Qb Herbal Detoxification

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

The Body

1

• The body accumulates toxins over time • Metals, pesticides, etc.

• The body undergoes stress • During digestion process

• Natural detoxifiers in the body • The gastrointestinal tract (GIT) • The liver • The kidney

. Naturaldatabase: Detoxification

Detoxification • Goal: remove toxins and prevent illnesses • Methods: • Special “detox diet” regimens1 • Aka Diet Detox, Fad Diet, Juice Fasting, Starvation Diet, Water Diet, Water Fasting, etc.

• Herbals remedies • Supplements2-4 • SAMe (1200 mg/day) – antioxidant and increases bile flow • Soy Phosphatidylcholine (900 mg/day) – removes fatty deposits in liver • • • • •

Lecithin found in eggs, liver, organ meats, soya beans, nuts & wheatgerm

Naturaldatabase: Detoxification Healthnotes: Liver Cirrhosis. Accessed 4/1/2009 http://www.thehealthierlife.co.uk/natural-health-articles/weight-loss/liver-detox-shift-pounds-00985.html Berardi RR, Kroon LA, McDermott JH, et al. Handbook of Nonprescription Drugs: An Interactive Approach to Self-

• Colonic irrigations

Liver-Loving 1 Lifestyle • Eat well • Vegetables (esp. Brassica family) • Broccoli, cabbage, cauliflower, Brussels sprouts • Caraway and dill seeds

• Avoid toxins • Prefer organics, no alcohol or smoking • Avoid chemicals • From household cleaning products & lawn/garden supplies

• Avoid acetaminophen and ibuprofen

• Sweat well • Regular physical activity increases phase 1 liver

hite LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387

Herbal Remedies for 1 Liver Detoxification Herbal Remedies Milk thistle (Silybum marianum) Dandelion root (Taraxacum officinale)

Reasons

Typical Dosages

Liver protector and healer

• 70-210 mg silymarin capsules 3 times daily • ¼ - 1 tsp milk thistle tincture 3 • 1 cup of tea 3 times daily times daily • Simmer 1 tsp dried root + 1 cup water for 10 mins

Enhance liver function (increase bile production & improve gallbladder func.) Has choline (form of Vit B) for normal liver function Antioxidant properties Nearly double bile ouptu & increase bile solubility to prevent & treat gallstones

• Cook with turmeric 3 times weekly • 250-500 mg capsules 2-3x/d with meals • 1/8 to ½ tsp tincture or glycerite 3x/d • Take with bromelain (enzyme in • ½ - 1 tsp tincture 3 times daily Bupleurum Chinese herb that stimulates the pineapple) better abs • 1 cup tea for (Bupleurum immune system. Beneficial studies 3 times daily • Simmer 1 tsp root + 1 cup water chinensis) in treatment of viral hepatitis. 10-15 • Up tomins Schisandra Berries with antioxidant effects six 580 mg capsules daily • 1/8 – 1 tsp tincture or glycerite up (Schisandra Has mild adaptogen (gradually chinensis) improves over help) so helpful in to 3x/d • 1 cup tea 3 times daily chronic stress • Simmer 1/3 – ½ tsp dried fruit + 1 cup water for 10-15 mins hite LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387 Turmeric (Curcuma longa)

Milk Thistle

1

• Milk thistle (Silybum marianum) as main herb • Approved by the Commissions E of German BGA & WHO monographs2-3 • Recommend 12 – 15 g/day = 200 – 400 mg silymarin4

• Main uses: • Dyspepsia: acid reflux, cramp, nausea and vomiting

• Liver health 1. 2. 3. 4.

• Alcohol-related liver disease, hepatitis B or C Naturaldatabase: Thistle •MilkAmanita mushroom poisoning Tyler VE. Herbs of choice: the therapuetic use of phytomedicinals. Pharmaceutical Product Press. NY. 1994. pp 63-65 Boncompagni E • and Lugli A. Aboca, the evoluation of phytotherapy. ABOCA USA Inc. CO. 2007. pp 116-117 Toxin-induced liver damage Blumenthal M, et al. The Complete German Commission E Monographs: Therapuetic Guide to Herbal Medicines. 1998.

