A Theoretical and Practical Approach 2 1st English edition, June 2007 2007 by Biologische Heilmittel Heel GmbH, Baden-Baden, Germany. Printed in Germany 64900 06/07 Dinner Druck Biologische Heilmittel Heel GmbH Dr.-Reckeweg-Strae 2-4 76532 Baden-Baden, Germany Phone +49 7221 501-00 Fax +49 7221 501-450 www.heel.com Contents Part I / Classes of Homotoxins ...5 1 Introduction 5 2 Effects of Toxins in General 6 3 Measurement of Toxicity 6 4 Classes of Toxins 7 4.1 Pollutants 4.2 Metals 4.3 Agricultural Chemicals (Pesticides) Including Wood Preservatives 4.4 Plasticizers and PBBEs 4.5 Therapeutic Drugs and Drugs of Abuse 4.6 Food Additives and Preservatives 4.7 Endogenous Toxins Part II / The Physiology of Detoxication ...13 1 Absorption 14 2 Transport 14 3 Distribution and Storage 15 4 Metabolism of Toxins 16 4.1 Phase I Reactions 4.2 Phase II Reactions 5 Elimination 17 Part III / The Organs of Detoxication and Elimination ...21 1 The Liver 21 2 Excretion in Bile 22 3 Entero-hepatic Circulation 22 4 The Kidneys 22 5 The Matrix and Lymph 23 5.1 The Matrix 5.2 The Lymph System 6 The Lungs 26 7 The Mucosal Membranes 26 8 The Skin 27 9 Sweat 28 10 Hair 28 11 Other Routes of Elimination 28 Part IV / Tools for Detoxication ...30 1 Why Does a Person Need 30 to Detoxify and Eliminate 2 Tools for Detoxication and Drainage 31 2.1 The General Basic Detoxication 2.2 The General Advanced Detoxication 2.3 The Catalysts Part V / Practical Detoxication ...38 1 Clinical Groups 38 1.1 The Detoxication Point Scale 1.2 The Clinical Assessment of the Patient 2 How Long Should the Patient Detox? 39 3 Blocked Excretion 39 4 The Decision Tree 40 Part VI / The Organ-specic Treatment ..42 1 The Liver 42 1.1 Therapy Scheme for Detoxication in Chronic Viral Infection like Hepatitis C 1.2 Detoxication of the Gallbladder and the Bile 1.3 Therapy Scheme for Fatty Inltration of the Liver in Type II Diabetics: So-called NASH (Non Alcoholic Steatotic Hepatitis Syndrome) 2 The Kidneys 46 2.1 Therapy Scheme for Kidney Stones 2.2 Therapy Scheme for Chronic Recurrent UTIs 2.3 Interstitial Cystitis 3 The Lymphoid System 49 3.1 Therapy Scheme for Chronic Recurrent Tonsillitis 4 The Skin 51 4.1 Therapy Scheme for Acne Vulgaris Part VII / References ...53 3 4 Note Since this is an international publication, names and formulas of the products mentioned in this booklet may vary from one country to another. Classes of Homotoxins 5 Part I / Classes of Homotoxins 1 Introduction To better understand the rationale and methods for Detoxication and Drainage, it is useful to dene what are toxins, their origin and nature, how they reach the body cells and tissues, and how they even- tually inuence homeostasis and become eventually etiological factors for inducing disease processes. Any agent (physical, chemical, microbial, etc.) that adversely modies or damages a balanced biological system is considered a toxin. Toxins may enter the body from the external environment (exogenous also called toxicants or xenobiotics) through the gas- trointestinal system by ingestion, the respiratory sys- tem by inhalation, and the skin by passive absorption or by injection. Toxins may also originate within the body itself (endogenous toxins) as by-products of physiological metabolism (bilirubin, creatinine, lactic acid, etc.) or as metabolites under abnormal meta- bolic conditions (excess production/degradations of neurotransmitters and/or hormones, excess free rad- ical formation, etc.). Modern medicine is quite successful in diagnosing and treating acute intoxications as medical emergen- cies for heavy metals, drug poisoning, etc. as well as symptomatic sub-acute poisonings from a variety of toxins (chemical, drugs and/or other xenobiotics), but only if some laboratory evidence of intoxication is found. Unfortunately for the patient, sub-clinical or subtle states of chronic intoxications are not rec- ognized, except for the fact that the appearance of any symptomatology is treated with suppressive medications independently of its etiology. Biological effects of chronic subtle states of intoxica- tions are of great importance to biological medicine. Paracelsus is often paraphrased as stating that the dose makes the poison. Often, if the dose is not high enough to produce immediate acute effects and/or cannot be detected with our present techno- logical limitations, then the toxin is seen as not re- sponsible and the question is just dismissed as not being responsible for the biological effects and inu- ences upon the health of the individual. Another very important consideration to bear in mind is the individuals tolerability or susceptibility to specic toxins. The tolerability of biological systems to a toxin is in part genetically determined and in part acquired on the basis of enzymatic induction an/or inhibitions, the degree of functionality of the target organ, and functional reserve capacity of spe- cic organ-systems. The clinical manifestations of biological effects of toxins depend on the physical and chemical properties of the toxin itself, but also on the duration and route of exposure, its mecha- nism of action, and obviously on the individual sus- ceptibility, as previously described. Chemical compounds, which compromise the bulk of environmental toxins, are currently spread all over the world, even if the chemical was not used in that area. This is due to spread via the ground water, sur- face rain and winds. Bioaccumulation of these compounds cause disease in living beings, and in humans, the immune system, endocrine system and neurological system is the most affected. (Crinnion, 2005) The effects of toxins are documented in a number of diseases, ranging from asthma, allergies, autoimmu- nity, cancers, cognitive decit, and obesity. New diagnoses also include so-called sick building syndrome, and multiple chemical sensitivity. Sick buil- ding syndrome (SBS) is a combination of ailments associated with an individuals place of work (typi- cally, but not always, an ofce building), though there have also been instances of SBS in residential buildings. A 1984 World Health Organisation report into the syndrome suggested up to 30% of new and remodelled buildings worldwide may be linked to symptoms of SBS. Multiple chemical sensitivity is a condition even more difcult to treat, and is recog- nized in some individuals who develop chemical sen- sitivity to a host of environmental chemicals. 6 2 Effects of Toxins in General Toxins can have several effects on their environment/ host namely: Acute lethality Sublethal effects on non-mammalian species Sublethal effects on plants Sublethal effects on mammals Teratogenicity Genotoxicity/mutagenicity Carcinogenicity We will only consider the effect on mammals espe- cially on man. Here the effect of the toxin on the host will be determined by several factors, namely the substance and its concentration, the rate of in- toxication and the host. Toxins can cause temporary dysfunction in the body, lead to permanent damage in the case of chronic intoxication, or even to death in the case of acute intoxication. In reality all toxins can be detrimental to the body in the correct dose. In the words of Paracelsus, only the dose makes the poison. The toxicity, or rather the effect of the toxin on the body in relationship to the dose is dependent on sev- eral factors: 1. The galenic form of the toxin. For instance, or- ganic mercury is much more toxic in a gaseous form than as in liquid form. 2. When a toxin is mixed with other toxins, the tox- icity may go up, as toxins often potentize each other. For instance, two environmental toxins may be present in a sub-toxic concentration, but together with another toxin becomes severely toxic. 3. The time in which it is taken in, thus acute, sub- acute or chronic intoxication. If someone would drink 10 liters of water at once, it will cause hyponatraemia and death, for instance. Often intoxication in minute amounts over time have a different effect on the organism, e.g. cause cancer, or affect the immune system, whereas an acute intoxication will have a totally different effect. 4. The patient: a The ability of the patient to regulate in view of the intoxication. b The gender of the patient. c The body weight. d A possible tolerance to the substance, especially if it is given in low doses orally over time. The latter (a-d) has important implications for treat- ment strategies and will be discussed more in depth later. 3 Measurement of Toxicity To compare the toxicity of toxins with each other, it is tested under strictly controlled laboratory condi- tions, mainly on animals. This is expressed as the so- called LD 50 which determines in which dose de- pending on the body weight, half of the test population will die. LD thus stands for lethal dose. The dose response curve of such intoxication is linear or sigmoidal. However, recently the interest has been revived in toxic exposure at doses below the so- called NOAL (no observed adverse effect level) over time. It is now known that many environmental toxins over time will exert a stimulatory or an inhibitory ef- fect on processes in the body in the so-called U- shaped response curves, such as seen in hormesis. This means that a toxin may only exert a certain ef- fect in a specic low dosage range. If the concentra- tion goes below this very low dose, it has no effect, and if the substance occurs in full strength it may also have no effect or another effect. A toxin thus may be highly toxic when given in a high dose, loose this toxicity in a lower dose, but then still have a detrimental effect over long term exposure in min- ute concentrations. Especially for chemical carcino- 7 Part I / Classes of Homotoxins gens acting by a genotoxic effect this is of impor- tance. (Calabrese, 2001) Recently, a publication in Science brought to light an even more frightening fact concerning the effect of environmental toxins. This concerns the area of epi- genetics, where genetic material is damaged by tox- ins in one generation and the damage is transferred to the next, where the effects are seen for the rst time. (Skinner et al., 2005) The effects on reproduction correlate with altered DNA methylation patterns in the germ line. The abil- ity of an environmental factor (for example endo- crine disruptor) to reprogram the germ line and to promote a transgenerational disease state has sig- nicant implications for evolutionary biology and disease etiology. 4 Classes of Toxins Given the large amount of toxins it is difcult to clas- sify them chemically, either by function or by mode of action, since many of them will fall into more than one class. Toxins can enter the body through air, wa- ter, soil pollution (in terms of accumulation into food sources). Others enter the body through deliberate use, such as drugs of abuse, therapeutic drugs, cos- metics, food additives and contaminants. A number of these toxins can be classied as so-called anthro- pogenic toxins, as they are connected to the actions of man, for example by Industrial processes Mining and drilling Combustion of fossil fuel for heating and power and exhaust fumes from transportation vehicles 4.1 Pollutants Gaseous pollutants These substances are gases at normal temperature and pressure. Amongst the pollutants of greatest concern are: Carbon monoxide (CO) Hydrocarbons Hydrogen sulphide (H 2 S 2 ) Nitrogen oxides (NO) Ozone (O 3 ) and other oxidants Sulfur oxides Carbon dioxide (CO 2 ) Particulate pollutants Dust Fumes Mist Smoke Aerosols The effects of the pollutants are numerous, but among the most important are the damaging effect on the lung and the respiratory mucosa, which con- tribute to allergy, asthma and cancer. 4.2 Metals Metals are naturally occurring but accumulate due to their uses in our activities of civilization. These in- clude arsenic, lead, mercury, cadmium and chromi- um. Metals have a wide range of detrimental actions on the body, and share common toxic mechanisms and sites of action. Enzyme inhibition/activation. Especially enzymes containing sulfhydryl (SH) groups, which bind certain metals in the body as a co-factor may be affected as the toxic metal could displace the co- factor. Sub-cellular organelles. Toxic metals disrupt the structure and function of a number of organelles, such as the endoplasmic reticulum, the lysosomes and the mitochondria. Metal inclusion bodies may form in the nucleus. Carcinogenicity: Arsenic, chromium, nickel, as well as cadmium, and cis-platin are human car- cinogens. This is due to the interactions of the metallic ions with the DNA. 8 Kidney: This is due to the fact that the main ex- cretory organ in the body for metals is the kidney. Cadmium and mercury especially are nephro- toxic. Nervous system: Especially the lipid soluble met- als, such as methylmercury and organic lead com- pounds are neurotoxic as they readily cross the blood brain barrier. Endocrine and reproductive effects: Because the male and female reproductive systems are under complex neuroendocrine control, any toxin inter- fering with any of these processes can affect the reproductive system. Respiratory system: Acute exposure to metals leads to irritation and inammation of the respi- ratory tract, whereas chronic exposure may result in brosis (aluminium) or to carcinogenesis (arse- nic, lead, nickel). Metal binding proteins: The toxicity of many of the metals, such as cadmium, lead and mercury depends on their transport and intracellular bio- availability. This is regulated by the high afnity to certain cytosolic proteins. These proteins typi- cally are rich in thiol (SH) groups. These intracel- lular sinks are particularly important to seques- ter metals away from vital organelles. The role of the extracellular matrix must also be mentioned here, as it will be an important storage place for metals before they reach the cell as it is also rich in thiol groups. 