D-Tox Phase V
This DTOX manual is meant to be followed and adjusted for each of Dr. Wald's patient's individually. It should not be printed or implemented without direct professional supervision and is meant for patients of Integrated Medicine of Mount Kisco only. This manual is for educational purposes only and is not meant to substitute for sound medical or health advice. Statements may be contained within the manual that are not approved by the FDA (Food & Drug Administration).
D-Tox Phase V
An organic, brown rice product naturally created to provide high quality proteins. Proteins are essential for tissue building, energy, for the maintenance of lean organ and muscle mass. Importantly, DTOX V provides 15 grams of high quality, low allergy potential protein required for a specific phase of detoxification in the liver known as phase II detox. Phase II detoxification is a complex process requiring very specific natural compounds – many of which are derived directly from proteins and their component amino acids. Below is a detailed outline of phase II detoxification. Here is what you need to know about this comprehensive product provided by Dr. Michael Wald and Blood Detective Nutritionals.
DTOX V was created to help restore and support the nutrition required for phase II liver detoxification by providing protein, fiber, and nutrients to help eliminate toxins from the body; and for use along with a balanced diet.
Overview of Detoxification†
The human body is exposed to a wide variety of toxins on a daily basis including chemicals found in foods, environmental toxins, and pharmaceuticals. The liver is the body’s main detoxification organ that provides enzyme systems that safely process and remove xenobiotics (foreign chemical substances) out of the body, as well as unhealthy hormone metabolites. These detoxification systems are very complex and require a variety of nutrients for optimal function.
There are two main pathways of detoxification in the liver, known as phase I and phase II. In phase I, composed mainly of cytochrome P450 enzymes, non-reactive compounds undergo specific reactions that use oxygen to form a reactive site on the compound. Most pharmaceuticals are metabolized through phase I biotransformation. This prepares the metabolite for the next step of detoxification knows as phase II. Phase II is a crucial step- if molecules from phase I are not fully metabolized by phase II conjugation they may cause free radical damage to proteins, RNA, and DNA within the cell. Phase II reactions result in the biotransformation of fat-soluble compounds into water-soluble compounds that can then be excreted in the urine, bile, or stool.
The ingredients included in Core Support were chosen for their ability to support one of the six pathways of phase II detoxification. N-acetyl cysteine along with glycine and taurine are well known amino acids for their role in supporting the liver. Antioxidants such as lipoic acid, green
† This statement has not been evaluated by the Food and Drug Administration.
N-Acetyl Cysteine (NAC) is a sulfhydryl containing amino acid that is commonly used to support liver health. Though studies have shown the absorption of oral glutathione to be limited, supplementation with NAC has been shown to significantly increase circulating levels of glutathione, a primary antioxidant that plays a major role in protecting cellular health. [1-3] Increasing glutathione levels in turn increases the production of specialized antioxidant enzymes such as glutathione peroxidase, glutathione reductase and detoxification enzymes such as glutathione s-transferase. Through the activity of these enzymes, NAC protects the body from oxidative damage, increases phase II detoxification, and enhances the normal breakdown of toxins and other metabolic by-products of the body.
One of the six phase II detoxification pathways is amino acid conjugation (the attachment of amino acids to a toxin). Glycine is one of the amino acids used in this process. Glycine also aids in glutathione conjugation. Glycine preserves intracellular glutathione concentration and protects cells from oxidative damage. This process is mediated by a protein called glycine transporter 1 or GLYT1. Research has shown that glycine treatment of human intestinal cells against an oxidative agent, reduced the intracellular concentration of reactive oxygen species (ROS) when exposed to oxidative challenge.
† This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
The sulfation pathway is another important phase II detoxification pathway. During the sulfation pathway, a sulfur-containing molecule is attached to the toxin in order to produce a compound that can be excreted out of the body. Studies show taurine effectively conjugates bile acids,  and protects the liver against toxic heavy metals such as arsenic by supporting gluthathione levels in the liver. 
