COURSE This course provides an advanced insight into the benefits and

mechanisms of detoxification in the human body

DETOX SPECIALIST WWW.THEHEALTHTHERAPIST.COM

Note: As a student you can redistribute and use YOUR own logo on our materials in either the course purchased or
the accompanying protocol, but you do not have the right to sell or use this materials as part of an online course

WHAT IS DETOX DO WE NEED TO DETOX DETOX APPROPRIATE TESTING

MODULE 1 MODULE 2 MODULE 3

PHASE 1 DETOX PHASE 2 DETOX DETOX SUPPLEMENTS

MODULE 4 MODULE 5 MODULE 6

SMOKING ALCOHOL SLEEP

MODULE 7 MODULE 8 MODULE 9

(& Appendices 1-6)

"NEVER ADVISE A CLIENT YOU SUSPECT OF BEING ALCOHOL OR DRUG DEPENDENT OR ADDICTED TO SUDDENLY STOP AS WITHDRAWL
SYMPTOMS CAN BE SEVERE"

N U T R I T I O N C A R E W I T H I N R E A C H
DETOX Module 1: 
What is detox?
 THE HEALTH
THERAPIST
ACADEMY

DETOXIFICATION:
DEFINITION

Detoxification or detoxication (detox for short) is the physiological or medicinal removal

of toxic substances from a living organism, including the human body, which is mainly
carried out by the liver. Additionally, it can refer to the period of withdrawal during
which an organism returns to homeostasis after long-term use of an addictive
substance.

In Nutritional Therapy detox is a way by which we support the liver's natural process
when people have gone through periods of stress or dietary imbalance that may have
put the liver and the bodies normal detoxification systems under pressure

DETOX

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 THE HEALTH
THERAPIST
ACADEMY

DETOXIFICATION:
DEFINITION

We need to detox when we have been living unhealthily for some time, examples
include when we regularly smoke, drink alcohol or have little sleep or rest and have a
diet high in sugar and unhealthy saturated and trans fats. Other times when we may
need detox include if we live or travel in areas of high pollution, or have had surgery in
the past resulting in heavy metal contamination, diets above 3 servings of oily fish a
week can also create heavy metal stress on the liver

Whereas its true that healthy people rarely need to detox if their liver is working well,
alternative and complimentary medicine providers point to the fact that if the liver is
under significant stress everyday then this makes it less able to respond to sudden
increases in demand when needed
DETOX

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 THE HEALTH
THERAPIST
ACADEMY

DETOXIFICATION:
DEFINITION

Let's take 'Sally' as an example. She is 32 years old and is a single mum working hard
with little sleep, this can lead to a condition known as adrenal fatigue, where the lack of
sleep causes an increase in the stress hormone cortisol causing an increased demand
for B vitamins and magnesium, this can lead to borderline B vitamin deficiency which
impairs metabolism, in short the body stops being able to get what it needs from the
current supply of nutrients. This impairs methylation processes, an important part of the
detoxification process as you will see later, leading to impaired detoxification. Sally also
rides to work on a Bike through a very polluted traffic route, can you think of why Sally
may benefit from support to the bodies natural detoxification systems?

DETOX

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 THE HEALTH
THERAPIST
ACADEMY

DETOXIFICATION:
DEFINITION

When the body is under stress diets high in sugar, low in antioxidants, vitamins and
minerals, high in unhealthy saturated and trans fats as well as diets high in artificial
additives, chemicals and pesticides may place additional strain on the body. Although
the benefit of organic food is scientifically unproven many people report a beneficial
change in health and wellbeing following a detox diet low in sugar, 'bad' fats, and
artificial chemicals. A detox diet is NOT advised in alcohol or drug addicts due to risk of
severe withdrawl effects and the need for full medical supervision

DETOX

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DETOX Module 2:
Do we need to detox?
 DETOXIFICATION NEED:

Do they drink more than 2-3 units of alcohol a day

(woman/man), do they drink more than 14/21 units a
week?

Do they smoke cigarettes or e-cigs?

The Need Do they live in a polluted area or commute

through a polluted area?

for Detox
Pyramid
Have they had surgery in the past 5
years? - Note: detox is unsuitable in the
12 months following major surgery or
6 months after minor surgery

If your client answers yes to any of these

questions then there is a possible need for Do they have issues

with sleep or stress?
detox, this is confirmed by taking the detox
If yes to any then
questionnaire attached as addition support there is a possible
need for detox
material
DETOX A Detox is a global brand, pollution isn't just limited to the

developing world, London is one of the most polluted

GLOBAL BRAND cities in Europe. Alcohol consumption is high in

developed countries and although witching to e-cigs is

better than smoking tobacco it still impairs nutrient

absorption

INCREASED STRESS
IMPAIRED NUTRIENT
ABOSRPTION

MORE LIKELY TO TIREDNESS FATIGUE MORE LIKELY TO

SMOKE OR EAT 'JUNK' DRINK ALCOHOL
FOOD Less likely to eat well
Impaired judgement
Impaired judgement

NEED FOR DETOX NEED FOR DETOX NEED FOR DETOX NEED FOR DETOX

"The need to detox can be cyclical"

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DETOX TASK Take the attached questionnaire and test your need to

detox, how well did you score? Do you need to detox?

INCREASED STRESS
IMPAIRED NUTRIENT
ABOSRPTION

MORE LIKELY TO TIREDNESS FATIGUE MORE LIKELY TO

SMOKE OR EAT 'JUNK' DRINK ALCOHOL
FOOD Less likely to eat well
Impaired judgement
Impaired judgement

NEED FOR DETOX NEED FOR DETOX NEED FOR DETOX NEED FOR DETOX

"The need to detox can be cyclical"

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DETOX Module 3
Detox - appropriate testing
 HEAVY METAL AND HAIR MINERAL ANALYSIS

PLANNING DIRECTOR
A screening test that doesn't give diagnosis only an indicator of
liklihood

APPROPRIATE TESTING AMINO ACID PROFILE

A good general test that gives an indicator of the
FOR DETOX body's health as well as need for B vitamins and
magnesium and detoxification

BLOOD HEAVY METAL TESTING

01 A good and accurate test performed in a phlebotomy clinic

THE SEQUENCE
A questionnaire response gives some indicator, but more
QUESTIONNAIRE
specific tests exist for clients able to afford them. It 02
Credit and collections, Financial Assistance
should be noted that all labs provide interpretation
guides to the results and more information on each test
can be found in our advanced nutritional therapy TEST FOR FOLLOW-UP
Research and Development
diploma. 

DEPARTMENT ADMIN
OR DETOX PROTOCOL 
If no test then explain to client the risks of following
a detox protocol, i.e. risk of nutritional deficiency
due to dietary restriction and stress the need for
appropriate vitamin and mienral supplementation
 THE HEALTH APPROPRIATE
THERAPIST TESTING:
ACADEMY Hair mineral and toxic metal testing
has received a bad press and many
scientists criticise it due to an earlier
review pointing to unreliable results,
CPD a later review however demonstrated
this was due to improper following of
each labels different washing
WHY DO WHY WE procedure and found reliable results
WE NEED NEED TO across centres. If positive for heavy
TO DETOX 1 DETOX 2 metal contamination request blood
test or GP referral
INCREASED NUTRIENT IMPAIRED NUTRIENT
DEMAND ABSORPTION

STRESS DIET POLLUTION ALCOHOL

/ SMOKING
www.thehealththerapist.com
 THE HEALTH APPROPRIATE
THERAPIST TESTING:
ACADEMY
Amino acid profiles look at 24 hour

CPD
urine samples in your clients
collection jars that they send off to
the lab themselves in the attached
postal kit. The results give a lot of
WHY DO WHY WE information about a persons need for
WE NEED NEED TO B vitamins, magnesium, protein and
TO DETOX 3 DETOX 4 the state of their gut bacteria balance
as well as need to detox
INCREASED STRAIN ON INCREASED TEMPORARY
LIVER DAMAGE TO LIVER 

STRESS DIET POLLUTION ALCOHOL

/ SMOKING
www.thehealththerapist.com
 THE HEALTH APPROPRIATE
THERAPIST TESTING:
ACADEMY
Blood testing for heavy metals, if the

CPD
test is positive then you should
consider suspending dietary advice
for detox in favour of standard dietary
advice until the doctor has treated
WHY DO WHY WE them, then 6-12 months post
WE NEED NEED TO treatment the detox protocol could
TO DETOX 5 DETOX 6 be of some use

FAST METABOLISM SLOW METABOLISM

STRESS DIET POLLUTION ALCOHOL

/ SMOKING
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DETOX Module 4
Phase 1 detoxification
PHASE 1 DETOX Initially, the “phases” of detoxification were described as functionalisation (or phase I),
or the addition of oxygen to form a reactive site on the toxic compound, and
conjugation (phase II), or the process of adding a water-soluble group to this now
reactive site. Think of phase 1 as the preparation step making it easier for the liver to
process toxic molecules and phase 2 as the step by which they are processed and
broken down

CYP1 ENZYMES CYP2 ENZYMES CYP3 & 4 ENZYMES

PHASE 1 DETOX PHASE 1 DETOX PHASE 1 DETOX

THE CYP1 FAMILY IS INVOLVED IN THE

INVOLVED INMETABOLIZING METABOLISM OF DRUGS, LESS IS KNOWN
PROCARCINOGENS,  XENOBIOTICS, HORMONES, 

AND OTHER ENDOGENOUS

HORMONES, AND INVOLVED IN DRUG
COMPOUNDS SUCH AS
PHARMACEUTICALS METABOLISM
KETONES, 

GLYCEROL, AND FATTY

ACIDS

NOTE: AN ENZYME IS A CHEMICAL THAT HELPS REACTIONS HAPPEN AND  WWW.THEHEALTHTHERAPIST.COM

XENOBIOTICS ARE SUBSTANCES NOT NORMALLY FOUND WITHIN AN ORGANISM
CYP1 Enzymes:
Many foods appear to act as both inducers and inhibitors of CYP1 enzymes, an
effect which may be dose dependent or altered by the isolation of bioactive
compounds derived from food. Curcumin at 0.1% of the diet has been shown, in
animals, to induce CYP1A1, for example, yet a diet of 1%turmeric was inhibitory.
Black tea at 54 mL/d induced both CYP1A1 and 1A2, yet 20 mg/kg of theaflavins
was inhibitory to CYP1A1. Soybean intake at 100 mg/kg up-regulated CYP1A1
activity, yet at 1 g/kg black soybean extract and 200 mg daidzein twice daily [49], its
effect was inhibitory

Note: Up-regulating increases an enzymes activity, inducing it,

down-regulating reduces or inhibits it's activity
CYP2 Enzymes:
The large CYP2 family of enzymes is involved in the metabolism of drugs,
xenobiotics, hormones, and other endogenous compounds such as ketones,
glycerol, and fatty acids. Clinical evidence exists for the induction of CYP2A6 by
quercetin and broccoli. In animals, chicory appears to induce CYP2A enzymes and
rosemary and garlic may up-regulate CYP2B activity. Clinical studies using
resveratrol and garden cress indicate CYP2D6 inhibition. Ellagic acid, green tea,
black tea, and cruciferous vegetables also appear to inhibit various CYP2 enzymes

Note: Up-regulating increases an enzymes activity, inducing it, down-regulating reduces or inhibits it's activity.
Ketones, glycerol, fatty acids, quercetin and reseveratrol are all chemical substances the last 2 being potent
antioxidants that reduce free radical or free oxygen damage to cells
CYP3/4 Enzymes:
The occurrence of the different CYP3A forms is tissue-specific. Rooibos tea, garlic,
and fish oil appear to induce the activity of CYP3A, 3A1, and 3A2. Possible
inhibitory foods include green tea, black tea, and quercetin. The most clinically
relevant of the enzymes is CYP3A4, which is expressed mainly in the liver and to a
lesser extent in the kidney and is involved in 50% of all drug and pharmaceutical
reactions.