4.3 Agricultural Chemicals (Pesticides) Including Wood Preservatives The use of chemicals to control pests goes back cen- turies to the ancient Chinese and the Romans. How- ever, in the 1900s, compounds which we now iden- tify as pesticides came into being. Ideally pesticides should be highly specic, and only harm the intend- ed target, but subsequently many health hazards have been recognized coming from these substanc- es. A major risk is the environmental contamination, especially where they may enter the food chain and the natural water resources. Of course a very serious concern is the long half life of certain of these com- pounds, as well as their lipophilic nature, which makes bioaccumulation and especially accumulation in the human body a real threat. Many of these are classied as Persistent Organic Pesticides (POPs). The Globally Harmonized System (GHS) for the clas- sication and labeling of hazardous chemicals is an initiative to promote common, consistent criteria for classifying chemicals according to their health, phys- ical and environmental hazards, and to develop compatible labeling, safety data sheets for workers, and other information based on the resulting classi- cations. This is an ongoing initiative of the Environ- mental Protection Agency (EPA) in the USA. The primary classes of pesticides produced today are: fumigants, fungicides, herbicides, and insecti- cides. In the USA alone, the total production per year is 1.2 billion pounds of such chemicals. Produced are also some 665 million pounds of wood preservatives. Organochloride pesticides are probably the best known class of pesticides. These substances, intro- duced in the 1940s and 1950s include familiar pes- ticides such as DDT, Chlordane, and Dieldrin (devel- oped later as an alternative to DDT). In acute intoxication, organochlorides act as neuro- toxins. The persistence of this group of pesticides for instance is a major concern, and they were banned in the USA in 1972 after the book by Rachel Carson: The Silent Spring in 1962. (Carson, 1962) However, ground water in many parts of the world still remains contaminated. Some biological effects of pesticides and wood pre- servatives include: Direct damage to DNA and thus carcinogenic Interference with immune function Induction of the P-450 enzyme detoxication system Endocrine disruptors 9 Part I / Classes of Homotoxins 4.4 Plasticizers and PBBEs Plasticizers, most commonly, phthalates, alkylphe- nols, bisphenol A are additives, which soften the materials to which they are added, e.g. those that give hard plastics like PVC its exibility and PBBEs (ame retardants), which also include the so-called phthalates occurring in softeners of plastics, oily substances in perfumes, additives to hairsprays, lu- bricants, paint and wood nishers is of particular concern here. Flame retardants, such as Polybromat- ed biphenyl ethers (PBBEs) are materials that inhibit or resist the spread of re. While high doses of phthalates do constitute risks in the sense of traditional toxicology, low doses also change the stakes dramatically. Research reveals that male reproductive development is acutely sensitive to some phthalates. For example, the phthalates di- butyl phthalate (DBP) and diethylhexyl phthalate (DEHP) produced dramatic changes in male sexual characteristics when exposure took place in utero, at levels far beneath those of previous toxicological concern. These changes included increases in the rates of hypospadias and other indications of de- masculinization. (Clark et al., 1999) Bisphenol also has been implicated in the develop- ment of cancer. (Welshons et al., 2003) 4.5 Therapeutic Drugs and Drugs of Abuse This is a huge group of chemicals which will not be discussed in-depth here. Apart from the known side effects of this group, many will also disrupt the self- regulatory processes of the body and will cause de- regulation and other disease. Many, who will treat one condition, will put the patient at risk for anoth- er. For instance, many immunosuppressant agents, used in auto-immune diseases are known to be car- cinogenic. 4.6 Food Additives and Preservatives Additives are added to foods as preservatives (such as metyl-p-benzoic acid, propionates) but also to change the physical characteristics, such as color (tartrazine) odor and taste (Saccharin and Aspar- tame, Piperonal as well as nitrates and nitrites). Cer- tainly hundreds, and possibly thousands, of food ad- ditives are in use world wide, many with inadequate testing. Some of these were introduced when toxic- ity testing was not sophisticated and subsequently were showed to be toxic. The question of synergistic interactions between all of these has not been looked at adequately. Many of these are carcinogen- ic or mutagenic. 4.7 Endogenous Toxins These are products of normal regulatory processes in the body, which accumulate, either through an overproduction, or due to the fact that they are not adequately metabolized or excreted. Examples of these are substances such as adrenalin and hista- mine. It is important to note that these substances are also metabolized by the same processes which metabo- lize external toxins. When these enzyme systems are overloaded by external toxins, it can lead to the ac- cumulation of these internal toxins. This is why for instance toxic patients will often suffer from panic attacks, as the metabolism of adrenalin will be im- paired. Psycho toxins will cause an imbalance in the neurotransmitter status, and will disturb the normal homeostasis. Furthermore, the chronic stress hor- mone, cortisol, plays a very important role in the me- tabolism and the resultant detoxication of the ex- tracellular matrix, so that chronic stress will impair the renewal of the matrix and promote an accumu- lation of toxins in the matrix. 10 P R A C T I C A L C L A S S I F I C AT I O N O F T O X I N S (There is no place in which we dont encounter toxins, but by becoming aware of the exposure possibilities, we may better plan to avoid them, and if not possible, at least limit them and/or learn to detoxify.) E X O G E N O U S (Toxicants or Xenobiotics) INGESTION The mucosal surface of the GI tract is about 200x that of the skin sur- face. In a persons lifetime over 25 tons of food is processed by the GI system, thus an enormous load of possible toxins (antigens, xenobiotics, microbes etc.). INHALATION (Environmental) The lungs have the greatest exposure of any organ to the environment. The air we breathe contains dust, chemicals, pollutants, gases, microbes, small particles and liquid aerosols. FOOD OUTDOOR WATER DRUGS INDOOR Chemical Contamination Chemicals 1 Toxic Metals Arsenic, Lead, Cadmium, Hg, etc. 2 Polycyclic Aromatic Hydrocarbons from incomplete combustion of hydrocarbons 3 Industrial Chemicals PCBs Chloroform Trichloroethylene etc. 4 Hormones & Drugs in Animals 5 Fertilizers 6 Pesticides 1 Solvents 2 Phosphates 3 Nitrates 4 Herbicides 5 Pesticides 6 Fertilizers 7 Industrial wastes etcWater is usually analyzed for less than 60 of over 700 chemicals found regularly in drinking water. By Products of Microbes 1 Bacteria e.g. E. Coli 2 Viruses e.g. Hepatitis virus 3 Parasites e.g. Giardia 4 Algae & their toxins Prescription Recreational Air quality standards measure 6 pollutants: 1 Suspended particulates 2 Carbon dioxide 3 Nitrogen oxides 4 Sulphur dioxide 5 Photochemical oxidants e.g. ozone, aldehydes 6 Lead Microbes 1 Bacteria viruses 2 Protozoa e.g. Giardia Indoor air pollutants may come from outdoor, from materials in the building, or from human activities. Chemicals & Minerals 1 Asbestos 2 Formaldehyde 3 Volatile organic chemicals (VOCs) 4 Radon gas 5 Nitrogen oxide 6 Carbon dioxide Furniture & Renovations 1 Wood (phenols & formaldehyde from plywood, paelling, etc.) 2 VOCS (from glues, llers, paints, stains, varnishes, etc.) 3 Paints (with volatile fungicides, pesticides, mildew-cides) 4 Fiberglass (from insulations) 5 Plasticizers (exible vinyl oors) 6 Upholstery fabrics & carpets (dye, formaldehyde, plasticizers, fungicides) 7 New carpets (contain more than 20 chemicals to kill bacteria, hold colors, bind bers and also release acetone, benzene, styrene, xylene, toluene and formaldehyde ... in addition to dust, chemical and microbes that it can harbor) Household Products 1 Personal care products 2 Laundry products & fabric softeners contain numerous toxic chemicals such as: Carcinogenics (chloroform, benzyl acetate, limonene) S.N.C. toxins (camphor, ethyl acetate, benzyl alcohol, linalool, pentane) 3 Household cleaning products 4 Pesticides (used frequently) Microbes, Molds, Dust, Pets 1 Molds & mildews in humid areas 2 Dust & dust mites 3 Bacteria, viruses, fungi, etc. 4 Pets increase toxins (dander, eas, use of ea powder & collars that have toxic chemicals, etc.) Human activities 1 Transmission of microbes 2 Tobacco smoke & replaces 3 Recreational drugs etc. Air-conditioning & heating systems together with better sealings from windows/doors have drastically reduced natural ventilations the number of air exchanges have been practically eliminated (toxins remain and further accumulate inside) Natural Sources of Air Pollutants 1 Volcanoes (ashes) 2 Natural gas 3 Terpenes (plants) 4 Ammonia (from biological decomposition) 5 Smoke (res) 6 Dust (soil) 7 Plants/pollens 8 Microbes Human-Caused Air Pollutants 1 Chemical dumps 2 Waste disposal 3 Fuel combustion 4 Transportation 5 Industrial 6 Farm spraying etc. Mycotoxins 1 Toxins Produced by Molds e.g. Aatoxins produced by the Aspergillus molds Heavy Metals 1 Mercury 2 Lead 3 Arsenic etc. Others 1 Asbestos 2 Radioactive elements radon, radium, uranium 3 Gasoline etc. Food Additives 1 Coloration 2 Preservatives etc. 11 Part I / Classes of Homotoxins P R A C T I C A L C L A S S I F I C AT I O N O F T O X I N S (There is no place in which we dont encounter toxins, but by becoming aware of the exposure possibilities, we may better plan to avoid them, and if not possible, at least limit them and/or learn to detoxify.) E X O G E N O U S (Toxicants or Xenobiotics) E N D O G E N O U S (Toxins) INHALATION (Environmental) The lungs have the greatest exposure of any organ to the environment. The air we breathe contains dust, chemicals, pollutants, gases, microbes, small particles and liquid aerosols. DERMAL (Skin) INDOOR Indoor air pollutants may come from outdoor, from materials in the building, or from human activities. Chemicals & Minerals 1 Asbestos 2 Formaldehyde 3 Volatile organic chemicals (VOCs) 4 Radon gas 5 Nitrogen oxide 6 Carbon dioxide Furniture & Renovations 1 Wood (phenols & formaldehyde from plywood, paelling, etc.) 2 VOCS (from glues, llers, paints, stains, varnishes, etc.) 3 Paints (with volatile fungicides, pesticides, mildew-cides) 4 Fiberglass (from insulations) 5 Plasticizers (exible vinyl oors) 6 Upholstery fabrics & carpets (dye, formaldehyde, plasticizers, fungicides) 7 New carpets (contain more than 20 chemicals to kill bacteria, hold colors, bind bers and also release acetone, benzene, styrene, xylene, toluene and formaldehyde ... in addition to dust, chemical and microbes that it can harbor) Household Products 1 Personal care products 2 Laundry products & fabric softeners contain numerous toxic chemicals such as: Carcinogenics (chloroform, benzyl acetate, limonene) S.N.C. toxins (camphor, ethyl acetate, benzyl alcohol, linalool, pentane) 3 Household cleaning products 4 Pesticides (used frequently) Microbes, Molds, Dust, Pets 1 Molds & mildews in humid areas 2 Dust & dust mites 3 Bacteria, viruses, fungi, etc. 4 Pets increase toxins (dander, eas, use of ea powder & collars that have toxic chemicals, etc.) Human activities 1 Transmission of microbes 2 Tobacco smoke & replaces 3 Recreational drugs etc. Air-conditioning & heating systems together with better sealings from windows/doors have drastically reduced natural ventilations the number of air exchanges have been practically eliminated (toxins remain and further accumulate inside) Active (Injections) 1 Prescription drugs 2 Recreational drugs 3 Animal toxins bites or puncture by sh, arthropods, parasites, etc. Passive Substances that are both water & fat soluble are more easily absorbed through the epidermis especially if not integral and through the hair follicles: 1 Drugs 2 Cosmetics 3 Chemicals especially from the air and from waters. showers, bathing, etc.) 4 Radiations Produced in the Body 1 Physiologically - Bilirubin - Ammonia - Uric acid - Lactic acid - Creatinine etc. Become toxic if in excess for: - production - detoxication and excretion 2 Under Abnormal Conditions - production of waste products (CO 2 , H 2 O 2 , free radicals, etc.) - hormones and/or neurotransmitters - microbial debris - pH imbalances etc. Stored in the Body Originally from external origin but introduced into the body where they are stored and become a continuous source of toxic release (Water soluble chemicals are easily excreted, but fat soluble chemicals accumulate in fat cells and cell membranes) 1 Dental materials 2 Medical implants 3 Microbes (foci) etc. Conclusion Toxins are ubiquitous in our environment and can accumulate for years in the ground water, as well as cover vast distances due to climatic phenom- ena. Different classes of toxins exist, such as pollut- ants, metals, agricultural chemicals, plasticizers, food additives, therapeutic drugs and endoge- nous toxins which are formed in the body and not adequately excreted. Many toxins occur in the so-called NOAL (no ob- served adverse effect level), but still cause long- term problems such as carcinogenesis if present at minute concentrations. Epigenetic effects of toxins are now recognized, where one generation is exposed to the toxin, but the effect is only seen in the offspring. The toxicity of toxins range from lethality to tera- togenicity to genotoxicity as well as carcinoge- nicity. Toxins can also impair the immune system, the intracellular organelles and cause enzyme inhibi- tion or activation, or mimic endogenous hor- mones, when they are called hormone disrup- tors. 12 13 The Physiology of Detoxication Part lI / The Physiology of Detoxification In the previous chapter we saw that the body is ex- posed to a wide variety toxins present in the