Dr. Kathleen Jade, N.D.

doctor of naturopathic medicine

Complete, Unedited Answers To Readers’ Questions

Last year I did a “juice cleanse” and while I do not feel like I was doing anything bad for my health with this cleanse, I know some health experts question the safety of juice cleanses and I was curious if there is any medical research to support opinions one way or the other? – Alisa

In fact, Alisa, there is medical research on the effects of fasting some of which shed light on the effects of a “juice cleanse.” However, like much medical research, drawing conclusions from it is not black and white. Cleansing our bodies through fasting is a method of detoxification which allows the body to take a break from its digestive duties in order to focus on healing, and it triggers a release of toxins. Most of the research into the therapeutic value of fasting has explored the water-only method. Articles have appeared in conventional medical journals in both the United States and Europe showing the positive results of supervised fasting in treating various diseases, including hypertension, cardiovascular disease, autoimmune disorders, diabetes, skin disease, gastrointestinal disease, arthritis, and allergies. How fasting positively affects these diseases, and what its long-term effects are, depends on the ailment. However, through recent research, we now know that truly healthy and effective detoxification requires a level of nutritional support that is unlikely to be reached via juice (or water) fasting alone. Therefore, I never recommend water or juice fasting during a detoxification protocol unless it is very short-term and supplemented with protein and certain types of nutrients.

The toxins that can be released through fasting put too much strain on the detoxification organs. This research indicates that our body’s detoxification enzyme systems require many key nutrients to function optimally. Because some of the more recent studies have shown that water or juice fasting can actually be detrimental to the body's ability to support detoxification and excretion of toxins, I usually prescribe a high quality meal replacement powder containing hypoallergenic protein along with specific aids to detoxification including vitamins, minerals, fiber, and specific phytonutrients. Also, because of the typical standard American diet (S.A.D.), high in refined carbohydrates and calories (but low in nutrients), many people have imbalances that are contraindicated for fasting, especially those with hypoglycemia, diabetes, eating disorders, and kidney disease.

Why was grapefruit prohibited on your detox? I thought it was good for you! – Patrick, Seattle

Grapefruit juice was prohibited because it inhibits the detoxification process. In order to understand why, it helps to have a brief overview of the liver’s detoxification enzyme systems. The liver clears our blood of the many environmental toxins we are exposed to every day. It has two phases of detoxification, conveniently named 1 and 2, each of which must function properly for us to maintain health. Exposure to certain toxins can change the speed at which each phase occurs. It is not uncommon for Phase 1 to be upregulated (or work faster) in comparison to Phase 2. When this happens, the products generated by Phase 1 (which are often more harmful than the original toxins) are not removed fast enough by Phase 2. The result is a buildup of toxins in the body. In contrast, some substances, including a compound in grapefruit juice, inhibit (slow down) certain Phase 1 enzymes, allowing some toxins to remain in the body for longer time period. Doing a supervised detox can address this imbalance, using targeted nutrients to bringing Phase 1 and Phase 2 activity back into balance, optimizing the liver's function, and gradually clearing any toxins that have built up.

Do you think drinking coffee, even a little, lessens the good effects of a detox? – Sarah W., Anacortes

The short answer is yes, caffeine compromises detoxification because it is an addictive drug that must be processed by the liver. One of the primary reasons for undergoing a detoxification protocol is that by avoiding substances that tax the liver, you allow your body a chance to function optimally. This will make more sense if you consider some of the basics of the liver’s detoxification enzyme systems. The liver clears our blood of the many environmental toxins we are exposed to every day. It has two phases of detoxification, conveniently named 1 and 2, each of which must function properly for us to maintain health. Exposure to certain toxins can change the speed at which each phase occurs. Coffee, along with alcohol, smoking, and certain medications, such as oral contraceptives, stimulates the first phase of the body’s detoxification process. This can have a negative effect on the balance between the two phases, because the second phase pathways may be unable to keep up with the increased demand. This results in an increase in free radical production which damages our cells. Your question brings up another very important issue regarding detoxification: the real effect of coffee on detoxification depends on your genes! Here’s why: The liver utilizes thousands of specialized proteins known as enzymes. Each of these enzymes is specifically designed to chemically alter a single compound in order to keep it from harming our bodies. We need thousands of different enzymes in the liver to process the thousands of substances we constantly encounter. What’s important is that because of genetic differences, we all have very different enzymes and therefore very different abilities to process and detoxify different compounds. If we lack a particular enzyme or set of enzymes, we are uniquely susceptible to the harmful effects of particular compounds. In the case of coffee, genetic differences determine whether our livers process caffeine quickly, or allow it to linger in our systems. If you’re one of the many people who has the gene that leads to slow coffee metabolism, as little as one cup could be equivalent to four cups in the fast metabolizers. This has major health implications: A recent study published in the Journal of the American Medical Association found that slow caffeine metabolizers who drink more coffee have a significantly increased risk of heart attack. Many other studies also show how genetic differences in enzyme function are associated with health problems such as cancer, Parkinson’s disease, ALS (Lou Gehrig’s disease), Alzheimer’s disease, Multiple Sclerosis, kidney and liver disease, cardiovascular disease, as well as medication side effects and toxicity. This is an exciting and exploding field of research. Science is just beginning to be able to identify and test for specific enzyme function. Many naturopathic physicians use tests now available to identify weaknesses or deficiencies in certain detoxification enzyme systems. We can then help our patients support and improve theses weaknesses for treatment and prevention.