Lipoic acid is a potent antioxidant which has been shown to increase glutathione, vitamin E, and vitamin C levels in the body. Lipoic acid has been shown to support phase II detoxification by increasing the activity of enzymes including NAD(P)H, quinine oxidoreductase, and glutathione- S-transferase. Lipoic acid has been used to detoxify mycotoxins (toxic by-products produced by fungi and molds). Some mycotoxins have been found to mimic xenobiotics (foreign chemical substances) in their effects on the body and in their routes of detoxification. Lipoic acid has also been shown to reverse age-related loss of glutathione synthesis.
Green Tea Extract†
Green tea is one of the most widely consumed beverages throughout the world and is traditionally consumed in numerous cultures for its health- promoting benefits. One of the main polyphenols in green tea includes epigallocatechin- 3-gallate (EGCG). Green tea polyphenols have demonstrated significant antioxidant and inflammatory balancing effects. Green tea has also been shown to provide phase II stimulating properties. Studies have shown that green tea extract increases phase II enzymes such as glutathione transferase, NAD(P)H, quinine reductase, epoxide hydrolase, and UDP- glucuronosyltransferase. EGCG potentiates cellular defense capacity against chemical toxins, ultraviolet radiation, and oxidative stress. 
Rosemary contains polyphenols that are potent antioxidants, which provide a significant boost to immune response and up-regulate detoxification mechanisms of the liver.  Carnosol, an antioxidant in Rosemary, induces glutathione-s- transferase, as well as other important phase II enzymes.  Rosemary essential oil and carnosol have also been shown to increase intracellular glutathione levels. 
Vegetable Antioxidant Blend†
DTOX V contains VitaVeggie®, a blend of high concentration superfood vegetables with significant antioxidant potential. VitaVeggie® is high in ORAC value (oxygen radical absorbance capacity- a method of measuring antioxidant activity) and contains health promoting compounds including sulphoraphane and glucosinolates. Cruciferous vegetables including broccoli, kale, and Brussels sprouts increase the enzyme activity of both phase I and phase II detoxification pathways.  Sulforaphane, a naturally occurring isothiocyanate derived from cruciferous vegetables, induces phase II detoxification enzymes and supports the body’s response to oxidative stress to promote balanced inflammation.  Glucosinolates present in Brassica vegetables serve as precursors for biologically active metabolites, which induce phase 2 enzymes via the activation of Nrf2, the master cellular switch responsible for antioxidant production.
Schizandra Berry Extract†
Schizandra is an adaptogenic herb used medicinally to help fight off the physical and mental effects of stress. Schizandra is also used to support liver health and neutralize the effects of toxin exposure. Schizandra enhances liver detoxification pathways by increasing the levels of reduced glutathione in the liver as well as glutathione reductase and glutathione S-transferase activity. In animal studies, schizandra has been shown to support phase I metabolism and protect the liver from free radical damage induced by toxic chemical exposure following ingestion of carbon tetrachloride. 
Psyllium husk is from the plant Plantago ovata and largely used for its fiber content. Psyllium husk contains a large amount of soluble fiber per volume. Psyllium is used to improve GI transit time, in GI related health issues, and for cardiovascular health by promoting normal cholesterol levels through the elimination of cholesterol-rich bile. Studies show psyllium husk powder up-regulates genes involved in bile acid synthesis and binds to bile-acids in the intestines to gently remove them from the body. [21, 22]
Mix 2 scoops (39.0 grams) of Core Support with 8 oz. of water or the beverage of your choice 2 times daily or as recommended by your health care professional.
Does Not Contain
Gluten, yeast, artificial colors and flavors.
Do not consume this product if you are pregnant or nursing. Consult your physician for further information.
† This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
1. Witschi A, et al. The systemic availability of oral glutathione. Eur J Clin Pharmacol 1992;43:667-9.
2. De Rosa SC, et al. N-acetylcysteine replenishes glutathione in HIV infection. Eur J Clin Invest 2000 Oct;30(10):841-2.