CYP4 enzymes:
Less is known about this family of enzymes, since it is thought to play a smaller role
in drug metabolism, but it plays a role in fat metabolism and some drugs

Note: Up-regulating increases an enzymes activity, inducing it, down-regulating reduces or inhibits it's activity.
Ketones, glycerol, fatty acids, quercetin and reseveratrol are all chemical substances the last 2 being potent
antioxidants that reduce free radical or free oxygen damage to cells
OUR BODIES DETOXIFY

• Exogenous, foreign
substances
• Endogenous, internally
created substances
ENDOGENOUS SUBSTANCES
Gut toxins
- bacteria
- parasites
- yeast
Hormones
Bile acids
Metabolic intermediates
EXOGENOUS SUBSTANCES
Xenobiotics
- herbicides
- pesticides
Air pollutants
- auto exhaust
- tobacco smoke
Pharmaceuticals
 DETOXIFICATION
TRANSFORMS MOLECULES

•  Functionalisation Phase I


•  Conjugation Phase II

MAJOR SITES OF ENZYMATIC
DETOXIFICATION

•  Liver
– most important organ

•  Lung, intestine, kidney & skin

– demonstrable detox capability
 LIVER DETOXIFICATION

•  PHASE ONE: OXYGENATION

•  PHASE TWO: CONJUGATION

 PHASE ONE ENZYMES
•  Cytochrome P450 system (20-30
enzymes)
•  Use oxygen to alter molecules
•  By-products include free oxygen
radicals
•  End products may be more dangerous
than the initial chemicals
 PHASE ONE ACTIVITY
•  Increased in tobacco smokers
•  Increased or decreased by medications
•  Increased by char-broiled meats and
high intake of alcohol, BHT or
vegetable oils
•  Variably in_luenced by phytochemicals,
especially _lavonoids
•  Decreased in vegans
 PHASE ONE INDUCERS
•  cabbage, broccoli, brussel sprouts
(indole-3-carbinol)
•  oranges and tangerines (limonene)
•  caraway and dill seeds (limonene)
•  Turmeric extract at 500mg/day
 PHASE ONE INHIBITORS
•  grapefruit
(naringenin)
•  turmeric (curcumin) at
1% of diet
•  capsicum (capsaicin)
•  cloves (eugenol)
•  onions (quercetin)
•  ZINC DEFICIENCY DISRUPTS PHASE ONE
ACTIVITY, SHIFTING ENZYME PATTERNS TO
INCREASE THE PRODUCTION OF CANCER
PROMOTERS

•  OVER ACTIVE PHASE 1 & 2 ENZYMES ALSO
INCREASE OXIDATIVE STRESS AND THE NEED
TO DETOXIFY TOO!
 METHYLATION
•  protects DNA from mutation
•  depends upon methionine (SAM), folic
acid, vitamin B12
•  enhanced by dimethylglycine (DMG),
choline, betaine
•  CAVEAT: methylation inactivates
genes; aberrant methylation may
inactivate tumor suppressor genes
 THE INTESTINES
AND DETOXIFICATION
•  absorption and excretion of toxins
•  second largest volume of detox
enzymes
•  intestinal toxicity stresses the liver
 DETOXIFYING AGENTS
•  dietary _iber (beans, grains)
•  antioxidants (vegetables, seeds, fruit)
•  Phase Two inducers (cruciferous veg)
•  glutathione enhancers (selenium...)
•  methylation enhancers (folic acid...)
•  spices (turmeric, rosemary)
•  herbs (milk thistle, Ginkgo biloba)
DETOX Module 5
Phase 2 detoxification
PHASE 2 DETOX Phase II Conjugation Enzymes. After a xenobiotic  or foreign substance has gone
through the process of becoming hydrophilic through reactions overseen by CYP
enzymes, its reactive site can be conjugated/joined with an endogenous
hydrophilic(water loving) substance to make it easier to break down and be passed
out of the body.

UG/GST TRANSFERASES METHYLATION SUPPORT NRF2 TRANSCRIPTION FACTOR

PHASE 2 DETOX PHASE 2 DETOX PHASE 2 DETOX

ELIMINATION VIA FACES AND INVOLVED IN PAHSE 2 LESS IS KNOWN

URINE DETOX 

METABOLISES STEROID DIETS HIGH IN SUGAR, IMPORTANT IN ANTI-

HORMONES BY MAKING SUCROSE IN PARTICULAR INFLAMMATORY RESPONSE
WATER LOVING IMPAIR TO DRUGS AND CHEMICALS

METHIONINE, B12, B6, B9

CHOLINE AND BETAINE
SUPPORT

NOTE: TRANSFERASES TRANSFER A FUNCTIONAL GROUP OR REACTIVE GROUP FROM ONE CHEMICAL TO
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ANOTHER. TRANSCRIPTION FACTORS CONTROL DNA EXPRESSION AND HENCE PROTEIN AND ENZYME FUNCTION
PHASE TWO CONJUGATION
•  involves sulfates and UGT/GST enzymes
•  amino acids: glycine, taurine, glutamine,
ornithine, arginine
•  glutathione
•  methylation
•  glucuronic acid
 PHASE TWO INHIBITION
•  nutritional de_iciency
•  toxin exposures that exhaust supplies of
substrates or co-factors
•  example: alcohol and low protein
intake deplete glutathione, which is
needed for phase 2 detoxi_ication
 PHASE TWO STIMULATION
•  cabbage, broccoli, cauli_lower, brussel
sprouts, kale (glucosinolates)
•  garlic oil, rosemary, soy
•  citrus peel, dill and caraway oils
(limonene)
•  curcumin at certain amounts
•  S-adenosyl methionine (SAM)
•  milk thistle (silymarins)
 PHASE TWO GENETICS
•  Genetic variation in the activity of
different Phase two enzymes in the liver,
brain or intestines may account for
disease susceptibility:
•  colon cancer
•  breast cancer
•  Parkinson’s disease
UDP-Glucuronosyltransferases (UGT). This class of enzymes, comprising multiple proteins and even subfamilies,
plays an essential role in enhancing the elimination of biotransformed toxins in urine and faeces, as well as
metabolising steroid hormones and bilirubin (a breakdown product of blood). Clinical and observational studies
point to cruciferous vegetables, resveratrol, and citrus as foods and bioactive compounds that induce UGT
enzymes. Animal studies also suggest the potential for other foods and nutrients, including dandelion, rooibos tea,
honeybush tea, rosemary, soy, ellagic acid, ferulic acid, curcumin, and astaxanthin, to enhance UGT activity  

Glutathione S-Transferases. Similar to the aforementioned categories of conjugating enzymes, glutathione S-

transferases (GSTs) include a complex of enzymes, whose main function is to attach a glutathione group to a bio-
transformed chemical. This is stimulated by NrF2 transferases. Cruciferous(cabbage family) and allium(onion
family) vegetables and resveratrol demonstrate ability to induce GSTs in humans

Support for methylation consists of nutrient cofactors and methyl donors, such as methionine, vitamin B12,
vitamin B6, betaine, folate (B9), and magnesium. Various foods can provide these nutrients see table on this page.
Conversely, a high sucrose/sugar diet may inhibit methylation enzymes

The transcription factor, Nrf2 [nuclear factor erythroid 2 (NF-E2) p45-related factor 2], is key to regulating the
body’s detoxification and antioxidant system. Research demonstrates that dietary components, especially
phytochemicals (antioxidants found in whole plant foods), not only scavenge reactive oxygen species, thereby
acting as direct antioxidants, but also regulate Nrf2 activity 
DETOX Module 6
Detox supplements
 Detox Supplements:

Curcumin/Turmeric:
500mg/day of turmeric extract helps up-regulate CYP1 and phase 1 detoxification, it also is a powerful anti-inflammtory agent

Reseveratrol:
An antioxidant that helps with phase 1 detoxification

Quercetin:
Another pwerful antioxidant that helps with phase 1 detoxification

Green Tea:
A general detox aid at 8 cups a day and when 12850mg/day of extract is used helps up-regulate CYP2/3

Roobos:
UGT/GST up-regulates at around 8 cups a day helping phase 2 detox

Grapefruit Juice:
Helps down regulate CYP1 which may be beneficial if this response is over active - a potential reason why a person may be suffering from impaired
detoxification - remember enzymes work best at 'normal' levels of activity too low or too high is not good

Lycopene
2 x 15mg/day helps up-regulate and NRF-2 and hence phase 2 detoxification and anti-inflammtory checmicals in the body

SAMe:
S-ADENOSYL-METHIONINE 500M G/D, help methylation and phase 2 detox

Note: Our protocol is designed to test different pathways of detoxification sequentially to see if there is any benefit from the specific substance
being tested, it is also designed to not be too expensive on the client too be eliminating the need for supplementation with expensive capsules at
every stage
 ANTIOXIDANT BENEFITS
•  protect DNA and cell or organelle
membranes from free radical damage
•  elevate levels of glutathione
•  stimulate immune responses
•  increase activity of tumor suppressor
genes
•  inhibit activity of enzymes needed for
tumor growth
ANTIOXIDANT PROTECTION
•  vitamins A, E and C
•  carotenoids (carotene, lycopene, lutein)
•  Flavonoids
•  selenium, zinc
•  glutathione
•  lipoic acid
 CLASSES OF FLAVONOIDS
•  Glycosides
–  rutin, hesperidin
•  Aglycones
–  _lavonols (quercetin)
–  anthocyanidins (catechin)
•  Proanthocyanidins
–  dimers, trimers of anthocyanidins
•  Tannins
–  polymeric anthocyanidins
 FLAVONOID EFFECTS ON
MAMMALIAN CELLS
•  potent anti-oxidants
–quench free radicals
–chemicals that cause cell
damage