air, wa- ter, soil and food. The body has several inherent de- fense mechanisms and membrane barriers to prevent the absorption and distribution of the toxin when the intoxication has occurred. Once inside the body, the internal defense system, or Basic Bioregulatory System will be mobilized in order to eliminate the toxin or at least try to compensate for it. In this chapter, we will look at the way the body deals with these toxins. Before a toxin can have a detrimental effect on the body, it needs to reach the target organ or cell. In principle four steps are necessary for this: Absorption Transport Metabolism Distribution and storage Elimination Toxicokinetics studies the absorption, distribution, elimination, metabolism and/or clearance that take place in the body after exposure to the toxin. Toxico- dynamics on the other hand studies the biochemical and physiological effects of drugs and toxicants and determines their mechanism of action. Toxicokinet- ics can also be seen in the diagram below. Exposure Absorption at the portals of entry Distribution to the body Metabolism to less toxic metabolites Metabolism to more toxic metabolites Metabolism to conjugation metabolites Excretion Interaction with macromolecules (proteins, DNA, receptors) Toxic effects: genetic carcinogenic, immunologic Turnover and repair Fig. II,1: Toxicokinetics 14 1 Absorption Toxins can enter the body through all the surfaces which are in contact with the outside world. These comprise the skin, the mucous membranes and also the gastrointestinal tract. In general, the absorption over the respiratory mucosa is the quick- est, whereas it is the slowest over the dermal route. The overall entry depends on the amount of toxins present, but also on the saturability of the transport process. The mucosal surfaces have several barriers which will prevent toxins from entering the body, such as a mucosal barrier, the physical presence of symbiotic bacteria as well as the so-called tight junction. The skin also has barriers in the form of a certain level of pH, etc. 2 Transport Once the toxicant is absorbed into the body it moves around in two ways, either by bulk transfer via the blood or lymph, but also locally through diffusional transfer over short distances. The path which a toxin takes after absorption is illustrated in Fig. II,2. During absorption, distribution and elimination, a toxin will encounter various cell membranes before interacting with the target tissue. These membrane barriers will differ from relatively thick areas of the skin to relatively thin lung membranes, in all cases though the composition is relatively similar. The cell membrane can be seen as a lipid matrix. It contains both phospholipids (hydrophobic) portions as well as hydrophilic heads. Intra- and extracellular proteins transverse the membrane. Fig. II,2: Toxin path after absorption Environment Interstitial uid Plasma Interstitial uid Mucosa of organ of elimination, skin Capillary membrane Target cell membrane Capillary membrane Intracellular uid Subcellular organelle membrane Intra-organelle uid (mitochondria, liposome, nucleus) 15 This will differ from organ to organ. The myelin in the brain consists of 100% lipid bilayer whereas mi- tochondria have only a 40% lipid bilayer. This, of course has implication for the distribution of fat sol- uble toxins. Depending on the fat solubility of the toxin, it will thus transverse the cell membrane. Many of the proteins which tranverse the membrane are active in transport of toxins over the cell mem- branes. The distribution of the absorbed toxin will depend on various factors, such as physiological factors, but also the physiochemical properties of the drug. This process is thus a REVERSIBLE movement of the toxi- cant between the blood and tissues and between the extracellular and intracellular compartment. The velocity at which this movement is reversible be- comes important when we address the mobilization and drainage of toxins later on. Factors which can complicate the distribution of a toxin can be the following: Perfusion of the organ The well perfused tissues include the liver, kid- neys and brain; whereas the low perfused tissues include the bone and fat tissue where there is slow elimination from these tissues. Protein Binding There also may be signicant protein binding which could affect the delivery of the drug to the tissues and vice versa. Especially binding of toxins to the matrix structures may trap these toxins there for years and prevent elimination. Protein binding also plays a very important role in the transport of toxins. There are many plasma pro- teins involved in such a transport, but mostly invol- ved are albumin, alpha-acid-glycoprotein, the lipo- proteins, and globulins. The lipoproteins, such as HDL, LDL and VLDL are very important here, as so many toxins are lipophilic, and therefore they will carry a number of toxins. Iron and copper will again be carried by the metal binding globulins, transferrin and cereluplasmin. 3 Distribution and Storage Plasma protein binding is not selective and toxins can thus compete with each other and even with endogenous substances for binding. Covalent binding to the protein forms a minor part, but the dissociation is extremely difcult and the car- rier molecule is changed, and may eventually play a role in carcinogenesis. Noncovalent binding is more common. The toxin can dissociate easier from this bond. However, in some cases the bond may be so strong that the tox- in remains bound for weeks, months or years. Cer- tain metals have high association constants and their dissociation is extremely slow. If the afnity for an organ is large, the toxin will ac- cumulate or form a depot for years. In general, lipid insoluble toxicants stay in the plasma and interstitial uids, while lipid soluble contaminants reach all compartments, and may accumulate in fat. Some toxins have specic afnity for certain tissues. Tetracyclines have a high afnity for the calcium con- taining tissues, which is seen in the discoloration of teeth if it is given under the age of 14 years. Simi- larly, the anti-malarial, chloroquine has an afnity for the melanin, and can be taken up by tissues like the retina, causing a retinitis. This drug is often used in lupus and other connective tissue diseases, which makes an ophthalmic check up every six months mandatory. Bone will also concentrate certain toxicants such as lead where a sudden loss of bone can lead to acute release of the toxin and have dire consequences, es- pecially after menopause when there may be a sud- den bone loss. This will be discussed later when we look at the ide- al rates of detoxication. Lipophilic pesticides, such as the organochlorines and PCBs can be expected to accumulate in fat tis- sues. The afnity of metals to SH groups have also been addressed in the previous chapters. Part lI / The Physiology of Detoxification 16 The binding of these metals to the numerous thiol groups in the extracellular matrix is of special con- cern. Certain areas will be naturally less penetrable to tox- ins. The brain, which is protected by the blood brain barrier, is such an example. Disease processes such as meningitis and other inammatory or infective processes can disrupt this barrier and thus cause tox- ins to enter the brain tissue. Other tissue blood barriers include the prostate/ blood barrier and the testis /blood barrier. Unfortunately, other than what is generally believed, the placenta is a poor barrier and the fetus is thus exposed to all the toxins to which the mother is ex- posed. This has been seen in fat tissue biopsies which were performed on newborns and found numerous toxins such as PCBs, dioxin and others in the tissues. We need thus to assume in todays environmental pollution, that our newborns are already contami- nated with toxins. 4 Metabolism of Toxins One of the most important determinants of the per- sistence of toxins in the body is the extent to which they can be metabolized and excreted. Several families of metabolic enzymes are active in metabolism of endogenous and exogenous toxins. These include one of the most important, the P450 system, but also the avin containing monooxidases (FMOs), the alcohol and aldehyde dehydrogenases, amine oxidases cyclooxygenases, reductases, hydro- lases and the conjugating enzymes such as the me- thyl transferases as well as the glutathione transfer- ases to name a few. Most of the metabolism takes place in the liver, and as most of the toxins entering the body are lipophil- ic, they need to become water soluble for excretion. After entrance to the liver and other organs, xenobi- otics may undergo two phases of metabolism. This is demonstrated in Fig II,3. Xenobiotic Cysteine, Glucoronic Acid, Alcohol GSH Aldehyde Glutathione Acid Phase I Phase II Free Radical Nitric Oxide Tissue destruction P450 Vit C, Mg, Fe Selenium, Mg, B3 Zn, NADH Fe, Mo, B2 Excretion Conjugation Fig II,3: Liver metabolism pathways 17 Part lI / The Physiology of Detoxification 4.1 Phase I Reactions Phase I metabolism involves mainly the CYP (P450) system, the FMOs and the hydrolases. Following the addition of a polar group, conjugating enzymes typ- ically add more constituents, such as sugars, sulfate- sor amino acids which make the compound more water soluble. In this process, however sometimes more toxic inter- mediate metabolites are formed, these then will have to be detoxied again. These intermediate me- tabolites are likely to react with nuclear parts of macromolecules unless they are further detoxied. An example is the breakdown of alcohol to acetalde- hyde, which is much more toxic that the alcohol. The CYP system or P450 plays a very important role in the phase I reactions. The CYPs which constitutes the carbon monoxide-binding pigment of the liver microsomes are heme proteins. A nomenclature has been developed for the different types and iso- forms. Although mammals are known to have 18 CYP fam- ilies, only three are reponsible for xenobiotic metab- olism. The remaining are involved in steroid hormone production. They are classied according to the gene, subfamily and lastly the isoform (arabic nu- meral, letter, arabic numeral). Thus CYP 3 A 4 is responsible for the metabolism of many drugs as well as endogenous toxins and exog- enous toxins. Its activity can also be inuenced by a host of drugs and chemicals, and it can either be induced, which will have the result that certain drugs are broken down too quickly, e.g., warfarin, whereas grapefruit juice in large quantities is known in fact to damage this system irrevocably and thus may lead to an ac- cumulation of drugs. The Phase I detoxifying pathway takes care of envi- ronmental toxins such as pesticides, pollutants and food additives as well as drugs and alcohol. The end products of our own metabolism are also processed here for excretion. Fat soluble toxins are changed by way of oxidation, reduction and hydrolysis to make them more water soluble for excretion via the bile and the kidney. It is important to note that these enzymes need cer- tain co-factors to fulll their action. These are trace elements, vitamins, amino acids and substances like NADH. (see Fig II,3) Phase I produces signicant amounts of free radicals during this detoxication process, and if the antioxi- dant status of the patient is not adequate tissue damage may occur if the P450 is overloaded, or in- duced. Some substances, such as caffeine, alcohol, certain drugs, dioxin and organophosphates (used as pesticides), and paint fumes can induce this path- way. Sometimes intermediate substances like the acetaldehyde formed during the metabolism of cer- tain toxins, like alcohol, can be more toxic to the body than the original substance. Certain people, cal led fast acetylators, will then be more prone to damage of the liver, as the toxin is fast metabolized to this dangerous intermediate, and then the pro- cess is slow again. These individuals are at higher risk for liver damage during ingestion of toxins which will use the alcohol dehydrogenase pathway to be detoxied, for example when paracetamol overdose occurs. 18 4.2 Phase II Reactions The Phase II pathway or conjugation pathway uses substances rich in sulfhydryl groups to metabolize toxins. A number of these substances, like cysteine and taurine as well as glutathione which are formed from glycine, glutamine and cysteine under inu- ence of a selenium dependent enzyme, also act as free radical scavengers and heavy metal chelators. During conjugation of toxins they are lost to the body forever, as they are excreted with the toxin, whereas as free radicals they can be regenerated. Some substances will only use phase I or phase II to be detoxied, others will use both. It is thus clear, that if the phase II pathway is overloaded, the free radical scavenging ability will be given up in favor of the conjugation function and further damage to the liver parenchyma may occur. Also if the patient is decient in selenium for instance, glutathione pro- duction will be impaired, with the resultant of toxic- ity and free radical damage. 