, sweet potatoes, cauliflower
• Grapes have potassium, which increases blood pH
• Ensure optimal kidney function & eliminate uric acids
• Cranberries have quinine
• Convert to hippuric acids in liver to eliminate urea & uric acids
• Herbal remedies
• Nettle soup or dandelion tea 2-3 times a day
• Ginger root + turmeric tea twice daily after meals

• Goals: colorless & odorless urine = healthy kidney

1. http://www.all4naturalhealth.com/kidney-detox.html
2. http://www.thedetoxspecialist.com/Kidney_Detox.html
3. White LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp 372-375
 Herbal Remedies for
Kidney Stones 1
Herbal Reasons Typical Dosages
Remedies
Valerian Antispasmodic & strongly • 1 cup tea or 1 tsp tincture every hour until pain
(Valeriana sedative subsides
officinalis)  relax ureter for small stones to • Take only for 1 day (b/c hi dose); Avoid in
Skullcap Antispasmodic & mostly sedative • 1 cup tea 4x/d or every hour until pain eases
pass pregnancy
(Scutellaria  relax ureter for small stones to • ¼ - 1 tsp tincture 4x/d or every hour until pain
lateriflora) pass eases
Wild Yam Antispasmodic with no sedative • Up to two 400 mg capsules per day
(Dioscorea villosa) effect • ¼ - 1 tsp tincture up to 5 times daily
Good alternative if need to stay
Khella Relax muscles of ureter and • 250 – 300 mg extract standardized to 12%
awake
(Ammi visnaga) urinary tubules but is hard to find khellin per day in divided doses
Marshmallow Demulcent to soothe irritated • Up to six 400 – 500 mg capsules/d
(Althacea urinary tissues • 1 cup tea divided into 3 portions daily
officinalisI) May decrease certain • 20-40 drops tincture up to 5x/d
medications
Slippery Elm Eases irritation and heals body • Up to twelve 370 mg capsules daily
(Ulmus rubra) tissues • 2 – 3 cups tea daily
May decrease certain • 10-30 drops of tincture up to 5 times daily
medications
Corn Silk Strings in ear of corn that soothe • 4 – 6 cups tea per day
(Zea mays) and relax urinary tubes not • ¼ - 1 tsp tincture 4 – 5 times daily
kidney itself
Aloe Has anthraquinones that prevent • 1 tsp after meals
(Aloe vera) kidney stones • Reduce dose if experience laxative effects
Yellow Dock Traditional blood purifier • Up to four 500 mg capsules per day
(Rumex crispus) containing anthraquinones • 20 – 40 drops tincture up to 2 times daily
• Reduce dose if experience diarrhea. Avoid in
pregnancy
White LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387
 Detoxification
Recommendations
• Lifestyle changes
• Drink 8-10 cups of water but avoid excess
drinking.
• Eat plenty of washed fruits and vegetables
• Exercise regularly

• Herbal remedies & alternative choices

• Milk thistle is relative safe for liver
detoxification
• Communicate with physicians and
pharmacists about current and planned
herbal regimen
 Herbal Remedies for
Liver Detoxification
Herbal
Remedies
(Review)
Reasons
1
Typical Dosages

Milk thistle Liver protector and healer • 70-210 mg silymarin capsules 3

(Silybum times daily
marianum) • ¼ - 1 tsp milk thistle tincture 3
Dandelion root Enhance liver function (increase bile • 1 cup of tea 3 times daily
times daily
• Simmer
(Taraxacum production & improve gallbladder 1 tsp dried root + 1 cup
officinale) func.) water for 10 mins
Has choline (form of Vit B) for
normal liver function • Cook with turmeric 3 times weekly
Turmeric Antioxidant properties
(Curcuma longa) Nearly double bile ouptu & increase • 250-500 mg capsules 2-3x/d with
bile solubility to prevent & treat meals
gallstones • 1/8 to ½ tsp tincture or glycerite
3x/d
• Take with bromelain (enzyme in
Bupleurum Chinese herb that stimulates the • ½ - 1 tsp tincture 3 times daily
pineapple)
• 1 cup tea for better abs
(Bupleurum immune system. Beneficial studies 3 times daily
chinensis) in treatment of viral hepatitis. • Simmer 1 tsp root + 1 cup water
10-15
• Up tomins
Schisandra Berries with antioxidant effects six 580 mg capsules daily
(Schisandra Has mild adaptogen (gradually • 1/8 – 1 tsp tincture or glycerite up
chinensis) improves over help) so helpful in to 3x/d
chronic stress • 1 cup tea 3 times daily
• Simmer 1/3 – ½ tsp dried fruit + 1
cup water for 10-15 mins
hite LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387
 Herbal Remedies for
Kidney Stones
Herbal
Remedies
Valerian
(Review)
Reasons
1
Antispasmodic & strongly
Typical Dosages

• 1 cup tea or 1 tsp tincture every hour until pain

(Valeriana sedative subsides
officinalis)  relax ureter for small stones to • Take only for 1 day (b/c hi dose); Avoid in
Skullcap Antispasmodic & mostly sedative • 1 cup tea 4x/d or every hour until pain eases
pass pregnancy
(Scutellaria  relax ureter for small stones to • ¼ - 1 tsp tincture 4x/d or every hour until pain
lateriflora) pass eases
Wild Yam Antispasmodic with no sedative • Up to two 400 mg capsules per day
(Dioscorea villosa) effect • ¼ - 1 tsp tincture up to 5 times daily
Good alternative if need to stay
Khella Relax muscles of ureter and • 250 – 300 mg extract standardized to 12%
awake
(Ammi visnaga) urinary tubules but is hard to find khellin per day in divided doses
Marshmallow Demulcent to soothe irritated • Up to six 400 – 500 mg capsules/d
(Althacea urinary tissues • 1 cup tea divided into 3 portions daily
officinalisI) May decrease certain • 20-40 drops tincture up to 5x/d
medications
Slippery Elm Eases irritation and heals body • Up to twelve 370 mg capsules daily
(Ulmus rubra) tissues • 2 – 3 cups tea daily
May decrease certain • 10-30 drops of tincture up to 5 times daily
medications
Corn Silk Strings in ear of corn that soothe • 4 – 6 cups tea per day
(Zea mays) and relax urinary tubes not • ¼ - 1 tsp tincture 4 – 5 times daily
kidney itself
Aloe Has anthraquinones that prevent • 1 tsp after meals
(Aloe vera) kidney stones • Reduce dose if experience laxative effects
Yellow Dock Traditional blood purifier • Up to four 500 mg capsules per day
(Rumex crispus) containing anthraquinones • 20 – 40 drops tincture up to 2 times daily
• Reduce dose if experience diarrhea. Avoid in
pregnancy
White LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387