(they also alter activity of

ION pumps affecting what
can get into cells)
 FLAVONES
“Flavones are mainly found in spices and red or purple
plant foods. The estimated daily intake of _lavones is
about 2 mg per day. Flavones have no proven
physiological effects in the human body and no
antioxidant food value, they are rapidly excreted in the
urine

THEY DO AFFECT CYP 450 ENZYMES AND PHASE 1 AND
2 DETOXIFICATION IT IS IMPORTANT TO EAT THESE
FOODS IN THE EARLY STAGES OF A DETOX DIET”

 FLAVONOLS
Flavonols are present in a wide variety of fruits and
vegetables. Flavonol aglycones in plants are potent
antioxidants that serve to protect the plant from reactive
oxygen species (ROS). They may also have anti-bacterial
properties. They are inhibitors of CYP2 and 4 enzymes
when taken in large amounts and may help if these are
overactive, they are necessary in the diet so the body can
down-regulate these enzymes when needed



 CATECHINS
The main dietary sources of catechins in Europe and the
United States are tea and pome fruits. They are a potent
anti=oxidant removing free radicals caused in part by the
process of detoxi_ication

Catechins and epicatechins are found in cocoa, which,
has the highest content (108 mg/100 g) of catechins
among foods analysed, followed by prune juice (25 mg/
100 ml) and broad bean pod (16 mg/100 g). Açaí oil,
obtained from the fruit of the açaí palm contains
catechins (67 mg/kg).

Catechins are diverse among foods, from peaches to
green tea and vinegar. Catechins are also found in barley
grain
 PROANTHOCYANIDINS
These can be found in many plants, most notably apples,
maritime pine bark and that of most other pine species,
cinnamon, aronia fruit, cocoa beans, grape seed, grape
skin (procyanidins and prodelphinidins), and red wines
of Vitis vinifera (the European wine grape).

However, bilberry, cranberry, black currant, green tea,
black tea, and other plants also contain these _lavonoids.
Cocoa beans contain the highest concentrations.

They are a potent anti-oxidant and help mop up free-
radicals from the detoxi_ication process as well as
protect cells from damage
DETOX Modules 7, 8 and 9
Smoking, alcohol and sleep
 Withdrawal Analogy
It’s a very cold day in the middle of winter, with temperatures well below
zero. Suddenly, the furnace quits and the windows in your home are opened
wide, allowing a freezing north wind to blow through every room.


You reach for a blanket, but it’s hardly sufficient. You shiver. You’re
exceedingly uncomfortable. You might even die. The warmth your body
needed to be comfortable and to sustain its proper funcCons has been
removed. It complains. And so it is with drug withdrawal. Your body craves
something and it isn’t geEng it.

DO NOT RECOMMEND SOMEONE WHO IS DRUG OR ALCOHOL DEPENDENT
CEASE ALL INTAKE IT NEEDS TO BE REDUCED GRADUALLY IN A MEDICALLY
SUPERVISED ENVIRONMENT
THE HEALTH THERAPIST ACADEMY RELAPSE IS NORMAL

MODULE 7: SMOKING
Smoking is a massive anti-nutritional factor impairing B vitamin and magnesium abosrption
as well as bone minerals like calcium and phosphorus and the anti-oxidants(and promoters),
A, C, E, Selenium and Zinc. Giving up can seem hard, but apps like MY last Cigerrete give you
daily motivation by showing how much you health has imporved and when your cravings are
likely to start decreasing. Other apps offer group support from fellow 'quitters'.

Remember relapse is a normal part of behaviour change, use the attached relapse
prevention and goal/problem solving sheets to treat each relapse like a problem that needs
to be solved, don't beat yourself up just remeber to learn from the process, the same is true
of clients who quit too. Encourage them to adopt a reflective attitude and when problem
solving together you can use motivational interviewing tips like get them to rate their ability
to solve the problem on a scale of 1-10 then ask what would it take to go 2-3 points higher, if
they're stuck as them to think of a person they would rate as being higher on the scale, then
ask them about what is different between them and that person and go from there

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THE HEALTH THERAPIST ACADEMY RELAPSE IS NORMAL

MODULE 8: ALCOHOL
Alcohol is also another powerful anti-nutritional factor, it also places a strain on the liver
making detoxification more difficult, it is obvious to see giving the liver a break from alcohol
could provide health benefits. 2-3 units a day for women/men respectively is the normal limit
though it is recommended to not drink alcohol at all when on a detox diet. A unit of alcohol is
equal to the measures opposite

If a client needs extra support refer them to a counsellor or psychologist as this will help
them get to grips if they are alcohol dependent with the route causes. Hypnotherapy may
also be of some benefit. As a student you have the right to use our protocol and materials as
part of your practice, but not to sell them as part of an online course. A detox diet is not
recommended for alcohol or drug dependency as full medical supervision is required, these
individuals should not suddenly stop taking their addictive substances as withdrawl can be
serious and severe

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THROUGH SOCIAL MEDIA
THE HEALTH THERAPIST ACADEMY RELAPSE IS NORMAL

MODULE 9: SLEEP
Aim to get between 7-9 hours sleep a day and make a sleep journal, encourage your clients to
do the same this will allow them to find out what amount of sleep works for them. Limiting
screen time before bed e.g. laptop or tablet devices as well as TV can also help, try not to
have caffeine on a detox diet and certainly not after 7.30pm (or 3-4 hours of bed). Caffeine is
another anti-nutritional factor and should also be avoided around meals. If your client insists
on having caffeine 2 hours after a meal is best as many nutrients have been absorbed by this
time. 

Making sure your client has a night-time routine and a way of 'de-stressing' before bed such
as gentle yoga, stretching or meditation a routine that ideally should be repeated and
reinforced in the morning is important to. Get them to focus on their breathing, sometimes if
they are stressed a lukewarm shower before bed may also be relaxing. 

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 A Few Final Words:
"Please always refer if in doubt about ability to help a client, clients should always also continuing
seeing medical professionals about health complaints and illnesses. 

Detox is not a magic bullet that can sort out all conditions, it may help people manage low level
symptoms better. A client should follow a general detox diet before testing specific pathways as
per our example protocol as genetic mutations and problems with pathways only affect a  small
number of people, finally we do not offer quercetin or reseveratrol as part of the plan due the large
amount needed, cost implications and lack of pathway specificity at appropriate dosages"

GOOD LUCK IN YOU EXAMINATION...

 Appendix: Why Detox?
Tips and Tricks for Guiding Your Clients towards a
Healthy Liver
 Why Detox
• OBJECTIVES
• At the end of this presentation you will be
able to:
– Identify common toxins in our daily environment
and their associated health risks.
– Discuss how the body’s detoxification system
works.
– Implement dietary strategies for helping patients
support the liver detoxification process and avoid
future exposure to toxins.
What detox isn’t...
 What IS detoxification?
• Biochemical process by which non water
soluble compounds are transformed into
water soluble compounds that are then
excreted by the body through urine, sweat, or
stool
• Benefit: Protects body from adverse effects of
external and internal toxins
Detoxification: Basis of Drug Metabolism
• MERCK MANUAL
– http://www.merckmanuals.com/professional/clinical_pharmacology/p
harmacokinetics/drug_metabolism.html
• Drug metabolism is also known as xenobiotic metabolism

• Living organisms modify pharmaceutical substances (xenobiotics)

through special enzyme pathways

• This metabolism converts fat soluble chemical compounds into

water soluble products the body can excrete.

• The rate of metabolism determines the duration and intensity of a

drug's pharmacological action.
 Why Detox?
• Most people should be able to detoxify but
an overload of toxins
an undernourished body
a compromised digestive system
(all make for a less effective detoxification process)

• Detoxification is nutrient dependent

• What is a “toxin”?
– Irritating substance that is disruptive to the proper
functioning of our bodies
WHY DETOX?

Where do toxins come from?

 Where do toxins come from?
• Exposure to 1000’s of chemicals every year

– Pollution
– Pesticides & herbicides
– Plastics & Plasticizers (BPA)
– Body care products
– Household cleaning products
– Flame retardants
– Exhaust & cigarette smoke
– Food additives & preservatives & artificial colorings etc.
– Medications & drugs
– Caffeine & alcohol
 WHY DETOX?

What are the risks with these toxins?

 Why Detox?
• Chemicals associated with many chronic diseases

– Fibromyalgia & CFS

– Diabetes
– Parkinson’s & Neurological issues
– Cardiovascular issues
– Endocrine/hormonal issues
– Cancer
– Alzheimer's
– Obesity
– Depression
– Overall malaise and poor energy
 Environmental Working Group
Study: “10 Americans”
Umbilical blood study of 10 American born babies, showing 413 different chemical toxins

• Hormone disruption was found to be associated with

about 154 chemicals

• Infertility, which is on the rise in the United States, was

associated with 186 chemicals found in the study

• Immune system disruption, which is also on the rise,

was associated with 130 chemicals in the study

• Neurotoxins were associated with 158 chemicals

 Sources of Toxins
• AIR pollution
– Contributes to cardiovascular issue
• Ozone can contribute to oxidative damage, which
mutates your DNA and disrupts autonomic nervous
system
– WHO says air pollution contributes to premature
death of 3 million people annually
 Sources of Toxins
• Agricultural
– Atrazine: most widely used herbicide in the US5
• Endocrine disruptors: decreases testosterone,
feminization
• Increases gluconeogenesis
• Increases inflammation
• Disrupts hormone signaling
• Increases a p450 enzyme that converts androgens to
estrogens
 Sources of Toxins
Agricultural:
• Glyphosate (Roundup) herbicide

– Prevents formation of amino acids

– Inhibits beneficial bacterial growth and promotes microbial

colonization

– Estrogenic properties: increases breast cancer proliferation

– Found in urine of city folk who haven’t been exposed to

agriculture
– Glyphosate & Non-Hodgkins Lymphoma (NHL):
• “In conclusion our study confirmed an association between exposure
to phenoxyacetic acids and NHL and the association with glyphosate
was considerably strengthened.” Int J. of Cancer
 Why Detox?
• Pesticides
– Linked to cancer
• “Nonetheless, the available scientific evidence does strongly
suggest that pesticides do cause cancer in both those who
use the pesticides directly and those who are exposed
because of applications others make.”