5 Elimination After the toxins have gone through these two phas- es, they are ready to be eliminated. However, if the intermediary toxin is not broken down, or the toxin load is too high there will be bioaccumulation of the toxin. The ability to detoxify and eliminate toxins is para- mount to the maintenance of health in an organ- ism. For unicellular organisms a simple process of diffu- sion is enough to eliminate toxins, however, multi- cellular organisms, especially if there has been an in- crease in complexity, needs to nd other ways to eliminate toxins. Environment Interstitial uid Plasma Interstitial uid Mucosa of organ of elimination, skin Capillary membrane Target cell membrane Capillary membrane Intracellular uid Subcellular organelle membrane Intra-organelle uid (mitochondria, liposome, nucleus) Fig II,4: Toxin path for excretion With an increase in complexity, organisms have de- veloped an increase in size, a decrease in surface area to body mass ratio, compartmentalization of cells and organs, as well as an increase in lipid con- tent. Together with the fact that organisms need to protect themselves from the environment with barri- ers such as scales and skin, means that there is less possibility for toxins to diffuse out of the body. This was solved, by developing specialized methods of metabolism for toxins and specialized routes of elim- ination. We have thus major and minor elimination routes The major routes involve the liver, the kidneys, the mucous membranes and the lungs as well as the skin, whilst the minor routes involve the saliva, sweat, milk, hair, and secretion from reproductive organs. To eliminate the toxin, it must go through the re- verse route as was described in section II from the place of storage back to the external environment (Fig II,4). Chemicals are transported from the place of storage mainly via the blood stream. As the circulatory sys- tem leans itself toward the transport of water solu- ble substances, the more lipophilic substances are, the less likely they are to freely diffuse into the blood and thus the mobilization of these toxins from their place of storage is more difcult. The same process as was discussed in section II, where binding of tox- ins to carrier proteins and lipoproteins is the way these toxins will enter the blood stream. The toxins are thus transported back to the organs of elimination, but if these organs are dysfunctional, overloaded or damaged, the toxins cannot be ex- creted. This means that such toxins will circulate fur- ther in the blood stream and through diffusion enter some compartments again, e.g. a fat soluble toxin may now be stored in the brain, with dire conse- quences. The stimulation of toxins out of their com- partments should thus be a slow and careful pro- cess. Here we distinguish two groups of compartments: 1 The rapid-exchange system in these compartments, tissue concentration of toxicant is similar to that of the blood 2 The slow-exchange system in these compartments, tissue concentration of toxicant is higher than in blood due to binding and accumulation-adipose tissue, skeleton and kidneys can temporarily retain some toxins, e.g. arsenic and zinc. The important fact is that Detoxication and Drain- age should carry on so long till the slow exchange system is given a chance to give up all the toxins.The organs involved in the Detoxication and Drainage of the toxins will be discussed in the next section. 19 Part lI / The Physiology of Detoxification Conclusion Toxins have to cross several membranes in the body to be absorbed, and to eventually be stored, or eliminated via the organs of elimination. Toxins follow simple kinetics, and observe the dif- fusion over semi-permeable membranes till a steady state is achieved on both side of the mem- brane. These basic kinetics are different for toxins who has a high association co-efcient with proteins and cellular structures, be it in the blood or in the organ of storage. These kinetics affect both the storage and the mobilization of toxins in and out of these com- partments and needs to form the basis on which the practical Detoxication and Drainage is exe- cuted. Two groups of compartments can be distin- guished, depending on the perfusion of the or- gan and the amount of toxin bound to protein. The rapid-exchange system. In these compartments, tissue concentration of toxin is similar to that of the blood. The slow-exchange system In these compartments tissue concentration of toxin is higher than in blood due to binding and accumulation.
Many toxins are metabolized before they can get excreted. One of the main purposes of this is to render fat soluble toxins water soluble for excre- tion in the bile and kidneys. The P450 system of enzymes plays a major role here, especially in the liver, where it comprises the phase I reactions. This is augmented by the phase II reactions. Organs are at danger during the act of Detoxi- cation and Drainage, due to the high concentra- tion of toxins moving through the organ at the time, and through the generation of free radicals during the detoxication process. Support of theses organs is thus of utmost im- portance during detoxication and the elimina- tion of the toxin. 20 As was seen in the previous chapter, many organs and tissues are involved in the absorption, the trans- port, the metabolism, the storage and the elimina- tion of toxins. These highly complex processes re- quire special properties of the organ to fulll this function. Often, the organ itself may be endangered by disease due to the excretion, storage and move- ment of toxins through it. We shall now consider these organs in more depth. 1 The Liver
The liver is one of the most im- portant detoxifying and elimi- nation organs in the body, and metabolically the most complex. The liver is a major organ of chemical elimination in that it takes up chemicals from blood, metabolizes chemicals, and ensures the biliary and renal secre- tion of toxins. The liver detoxies a large array of external and internal toxins. It also plays a role in the cholesterol metabolism, glycolysis and gluconeogen- esis, providing many of the plasma proteins neces- sary for carrying hormones, fats and provides clot- ting factors, to name a few of its numerous functions. The principal cell in the liver responsible for the de- toxifying action is the hepatocyte which facilitates the two pathways discussed in section II in dealing with mainly fat soluble toxins in order to render them hydrophilic or water soluble. We have seen that most toxins reach the organs of elimination via the blood stream. The liver is very well perfused, and gets its blood from two sources: the arterial oxygen rich blood which is delivered through the hepatic artery, and the venous blood through the portal vein from which the liver gets all the blood that is shunted from the capillaries of the gut and spleen. Hepatocytes are practically bathed in blood as this blood transverses a system of sinusoids. This provi- des a very large surface for chemicals to easily dif- fuse into the liver cells or hepatocytes (see Fig III,1). Due to the high lipophilic character of many of the chemicals which are metabolized by the liver, to be able to enter the water soluble area, they will need carrier proteins. Several intracellular carrier proteins are present in hepatocytes. The Organs of Detoxication and Elimination 21 Part lll / The Organs of Detoxification and Elimination Fig. III,1: The liver as detoxication organ Canalicular Membrane Bile duct Hepatic Portal Vein Hepatic Artery Hepatocytes Sinosoid To Central Vein Water soluble Toxin 22 Once inside the hepatocyte the chemical can inter- face with the phase I and II enzymes to undergo bio- transformation and become water soluble. A num- ber of these substances then diffuse back into the blood, where they will be transported to the kidneys for elimination. 2 Excretion in Bile These bio-transformed molecules can also diffuse over the membranes of the bile canalilculus, and therefore ow into the bile duct. This is then further delivered with the other constituents to the gall- bladder which excretes the bile into the intestine for fecal elimination. (See Fig. III,1) In many instances we also want to facilitate the drainage of bile. The gallbladders primary function is to secrete bile and release it through the cystic duct. This duct joins the hepatic duct from the liver to create the common bile duct, which then empties into the upper part of the small intestine, thus into the duodenum. Bile not only carries away and neu- tralizes toxins, but it stimulates and aids digestions by emulsifying fats, stimulating peristalsis, and act- ing as a natural laxative. 3 Entero-hepatic Circulation This is a process whereby already conjugated chemi- cals which are water soluble is deconjugated by hy- drolytic enzymes in the gut, and then rendered lipo- philic again, and are once more reabsorbed by the gut. The liver is thus exposed to another round of the same toxin to reprocess it again and again. This increase the retention time for toxic chemicals in the liver, and may increase liver toxicity. Some of these metabolites are more dangerous than their original substance and as we saw above, the P450 is also a source of free radicals which will thus further dam- age the liver cell. It is thus imperative to protect the liver as well during the process of Detoxication and Drainage. This will be further discussed in the section on methods of detoxication. 4 The Kidneys
The kidneys are organs specialized in the excretion of numerous water soluble toxins and metabolites, maintaining ho- meostasis of the organism. The kidneys detoxify Drugs Heavy metals Other toxins Each kidney possesses about one million nephrons able to perform excretion. Renal excretion repre- sents a very complex event encompassing three dif- ferent mechanisms: Glomerular ltration by Bowmans capsule Active transport in the proximal tubule Passive transport in the distal tubule Blood is delivered to the kidneys via the renal artery and about 625 ml of plasma move through the kid- neys per minute, and of that 125 ml is ltered through the glomelular membrane. Most of the wa- ter is then reabsorbed again in the proximal and dis- tal tubule, so that only approximately 1-2 liters of urine is formed per day. (See gure III,2) 23 Fig. III,2: Filtration in the kidney Some ltered substances, such as glucose will also be totally reabsorbed, so that in normal conditions there is no glucose in the urine. Other substances, many of which are harmful to the body are ltered, secreted and then minimally reabsorbed. Creatinine is such a substance, and can thus be used to test the efciency of the kidneys in clearing harmful sub- stances. It accumulates in the blood when the kid- neys are dysfunctional. If the kidneys are damaged through disease or toxins (drugs and chemicals), their ability to excrete drugs is reduced, and in con- ventional medicine, the dose of drugs in needs to be adjusted accordingly. It is important for the urine to be on the alkaline side, as it facilitates the secretion of certain drugs, like barbiturates for instance, and alkaline urine will prevent urinary tract infections. The kidneys commonly bear the brunt of chemical toxicity since the nephron tends to concentrate the toxin and thus increase levels of toxic exposure in the tubules. The kidneys thus also need protection and support throughout the Detoxication and Drainage stages. 5 The Matrix and Lymph 5.1 The Matrix This forms the nal biophysical layer between the cell and the regulatory organs. This system was lar- gely forgotten since Virchow, a physician who wor- ked in Vienna and a contemporary of Freud, saw a cell through a microscope and postulated that all diseases originated on a cellular level. Another phy- sician working there at the time, Rokitansky, wanted to still bring in the humeral theory, but was largely ignored. Pischinger and Heine, two modern researchers, brought this back into balance, and the newer mo- lecular biology texts increasingly recognize the role of the matrix. The cell on its own is actually an abstraction. The cell does not come in contact with the blood vessels, nerves, veins and lymph vessels which deliver nutri- ents and messengers and remove toxins. It relies for this on the biophysical layer made up of highly po- lymerized sugar protein complexes called Glycoami- noglycans (GAGs) like hyaluronic acid, chondroitin Fig. III,3: The extra-cellular matrix Part lll / The Organs of Detoxification and Elimination Glomerular Capsule Proximal Tubes To the Urinary Bladder Capillary Bed Vein Loop of Vein Glomerulus Artery 24 sulphate and heparin or when they are linked to a protein backbone, they are called proteoglycans (PGs). This molecular sieve must be crossed by the entire array of metabolic products. Sugar protein complexes are phylogenetically con- sidered the best carriers of information. Heine and Pischinger could show that if the matrix is disturbed by a pin prick in one place, the disturbance is com- municated to the whole matrix in seconds. This ma- kes it an ideal system through which to give any in- formation to the body. The acupuncture point is an anatomical structure originating in the matrix, a bell like structure, and it offers a wonderful window into this system. Unfortunately, because of the chemical and electri- cal charges on the GAGs and PGs, they also be- come the place where toxins are stored for a long time. The matrix is also one of the tissues with a slow per- fusion, and thus will have pattern of slow turnover. The matrix has its own biorhythm, and is dependent for instance on cortisol and thyroid hormone to be activated. During the early hours of the morning, the body goes into an ebb phase with a low cortisol, and it is during this ebb phase that the matrix will purge itself from toxic materials. Stressed patients, or patients who through a change in their sleep- wake cycle have lifted or disturbed the diurnal rhythm of cortisol, will not be able to detoxify, as there may be a misring between the matrix and the liver. Cortisone in high doses as medication will also disturb the innate rhythm of the body, and re- sult in matrix toxicity. We can see that in patients who has been on cortisone therapy, as they become swollen and puffy in the matrix. Patients who are hypothyroid have been described as having myxo- edema in the older textbooks. The same swelling will be apparent in the matrix if the matrix biorhythm is disturbed. Many toxins are hydrophilic and will draw uid into the matrix. The result is edema, which we in clinical medicine see as cyclical edema in fe- males or as cellulite. It is clear from the above that if the molecular sieve of the biophysical layer fails, is polluted that there will be distortion of information to and from the cell. If the disturbance is severe enough, cellular disease will ensue. Newer molecular biological research shows that the matrix is the site for many messengers which codes for intracellular phenomena, which, if disturbed, can contribute to many disease phenomena, including cancer. (Lukashev ME, Werb Z, 1998) 5.2 The Lymph System