3. Atkuri KR, Mantovani JJ, Herzenberg LA, et al. N-Acetylcysteine—a safe antidote for cysteine/ glutathione deficiency. Curr Opin Pharmacol 2007 Aug;7(4):355-9. Review.
4. Liska DJ. The detoxification enzyme systems. Altern Med Rev 1998; 3(3):187-198.
5. Howard A, Tahir I, et al. Glycine transporter GLYT1 is essential for glycine-mediated protection of human intestinal epithelial cells against oxidative damage. J Physiol 2010; 588(Pt 6):995-1009.
6. Birdsall T C. Therapeutic applications of taurine. Altern Med Rev 1998; 3(2):128-136.
7. Das J, Ghosh J, et al. Protective role of taurine against arsenic-induced mitochondria-dependent hepatic apoptosis via the inhibition of PKCdelta-JNK pathway. PLoS One 2010; 5(9):e12602.
8. Smith A R, Shenvi S V, et al. Lipoic acid as a potential therapy for chronic diseases associated with oxidative stress. Curr Med Chem 2004; 11(9):1135-1146.
9. Flier J, Van Muiswinkel F L, et al. The neuroprotective antioxidant alpha-lipoic acid induces detoxication enzymes in cultured astro glial cells. Free Radic Res 2002; 36(6):695-699.
10. Rogers,SA.Lipoicacidasapotentialfirstagentfor protection from mycotoxins and treatment of mycotoxicosis. Arch Environ Health 2003; 58(8):528-532.
11. ShayKP,MoreauRF,etal.Alpha-lipoicacidasadietary supplement: molecular mechanisms and therapeutic potential. Biochem Biophys Acta 2009; 1790(10):1149- 1160.
12. YuR,JiaoJJ,etal.Activationofmitogen-activated protein kinases by green tea polyphenols: potential signaling pathways in the regulation of antioxidant- responsive element-mediated phase II enzyme gene expression. Carcinogenesis 1997; 18(2):451-456.
13. NaHK,SurhYJ.ModulationofNrf2-mediated antioxidant and detoxifying enzyme induction by the green tea polyphenol EGCG. Food Chem Toxicol 2008; 46(4):1271-1278.
14. Offord EA, Mace K, et al. Mechanisms involved in the chemoprotective effects of rosemary extract studied in human liver and bronchial cells. Cancer Lett 1997; 114(1- 2):275-281.
15. SingletaryKW.Rosemaryextractandcarnosolstimulate rat liver glutathione-S-transferase and quinone reductase activities. Cancer Lett 1996; 100(1-2):139-144.
16. ChenCC,ChenHL,etal.UpregulationofNF-E2-related factor-2-dependent glutathione by carnosol provokes a cytoprotective response and enhances cell survival. Acta Pharmacol Sin 2011; 32(1):62-69.
17. NestleM.Broccolisproutsasinducersofcarcinogen- detoxifying enzyme systems: clinical, dietary, and policy implications. Proc Natl Acad Sci U S A 1997; 94(21):11149- 11151.
18. KimHJ,BarajasB,etal.Nrf2activationbysulforaphane restores the age-related decrease of T(H)1 immunity: role of dendritic cells. J Allergy Clin Immunol 2008; 121(5):1255- 1261.
19. HaackM,LowingerM,etal.Breakdownproducts of neoglucobrassicin inhibit activation of Nrf2 target genes mediated by myrosinase-derived glucoraphanin hydrolysis products. Biol Chem 2010; 391(11):1281-1293.
20. ZhuM,YeungRY,LinKF,LiRC.Improvementofphase I drug metabolism with Schisandra chinensis against CCl4 hepatotoxicity in a rat model. Planta Med 2000 Aug;66(6):521-5.
21. Chan,MY,HengCK.Sequentialeffectsofahigh-fiber diet with psyllium husks on the expression levels of hepatic genes and plasma lipids. Nutrition 2008; 24(1):57-66.
22. Burton R, Manninen V. Influence of a psyllium-based fibre preparation on faecal and serum parameters. Acta Med Scand Suppl 1982; 668:91-94.