– Linked to endometriosis
• Extensive past use of environmentally persistent OCPs in the
United States or present use in other countries may impact
the health of reproductive-age women
 PLASTICS
• BPA – common in can linings, plastic bottles
– found in some dental sealants and fillings, medical
devices, paints, epoxy adhesives and cash register
receipts.
– Endocrine disruptors – bind to hormone receptors
in body and activate or block them.
– Associated with Heart Disease
• “Higher urinary BPA concentrations are associated with an
increased prevalence of coronary heart disease.”
 PLASTICS
• BPA & Phtlalates linked to lowered fertility

• BPA linked to childhood obesity

– Journal of the American Medical Assoc:
• “Conclusions: Urinary BPA concentration was
significantly associated with obesity in this cross-
sectional study of children and adolescents.
Explanations of the association cannot rule out the
possibility that obese children ingest food with higher
BPA content or have greater adipose stores of BPA.”
 Body/Hair care
• Cosmetics, shampoos, lotions, hair products, nail products,
deodorants, soaps

• In the Environmental Working Group study

– 168 ingredients that are known to be toxic in 12 personal care

products specifically used by women on a daily basis.
– 85 ingredients that are known to be toxic in 6 personal care
products that are used by men on a daily basis.
– http://safecosmetics.org
– http://www.ewg.org/skindeep/

• Parabens, nitrosamines, octinoxates, 2-nonynoic acid

 Cleaning products
• Solvents used to dissolve dirt and
grime
– Toluene, benzene, formaldehyde, phenol
– Long term exposure
• Leukemia, heart arrhythmias, nerve damage
 Flouride
• May be associated with Thyroid issues
– “When there is excess of fluoride in the body it
can interfere with the function of the thyroid
gland. Thus, fluoride has been linked to thyroid
problems.”
 Dioxins: Persistant Organic
Pollutants
• By-products of industrial processes
• Chlorine bleaching of paper pulp,
manufacturing of some herbicides and
pesticides
• Can cause reproductive and developmental
problems, damage the immune system,
interfere with hormones and also cause
cancer
• Issues with thyroid
• Most through food - mainly meat, dairy, fish,
shellfish24
 Our Food
• Processed
• Preservatives
• Additives
• Artificial colors & flavors
• Emulsifiers
• Bleaching agents
• Poor quality soil
• Genetically modified foods
• Alcohol
• Caffeine
• Food allergies, sensitivities
 Our Food
• Dairy & Animal products
– Hormones
– Antibiotics
– Pesticides in animal feed
– Non-organic Cow’s milk contains insulin-like
growth factor-1(IGF-1)
• Also promotes undesirable growth - like cancer growth
and accelerated aging
• IGF-1 is one of the most powerful promoters of cancer
growth ever discovered for cancers of the breast,
prostate, lung, and colon
 Our Food
• Artificial sweeteners
– Metabolic issues
– Damaging to nervous system
– Promotes bad bacteria
• Refined sugars
• High fructose corn syrup
– Made using toxic solvents
• Brominated vegetable oil (BVO)
– central nervous system depressant and common
endocrine disruptor
 Why Detox?
Endogenous Toxins
– We create toxins all the time as by products from
our normal metabolic functions
– Healthy body can eliminate them
– If we are missing nutrients or if we have an
overload we cannot detoxify properly
– Liver cannot handle toxins and stores them in fatty
tissue like brain and nervous system
 Our body to the rescue!
• 6 organs of detox - working in concert
– Liver
– GI tract
– Kidneys
– Skin
– Lungs
– Lymphatic system

• LIVER acts as a filter

– Takes fat soluble compounds and turns them into
water soluble compounds to be excreted in urine or
stool
 The Liver’s Role
• 7.5 cups of blood pump through liver every minute

• Metabolizes protein, fat, carbohydrate from diet

• Balances blood sugar

• Aids in hormone balance

• Filters viruses & bacteria from blood

• Produces 1 QUART of bile daily

• Integral to digestive function

 Signs of a Struggling Liver
• Slow digestion • Foggy brain
• Inability to digest fats • Migraines
• Slow or sluggish metabolism • Hormonal issues
• Sugar cravings • Immune system issues
• Irritable bowel Issues • Thyroid Issues
• Abdominal bloating
• Fatigue
• Aches and pains
HOW THE LIVER WORKS DETOX REVISION
 PHASE I:
Cytochrome P450 Enzymes used
• Toxin is transformed into a “intermediate metabolite”
– Oxidation
– Reduction
– Hydration
– Hydrolysis
– Dehalogenation

Essentially- making the toxic compound “sticky” so that

something can be added to it.
 We need nutrients as co-factors
• Riboflavin • BCAA’s
• Niacin – Leucine, valine, isoleucine
• Pyridoxine • Folate
• B12 • Flavanoids
• Glutathione • Phospholipids
• Neutralizes free radicals
• Glutathione S Transferase
enzyme
 Phase II
• Enzymes convert the transformed “intermediate
metabolites” into water soluble compounds for
excretion
– Sulfation
– Glucoronidation
– Methylation
– Glutathione conjugation
• requires glutathione s-transferase aka “GST”
– Acetylation
– Amino acid conjugation - makes it lipophilic
 We need nutrients as co-factors
• Vitamin A • Silymarin
• Vitamin C • Thiols
• Vitamin E • Flavanoids
• Selenium • Co Q 10
• Copper
• Zinc
• Manganese
 METHYLATION simplified
• Adding a methyl group to a substrate

• Cofactors include Folate, B6, B12

• Involved in modification of heavy metals, regulation of gene

expression, regulation of protein function, and RNA
processing

• MTHFR gene - means we don’t detoxify well

 Why Detox
• Metallothioneins: intracellular, low molecular,
low molecular weight, cysteine-rich proteins.
• Large quantities are synthesized primarily
in liver and kidneys.
• Support Oxidant damage, and metabolic regulation
• Have metal-binding and redox capabilities
• Their production is dependent on availability of the dietary
minerals, as zinc, copper and selenium, and the amino
acids histidine and cysteine.
• http://www.ncbi.nlm.nih.gov/pubmed/12022471
• http://www.ncbi.nlm.nih.gov/pubmed/10331085
 Starting your clients on a detox
• Almost everyone/anyone can benefit
• Do you have a client with:
– Diabetes, hormonal issues, thyroid issues,
neurological issues, trouble losing weight?
• Those who should not detox:
– Pregnant
– Sick – even the flu
– In cancer treatment
– Those on large doses of medication
– A simple food detox is ok, remember still get medical
clearance if in doubt
 Self-managed Detox and Online:
Total of 14-30 days:

•4 day prep
– Getting ready
•1st Phase = 3 days
– Cutting back and reducing certain
foods
– Beginning to increase other foods
•2nd Phase = 7 days plus
– Complete elimination of avoid list foods
– Focus on whole foods, “clean” eating
All supported with high quality supplementation if desired
Where to begin? – Preparing Yourself
Prep Phase: 4-7 days
Notice:
• What you are eating
• How you are feeling
• How food affects you

• Check in with yourself:

– Where do you feel out of balance?
– How is your stress?
– What do you crave?
– Write down what you eat in a day
 Preparing yourself:
Detox can be challenging
Begin:
• Reading labels
• Noting what is in your kitchen/pantry
• Drinking more water
• Taking supplements or continue them
• Bring out the blender
• Tell your friends and family for
support
 Preparing yourself:
Detox can be challenging
• Go grocery shopping
• Take note of challenges a day might present
– Office meetings
– Dinner with friends
• Research restaurants/cafes in the
neighborhood that are detox friendly
– Practitioners can also provide for the patient
 1st Phase : 3-7 days: LIMIT
2nd Phase: up to 30 days: ELIMINATE
Limit/eliminate:
– Foods from the avoid list
– Limit non-organic foods
– Try to eat whole fresh foods as much as possible
– Smoked meat or processed meat products
– Any food you have a proven reaction too
– Toxins:
– Alcohol
– Tobacco
– Nicotine
– Drugs
– Stress (as far as possible)
 REPLACEMENTS are KEY
• Sugar - Use Grade B maple syrup, stevia, dates,
dried fruits, vanilla, coconut, cinnamon

• Dairy - Try avocado, nutritional yeast, Amande

yogurt, Alternative milks: hemp, almond, coconut
or make your own with nuts and water in blender

• Caffeine/coffee - Try green or white tea,

– kukicha, yerba mate, herbal teas, Teechino
• Alcohol - Try bitters in seltzer or kombucha
 REPLACEMENTS
• For Processed foods - Explore your supermarket
– Nuts and seeds instead of chips
– Mary’s Gone Crackers
– Flackers

• For Refined carbs and Gluten (wheat, rye, barley)

– Mochi squares
– Quinoa, Millet, Kasha
– Spaghetti squash instead of pasta
– Zucchini for pasta
 Increase :
Whole Foods  Fiber is key!
¢ Focus on whole fruits and veggies - organic
¢ Green is good

¢ Cruciferous: broccoli, cauliflower, kale, cabbage,

arugula
¢ “Glucosinolates” target Phase 1 & Phase 2

¢ Berries: blueberries, pomegranate, cranberries

¢ Ellagic Acid is protective

¢ Seaweed: Toss in soups, salads

¢ Burdock, celery: increase urine output

¢ Beets
 Increase :
Whole Foods  Fiber is key!
 SOME IDEAS
 Have as snacks

 Make salads

 Stir frys

 Roasted

 Throw veggies in a smoothie

 Add to soups

 Make into chips

 Increase:
Whole Foods  Fiber is key!
¢ Plant sources of protein
— Experiment with Beans & Legumes
— Cannellini, lentils (green, red, brown), navy beans, pinto,
black beans, mung beans, adzuki beans
— Provide recipes: Dips, chili, soups, salads,
— Nuts & seeds: brazil, pistachio, walnuts, almonds, etc
— Chia, flax, hemp
— Unprocessed soy only:
— Tempeh in small amounts
— Miso
— With animal products: ORGANIC only
 Increase These foods:
• Whole Grains (fiber!)
 Kasha
 Teff
 Millet
 Quinoa
 Sprouted corn tortillas –
 Recipes are key here: savory and sweet are both great

 Healthy fats: Avocado, olives, coconut, nuts/seeds

 Experiment with new oils
 Sesame, avocado, walnut, coconut,

 Coconut milk for cooking

 Increase These foods:
¢ Herbs and spices!