How do you get enough calcium if you don’t have dairy, and if you use supplements, how can you make sure they’re the kind that are absorbed well? – Barrie Phillips, Seattle

Your question assumes that you take it for granted that dairy is essential for our bodies to be healthy. However, numerous clinical studies have demonstrated the benefits of calcium supplementation. However, the effect of milk on bone health is debatable. The data is inconclusive and does not support the idea that “every body needs milk”. According to the Harvard School of Public Health, for example, there is currently no good evidence that consuming more than one serving of milk per day in addition to a reasonable diet (which typically provides about 300 milligrams of calcium per day from nondairy sources) will reduce fracture risk. This school’s researchers say that because of unresolved concerns about the risk of ovarian and prostate cancer, it may be prudent to avoid higher intakes of dairy products.

The data does, however, support the important role of calcium supplementation in reducing the risk of osteoporosis. To make sure your calcium supplements are a type that are absorbed well, purchase calcium bound to citrate, malate, or other Kreb’s cycle intermediates. Although this type of calcium is bulkier than calcium carbonate and therefore requires more tablets/capsules to achieve the same dosage, it is easily absorbed regardless of the output of stomach acid. It is available in powder form that is easily mixed with water and provides higher dosages. The most common form of calcium, calcium carbonate, is also absorbed relatively well except in people with low stomach acid production. Low stomach acid is estimated to occur in about 30% of North Americans, and is higher in post-menopausal women. If you do choose to take calcium carbonate because of its lower cost and ease of use, just make sure it is taken with food for maximum absorption.

Lastly, don’t believe the hype about coral calcium, which is essentially just calcium carbonate and which may be contaminated with lead and other impurities.

How necessary are the naturopath-prescribed supplements? To be honest, I've always wondered if those might not be kind of a racket. If you’re eating a so-called healthy diet, why do you need supplements? – Don J., Seattle

Licensed naturopathic physicians and other licensed healthcare providers skilled in nutritional medicine have access to physician-only lines of high quality, potent and maximally absorbable vitamins, minerals, and other neutraceuticals. There are no gimmicks or rackets involved when licensed physicians properly prescribe effective nutrients and botanicals to help patients heal! Physician-only supplements are often preferred for a number of reasons: the companies that make these supplements source the highest quality ingredients, voluntarily adhere to the highest standards of production, provide a more pure and potent supplement, and have certificates of analysis available to the doctors validating the exact contents of their products. Nutritionally-minded healthcare practitioners are able to hand-select supplements from a wide body of physician-only companies in order to give you the best quality and most effective products for your money. ND’s take great care, and are able with their education, to discern quality and potency and to prescribe only what is needed. Products sold over-the-counter at health food stores vary widely in quality, as there is currently no regulation of their production. Some supplements of low quality may be ineffective and harmless, but others may be dangerous.

While it is true that a high quality and balanced diet provides “satisfactory” levels of most nutrients, there are numerous reasons supplements are recommended in addition to a healthy diet, especially while undergoing a detoxification protocol:

• Supplementation is more than just a means to make up for deficiencies in the diet. Additional amounts of nutrients can protect against disease and help protect us against premature aging. We now know that healthy, balanced diets still do not provide levels of nutrients necessary for optimal health and maximum prevention of chronic disease. There has been a huge increase in scientific evidence documenting the beneficial effects of many nutrients not yet considered “essential”, such as fiber and probiotics, or which exert their benefits at dosages much higher than the RDA, such as vitamin E or D. This has led to a new awareness and appreciation for the way nutrients can have profound and positive effects on health and disease.

• Detoxification is now known to be highly dependent on adequate levels of certain nutrients. The purpose of using supplements as part of detoxification therapy is to improve the body’s ability to detoxify and excrete toxins, accelerate the body’s own natural detoxification process, and protect body tissues from the dangerous chemical products that are generated during detoxification. Supplements are used during detoxification protocols specifically to: o Support the body’s enzymatic processing and elimination of toxic substances o Support amino acid needs and energy production for detoxification o Protect cells from free radicals generated during detoxification o Balance the two phases of detoxification using phytonutrients, amino acids and antioxidants. This especially involves providing nutritional support for the second phase of detoxification, which is often sluggish, so that it can process the highly reactive compounds generated by the first phase. For example, certain nutrients are used to increase the production of a key molecule known as glutathione, which is a crucial antioxidant used to "mop up" toxic metals and other toxins. It then assists in the transport of these toxins to the liver and kidneys where they can be processed for disposal. o Stimulate the efficient production and flow of bile. Toxins processed by the liver are deposited in the bile, which must then be released into the small intestine. o Bind toxins that have been released in the intestine, preventing their reabsorption into the bloodstream. Without extra fiber and highly efficient elimination, a large percentage of toxins would head back to the liver, putting additional toxic stress upon the liver and reducing the quantity of toxins that are effectively disposed of.