Milk Thistle • Has 4 flavonolignans in the seed makes us silymarin1-3 • Silibinin (silybin) makes 70% of silymarin • Isosilybinin, silichristin (silychristin), and silidian

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

• Antioxidant3 1. 2. 3.

• Free radical scavenger & inhibitor of lipid Venkataraman peroxidation R, Ramachandran V, Komoroski BJ, et al. Drug Metabo Dispos. 2000;28:1270-3 Boerth J and Strong KM. J Herbal Pharmacotherapy. 2002;2:11-7 • Decrease insulin resistance, blood sugar, and Hume AL and Strog KM of Berardi RR, Kroon LA, McDermott JH, et al. Handbook of Nonprescription Drugs: An lipidto levels in Ed. patients with diabetes Interactive Approach Self-Care. 15 Ch 53. pp 1108-1109 th

4.

Flora K, Hahn M, Rosen H, Benner K. Am J Gastroenterol. 1998;93:139-43

Milk Thistle vs. Drugs • TNF inhibition1 • TNF is a cytotoxic, inflammatory, and an apoptosis inducer

• Inhibit P-glycoprotein transporter2 • May decrease drug resistance of cancer cells

• Antifibrotic, anti-inflammatory, & immunomodulatory effects3 • Decreased activity of organic anion transporting polypeptide (OATP1B1) & inhibit breast cancer resistance protein (BCRP)4 •  inhibit “statins” transport into the liver [mild Manna SK, Mukhopadhvay A, Van NT, Aggrawal BB. J Immunol. 1999;163:6800-9 interaction]

1. 2. Maltrelean M, Comte G, Barron D, et al. Bloorg Med Chem Lett. 2000;10:157-60 3. AHRQ evidence report/technology assessment: number 21. Avail at: http://www.ahrq.gov/clinic/epcsums/milktsum.htm 4. Deng JW, Shon JH, Shin HJ, et al. Pharm Res. 2008;25:1807-14

Milk Thistle vs. 1 Drugs • Inhibits beta-glucuronidase • Enzyme that turn glucuronides into toxic metabolites in liver & intestine • Protective against liver injury & colon cancer • Theoretically increase Estrogen clearance2 [mild interaction]

• Estrogenic effects3 • Avoid in hormone sensitive conditions

• Protective kidney effect4 • Vs. nephrotoxic drugs such as acetaminophen, cisplatin, and vincristin 1. 2. 3.

Naturaldatabase: Milk Thistle AHRQ evidence report/technology assessment: number 21. Avail at: http://www.ahrq.gov/clinic/epcsums/milktsum.htm Eagon PK, Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8-11

Milk Thistle vs. Drugs • Affect drug metabolism • Phase 1 drug metabolism • May not inhibits CYP2C91-3 • Amitriptyline, diazepam, verapamil, warfarin, zileuton, etc. [moderate interaction]

• Phase 2 drug metabolism • • • • • •

• Inhibits uridine diphosphoglucuronosyl transferase (UGT)4-6 [moderate Beckmann-Knopp S, Rletbrock S, Weyhenmeyer R, et al. Pharmacol Toxicol. 2000;86:250-6 interaction] Piscitelli SC, Formentini E, Burstein AH, et al. Pharmacotherapy. 2002;22:551-6 Gurley BJ, Gardner SF, Hubbard MA, et al. Clini Pharmacol Ther. 2004;76:428-40 Budzinski JW, Foster BC, Vandenhoek S, et al. Phytomedicine. 2000;7:273-82 Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R, et al. Pharmacol Toxicol. 2000:86:250-6 Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Drug Metabo Dispos.

Milk Thistle Dosing • Hepatic cirrhosis: • 420 mg/day of silymarin extract (Legalon)1 • Chronic active hepatitis: • 240 mg silibinin (Silibide) twice daily2

1. 2. 3.