¢ Cilantro, (binds to heavy metals) basil, dill, parsley,

¢ Rosemary contains “carnasol”: Detoxifying
enzyme
¢ Turmeric, curries, garam masala
• Increases glutathione s transferase
• Protects against oxidative stress
¢ Onions, Garlic – contain sulfur
¢ supports production of glutathione34
¢ Ginger
¢ Flavour is key
 Increase These foods:
¢ Fluids!
¢ Water

¢ Green/white teas,
• Compounds ECGC in green tea help to support phase I & Phase II
detox process
• Induces Phase II glucoronidation & GST enzymes
¢ Herbal infusions
¢ Nettle/burdock

¢ “Detox” teas

¢ Seltzers

¢ Kombuchas

¢ Coconut water
 Increase These foods:
 Condiments will help
 Mustards
 Miso paste
 Nut butters
 Tamari sauce
 Karam’s garlic sauce
 Sauerkraut – Try Firefly Kitchen!
 Fermented foods in general are great.

 Coconut milk
 Vinegars
 Nutritional yeast
 What detox is… plenty of FLAVOR!
Sample meals
Breakfast Snack Lunch Snack Dinner

Hummus & Hearty salads with Brown rice or

raw veggies lots of veggies, quinoa
plant protein
Rice cakes & (tofu, tempeh,
Stir fried veggies
nut butter or beans, lentils),
(cabbage, carrot,
avocado roasted nuts
broccoli, onion,) &
chick peas
Fruit & Nuts!

Ginger & garlic

 Dessert?
• Smoothie: cocoa powder, frozen banana,
dates, nut butter, “milk” in blender
• Rice pudding: sweet brown rice, almond
butter, coconut shreds, vanilla, maple syrup
“milk”
• Chia Seed pudding: ¼ cup chia & cup of
almond milk and add nuts/seeds, vanilla,
coconut, cinnamon, maple syrup
• Pecan Date Bon Bons: pecans, dates, miso,
coconut, cinnamon
 Juicing?
• Including as part of
detox is great
• Try as first thing in the
morning or between
major meals as snack
• Optional: One day of
just juicing, diluted
liquids
– Only on a stress free day
Additional lifestyle support
• Sleep
• Sauna
• Breathe & chew
• Slow down & De-stress
• Exercise
 IDEAS for increased compliance
• Grocery list
• Smoothies
• Easy Soups & Stews
recipes, Cold no-cook
recipes
• Resources: restaurants,
juice bars, etc...
• Nutribullet blender
• Support: Offer a group
Facebook page or regular
email access during the
program
 SUPPORTIVE SUPPLEMENTATION
• Ensures clients are meeting
all their nutrient needs
• Easy vehicle for liver
supportive compounds
• Daily dose of Phase I &
Phase II supportive
compounds
• Necessary for people in
need of comprehensive
liver support.
• Easily digestible protein
 SUPPORTIVE SUPPLEMENTATION
• FORMULATIONS
– Protein
– Spectrum of vitamins and
minerals
– Milk Thistle
– Turmeric
– Artichoke: glutathione
– Amino acids
– Green Tea Extract
– N-Acetyl Cysteine
– Dandelion
– Broccoli extract
 Probiotics
• Intestinal Ecosystem needs support during detox
– 10 trillion bacterial cells in intestine
• (1 trillion human cells in body)
– They protect out body from internal/external toxins
– Support immune system, moderate inflammation
– Metabolize carcinogens,
– Make B vitamins,
– Produce butyrate & short chain fatty acids that nourish
intestinal cells &
– Ferment non digestible fibers to help increase nutrient
absorption
– Fermented foods also important
 Milk thistle: silymarin
• Extract from flavanoids
– Increases glutathione synthesis
– Prevents depletion of glutathione
– Protects the liver from damage
– Acts as an antioxidant
– Increases rate of liver tissue regeneration
– Generally considered to be safe.
• Silymarin has been shown to decrease fasting
plasma glucose levels in patients with insulin-
dependent diabetes associated with cirrhosis.
•
•
•
• Pre – Detox :
•
•
• Post Detox:
•
•
 Additional Reading:
• 1. http://en.wikipedia.org/wiki/Drug_metabolism

• 2. http://www.autism.com/index.php/webinars/cook_2012

• 3. Srebot V, Gianicolo EA, Rainaldi G, Trivella MG, Sicari R. Ozone and cardiovascular injury. Cardiovascular Ultrasound. 2009;7(30).

• 4. Li N, Venkatesan MI, Miguel A, et al. Induction of heme oxygenase-1 expression

in macrophages by diesel exhaust particle chemicals and quinones via the antioxidant-responsive element. J Immunol. 2000 Sep
15;165(6):3393-401.

• 5. http://www.epa.gov/teach/chem_summ/Atrazine_summary.pdf

• 6. Hayes TB, Khoury V, Narayan A, et al. Atrazine induces complete feminization and chemical castration in male African
clawed frogs (Xenopus laevis). Proc Natl Acad Sci U S A. 2010 Mar 9;107(10):4612-17.

• 7. Suzawa M, Ingraham HA. The Herbicide Atrazine Activates Endocrine Gene Networks via Non-Steroidal NR5A Nuclear Receptors in
Fish and Mammalian Cells. PLoS ONE. 2008;3(5): e2117.

• 8. Samsel A, Seneff S. Glyphosate’s suppression of cytochrome P450 enzymes and amino acid biosynthesis by the gut microbiome:
pathways to modern diseases. Entropy. 2013;15(4):1416-1463.

• 9. Thongprakaisang S, Thiantanawat A, Rangkadilok N, Suriyo T, Satayavivad J. Glyphosate induces human breast cancer cells growth via
estrogen receptors. Food Chem Toxicol. 2013;59:129-36.
 References
• 10. Brändli D, Reinacher S. Herbicides found in human urine. Ithaka Journal. 2012:1:270–272.

• 11. Eriksson, M., Hardell, L., Carlberg, M. and Åkerman, M. (2008), Pesticide exposure as risk factor for non-Hodgkin lymphoma including
histopathological subgroup analysis. Int. J. Cancer. 2008;123:1657–1663.

• 12. Alavanja MCR, Ross MK, Bonner MR. Increased cancer burden among pesticide applicators and others due to pesticide exposure. CA: A Cancer
Journal for Clinicians. 2013;63:120–142.

• 13. http://well.blogs.nytimes.com/2013/11/05/pesticides-linked-to-endometriosis/?_r=0

• 14. http://ehp.niehs.nih.gov/1306648/

• 15. Diamanti-Kandarakis E, Bourguignon J, Giudice, LC, et al. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocr Rev.
2009;30(4):293-342.

• 16. Melzer D, Osborne NJ, Henley WE, et al. Urinary bisphenol A concentration and risk of future coronary artery disease in apparently healthy men
and women. Circulation. 2012;125(12):1482-1490.

• 17. Melzer D, Rice NE, Lewis C, et al. Association of Urinary Bisphenol A Concentration with Heart Disease: Evidence from NHANES 2003/06. PLoS
ONE. 2010; 5(1): e8673.

• 18. http://www.forbes.com/sites/alicegwalton/2013/10/14/plastics-may-be-linked-to-reduced-fertility-increased-miscarriage/

• 19. http://thechart.blogs.cnn.com/2012/09/18/chemical-bpa-linked-to-childrens-obesity/
 References
• 20. Trasande L, Attina TM, Blustein J. Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents.
JAMA. 2012;308(11):1113-1121.

• 21. Rieger R, Leung PS, Jeddeloh MR, et al. Identification of 2-nonynoic acid, a cosmetic component, as a potential trigger of primary biliary cirrhosis.
J Autoimmun. 2006 27(1):7-16.

• 22. http://toxtown.nlm.nih.gov/text_version/chemicals.php?id=30

• 23. Chandra S and Bathla M. Oral manifestations of thyroid disorders and its management. Indian J Endocrinol Metab. 2011;15: S113-116

• 24. http://www.who.int/mediacentre/factsheets/fs225/en/

• 25. Moschos SJ, Mantzoros CS. The role of the IGF system in cancer: from basic to clinical studies and clinical applications. Oncology. 2002;63(4):317-
32.

• 26. Pretorius E. GUT bacteria and aspartame: why are we surprised? Eur J Clin Nutr. 2012;66(8):972.

• 27. Walton RG, Hudak R, Green-Waite RJ. Adverse reactions to aspartame: double-blind challenge in patients from a vulnerable population. Biol
Psychiatry. 1993;34(1-2):13-7.

• 28. Dufault R, Schnoll R, Lukiw WJ, et al. Mercury exposure, nutritional deficiencies and metabolic disruptions may affect learning in children.
Behavioral and Brain Functions. 2009:5(44).

• 29. Swithers SE. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends Endocrinol Metab. 2013;
24(9):431-41.
 References
• 30. Konsue N, Ioannides C. Modulation of carcinogen-metabolising cytochromes P450 in human liver by the chemopreventive phytochemical
phenethyl isothiocyanate, a constituent of cruciferous vegetables. Toxicology. 2010 Feb 9;268(3):184-90.

• 31. Eun-Hwa S, et al. Protective effects of ellagic acid on ethanol-induced toxicity in hepatic HepG2 cells. Molecular & Cellular Toxicology. 2013;9(3):
249-256

• 32. Deshpande UR, Joseph LJ, Samuel AM. Hepatobiliary clearance of labelled mebrofenin in normal and D-galactosamine HCl-induced hepatitis rats
and the protective effect of turmeric extract. Indian J Physiol Pharmacol. 2003 Jul;47(3):332-6.

• 33. Ibrahim M. El-Ashmawy1,4, Khalid M. Ashry2, Abeer F. El-Nahas3 and Osama M. Salama4 Protection by Turmeric and Myrrh against Liver
OxidativeDamage and Genotoxicity Induced by Lead Acetate in Mice . Basic and Clinical Pharmacology and Toxicology, 2006, 98, 32–37. January
2006
• 34. Sparnins VL, Barany G, Wattenberg LW. Effects of organosulfur compounds from garlic and onions on benzo[a]pyrene-induced neoplasia and
glutathione S-transferase activity in the mouse. Carcinogensis. 1998;9(1):131-4.

• 35. Na HK, Surh YJ. Modulation of Nrf2-mediated antioxidant and detoxifying enzyme induction by the green tea polyphenol EGCG. Food Chem
Toxicol. 2008;46(4):1271-8.