• Supplements are needed to make up for drug-induced deficiencies. Many commonly prescribed drugs, including acid-blockers, asthma medications, and some cholesterol-lowering drugs, produce nutrient deficiencies that are often overlooked by the average doctor.

• Even when we eat a healthy diet, ingesting adequate levels of nutrients, those nutrients may not get delivered to our cells or be properly taken up by them. Many individuals have difficulty digesting and assimilating nutrients due to digestive system dysfunction. Impaired digestion and absorption are relatively common problems. In addition, each of these processes has been found to show great genetic variability between people.

So, what exactly was Anne Hurley supposed to be purifying and/or flushing out of her body? Was it there in the first place? What was filtered out of her drinking water? If this diet is so healthy, why did she need the unspecified "supplements"? – Jack P., Issaquah

Three separate questions/three separate answers:

What exactly was Anne Hurley supposed to be purifying and/or flushing out of her body?

Just like the rest of us, Anne Hurley has a “body burden” of toxins—a load of industrial chemicals stored in or passing through her body. All humans in the 21st century store chemical toxins which can be detected in blood, urine, and tissue samples. Recent “body burden” research proves we all have PCB’s, metals, chlorinated pesticides, phthalates, benzene, and flame retardants in our bodies. When the liver’s detoxification systems are overloaded or not working optimally, detoxification is slowed, resulting in more toxic substances circulating in the body. These toxins that are not easily eliminated are instead stored in fatty body tissue, including the brain and central nervous system cell, and may be released both through the skin and into the circulation with sauna therapy.

The general purpose of Anne’s detoxification protocol was to first give her body’s detoxification system, comprised of her skin, liver, kidneys, intestine, and lungs, a chance to rest by avoiding common sources of toxins, since even low-level toxins have profound effects on cells and the proper functioning of our body’s systems. Second, Anne’s detoxification protocol was designed to remove stored toxins by encouraging their mobilization and maximizing their elimination out of her body via her urine, feces, and sweat.

Some detoxification protocols involve the clearance of heavy metals like mercury and lead through a process called chelation. Anne’s detoxification protocol did not involve heavy metal chelation. Instead, her protocol included a series of low temperature (far infrared) sauna sessions and supplement-enhanced bowel elimination for the excretion of toxins.

What was filtered out of her drinking water?

I instruct my patients undergoing detoxification to use water that has been filtered via a reverse osmosis system which includes a carbon filter. This type of filtration system removes or greatly reduces lead, copper, arsenic, cadmium, chlorine, giardia, pesticides, salt, trihalomethanes (chlorination by-products), sulfates, cysts, and nitrates. These contaminants have been implicated in liver, kidney, nervous system, and circulatory system disorders, as well as cancer. During detoxification, if the water we’re ingesting carries a load of mineral salts, heavy metals, and pollutants, it cannot be efficient in its vital functions: the mobilization of toxic compounds from our fat cells, the processing of that waste through the liver and kidneys, and the excretion of the toxins through enhanced elimination. Adequate intake of filtered water is essential to maintain healthy kidney function and promote urinary excretion of toxins already in circulation.

If this diet is so healthy, why did she need the unspecified "supplements"?

The belief that the typical diet contains all the nutrients we need to be healthy is outdated, having been proven wrong in a large number of clinical trials. Numerous studies have shown that providing additional quantities of vitamins, minerals, amino acids, or other naturally occurring compounds can help relieve a wide range of symptoms and disorders. The detoxification system is especially dependent on nutrients. The liver and other tissues involved in the detoxification process must have available the right balance of protein, fiber, and vitamins, minerals, and proper phytochemicals (plant compounds) to be effective. The use of certain nutritional supplements during detoxification has been shown to enhance liver function and protect the liver and other tissues in the body from damage during the detoxification process.

Do you really need to buy organic everything? It's SO much more expensive. – Sally Taylor, Seattle

You don’t have to switch totally to organic foods during a detox, but you should at least replace the most commonly toxic foods with organic (or eliminate them entirely). Those foods listed as being the highest in pesticide residue are: dairy, beef, apples, bell peppers, celery, cherries, imported grapes, nectarines, peaches, pears, potatoes, red raspberries, spinach, and strawberries. You can lower pesticide exposure by 90 percent by avoiding the top twelve most contaminated fruits and vegetables listed above, and eating the least contaminated instead. Eating the twelve most contaminated fruits and vegetables will expose a person to nearly 20 pesticides per day, on average.