Apart from its role in the immune system, the lymph system also acts as a detoxifying organ and drains most of the toxins from the matrix or connective tissue via the lymph vessels, which nally drain into the superior vena cava. The lymph system is made up of a myriad of little lymph vessels which then aggre- gate into larger vessels. These larger ves- sels are interspersed by aggregations of lymphoid tissue, which are made up of immune competent cells. These lymph nodes, as the aggregations are called, really function as super detection centers for antigens, but it is also here whereto sensitized im- mune cells will migrate in order to produce millions of similar clones of that sensitized cell. The migra- tion is called homing in immunology and the mul- tiplication, cloning. The swelling we see in these lymph nodes during an infection is due to the activa- tion of the immune cascade by these sensitized cells. This will cause an inammation of the lymph node. A major portion of our immune system is located in these lymph aggregations, and in fact the largest part of our immune system is found in the gut lin- ings so-called Peyers patches. This is the reason why we can manipulate the whole of the immune system by intervening on the level of the gut lining. 25 Physiological considerations The lymph system is a slow drainage system, and the propulsion of lymph towards the heart is dependent on a number of factors. Firstly, the lymph vessels have no valves, but depend on a sort of negative suction action of the truncal vessels, which is similar to that of an amphibian heart. The lymph ows rela- tively slowly at a rate of 1-2 ml/min, against a high resistance, whereas the venous ow is rapid at 2-3 l/min against a low resistance. Two thirds of the body uid is located in the intracellular space, whilst a third is located in the extra-cellular space. Of this, 75% is in the interstitial space or connective tissue and about 25% circulates as plasma. The lymph and venous ow is responsible for circulating most of the extra-cellular uid, and the interstitial uid in par- ticular is drained mainly by the lymph system. From the above it is clear that the factors which will control the uid interchange will be: Oncotic pressure of the plasma and the lymph is determined by the amount of macromolecules such as protein, and the electrolyte content such as sodium, potassium, etc. in the solution. Sol- utes exert a certain pressure in any uid, as they draw water so to speak and the more there is of them in a solution, the higher the pressure. When a patient is protein decient for instance, through malnutrition or disease, we see that there are not enough macromolecules to keep the uid in the vascular compartment, and the uid will leak out into the interstitium, with edema as the result. Kidney failure on the other hand results in an ac- cumulation of electrolytes and other macromol- ecules in the interstitium. The result is that the oncotic pressure in the interstitium will exceed that of the plasma, and again edema will ensue. The hydrostatic pressure is a mechanical pres- sure, which can be compared to a hose pipe con- nected to an open tap. The smaller the diameter of the hose pipe, the higher the pressure, the more open the tap is, the higher the pressure, and if there is an obstruction like a kink in the hose, the higher the pressure before the kink, and the lower the pressure after the kink. Fluid always tends to drain from a high-pressure area to a low-pressure area over a semi permeable membrane, which is represented by the venous capillary or the lymph capillary, until the pressure is equal on both sides. Thus if there is obstruction in the venous system, similar to a kink in the hose, there will be a high pressure in the vein, and the body will try to equalize the pressure be- tween the vein and the interstitium, thus the uid will also accumulate in the interstitium. If there is for instance cardiac failure, we see a back pressure into the venous system, and in our hose model above, this will represent a wide open tap, with more pressure in the venous sys- tem, and then more uid in the interstitium. Lastly if there is an obstruction of the lymph ow, we will see a back pressure in the lymph sys- tem and edema will again be the result. We see this in diseases of the lymph vessels like Elephan- tiasis, where the lymph vessel is scarred by a par- asite for instance. The lymph system as a detoxifying organ The lymph system has a special relationship with the matrix. It is so to say as the only way out for toxins which are stored in the matrix is via the lymph sys- tem. It also means that if the matrix is overloaded with toxins, the lymph system will be overloaded with toxins as well, as the lymph system has to re- move the toxic debris out of the interstitium, and at a certain point will also be clogged with these. The stimulation of lymph ow is thus one of the most important steps to achieve when cleaning the matrix. Part lll / The Organs of Detoxification and Elimination 26 6 The Lungs Not only does the mucosa of the respiratory tract plays an im- portant role as a barrier to toxins as was discussed ear- lier, the lungs are also one of the main points of excre- tion of gaseous and volatile drugs such as anesthetics and even alcohol. Elimination via the lungs is typical for toxins with high volatility (e.g. organic solvents). Gases and va- pours with low solubility in blood will be quickly eliminated this way, whereas toxins with high blood solubility will be eliminated by other routes. Organic solvents absorbed by the GIT or skin are ex- creted partially by exhaled air in each passage of blood through the lungs, if they have a sufcient vapour pressure. The breathalyser test used for sus- pected drunk drivers is based on this fact. The con- centration of CO 2 in exhaled air is in equilibrium with the CO 2 -Hb blood content. Another example is the radioactive gas radon which appears in exhaled air due to the decay of radium accumulated in the skel- eton. A number of toxins and bacteria are also secreted in the mucous of the respiratory tract, and expectora- tion is thus welcomed and supported. 7 The Mucosal Membranes Mucosal membranes form the largest part of our bodies in contact with the outside world, and they are therefore very specialized. A mucosal surface is like a micro cosmos in itself, and a good example of all the components of the auto regulatory system active in one organ. With almost 80 % of the immune system forming the mucosal associated lym- phoid tissue (MALT), some hormones having receptors on the mucosal cells, a full complement of nerves me- diated by the autonomic ner- vous system, an active lymphatic drainage, and the large complement of extra-cellular matrix, the mucosal membrane compri- se one of the most important regulatory organs. Not only does it form a very selective barrier with the tight junction in between the epithelial cell and ad- hesion molecules playing an important role in decid- ing what will enter the body, mucosal surfaces can also let some of the immune cells, like neutrophils through the tight junction to ingest toxic material in the lumen. It further protects against toxins by se- creting chloride and other solutes into the lumen which will osmotically draw water in order to wash away the offender, a fact that we see as diarrhea in the gut for instance. The integrity of these surfaces is thus of major im- portance in the defense against toxins. The symbiotic gut bacteria also need mentioning here as a barrier function. Not only do they form a passive barrier against toxins coming in contact with the epithelial surface, they also contribute to the de- fense against toxins by producing certain metabo- lites which will serve as fuel for the gut lining, and as such will then help the mucosal cell to keep the in- tegrity of the tight junction. However, due to the hydrolytic enzymes produced by them, they can also contribute to the dangerous entero-hepatic circula- tion mentioned above. 27 Absorption via gastrointestinal tract Toxins can be ingested in the case of accidental swal- lowing, intake of contaminated food and drinks, or swallowing of particles cleared from the respiratory tract. In the case of toxins biotransformed in the liver to less toxic or non-toxic metabolites, ingestion may represent a less dangerous portal of entry. After ab- sorption in the GIT these toxins will be transported by the portal vein to the liver, and there they can be partially detoxied by biotransformation. The active area for absorption in the intestines is about 100 m 2 . Some toxic metal ions use specialized transport systems for essential elements: Thallium, cobalt and manganese use the iron system, while lead appears to use the calcium system. Many factors inuence the rate of absorption of tox- ins in various parts of the GIT: Physico-chemical properties of toxins, for exam- ple, particle size is important, the smaller the size, the higher the solubility. Quantity of food present in the gut (diluting ef- fect). Residence time in each part of the GIT (from a few minutes in the mouth to one hour in the stomach to many hours in the intestines). The absorption area and absorption capacity of the epithelium. Local pH, which governs absorption of dissociat- ed toxins; in the acid pH of the stomach, non-dis- sociated acidic compounds will be more quickly absorbed. Peristalsis (movement of intestines by muscles) and local blood ow. Gastric and intestinal secretions transform toxins into more or less soluble products; bile is an emulsifying agent producing more soluble com- plexes (hydrotrophy). Combined exposure to other toxins, which can produce synergistic or antagonistic effects in ab- sorption processes. Presence of complexing/chelating agents. The action of micro ora of the gut comprising about 1.5 kg made up of 60 different bacterial species which can perform bio transformation of toxins. When we thus detoxify and drain, it is also impera- tive to support the actions of the gut, but also to support the integrity of the barrier function in the gut. 8 The Skin The skin forms the second largest surface of our body after the mucosa which is in constant contact with the outside world. Apart from the barrier func- tion, it is also a major detoxifying organ, and has the same P450 system seen in the liver, as well as gluta- thione to take care of polycyclic aromatic hydrocar- bons. The skin can absorb many substances (like pesti- cides and chemicals in cos- metic products), and has to be able to detoxify them. Another important func- tion of the skin is to pro- tect us against the harm- ful UV rays from the sun. The glutathione and other free radical scavengers like catalase and super oxide dis- mutase are of importance, as they scavenge the free radicals formed by the UV ray exposure. Like in the liver though, induction of the detoxifying P450 path- way will also generate free radicals so that in the presence of toxins the skin is more exposed to the effects of free radicals, which leads to immunotoxic- ity, tissue destruction and eventually skin ageing as well as cancer. Conversely, UV rays damage the de- toxifying ability of the skin (the P450), and sun dam- aged skin is thus less able to deal with toxins. Part lll / The Organs of Detoxification and Elimination 28 Due to its role in detoxication, and being one of our most important excretory organs (through sweat and evaporation), we also see the skin often bearing the brunt when other detoxifying organs like the liver are overloaded. Eczema, drug induced rashes and increased sweating are examples of this. In these cases it is thus important to support other organs like the liver for detoxication in skin disease. The liver and skin for instance break down histamine in the body through the P450. If the systems are over- loaded, allergy will ensue. Histamine and other ami- nes are also formed during the inammatory pro- cess, and many environmental toxins, like alcoholic drinks, especially red wine can contain a large amount of histamine. 9 Sweat Many non-electrolytes can be partially eliminated via skin by sweat: ethyl alcohol, acetone, phenols, car- bon disulphide and chlorinated hydrocarbons. 10 Hair Analysis of hair can be used as an indicator of ho- meostasis of some physiological substances. Also exposure to some toxins, especially heavy metals, can be evaluated by this kind of bioassay. 11 Other Routes of Elimination Milk Many metals, organic solvents and some organo- chlorine pesticides (DDT) are secreted via the mam- mary gland in mothers milk. This pathway can rep- resent a danger for nursing infants. Saliva Some drugs and metallic ions can be excreted through the mucosa of the mouth by saliva, for ex- ample, lead (lead line), mercury, arsenic, copper, as well as bromides, iodides, ethyl alcohol, alkaloids, and so on. The toxins are then swallowed, reaching the GIT, where they can be reabsorbed or eliminated by feces. Part lll / The Organs of Detoxification and Elimination Conclusion Many organs are involved in the storage, metab- olism and elimination of toxins once the toxin is absorbed into the body. The liver is one of the major detoxication or- gans, and plays an especially important role in the processing of toxins being absorbed via the oral route. The liver is well perfused and also equipped with enzymes to render fat soluble toxins to water soluble toxins to be excreted in the kidney and bile. The kidney deals with the above mentioned wa- ter soluble toxins, but is also the major organ of elimination dealing with heavy metals and sev- eral drugs. The lung plays a major role in the elimination of volatile gases, e.g. organic solvents and gases and vapours with high solubility in the blood. The mucous membranes act as a barrier, but also contain the P450 system of enzymes and can ac- tively metabolize and excrete toxins.