• 36. Milk Thistle. Natural Standard. Available at

http://www.naturalstandard.com.buproxy.bastyr.edu:2048/databases/herbssupplements/milkthistle.asp?. Accessed on 18 November 2013.

• 37. Velussi, M., Cernigoi, A. M., De Monte, A., Dapas, F., Caffau, C., and Zilli, M. Long-term (12 months) treatment with an anti-oxidant drug
(silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatol.
1997;26(4):871
 Appendix: The Role of the Liver 101:

Learning objec-ves:
• Define metabolism
• Describe some of the chemical reac-ons that take place in the liver
What is metabolism?
 The sum of all
chemical reac-ons in
a cell or body
 Metabolic Reac5ons
Forming lipids/fats (triglyceride) from faDy acids and glycerol,
storage of fat for later use as fuel (krebs cycle)

Conver-ng glucose to glycogen (glycogenesis) for storage or

Breaking glycogen down to glucose for fuel (glycogenolysis)

Respira-on, oxygen provided to cell

mitochondria for aerobic reac-ons e.g. glycolysis
where glucose is burned as fuel to power the
krebs cycle where fat is used as the primary fuel for energy
crea-on
Assembly of amino acids into proteins for structures,
hormones and enzymes – in the ribosomes, sulphur group added
for e.g. methionine and cysteine

Breakdown of proteins and fat and conver-ng to glucose in absence
of sufficient glucose/glycogen stores (gluconeogenesis)
 Carries out over 500 jobs
Most metabolically complex organ including:

The only organ that can regenerate itself thus •  Figh-ng off infec-on
making it possible for one person to donate part •  Neutralizing toxins e.g.
of their liver to another person. AEer transplant, alcohol
the donor and recipient livers grow back to full •  Manufacturing proteins
size. and hormones
•  Controlling blood sugar
(along with pancreas)
I’m • 
• 
Helping to clot the blood
Passing the breakdown
amazing! products to the blood to
be excreted via kidneys
•  Breaks down old blood
cells and stores the iron
from haemoglobin un-l it
is needed to make more.
•  Breaks down lac-c acid
Largest internal organ

Contains about 10% of the blood in your body and

pumps about 1.4 litres/min
 Detoxifica5on & Breakdown Products:

The liver is the primary site of detoxifica-on where phase 1 and 2 detoxifica-on
occur. AZer phase 2 detoxifica-on where toxins have been made water soluble
they are passed to the kidneys to be excreted from the body in the urine.

The liver also deals with breakdown products of blood like bilirubin and
anaerobic respira-on like lac-c acid that can become toxic in large amounts
The Water Soluble Vitamins
Important for Detox:
 Appendix 4: Water Soluble Vitamins

• Dissolve in water
• Generally readily excreted

• Subject to cooking losses

• Function as a co-enzyme in detox

processes

• Participate in energy metabolism

• 50-90% of B vitamins are absorbed

• Marginal deficiency more common

 B Complex Vitamins

•  Co-enzymes (activate enzymes)

•  Found in the same foods

•  Single deficiency rare

•  Act together in metabolism

•  Metabolic pathways used by protein, carbohydrate, and
fat
 B Complex Digestion

•  Broken down from coenzyme form into free

vitamins in the stomach and small intestine
•  Absorbed, primarily in the small intestine (50%-90%)
•  Once inside cells, coenzyme forms are resynthesized
•  No need to ingest coenzyme forms; we can make them
B Complex Primary Functions

•  Energy metabolism
•  Thiamin (B-1), Riboflavin (B-2), Niacin (B-3),
Pyridoxine (B-6), Biotin, Pantothenic Acid

•  Red blood cell synthesis

•  Folate, B12

•  Homocysteine metabolism
•  Folate, B12, B6
 Enrichment Act of 1941 and
1998
•  Many nutrients lost through milling process of
grains

•  Grain/cereal products are enriched

•  Thiamin, riboflavin, niacin, folate, iron

•  Whole grains contain original nutrients

•  Enriched grains still deficient in B-6, magnesium and

zinc
 Thiamin (B1)

•  Contains sulfur and nitrogen group

•  Destroyed by alkaline and heat

•  Coenzyme
•  Releases energy from carbohydrate
•  CO2 is released from a larger molecule
•  Glucose metabolism
 Deficiency of Thiamin
•  Occurs where polished rice is the only staple

•  Beriberi (I can’t, I can’t)

•  Weakness, nerve degeneration, irritability, poor arm/leg
coordination, loss of nerve transmission
•  Edema, enlarged heart, heart failure
•  Symptoms due to poor metabolism of glucose
•  Depression and weakness can be seen after only 10 days on a
thiamin-free diet
 Food Sources of Thiamin
•  Wide variety of food

•  Pork, hot dogs, luncheon meat, cold cereal

•  Enriched breads and grains/ whole grains

•  Green beans, milk, orange juice, organ meats, peanuts,

dried beans and seeds

•  Thiaminase found in raw fish

•  Destroys thiamin
 RDA For Thiamin
•  1.1 mg/day for women
•  1.2 mg/day for men

•  Daily Value on food label is 1.5 mg

•  Most exceed RDA in diet

•  Low income people and older people may barely meet

needs (highly processed and unenriched foods, sugar, fat,
alcohol)

•  Surplus is rapidly lost in urine; non toxic; no Upper Level

 Alcohol and Thiamin

•  Alcoholics are at greatest risk for thiamin deficiency

because absorption and use of thiamin are
profoundly diminished and excretion is increased by
alcohol consumption

•  Poor quality diet makes it worse

•  Little stored in body, so alcoholic binge of 1-2 weeks

may result in deficiency
 Riboflavin (B2)

•  Coenzymes

•  Participate in many energy-yielding metabolic

pathways
•  Fatty acids broken down and burned for energy
 Deficiency of Riboflavin

•  Ariboflavinosis
•  Glossitis, cheilosis, seborrheic dermatitis, stomatitis,
eye disorder, throat disorder, nervous system disorder

•  Occurs within 2 months

•  Usually in combination with other deficiencies

 Food Sources of Riboflavin
•  Milk/products
•  Enriched grains
•  Ready to eat cereals
•  Liver
•  Oyster
•  Brewer’s yeast
•  Vegetables (asparagus, broccoli, greens)
•  Stored in paper, opaque plastic containers
 RDA for Riboflavin

•  1.1 mg/day for women

•  1.3 mg/day for men

•  Average intake is above RDA

•  Toxicity not documented

•  No upper level
 Niacin (B3)

•  Nicotinic acid and nicotinamide

•  Coenzymes
•  Needed when cell energy is being utilized
•  Synthetic pathways require niacin, especially
fatty acid synthesis
 Deficiency of Niacin: Pellagra
•  3 Ds
•  Dementia
•  Diarrhea
•  Dermatitis (worse with sun exposure)

•  Occurs in 50-60 days

•  Poor appetite, weight loss, weakness
 Pellagra
•  Prevented with an adequate protein diet

•  Enrichment Act of 1941

•  Became epidemic in southern Europe in early 1700s when

corn became a staple food (poor source)

•  Reached epidemic proportions in the southeastern U.S from

late 1800s to 1930s
•  Only dietary deficiency disease to reach epidemic proportions
in the US
 Food Sources of Niacin
•  Enriched grains, ready to eat cereals
•  Beef, chicken, turkey, fish
•  Asparagus, peanuts
•  Heat stable; little cooking loss
•  60mg tryptophan can be converted into 1 mg
niacin; meets 50% of our needs
•  Niacin in corn is bound by a protein
•  Soaking corn in alkaline solution, like lime water releases
niacin
•  Hispanic people soak corn in lime water before making
tortillas
 RDA for Niacin
•  14 (mg) NE/day for women

•  16 (mg) NE/day for men

•  Daily Value on labels is 20 mg

•  Upper Level is 35 mg

•  Toxicity S/S: headache, itching, flushing, liver and GI

damage

•  Megadose can lower LDL and TG and increase HDL

 Pantothenic Acid
•  Part of Coenzyme-A
•  Essential for metabolism of CHO, fat, protein
•  Deficiency rare

•  Usually in combination with other deficiencies

•  No known toxicity
 Food Sources of Pantothenic acid
•  Meat

•  Milk

•  Mushroom

•  Liver

•  Peanut

•  Eggs

•  Adequate Intake = 5 mg/day

•  Daily Value 10 mg
 Biotin

•  Free and bound form

•  Metabolism of CHO and fat

•  Assists the addition of CO2 to other compounds

•  Synthesis of glucose, fatty acids, DNA

•  Help break down certain amino acids

 Biotin Deficiency
•  Raw egg whites avidin bind biotin → deficiency
•  Requires large amount
•  Scaly inflamed skin, tongue, and lip changes
•  Poor appetite, nausea, vomiting
•  Anemia
•  Muscle pain and weakness
•  Poor growth
 Food Sources of Biotin
•  Cauliflower, yolk, liver, peanuts, cheese

•  Intestinal synthesis of biotin

•  Biotin content only available for a small number of foods

•  Unsure as to bioavailablity of synthesized biotin

•  We excrete more than we consume

 Biotin Needs

•  Adequate Intake is 30 ug/day for adults

•  This may overestimate the amount needed for adults

•  Deficiency rare

•  No Upper Level for biotin

•  Relatively nontoxic
 Pyridoxine (B6)

•  3 compounds

•  Coenzyme

•  Activate enzymes needed for metabolism of CHO, fat ,

protein

•  Synthesize nonessential amino acid via transamination

•  Synthesize neurotransmitters

•  Synthesize hemoglobin and WBC

Other Roles of Vitamin B-6

Homocysteine

•  Produces toxic effect on arterial walls (atherosclerosis)

•  Metabolized by vitamins B-6, B-12 and folate

 Food Sources of Vitamin B-6
Well absorbed
•  Meat, fish, poultry

•  Enriched cereals
•  Potatoes

•  Milk
Less well absorbed

•  Fruits and vegetables: Banana, spinach, avocado

Heat and alkaline sensitive

 B6 Deficiency

Widespread symptoms

•  Depression

•  Vomiting

•  Skin disorders

•  Nerve irritation

•  Impaired immune system

 B6 Toxicity

•  Nerve damage

•  Difficulty walking

•  Numbness in hands/feet
 RDA for Vitamin B-6

•  1.3 mg/day for adults

•  1.7 mg/day for men over 50

•  1.5 mg/day for women over 50

•  Daily Value set at 2 mg

•  Average intake is more than the RDA

•  Athletes may need more

•  Alcohol destroys vitamin B6

 B-6 As A Medicine?