• Dyspepsia: • 1 mL of product Iberogast 3 times daily x Ferenci P, Dragosics B, Dittrich H, et al. J Hepatol. 1989;9:105-13 Buzzelli G, Moscarella S,3-5 Giusti A, et al. Int J Clin Pharmacol Ther Toxicol. 1993;31:456-60 4 wks Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial

on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg Digestive Disease Week. May 1999 4. Madisch A, Holtmann G, Mayr G, et al. Digestion. 2004;69:45-52

Milk Thistle Dosing • Diabetes: • Silymarin 200 mg 3 times daily as additional x 4 mos1-2 • Amanita phalloides mushroom poisoning:3 • 20-50 mg/kg over 24 hrs, divided into 4 infusions of 2 hrs period each • Given 48 hrs after ingestion • Intravenous silbinin not available in US 1. Velussi M, Cernigol AM, De Monte A, et al. J Hepatol. 1997;26:871-9 2. Huseini HF, Larijani B, Heshmat R, et al. Phytother Res. 2006;20:1036-9 3. Hruby K, Csmos G, Fuhrmann M, Thaler H. Hum Toxicol. 1983;2:183-95

Milk Thistle – Side Effects • Well-tolerated. Contributory laxative effects1 • Less common GI effects2 • Nausea, diarrhea, dyspepsia, flatulence, abdominal bloating, fullness or pain, and anorexia

• Allergic reactions1-2 • Likely to occur if sensitive to Astreraceae/Compositae family • •

Ragweed, chrysanthemums, marigolds, Boerth J and • Strong KM. J Herbal Pharmacotherapy. 2002;2:11-7 AHRQ evidence report/technology assessment: number 21. Avail at: daisies, etc. http://www.ahrq.gov/clinic/epcsums/milktsum.htm

Colonic Irrigation

1

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

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

• Coffee Enema4-7 • • • • • • •

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

Kidney Cleansing

1

Eat proper fruits & vegetables, esp. organics •

Healthy water intakes (8-10 cups per day)2

•

Take foods rich in magnesium & Vitamin B63

•

•

Mg rich food: avocados, legumes, whole grains, dark greens veggies, nuts, seeds, soy, dried apricots

•

B6 rich food: avocados, legumes, whole grains, Brewer’s yeast, egg yolks, fish, sweet potatoes, cauliflower

Grapes have potassium, which increases blood pH •

•

Ensure optimal kidney function & eliminate uric acids

Cranberries have quinine •

Convert to hippuric acids in liver to eliminate urea & uric acids

• Herbal remedies

1. 2. 3.

•

Nettle soup or dandelion tea 2-3 times a day

•

Ginger root + turmeric tea twice daily after meals

• Goals: colorless & odorless urine = healthy kidney

http://www.all4naturalhealth.com/kidney-detox.html http://www.thedetoxspecialist.com/Kidney_Detox.html White LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp 372-375

Herbal Remedies for 1 Kidney Stones Herbal Remedies Valerian (Valeriana officinalis) Skullcap (Scutellaria lateriflora) Wild Yam (Dioscorea villosa) Khella (Ammi visnaga) Marshmallow (Althacea officinalisI) Slippery Elm (Ulmus rubra) Corn Silk (Zea mays) Aloe (Aloe vera)

Reasons

Typical Dosages

Antispasmodic & strongly sedative  relax ureter for small stones to Antispasmodic & mostly sedative pass  relax ureter for small stones to pass Antispasmodic with no sedative effect Good alternative if need to stay Relax muscles of ureter and awake urinary tubules but is hard to find

• 1 cup tea or 1 tsp tincture every hour until pain subsides • Take only for 1 day (b/c hi dose); Avoid in • 1 cup tea 4x/d or every hour until pain eases pregnancy • ¼ - 1 tsp tincture 4x/d or every hour until pain eases • Up to two 400 mg capsules per day • ¼ - 1 tsp tincture up to 5 times daily

Demulcent to soothe irritated urinary tissues May decrease certain medications Eases irritation and heals body tissues May decrease certain medications Strings in ear of corn that soothe and relax urinary tubes not kidney itself Has anthraquinones that prevent kidney stones

• Up to six 400 – 500 mg capsules/d • 1 cup tea divided into 3 portions daily • 20-40 drops tincture up to 5x/d

• 250 – 300 mg extract standardized to 12% khellin per day in divided doses

• Up to twelve 370 mg capsules daily • 2 – 3 cups tea daily • 10-30 drops of tincture up to 5 times daily • 4 – 6 cups tea per day • ¼ - 1 tsp tincture 4 – 5 times daily • 1 tsp after meals • Reduce dose if experience laxative effects