The symbiotic micro ora plays a special impor- tant role here. Sweat, hair, milk and saliva are minor elimination organs, and can be used to test the elimination of toxins such as heavy metals and other toxins. Excretion of toxins in milk pose a risk to the in- fant. The matrix and also with it the adipose tissue form a major site of deposition of both water and fat soluble toxins, and due to the fact that this is a slow exchange compartment and in close association with the cell, is a major area of con- cern in chronic intoxication. The lymph system is the only signicant way tox- ins can be drained from this compartment and therefore needs special attention during the drainage process. 29 30 Tools for Detoxication In the previous sections we looked at the various toxins which can affect the organism as well as at the way the organism deals with the toxin under normal physiological conditions. In this and the next section we will explore how to support this process in well persons but mostly in patients with mild or serious disease. We have seen in the previous sections that: 1 We are surrounded by toxins, and that there is no place on earth that is safe anymore. 2 That these toxins can enter the body, and if not metabolized and eliminated can stay in the body for years, in compartments that are relatively poorly perfused, like the fat tissue and the con- nective tissue. 3 That these toxins can have detrimental effects in the body, even if present in minute amounts over many years. 4 That the human body being a complex organism has developed sophisticated mechanisms to se- questrate, metabolize and eliminate these tox- ins. 5 That the organs of elimination can be less ef- cient through disease and overload or, through the lack of vital co-factors needed for the proper functioning of enzymes. 6 Those toxins follow simple toxicokinetics in that they diffuse over several membranes as well as bind to plasma proteins. This will determine the rate that they enter the body and certain tissue compartments, but also the rate that they are re- moved from these compartments. 1 Why Does a Person Need to Detoxify and Eliminate? It should be clear from the above that toxins stored in the body or not eliminated, will be detrimental for various reasons. Toxins can have a wide range of ef- fects, such as fatigue, brain fog, concentration loss, but also other not such apparent manifestations such as the so-called chloracne which is caused by halogenated toxins. As we saw above, some toxins can be endocrine dis- ruptors, cause immune dysfunction, and in the worst scenario act as carcinogenic substances. Due to the wide distribution of toxins, and our fast lifestyle with modern malnutrition and toxic food, as well as the increase in psychological stress, the need for Detoxication and Drainage exist in every pa- tient. Detoxication and drainage requirements, however, will be different in different populations. The aims of detoxication can be summarized as the so-called 4-S treatment: STOP external supply of toxins. SUPPORT the organs of Detoxication and Drainage. STIMULATE elimination of toxins. SENSITIZE the patient for further detoxication. We saw in part II of this booklet that toxins have basic kinetics. Toxins need to diffuse over several membranes, to reach different compartments. Most toxins reach the other compartment by passive dif- fusion over semipermeable membranes. Toxins are carried to and from compartments in the blood, and therefore it means that we would like to reduce the concentration of toxins in the blood so that the tox- ins can start to diffuse back into the blood stream again. For this reason we put the patient on a non-toxic diet, give a lot of uids during the detoxication pe- riod, and also pro-actively stop the supply of toxins, such as inhalants, alcohol and other toxins. This is the rst S: STOP. In other cases, the toxins are bound to proteins and also to SH groups in the cell and in the matrix. We often then have to stimulate the release of the toxin from these molecules. This is an active process and needs support. To get the body to free itself of toxins we need to do two things: Support the organs which 31 Part IV / Tools for Detoxification metabolize harmful substances, support the func- tion of the organs which store toxins, such as the matrix, and lastly we also have to stimulate elimina- tion from these organs. It is important to note that once stored toxins are released they often have not completed their me- tabolism, and therefore still need to be made water soluble in the liver before getting excreted in the kid- ney and other organs. If the stored toxins are released too rapidly all at once, or the liver and other metabolizing and elimi- nation organs are overloaded or not functioning properly, the released toxins will diffuse into the blood, but cannot be excreted. They will thus circu- late in the blood stream till they found a compart- ment where the concentration is less than in the blood and then diffuse into this compartment. The crux is that in this way toxins are merely shifted from point A to B. This is not such a problem in well per- sons or patients with mild toxicity, but in patients with severe toxicity it may have repercussions, such as heavy metals now entering the brain where it is extremely difcult to remove them. Especially in patients where the organs of elimina- tion are not functioning properly or burdened by dis- ease or with other toxins (such as seen in patients on chemotherapy), this needs to be considered. In these patients we need to support the organs of detoxi- cation and elimination rst before we actually drain the tissues. It is also important to note that the process of De- toxication and Drainage puts a severe burden on the body, and thus in the very frail and sick patients it can put another burden on the body and in these patients detoxication should be done as a later event, when the patient has received other medica- tions to support the body. Detoxication and drain- age also needs energy, and therefore the catalysts are a standard addition to more strenuous detoxi- cation programs. Apart from the fact that they also play a role in cellular detoxication. (See below) 2 Tools for Detoxication and Drainage For each organ there is a product which will support the tissues. These are mostly the so-called composita preparations which also contain tissue extracts and often catalysts. And there are basic preparations which are combinations of plant materials and also minerals on the other hand are mostly (but not only) used to stimulate elimination. We shall now discuss the various medications available for detoxication. Firstly the basic regimens, which can be generally applied in all diseases, and then a number of disease processes will be discussed separately. Mild to moderate toxicity Organs Moderate to severe toxicity Detox-Kit Liver Hepar compositum contains + Nux-vomica Homaccord, Kidney Solidago compositum Berberis-Homaccord and + Lymphomyosot Matrix Pulsatilla compositum/Thyreoidea compositum + Coenzyme compositum Cell Ubichinon compositum/Glyoxal compositum Use at least for 6 weeks Use rst for six weeks, then Detox-Kit for another 6 weeks Fig. IV,1: General Detoxication and Drainage 32 2.1 The General Basic Detoxication This regimen is often used initially in patients with mild to moderate toxicity. With this basic regimen, we want to support the liver and gut, the kidneys and drain the matrix of toxins as well as help the excretion. These preparations come in drop form and 30 drops of each can be added to a 1.5 liter bottle of water to be taken over the day. This is thus a convenient method to deliver the medications. Nux vomica-Homaccord supports the liver and the gut. Like with most Homaccords this medication is also functiotropic to the liver and gut, which means that it will improve the function of these organs. Nux vomica-Homaccord Liver Nux vomica, Lycopodium Gut Bryonia, Colocynthis Fig. IV,2: Nux vomica-Homaccord Fig. IV,3: Berberis-Homaccord Berberis-Homaccord Urinary tract Berberis Liver and gut Colocynthis, Veratrum Skin Berberis 33 Part IV / Tools for Detoxification Berberis-Homaccord has the same effect as above, but is more functiotropic for the kidneys, however, it also has an action on the liver and gallbladder. Lymphomysot has been designed to be a drainage remedy, and should not be used initially in the case of severe toxicity, or if the liver and kidneys are over- loaded. It has several components which helps drain the tis- sues of the various organs. It is thus a universal drainage remedy and can also be used in the case of disease of the lymphoid organs. Lymphomysot has been studied in cases of diabetic neuropathy where it was seen to be as effective as alpha lipoic acid in- fusions, which are currently the treatment of choice for diabetic polyneuropathy. The postulation was that Lymphomyosot will drain the so-called Advanced Glycosylation End products (AGEs) in the matrix of these patients and thereby reduce the inammatory potential around the nerves. (Dietz et al., 2004) The actions of the various constituents of Lympho- myosot are depicted in the gure below. In some countries, Nux vomica-Homaccord, Berberis-Homaccord as well as Lymphomyosot are combined into one pack, the so-called Detox- Kit. In most patients with mild to moderate toxicity the three products can be given together as Detox-Kit. Often Coenzyme compositum is given together with these three products. The catalysts will be dis- cussed separately below, but this is mainly to sup- port the Krebs cycle, and also to detoxify the cellular structures. This makes the Detoxication and Drain- age quite complete. The symptoms of Detoxication and Drainage can vary from patient to patient. Most patients start with a diuresis, or losing water, while others may drain preliminarily over the gut, with slight diarrhea and loose stools. The color of the urine and stools may also change. Some patients will use the skin and the lungs to detoxify, which manifests as an increase in sweat with odor or with a tachypnea. Lymphomyosot Respiratory tract Myosotis Teucrium Natrium sulfuricum Nasturtium Lymphatic system and the Matrix Pinus silvestris Scrophularia Levothyroxine Calcium phosph. Juglans Ferrum jodatum Fig. IV,4: Lymphomyosot Liver and gut Fumaria, Geranium, Gentiana Urinary tract Sarsaparilla, Equisetum 34 2.2 The General Advanced Detoxication The purpose of this advanced detoxication is to support the organs of detoxication, especially in patients with a high toxic burden, or in patients where the organs of Detoxication and Drainage are not functioning optimally. This is also true for pa- tients who are debilitated. In these patients it is very important not to increase the load of toxins too early, as these patients often already have genotoxic effects of toxins or active cancer. For instance, if a patient with breast cancer is highly contaminated with DDT, which is an estro- genic like substance, it can act as a promoter for the cancer. Experiments with ovarectomized mice have shown that the mice can develop breast cancer if they are intoxicated with DDT, then ovarectomized so that there is no internal source of estrogens. The mice then developed breast cancer from the release of DDT from the tissues. (Bigsby et al., 1997) It is thus wise to go slowly in patients with decreased detox ability, or high loads of toxins as well as in obese patients which could store a number of lipo- philic toxins. Fasting should be avoided in most pa- tients for this reason, as fasting causes a very quick release of toxins from the storage compartments into the blood stream due to the fact that there are no immediate toxins coming in from the food, and the elimination and detox organs will then turn their attention to older stored toxins and these may then be released in large amounts and at once. The advanced detoxication products aim to sup- port the major organs of Detoxication and Drain- age (see Fig IV, 5). These products are mostly com- posita preparations, which implies that they have a special formulation with plant and mineral material, but then also contain organ extracts of the specic target organs, or tissue which will support the target organs, as well as catalysts and sometimes vitamins in dilution. The plant material is in a low dilution and has a ho- meophytotherapeutic effect, whilst the minerals, catalysts and organ extracts occur in concentrations which are thought to be stimulatory. These concen- trations are the same as those in which many of the bodys internal messengers such as neurotransmit- ters and cytokines are present. Fig. IV,5: Advanced detoxication products Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic Detox-Kit Detox-Kit Detox-Kit - Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel detoxication/ Homaccord drainage Advanced Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. detox 1 Advanced Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. detox 2 Lymphomyosot Homaccord Tropfen (new) Advanced Injeel-Chol Galium-Heel/ detox 3 Lymphomyosot