•  PMS
•  B-6 to increase the level of serotonin
•  Not a reliable treatment

•  Carpal tunnel syndrome

•  Toxicity potential
•  Can lead to irreversible nerve damage with > 200
mg/day
•  Upper Level set at 100 mg/day
 Folate

•  Coenzyme

•  DNA synthesis
•  Anticancer drug methotrexate

•  Homocysteine metabolism

•  Neurotransmitter formation
 Deficiency of Folate

• Similar signs and symptoms of vitamin B-12

deficiency
• Anemia
• RBC grow, cannot divide
• Megaloblast: large, immature RBC

• Pregnant women
• Alcoholics
• Megaloblastic Anemia
 Neural Tube Defects

• Neural tube closes first 28 days of

pregnancy
• Forms brain and spinal cord
• By the time pregnancy is confirmed,
damage is done
 Neural Tube Defects
• Spina bifida
• Spinal malformation
• Paralysis
• Anencephaly
• No brain cortex
• Stillborn or die within hours
• Importance of folate before and during pregnancy
• Government requires folate enrichment of flour and
cereal
• May prevent 50% neural tube defects
 Folate and Homocysteine

•  High homocysteine levels in blood associated with

increased risk of CVD

•  Folate deficiency → homocysteinemia

 Food Sources of Folate

•  Liver

•  Fortified breakfast cereals

•  Grains, legumes

•  Foliage vegetables

•  Susceptible to heat, oxidation, ultraviolet light

•  Synthetic form better absorbed

 RDA for Folate

•  400 ug/day for adults

•  (600 ug/day for pregnant women)
•  Average intake below RDA
•  FDA limits nonprescription supplements to 400 ug per
tablet for non-pregnant adults
•  OTC Prenatal supplement contains 800 ug
•  Excess can mask vitamin B-12 deficiency
•  Upper Level set at 1 mg
 Vitamin B-12

•  Compounds containing the mineral cobalt

•  Synthesized by bacteria, fungi, and other lower organisms

•  Role in folate metabolism

•  Maintenance of the myelin sheaths

•  RBC formation

•  Pernicious anemia (associated with nerve degeneration

and paralysis)
 Deficiency of Vitamin B-12
•  Pernicious anemia
•  Nerve degeneration, weakness
•  Tingling/numbness in the extremities (parasthesia)
•  Paralysis and death
•  Looks like folate deficiency
•  Usually (95%) due to decreased absorption ability

•  Achlorhydria especially in elderly

•  Injection of B-12 needed

•  Takes ~20 years on a deficient diet to see nerve destruction

Therapy for Ineffective Absorption

•  Many factors can disrupt this process

•  Monthly injections of vitamin B-12

•  Vitamin B-12 nasal gel

•  Megadoses of vitamin B-12 to allow for passive diffusion

 Food Sources of Vitamin B-12
•  Synthesized by bacteria, fungi and algae

•  (Stored primarily in the liver)

•  Animal products

•  Organ meat

•  Seafood

•  Eggs

•  Hot dogs

•  Milk
 Low B12 Intake

•  Vegans: will have to find alternative source

•  Breastfed infants of vegan mothers

•  Symptoms of Pernicious anemia

•  Takes longer to develop
•  5-10 years of anemia
•  20 years nerve damage
 RDA for Vitamin B-12
•  2.4 ug/ day for adults and elderly adults

•  Average intake exceeds RDA

•  B-12 stored in the liver

•  Non-toxic (no Upper Level)

 Vitamin C

•  Synthesized by most animals (not by humans)

•  Decrease absorption with high intakes
•  Excess excreted
 Functions of Vitamin C

•  Reducing agent (antioxidant)

•  Iron absorption (enhances)
•  Synthesis of collagen
•  Immune functions
•  Does not prevent colds, but may reduce
duration of symptoms by a day or so
•  Wound healing
 Antioxidant

•  Can donate and accept hydrogen

atoms readily
•  Water-soluble
•  Needs are higher for smokers
•  May prevent certain cancers
(esophageal, oral, stomach cancer,
cardiovascular disease, cataracts)
 Vitamin C Deficiency: And Scurvy
•  Sailors on long sea voyages suffered horribly from scurvy
•  Jacques Cartier and his exploring party suffered from scurvy in
Canada during the winter of 1535-6. Local Indians showed them
how to brew a tea from evergreens
•  On Vasco da Gama's voyage to the East Indies in 1497, 100 out
of 160 men were lost from the disease.

•  Scurvy was also seen in the Great Potato Famine, in soldiers

during the Civil War, and in California Gold Rush communities
 Deficiency of Vitamin C
•  Scurvy
•  Deficient diet for 20-40 days
•  Fatigue, pinpoint hemorrhages
•  Bleeding gums and joints. Hemorrhages
•  Associated with poverty; macrobiotic diet

•  Rebound Scurvy
•  Sudden halt to high levels of vitamin C supplements
 Food Sources of Vitamin C
•  Citrus fruit •  Easily lost through cooking

•  Potato •  Sensitive to heat

•  Green pepper •  Sensitive to iron, copper,

oxygen
•  Cauliflower

•  Broccoli

•  Strawberry

•  Romaine lettuce

•  Spinach
 RDA for Vitamin C
•  90 mg/day for male adults

•  75 mg/day for female adults

•  +35 mg/day for smokers

•  Average intake ~72 mg/day

•  Daily Value is 60 mg

•  Fairly nontoxic (at <1 gm)

•  Body is saturated at intake of 200 mg/day

•  Upper Level is 2 g/day

 Vitamin C Excess

•  Hemochromatosis
•  Vitamin C enhances iron absorption

•  Oxalate kidney stones

•  Erodes tooth enamel

 Vitamin C Deficiency

•  In the U.S., deficiency is seen mostly in alcoholic persons

with poor diets and older persons who eat poorly (no
fresh fruits and vegetables)
Appendix 5: Choline: For Health & Detox:
 Choline, Is Everyone Deficient?
•  About 90% of the U.S. (and UK) population is not consuming enough choline.
Analysis of USDA’s 2003-2004 National Health and Nutrition Examination Survey
(NHANES) showed that only 10 percent or fewer had usual intakes at or above the
AI; only young children typically consumed the recommended amount. Choline
intakes also decrease with age and adults over 71 years of age consumed on
average 264 mg/day, which is about half of their requirement.

•  During pregnancy, recommended choline levels increase to 450 mg/day; during

lactation the RDA rises to 550 mg/day. The Nurses’ Health Study, reported in 2010,
found that 95% of pregnant women consumed less than 411 mg of choline/day. In
fact, the average consumption was 337 mg/day.

•  Remember dietary restrictions like a detox diet ARE NOT RECOMMENDED in

pregnancy
 Choline and Health:

Benefits for a range of issues:

•  Pregnancy: Brain / Memory Development

•  Liver Health
•  Heart Health
•  Mental Cognition
•  Sports Performance

Remember supplements are a good way to get enough choline

 Lack of Awareness:

*  It is unlikely your clients will be getting enough choline or have even heard of it, similarly
knowledge of requirements amongst health professionals is poor.

*  Awareness of choline’s health benefits among the professional community is so low that
relatively few choline supplements exist, although it is added to some B-complex vitamin
formulas.

*  Only 15% of consumers were aware of choline in Dec. 2013. Only 2% of consumers were making a
strong effort to get more choline. Health professional awareness is also very low—only 1% of
doctors recommended choline supplements to their patients in 2013, according to Gallup.

*  Major trackers of supplement sales have not yet begun to monitor cthe sales of choline
supplements. Only Nielsen/ SPINS reported on choline sales in 2012, and only in
combination with inositol. Sales in combined natural/mass channels reached $428,000, far
from the million-dollar threshold.
 Choline Is an Opportunity:
•  Similarly, choline’s role in pregnant and lactating women has a parallel impact similar to
folate - for which a national campaign was launched to include folic acid in food fortification
with the objective to prevent neural tube defects. Yet, choline has not received similar
attention.

•  The European Food Safety Authority’s Panel on Dietetic Products, Nutrition and Allergies
approved a health claim related to supplemental folate intake and the reduced risk of
neural tube defects on July 26, 2013, but not choline. The opportunity exists to promote
choline for all ages, and particularly for pregnant and lactating women, and women of
reproductive age.

•  Only 15% were aware of choline according to Gallup’s Dec. 2013 survey.
Choline: A Marketing Opportunity:
 Choline Marketing Potential:

*  Choline is currently a missed opportunity and marketers should have choline-containing

supplements and fortified foods in the marketplace. They should initiate an extensive public
relations effort.

*  Choline quietly became a mass market opportunity in 2009-2010 according to the TrendSense™
model, and has continued to accelerate in terms of its marketability ever since. With Medical
Counts/research activity at this high level and growing, the marketability should be higher at this
point in time.

*  Normally, this pattern is indicative of a market “artificially” held down by other market factors. In
this case, it is likely due to relatively low awareness of 15% in Dec. 2013.
 Choline’s Increasing Market Potential:

•  Prenatal support for normal brain development and development of the memory center in utero
•  Supporting prenatal nutrition
•  Brain development in infants
•  Memory development in children
•  Prevent neural tube defects in fetal development
•  Support normal liver health and function
•  Promoting heart health
•  Promoting brain health
 “Choline: Are We Concerned”
•  The 2010 Dietary Guidelines for Americans Advisory Committee considered choline as “Nutrient
of Concern” that is under consumed, but failed to call it out in their final report.

•  Choline is an under consumed nutrient it plays an important role in detoxification along with its
pre-cursor betaine. It provides methyl donors for methylation part of phase 2 detoxification as
well as to down regulate DNA which can have positive or negative effects on health e.g. by
suppressing genes tat protect us from tumours - for this reason do not exceed supplementation
of 650mg/day
 Institute of Medicine Priority Nutrients:

ü  Arachidonic acid (AA)
ü  Choline
ü  Chromium
ü  Docosahexaenoic acid (DHA)
ü  Eicosapentaenoic acid (EPA)
ü  Fiber: Viscous and fermentable fibers
ü  Magnesium
ü  Niacin
ü  Potassium
ü  Protein
ü  Saturated fat
ü  Stearic acid
ü  Sodium
ü  Vitamin B6
ü  Vitamin E
ü  Zinc

•  Homework task check web-md for definitions of these nutrients, note how web-md is cautious
about the evidence base for supplements, this is because supplement research is poorly funded and
normally done by university departments with heads with an expressed interest in the field rather
than large scale clinical trials as the ingredients can not be patented unlike unique bioengineered
medicines manufactured by the big pharmaceutical companies
 Awareness of Choline Averages at 15%
Gender & Age

•  Choline is found in meat, eggs, and foods 18.0% 17.1%
that generally have a high protein content,
16.0%
it’s pre-cursor betaine is found in fruit and
veg and whole-grains as well as seeds and 14.0% 13.2% 12.8%
nuts. As increasing choline would typically
11.6%
increase cholesterol health professionals 12.0% 10.7%
are typically afraid of recommendations to
increase choline content of the average 10.0%
diet and hence supplementation at around 7.3%
8.0%
400-650mg/day is a valid option.
6.0%
•  Choline deficiency typically effects up to
90% of the population. 4.0%

2.0%

0.0%
Male Female 18-34 35-49 50-64 65+
 Choline a Summary:
Dietary Intake: 90% Deficiency in the U.S. and UK:

*  About 90% of the U.S/UK. population is not consuming enough choline. Data from the
2007-2008 NHANES Evaluation showed that only 10% or fewer had usual intakes at or
above the AI; only young children typically consumed the AI.