• Up to four 500 mg capsules per day • 20 – 40 drops tincture up to 2 times daily • Reduce dose if experience diarrhea. Avoid in pregnancy White LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387 Yellow Dock (Rumex crispus)

Traditional blood purifier containing anthraquinones

Detoxification Recommendations • Lifestyle changes • Drink 8-10 cups of water but avoid excess drinking. • Eat plenty of washed fruits and vegetables • Exercise regularly

• Herbal remedies & alternative choices • Milk thistle is relative safe for liver detoxification • Communicate with physicians and pharmacists about current and planned herbal regimen

Herbal Remedies for Liver Detoxification 1 (Review)

Herbal Remedies Milk thistle (Silybum marianum) Dandelion root (Taraxacum officinale)

Reasons

Typical Dosages

Liver protector and healer

• 70-210 mg silymarin capsules 3 times daily • ¼ - 1 tsp milk thistle tincture 3 • 1 cup of tea 3 times daily times daily • Simmer 1 tsp dried root + 1 cup water for 10 mins

Enhance liver function (increase bile production & improve gallbladder func.) Has choline (form of Vit B) for normal liver function Antioxidant properties Nearly double bile ouptu & increase bile solubility to prevent & treat gallstones

• Cook with turmeric 3 times weekly • 250-500 mg capsules 2-3x/d with meals • 1/8 to ½ tsp tincture or glycerite 3x/d • Take with bromelain (enzyme in • ½ - 1 tsp tincture 3 times daily Bupleurum Chinese herb that stimulates the pineapple) better abs • 1 cup tea for (Bupleurum immune system. Beneficial studies 3 times daily • Simmer 1 tsp root + 1 cup water chinensis) in treatment of viral hepatitis. 10-15 • Up tomins Schisandra Berries with antioxidant effects six 580 mg capsules daily • 1/8 – 1 tsp tincture or glycerite up (Schisandra Has mild adaptogen (gradually chinensis) improves over help) so helpful in to 3x/d • 1 cup tea 3 times daily chronic stress • Simmer 1/3 – ½ tsp dried fruit + 1 cup water for 10-15 mins hite LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387 Turmeric (Curcuma longa)

Herbal Remedies for Kidney Stones 1 (Review)

Herbal Remedies Valerian (Valeriana officinalis) Skullcap (Scutellaria lateriflora) Wild Yam (Dioscorea villosa) Khella (Ammi visnaga) Marshmallow (Althacea officinalisI) Slippery Elm (Ulmus rubra) Corn Silk (Zea mays) Aloe (Aloe vera)

Reasons

Typical Dosages

Antispasmodic & strongly sedative  relax ureter for small stones to Antispasmodic & mostly sedative pass  relax ureter for small stones to pass Antispasmodic with no sedative effect Good alternative if need to stay Relax muscles of ureter and awake urinary tubules but is hard to find

• 1 cup tea or 1 tsp tincture every hour until pain subsides • Take only for 1 day (b/c hi dose); Avoid in • 1 cup tea 4x/d or every hour until pain eases pregnancy • ¼ - 1 tsp tincture 4x/d or every hour until pain eases • Up to two 400 mg capsules per day • ¼ - 1 tsp tincture up to 5 times daily

Demulcent to soothe irritated urinary tissues May decrease certain medications Eases irritation and heals body tissues May decrease certain medications Strings in ear of corn that soothe and relax urinary tubes not kidney itself Has anthraquinones that prevent kidney stones

• Up to six 400 – 500 mg capsules/d • 1 cup tea divided into 3 portions daily • 20-40 drops tincture up to 5x/d

• 250 – 300 mg extract standardized to 12% khellin per day in divided doses

• Up to twelve 370 mg capsules daily • 2 – 3 cups tea daily • 10-30 drops of tincture up to 5 times daily • 4 – 6 cups tea per day • ¼ - 1 tsp tincture 4 – 5 times daily • 1 tsp after meals • Reduce dose if experience laxative effects

• Up to four 500 mg capsules per day • 20 – 40 drops tincture up to 2 times daily • Reduce dose if experience diarrhea. Avoid in pregnancy White LB and Foster S. The herbal drugstore. Rodale Inc. US. 2000. Pp384-387 Yellow Dock (Rumex crispus)

Traditional blood purifier containing anthraquinones