For cellular Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ detoxication Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. in addition 35 Part IV / Tools for Detoxification The support medication for the liver is Hepar com- positum. This product has the typical compositum conguration, and will also support other tissues such as the pancreas and the colon. It is designed to support the detoxifying ability of the liver and gall- bladder. For the kidney, the medication of choice is Solidago compositum. Again this typical compositum prod- uct combines organ extracts with plant materials and minerals as well as with some catalysts. This product has a strengthening and toning effect on the renal tract. The last part of the advanced detox is the support and activation of the extra cellular matrix. It is impor- tant to realize that fat tissue, bone, and also carti- lage are all part of the extra cellular matrix, albeit with differences in density and types of bres. How- ever, these compartments are relatively poorly per- fused and all drained by the lymph system. They all also share the high concentration of negatively charged amino acids and SH groups which will all bind toxins tightly and will keep these toxins seques- trated for years. Furthermore, adipose tissue offers a large reservoir for fat soluble toxins. The matrix is in constant renewal through a balanced process of controlled degradation and controlled re- pair. The degradation is mediated via the pro inam- matory cytokines which in turn will mobilize the so- called matrix metalloproteinases (MMPs) which dissolves the tissue of the matrix and through this method also get rid of toxic complexes. (See Figure IV,6) Interleukin-1 Interleukin-6 Tumor Necrosis Factor Metalloproteinases T I S S U E I N F L A MMAT I O N A N D D E G R A DAT I O N (Free radicals) Osteoarthritis Atherosclerosis Cancer Transforming Growth Factor Anti-Metalloproteinases T I S S U E R E PA I R Tissue healing Fig. IV,6: Degradation and repair in the matrix 36 This process is under control of several physiological substances, like cortisol and thyroid hormone to name a few. If patients for instance loose the bio- rhythm of cortisol which we need to control this re- pair process in the matrix, the patient will end up with a toxic and edematous matrix, such as seen in patients on long-term cortisol therapy. In such cases and in cases where the patient has been under severe psychological stress, we need to activate the matrix as an organ again. This is best achieved by products containing the fac- tors needed for the activation and strengthening of the matrix, and therefore we use products such as Thyreoidea compositum, as it has a number of suis embryological and stem tissues in it, such as Funiculus umbilicalis made from Whartons jelly. These have a strengthening and activating effect on the mesenchyme, of which the matrix is part of. One other medication used in the activation of the matrix is Pulsatilla compositum. This medication contains a plant, Pulsatilla, the mineral sulfur in ho- meopathic form and lastly also cortisone in a high dilution. This high dilution will have a homeopathi- cally reversal effect if a patient had a high dose of cortisone over time. The sulfur is thought to activate the sulfur containing substances of the matrix. 2.3 The Catalysts This group of substances are used in detoxication in two ways, namely as support for the Krebs cycle and secondly as cellular detoxiers. There are three of them, the rst being Coenzyme compositum, the second Ubichinon compositum, and lastly Glyoxal compositum. Coenzyme compositum has all the factors in the Krebs cycle and many of the co-factors involved in the Krebs cycle. The vitamins in dilution are thought to have a detoxifying effect on the cellular struc- tures. Ubichinon compositum has a number of quinones in and apart from supporting the electron transfer chain during cellular respiration, they are also em- pirically used in cancer patients. Glyoxal compositum which is a mixture between Glyoxal and Methylglyoxal will have a stimulating ef- fect on the cellular respiration. The latter is thought to have the most stimulatory effect, although this has not been studied. Current studies are being initi- ated to scientically prove the action of these ho- meopathically prepared catalysts which has been empirically used since 1976. The catalysts play a specically important role in de- toxication, and are added to detoxify cellular struc- tures. The action of Glyoxal compositum is thought to be deeper than that of Ubichinon compositum. and Coenzyme compositum. Glyoxal composi- tum is used in patients who have a severe cellular toxicity, such as cancer patients. Glyoxal composi- tum is used in longer intervals, together with Ubi- chinon compositum and Coenzyme composi- tum. For instance, Glyoxal compositum can be given 1x per week for 4 weeks together with the other catalysts with a break of several months in between and then used again. C oenzym e com p o s i t u m U bic hinon com p o s i t u m c o mpositu m G l yoxa l Fig. IV,7: Action of catalysts Conclusion Most people need to detoxify and drain due to the environmental load of toxins. Toxins accumulate through a combination of in- crease load as well as modern malnutrition and psychological stress, which impacts on the ability of the body to detoxify and drain . The 4-S regimen is a practical way to approach the problem of toxin accumulation: STOP external supply of toxins. SUPPORT the organs of detoxication and drainage. STIMULATE elimination of toxins. SENSITIZE the patient for further detoxication. Antihomotoxic tools for Detoxication and Drain- age can be used in two regimens, the basic and the advanced. General support of regulation is also needed in the form of vital co-factors to the detoxication systems (minerals, vitamins, trace elements, ami- no acids). The basic detoxication products Nux vomica- Homaccord, Berberis-Homaccord as well as Lymphomyosot form a trio to support the func- tion of the liver, the kidneys and nally to drain the tissues via the lymph system. The advanced detoxication offers a comprehen- sive support of the organs of detoxication and elimination and is used as a preparation phase in patients where detoxication needs to be done at a slower pace, or where the organs of Detoxi- cation and Drainage have been weakened by disease or overload. Special considerations need to be observed in certain clinical groups, such as obese patients, patients on chemotherapy, the elderly as well as patients with a history of drug abuse in the past. The preparation phase in the advanced detox is mandatory in these groups. 37 Part IV / Tools for Detoxification 38 Practical Detoxication This section will deal with the way we approach De- toxication and Drainage in the different patients. 1 Clinical Groups The assessment on where to start with the detoxi- cation process is made with two tools: The detoxication point scale The clinical assessment of the patient 1.1 The Detoxication Point Scale This is built up to incorporate all the major toxicity symptoms. Patients evaluate their symptoms on a scale of 0 to 4: Point count 0 = Never or almost never have the symptom 1 = Occasionally have it, effect is not severe 2 = Occasionally have it, effect is severe 3 = Frequently have it, effect in not severe 4 = Frequently have it, effect is severe Points are then totaled, yielding a score that indi- cates the severity of the patients toxic burden: Total points < 100: Patient with mild to moderate toxicity Total points > 100: Patient with moderate to severe toxicity 1.2 The Clinical Assessment of the Patient Group 1 Point count < 100: mild to moderate toxicity Mostly the well/healthy person who wants to clean her or his body and optimize the drainage of toxins as well as the patient with mild disease such as skin conditions, fatigue, acne, irritable bowel syndrome and other signs of mild toxicity. D Basic Detoxication and Drainage with Detox-Kit Group 2 Point count > 100: severe toxicity Mostly the patient with some diagnosed disease process, including autoimmunity and pre-cancerous conditions as well as the patient with severe toxicity. But also all the following patients must be regarded as special groups and will need advanced support rst: The cancer patient on active treatment such as chemotherapy and radiation therapy The older patient The obese patient with metabolic disease The patient with impairment of the elimination organs, such as the liver or the kidney The patient who had signicant drug addiction in the past, even if this was a long time ago D Advanced Detoxication and Drainage Note: Patients in the special groups are always classied into group 2 regardless of their point count. 39 We also use the point scale to follow our treatments and to decide when a patient with initial severe tox- icity should switch to the basic regimen. (See Fig. V,1: The Decision Tree) 2 How Long Should the Patient Detox? From our discussion above, we see that there are in general two waves of drainage when we start to ap- ply the 4-S regimen: STOP external supply of toxins. SUPPORT the organs of Detoxication and Drainage. STIMULATE elimination of toxins. SENSITIZE the patient for further detoxi- cation and lifestyle changes. First we see a fairly fast drainage of toxins through the well perfused compartments. This will result in an increase in urinary ow, loose stools, and increase in sweating and mild headache. After a few days the patient will feel better, but one should not stop the Detoxication and Drainage, as a second wave of Detoxication and Drainage will follow from the lower perfused compartments, such as the fat tissues and the connective tissues. It is thus important to clear these compartments totally, over weeks. In patients with severe toxicity (group 2) it is even good to continue the drainage process with Lymphomyosot up to 12 weeks or even longer, whilst in others, the patient can go on Lympho- mysot for 4-6 weeks (group 1). Note: If the patient has a point score of < 50 from the outset, only Lymphomoysot is used as treatment for 4 weeks. 3 Blocked Excretion Most patients drain the fast exchange compartment relatively easy and this will result in a fast excretion of toxins from the interstitium into the lymph system and blood stream. The toxins will thus move to or- gans of excretion or they may have to be made wa- ter soluble if they were stored in the lipophilic form. Increased urination, loose stools or mild diarrhea, mild fatigue as well as increased sweating are signs of a healthy excretory phase! If the organs of excretion are overloaded, lack co- factors to detoxifying enzymes or are diseased, and they have not been prepared with the advanced sup- port rst, the patient may have symptoms of blocked excretion. This can manifest as severe headache, nau- sea, muscle pain and joint pain. As this almost never happens in the support phase, we are looking at pa- tients on the Detox-Kit. A strategy change is then required and may be solved in two ways. The rst strategy is to separate the three products and give only the bottle of Nux vomica-Homac- cord rst, followed by the Berberis-Homaccord, and then followed by Lymphomyosot. Then a trial of all three together is made. The second strategy persists, go to a support phase rst for six weeks and then to the Detox-Kit again. The latter strategy is often used when a patient still has signs of blocked excretion after reintroduction after the second challenge with the whole kit. If no symptoms of blocked excretion occur on re- challenge, continue with the Detox-Kit as described below in the decision tree. Part V / Practical Detoxification 40 4 The Decision Tree Fig. V,1: Detoxication and Drainage decision tree Assign the patient to a group STOP external supply of toxins Advanced Detox treatment (see protocols) For 6 weeks or until point score is under 100 SUPPORT detoxication + STOP external supply of toxins Basic Detoxication and Drainage with the Detox-Kit For 12 weeks or until point score is under 50 STIMULATE drainage If there are signs of blocked excretion (e.g., headache, nausea, myalgia, etc.), use the Detox-Kit formulations consecutively: 1. Nux vomica-Homaccord (liver stimulation) 2. Berberis-Homaccord (kidney stimulation) 3. Lymphomyosot (matrix drainage and stimulation of cleansing) For 2 weeks each or until point score is under 50 After treatment with Detox-Kit is completed, continue with Lymphomyosot. If initial point score is < 50: 4 weeks 51-100: 6 weeks > 100: 12 weeks SENSITIZE patient: Healthier lifestyle, regular Detoxication and Drainage + Group I: Point score less than 100 Group II: Point score more than 100 (or special groups) Conclusion Practical tools for planning detoxication in a pa- tient is the practice based detoxication ques- tionnaire, which is a semi-subjective tool, as it is based on the assessment of the patient on her or his symptoms. Clinical assessment of the patient concludes the picture, and especially the special groups are considered. The decision tree is condensed into a ow chart.