*  Choline intake also decreased with age, with those over age 71 years, averaging 264 mg/
day, or about half of their requirement. Choline deficiency is associated with non-alcoholic
fatty liver in adults.

*  Dietary intakes in pregnant women ranged from less than 300 mg to over 550 mg/day.
Intakes at the lower end of this spectrum increase the risk of neural tube defects and
potentially compromised memory and cognitive development in newborns and functions
later in life.

*  Liver, eggs, egg yolks and a variety of meats are the richest sources of choline, but their
consumption has decreased in recent years.
 Actual Choline Intake Verses Requirements

550 550 550

600 450
425
500
396
400 337 337
200 260 264
300 216
200
100
0
Kids Men Women Pregnancy Lactation Men Age
70+

Average Intake (mg/day) Required (mg/day)

Institute of Medicine, Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12. Pantothenic Acid, Biotin, and
Choline. Jan 2008. USDA
Foods Rich in Choline (mg/100g)

USDA Database for Choline in Common Foods, Release Two, USDA-ARS, Jan 2008.
 Choline Requirements by Age (mg/day)

Infants/Children Pregnancy Lactation Men/Woman

Infants Men
•  0-6 months: 19-30 Years:
125mg/day 14-18 Years: 14-18 Years:
450 mg/day 550 mg/day 550 mg/day
•  7-12 months:
150mg/day
31-50 Years:
19-30 Years: 19-30 Years: 550 mg/day
51-70 Years:
Boys 450mg/day 550mg/day
•  9-13 Years:
550 mg/day
375 mg/day 31-50 Years: 31-50 Years >70 Years:
•  14-18 Years: 450 mg/day 550 mg/day 550 mg/day
550 mg/day Women
19-30 Years:
Girls 425 mg/day
•  9-13 Years: 31-50 Years:
375 mg/day
425 mg/day
•  14-18 Years:
400 mg/day
51-70 Years:
425 mg/day
>70 Years:
425 mg/day
USDA Database for Choline USDA Database for Choline in Common Foods, Release.
 Choline: Memory & Cognition:

*  Choline is linked to fetal and infant brain development and enhanced memory and cogni7on in
adults. It is a precursor to the neurotransmi;er, acetylcholine. Choline also func7ons as part of
phospha7dylcholine, a structural component of all cell membranes. Choline is important to the
integrity of the communica7on systems for cells within the brain and rest of the body.

*  Before birth, choline is needed to help form the membranes of the nervous system. Insufficient
choline in the fetal brain affects the development of the areas of the brain that regulate memory.

*  Choline may also support the brain during aging and help prevent changes in brain chemistry that
result in cogni7ve decline and failure.

Pregnancy/Lactation Supplementation:
 Choline: Critical During Pregnancy & Lactation
•  In 1998, The Ins7tute of Medicine - the public health arm of the Na7onal Academy of Sciences -
acknowledged the important role of choline in pregnancy and lacta7on. They set an Adequate Intake
(AI) level that was higher for pregnant and lacta7ng women than women in general. In recognizing
choline as an essen7al nutrient for humans, and cri7cal for fetal and proper child development, The
Ins7tutes of Medicine recommended an AI of 425 mg per day for women. During pregnancy, AI levels
increase to 450 mg per day, and during lacta7on the AI rises to 550 mg per day. There were 2.9 million
babies born in the U.S. in 2012, the latest sta7s7cs available.

•  Pregnant women are not consuming adequate amounts of choline. The issue is compounded because
many mul7-vitamins and prenatal supplements do not contain choline. The Nurses’ Health Study,
reported in 2010, found that 95% of pregnant women consumed less that 411 mg of choline per day,
below the recommended 450 mg. In fact, the average consump7on was 337 mg per day. Choline also
plays a cri7cal role in brain development in the fetus and in infants, especially in the development of
the hippocampus and basal forebrain - the parts of the brain known to regulate memory. Consuming
the adequate intake is also essen7al during lacta7on.
Choline & Liver Health:
•  The Liver is the primary site of detox
in the body and its health is crucial to
the bodies ability to detox, in
otherwise healthy individuals
unhealthy behaviours like drinking to
excess and smoking can impair liver
func7on and detoxifica7on, if phase 2
detox is impaired the liver faces
increased free radical damage.is the
 Liver Health:
•  Three first-time ever major government funded reports were released on liver health in Canada,
the UK and the European Union in 2013. All of these reports were intended to draw attention to
the growing crisis in liver health. Data support exponential growth in a wide variety of liver issues
in these countries, ranging from non-alcoholic fatty liver disease to cirrhosis. The Liver is the
main detoxification organ, along with the filtering action of the kidneys

United Kingdom
 Choline & Liver Health:
*  There is strong evidence that adequate choline supports normal liver functions and helps to
prevent nonalcoholic fatty liver disease (NAFLD) and fatty liver either as a result of choline
deficiency or alcohol consumption.

*  NAFLD is defined as a build-up of extra fat in liver cells that is not caused by alcohol. Although
the liver normally contains some fat, if more than 5% to 10% of the organ’s weight is fat, then it is
called a fatty liver (steatosis). NAFLD may cause the liver to swell - steatohepatitis - and over time
a swollen liver may cause scarring (cirrhosis) and may lead to liver cancer or liver failure.

*  NAFLD may affect up to 25% of the U.S. population, including 6 million children, and the
incidence is on the rise.

*  Those who are more likely to develop NAFLD include the overweight or obese, as well as those
with diabetes, high cholesterol or high blood triglyceride levers, according to the Am. Diabetes
Association. In addition, the incidence of NAFLD increases with age. Men are more likely to
develop NAFLD than women. Mexican-America men have the highest incidence of any U.S.
ethnic group.
 Risk Factors FOR NAFLD

More likely to develop a fatty liver if: Millions (20+) % Pop

HBP 77.9 34%
•  Overweight, obese Pre-hyper 67.0 30%
•  Have diabetes
Cholest > 200 98.9 46%
•  Huge weight circumference
•  High cholesterol
Cholest > 240 31.8 14%
•  High blood pressure LDL>130 mg/dL 71.0 33%
•  Diagnosed with insulin resistance HDL<40 48.7 16%
•  Diagnosed with Metabolic Syndrome Triglycerides 27.2 12%
Overweight 154.7 66%
•  Remember to look up these conditions in Obese 78.4 34%
web-md, also note these populations may Diabetes (Diag) 19.7 9%
benefit from a healthy BALANCED detox
Pre-diabetes 87.3 26%
diet in the absence of other significant
health conditions e.g. previous heart Met Syndrome 77.2 34%
attack history etc, always get medical
The American Liver Foundation/CDC, 2012; Am. Heart Assn.
clearance Statistics, 2014
 Choline & Heart Health

•  When thinking about detoxification do not forget that many phytochemicals and nutrients also have
a positive or potentially positive impact on heart health. Without a healthy heart it is harder to
exercise and hence burn off fat and reduce obesity, which are linked to non-alcoholic fatty liver
disease putting extra strain on the body’s natural detoxification systems.

•  Detoxification is not a process alone but part of the wider health of an individual, be careful about
recommending detox diets to patients with health conditions as the potential for harm is great, in
such cases ALWAYS get medical clearance
 Choline & Heart Health
•  Choline is a little-known but essential nutrient that helps ensure heart health in unique ways.
Choline supports heart health in a variety of ways. It lowers the levels of homocysteine, which
causes oxidative stress and damage to LDL cholesterol, leading to plaque formation. Choline also
works to support a strong heart muscle with regular contractions. This, in turn, leads to a
controlled and lower heart rate with less stress to the heart over time.

•  Heart disease ranks 8th among the health concerns that consumers are very/extremely concerned
about. Heart disease ranks in the top 10 health concerns for all ages in around the globe.
Preventing diseases later in life, e.g., heart disease, diabetes, is now mom’s #2 health concern for
their children.

•  83.6 million – or 37% of the U.S. adult population has have coronary vascular disease. Heart
disease is the number 1 cause of death in the U.S. and a leading cause in the UK along with stroke.
Choline & Sports Performance:
 Choline & Enhanced Sports Performance:

*  Choline can enhance muscle performance during exercise and improve stamina through its
activity at a cellular level. Choline supports communication with muscle fibers and promotes
muscle recovery following repetitive motion, resulting in better overall training output.

*  Choline promotes and regulates proper metabolism for increased energy and endurance. Choline
controls the deposition of fat, allowing the body to store it efficiently or tap it immediately as an
energy source for muscle use.

*  Choline supports messaging between the brain and muscle fibers for more efficient and precise
movements, and improved coordination. Choline aids in maintaining the nervous system, and
delays the onset of central fatigue during strenuous activity.

*  Choline also serves to protect the body’s natural pool of nitric oxide. Nitric oxide expands
arterial walls, increasing oxygen-rich blood flow to exercising muscles. However, nitric oxide is a
molecule that lasts for only a second in the bloodstream and then has to be replaced. Choline
supports optimal nitric oxide functions in the body, which is good for all athletes, especially body
builders. When athletes are deficient in choline – and the sources of choline are exhausted in the
body – the body will take choline away from other key systems and organs. Remember choline
toxicity occurs at >2000mg/day hence 650mg/day is a sensible precaution in case people over
consume and mega dose

Appendix 3: Behaviour
change:
Relapse Management 1:
 Relapse Management 2:

'List the strengths, weakness, opportunities and threats

to your potential solutions from the other sheet, after
doing this rate the effectiveness of your solution on a 1-10 scale
if it scores 6 or below then try coming up with an alternative
solution taking into account what you have just discovered, settle
on a solution when it is 7 or higher'