Although special tests for Detoxication and Drainage are available, they are still largely invali- dated, and whilst giving important information on the ability of the patient to detoxify remains impractical in general practice, due to the cost and the collection of samples. The total toxin load can be determined nally only by tissue samples which are out of the reach of most patients and practitioners. 41 Part V / Practical Detoxification 42 The Organ-specic Treatment Certain medications are also very specic for condi- tions which affect certain organs. 1 The Liver
In terms of basic and advanced detoxication we already looked at Nux vomica-Homaccord and Hepar compositum. A few other medications though need mentioning: Hepeel is a combination product existing of plant material and minerals. Although this is classied as a simple combination, it has been shown to have anti- oxidant and antiproliferative properties. (Gebhardt et al., 2003) Recent in vitro studies also looked at the role of Hepeel in view of the protection it offers in terms of exposure to heavy metals like cadmium. (Unpub- lished data) The protective antioxidant and antiproliferative ef- fect of Hepeel on liver cells has also been shown experimentally. (Gebhardt et al., 2003) We mentioned already in the previous sections the fact that detoxication through the Phase I reaction will generate large amounts of free radicals. By add- ing a compound such as Hepeel, which will at the same time stimulate drainage and act as an anti-oxi- dant; it will support the tissues during periods of in- creased detoxication. This is important in diseases such as alcoholic liver disease, as well as in viral dis- eases such as Hepatitis C where the tendency is to- wards fatty inltration and proliferation. Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Basic Detoxication and Drainage when point count is under 100 Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. 43 Part Vl / The Organ-specific Treatment * Products to be used for detoxication are highlighted 1.1 Therapy Scheme for Detoxication in Chronic Viral Infection like Hepatitis C In this type disease, the detoxication should be a late event, and the main aim is to support and protect the liver tissue. In all of the chronic viral diseases there is a tendency towards fatty inltration, brosis and nally cancer. Protocol for Hepatitis C* Disease-specic treatment Engystol N p Cellular Immunity Hepeel p Liver protection The above regimen for 4 weeks before the detoxication, continue with Hepeel during the detoxication for 12 weeks. Detoxication treatment Advanced support for 6 weeks or until point count is under 100 Note: Hepeel protects the liver cell from damage by the virus and endogenous immune system. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily 44 Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Note: Hepar compositum in this case will support the tissues of the liver and gallbladder. It should be used in patients who have big gallstones or obstruction of the bile duct. In obstruction of the bile duct with a stone, no drainage remedy such as Chelidonium-Homaccord should be used. Thus if a patient is jaun- diced from gall stone obstruction, or in acute cholecystitis, Chelidonium-Homaccord should not be used. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily Use for six weeks, then reassess with ultrasound. This regimen can be repeated after a 4 week interval of rest. Often 3-4 cycles are needed. 1.2 Detoxication of the Gallbladder and the Bile Certain medications have a special afnity for the liver and especially the bile duct and the gallbladder. Such medications often contains the ingredients Chelidonium and Carduus marianus or Sylimarin. Protocol for Gall Stones* Disease-specic treatment Chelidonium-Homaccord p see note below Detoxication treatment For 6 weeks * Products to be used for detoxication are highlighted 45 Part VI / The Organ-specific Treatment Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Note: Advanced support in this case for 12 weeks, independent of point count, as the tissue support is im- perative before the drainage takes place. The fat tissue in the liver will also store many fat soluble toxins, which will put the liver further in danger when toxins are drained too quiclky. Basic Detoxication and Drainage Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. 1.3 Therapy Scheme for Fatty Inltration of the Liver in Type II Diabetics: So-called NASH (Non Alcoholic Steatotic Hepatitis Syndrome) Protocol for Fatty Inltration of the Liver as seen in NASH and Alcoholic Liver Disease* Disease-specic treatment Syzygium compositum Nux vomica-Homaccord p in alcoholic liver disease Concomitant detoxication Advanced support for 12 weeks Note: Detox-Kit for further 6 weeks, and then Lymphomyosot only for further 8 months. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily * Products to be used for detoxication are highlighted Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. 46 2 The Kidneys
We have seen that the kidneys are mainly organs of elimination, and that they concentrate toxins, which may damage the kidneys them- selves. The perfusion of the kid- neys plays a very important role in the excretory function of the kidneys. The ow of urine also is important in the excretion. The support of the kidney function is thus of ma- jor importance in the process of draining of toxins, and it must be ensured that the kidneys are not overloaded, or impaired with disease. Three medications have a special importance in the treatment of the kidneys. Solidago compositum and Berberis-Homaccord have already been dis- cussed above as they are part of the advanced and basic Detoxication and Drainage regimens. It is also important to mention that Berberis-Homaccod has an important function in treatment of inammatory conditions of the kidneys. Reneel H is a further medication which is available as a drainage preparation for the kidneys. Certain diseases affect the kidneys, where drainage of toxins through the renal tract may play a role. In these cases it is of special importance to support the detoxication through the kidneys. * Products to be used for detoxication are highlighted 47 Part VI / The Organ-specific Treatment Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Basic Detoxication and Drainage when point count is under 100 Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. 2.1 Therapy Scheme for Kidney Stones These could be through an accumulation of internal toxins, such as uric acid, calcium or oxalates in the urine, which then precipitates into aggregations. The pH of the urine may play a crucial role here, it is thus important to do the 4-S regimen here. The patient must in the rst case STOP the supply of toxin, or the food which could lead to an accumulation of the toxin. In the case of uric acid this will be food like red meat, alcohol and shell sh. In the case of oxalates the green vegetables, such as spinach must be avoided. Protocol for Kidney Stones* Disease-specic treatment Berberis-Homaccord p Initially on its own, then after point count is under 100 as part of the Detox-Kit Detoxication treatment Advanced support for 6 weeks or until point count is under 100 Note: This must be accompanied with a diet low in oxalates, if the stones are oxalate stones, and also with a low uric acid diet if the stones are due to hyperuricemia. In this case, Hepar compositum is also contin- ued throughout the detoxication to support the liver. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily 48 2.2 Therapy Scheme for Chronic Recurrent UTIs This is a problem especially in small children and in females, for different reasons. In children the problem is more of a reux, whereas in females there is an anatomical as well as a hormonal reason. In both cases, drainage and support of the renal tract is of utmost importance. Protocol for Chronic Recurrent Urinary Tract Infections* Disease-specic treatment Berberis-Homaccord p Initially on its own, then after point count is under 100 as part of the Detox-Kit Echinacea compositum p Add in the case of acute infection Detoxication treatment Advanced support for 6 weeks or until point count is under 100 Note: Mucosa compositum supports the renal epithelium and Solidago compositum supports the whole re- nal tract. On this treatment, the patient may still suffer with acute UTIs. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Basic Detoxication and Drainage when point count is under 100 Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. * Products to be used for detoxication are highlighted 49 Part VI / The Organ-specific Treatment 2.3 Interstitial Cystitis This is a very difcult condition to treat. In this case the patient will rst need the advanced support and then the basic detoxication with a continuation of Lymphomyosot after that. Especially the addition of the tissue medications for the mesenchyme, such as Thyreoidea composi- tum and Mucosa compositum plays a vital role in this instance. The catalysts are added as a routine and only over months the relapses will get less and less as well as the severity diminish. In the end it is vital to drain the Interstitium over several months with Lymphomyosot. 3 The Lymphoid System The lymphoid system has two functions. That of a detoxifying and drainage organ and that of an im- mune function. Apart from edema which is mildly present in toxic people, we also see a higher rate of benign lymphadenopathy and of course also more tissue infections when the lymph system does not function sufciently. A number of products will support the lymphoid system especially, but the two most important are Lymphomyosot and Tonsilla compositum. Tonsilla composi- tum is a complex combination of plant, mineral, catalyst and organ ex- tracts. It is especially effective in the chro- nic recurrent infections, whether it is in child- hood or that of the elite sportsman. Together with Lymphomyosot, which add the drainage, many of these syndromes can be eliminated. 50 3.1 Therapy Scheme for Chronic Recurrent Tonsillitis Protocol for Chronic Recurrent Tonsillitis* Disease-specic treatment Calcoheel Detoxication treatment Advanced support if the point count is above 100 or in specialized groups * Products to be used for detoxication are highlighted Note: In chronic tonsillitis or tonsillar hypertrophy this is an excellent adjuvant treatment to diminish acute infections. This is not a regimen for the acute infection in these patients. The presence of beta-hemo- lytic Streptococci is a reason for conventional treatment. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Basic Detoxication and Drainage when point count is under 100 51 Part VI / The Organ-specific Treatment 4 The Skin 4.1 Therapy Scheme for Acne Vulgaris In patients with acne vulgaris, the detoxication should run parallel to the treatment scheme. It is bet- ter to do the advanced detox in patients with severe acne, but in patients with milder symptoms the basic support often is enough. The pilosebaceous unit (the sebaceous follicle, seba- ceous glands, and sebaceous ducts) is where acne oc- curs. Pilosebaceous units are concentrated in body sites that are prone to acne the face, back, and chest. The pathogenesis of acne is complex and mul- tifactorial. Although the etiology of acne is not clear, or why acne remits or resolves in most individuals but not in others the central pathogenic factors have been delineated. These are: Excessive sebum production secondary to androgen stimulation Altered follicular keratinization and desquamation, resulting in follicular plugging Proliferation of Propionibacterium acnes, an anaerobic organism normally resident in the follicle Inammation following chemotaxis and the release of proinammatory mediators, such as IL-1 Aims of the treatment: Reduce sebum formation Reduce inammation Normalize hormonal environment Combat super infection of the comedo Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. 52 Note: Hormeel can also be used in males for the treatment of acne. Dosage: Ampules: In general, 3-1 times weekly 1 ampule i.m., s.c., i.d. Drops: In general, 10 drops 3 times daily Protocol for Acne* Disease-specic treatment Hormeel Traumeel Echinacea compositum p in super infections of the comedo Detoxication treatment Advanced support if the point count is above 100 or in specialized groups * Products to be used for detoxication are highlighted Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Basic Detoxication and Drainage when point count is under 100 53 References Part VII / References 1 Armstrong B, et al. Lung cancer risk after ex- posure to poly cyclic aromatic hydrocarbons. En- viron Health Perspect 2004;112:94087 2 Ballatori N. Transport of toxic metals by molecu- lar mimicry. Environ Health Perspect 2002;110 (5):68994 3 Bigsby RM, Caperell-Grant A, Madhukar BV. Cancer Research 1997;57:86569 4 Brody JG, Rudel A. Environmental pollutants and breast cancer. Environ Health Perspect 2002; 111:100719 5 Calabrese EJ, La Hormesis B. U-shaped dose re- sponses and their centrality in toxicology. Trends in Pharmacological Sciences June 2001;22(6): 28591 6 Carson R. Silent Spring. Greenwich (Connecticut) 1962 7 Crinnion WJ. Environmental Medicine, Part 1: The Human Burden of Environmental Toxins and Their Common Health Effects. Altern Med Rev 2000;5(1):5263 8 Dietz AR. Adjuvant Homeopathic Treatment of Peripheral Diabetic Polyneuropathy. J of Biomedi- cal Therapy 2004;winter:12 9 Gray LE, Wolf C, Lambright C, Mann P, Price M, Cooper Rl, Ostby J. Administration of potentially antiandrogenic pesticides (procymidone, linuron, iprodione, chlozolinate, p,p-DDE, and ketocon- azole) and toxic substances (dibutyl- and diethyl- hexyl phthalate, PCB 169, and ethane dimethane sulphonate) during sexual differentiation produc- es diverse proles of reproductive malformations in the male rat. Toxicology and Industrial Health 1999;15:94118 10 Gebhardt R, et al. Antioxidative, Antiproliferative and Biochemical Effects in HepG2 Cells of a Ho- meopathic Remedy and its Constituent Plant Tinctures Tested Separately or in Combination. Drug Research 2003;53(12);82330 11 Hartwig A, et al. Interference by toxic metal ions with a DNA repair and cell cycle control. Environ Health Perspect 2002;110(5);79799 12 Harris JB, Blain PG. Neurotoxicology: What the neurologist needs to know. Journal of Neurology Neurosurgery and Psychiatry 2004;75:iii29 34 13 Hodgson E. A textbook of modern toxicology, 3rd edition. Wiley Interscience 2004; ISBN 978-0-471-26508-5 14 Lukashev ME, Werb Z. ECM signalling: orches- trating cell behaviour and misbehaviour. Trends Cell Biol 1998;8(11):43741 15 Skinner MK, et al. Epigenetic transgenerational actions of endocrine disruptors and male fertility. Science 2005 Jun 3;308(5727):14669 16 Rogan W, Chen A. Health risks and benets of bis(4-cholorophenyl)-1,1,1-trichloroethane(DDT). Lancet 2005 Aug 27;366(9487):76375 17 Poirier LA , Vlasova JT. The prospective role of ab- normal methyl metabolism in cadmium toxicity. Environ Health Perspect 2002;110(5):79395 18 Welshons WV, et al. Large Effects from Small Ex- posures. I. Mechanisms for Endocrine-Disrupting Chemicals with Estrogenic Activity. Environ Health Perspect 2003;111(8):9941006 Liver Urinary tract/ Lymph Skin Gut Gallbladder Connective Respiratory Kidney tissue tract Basic detoxication Detox-Kit Detox-Kit Detox-Kit Detox-Kit Chelidonium- Detox-Kit Bronchalis-Heel and drainage Homaccord Advanced detox 1 Hepar comp. Solidago comp. Tonsilla comp. Cutis comp. Mucosa comp. Hepar comp. Thyreoidea comp. Mucosa comp. Advanced detox 2 Hepeel Reneel H Galium-Heel/ Schwef-Heel Nux vomica- Leber-Galle Pulsatilla comp. Lymphomyosot Homaccord Tropfen (new) Advanced detox 3 Injeel-Chol Galium-Heel/ Lymphomyosot For cellular detoxication Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ Coenzyme comp./ in addition Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Ubichinon comp. Biologische Heilmittel Heel GmbH Dr.-Reckeweg-Strae 2-4 76532 Baden-Baden, Germany Phone +49 7221 501-00 Fax +49 7221 501-450 www.heel.com 54 Part I / Classes of Homotoxins 55 56 Biologische Heilmittel Heel GmbH, Baden-Baden, Germany, www.heel.com