Also see our other great complimentary D-TOX products commonly used together.
An organic, brown rice product naturally created to provide high quality proteins. Proteins are essential for tissue building, energy, for the maintenance of lean organ and muscle mass. Importantly, DTOX V provides 15 grams of high quality, low allergy potential protein required for a specific phase of detoxification in the liver known as phase II detox. Phase II detoxification is a complex process requiring very specific natural compounds – many of which are derived directly from proteins and their component amino acids. Below is a detailed outline of phase II detoxification.
DTOX COMPREHENSIVE APPROACH
Other products on this website including DTOX I, DTOX II, DTOX III AND DTOX IV contain hundreds of nutritional compounds, many of which are naturally-occurring in various plants and herbs, that have been studied for their potential role in helping the body to metabolize and detoxify dozens and dozens of toxins to which many of us are exposed to every day. DTOX products have not themselves been specifically studied, but contain many naturally-occurring compounds that have been studied for their role in eliminating various toxins, many of them potential carcinogens and immune suppressors, from the body.
Our office uses either all of our DTOX formulas for our patient’s needs, and various combinations of DTOX formulations, depending upon each person’s specific needs. Medications, current and past health issues, current health goals, exercise levels, level of fitness, allergens (both foods and environmental) and many other factors help us determine the best formulations and dosages. Other lifestyle adjustments are always made including specific food choices when creating the best health plan.
Below is a description of how Phase II detoxification works. For a detailed description of the Phase I detoxification process see the Product Descriptions found under, DTOX I, DTOX II, DTOX III AND DTOX IV found under our Supplement section of the website: www.blooddetective.com
DETOXIFICATION PROCESS – PHASE II OVERVIEW
Phase Two - Detoxification Pathway
This is called the conjugation pathway, whereby the liver cells add another substance (eg. cysteine, glycine or a sulphur molecule) to a toxic chemical or drug, to render it less harmful. This makes the toxin or drug water-soluble, so it can then be excreted from the body via watery fluids such as bile or urine.
Major Phase II pathways
Through conjugation, the liver is able to turn drugs, hormones and various toxins into water soluble excretable substances. Individual xenobiotics and metabolites usually follow one or two distinct pathways. This makes testing of the various pathways possible by challenging with known substances.
Sulphur containing foods and amino acids stimulate phase II detoxification
For efficient phase two detoxification, the liver cells require sulphur-containing amino acids such as taurine and cysteine. The nutrients glycine, glutamine, choline and inositol are also required for efficient phase two detoxification.
Eggs and cruciferous vegetables (eg. broccoli, cabbage, Brussels sprouts, cauliflower), raw garlic, onions, leeks and shallots are all good sources of natural sulphur compounds to enhance phase two detoxification. Thus, these foods can be considered to have a cleansing action.
The phase two enzyme systems include both UDP-glucuronyl transferase (GT) and glutathione-S-transferase (GSH-T).
Glutathione-S-transferase is the most powerful internal antioxidant and liver protector. It can be depleted by large amounts of toxins and/or drugs passing through the liver, as well as starvation or fasting. Phase II reactions may follow Phase I for some molecules or act directly on the toxin or metabolite.
Substrates of the glycine pathway
Salicylates and benzoates are detoxified primarily through glycination. Benzoate is present in many food substances and is widely used as a food preservative. Many other substances are detoxified as well via the glycine conjugation pathway. Patients suffering from xenobiotic overloads and environmental toxicity may not have sufficient amounts of glycine to cope with the amount of toxins they are carrying.
Substrates of the sulphation pathways
Neurotransmitters, steroid hormones, certain drugs such as Acetaminophen (also known as paracetamol) and many xenobiotic and phenolic compounds.
Substrates of glucuronidation
Polycyclic aromatic hydrocarbons, steroid hormones, some nitrosamines, heterocyclic amines, some fungal toxins, and aromatic amines. It also removes "used" hormones, such as oestrogen and T4 (thyroid hormone) that are produced naturally by the body.
If the phase one and two detoxification pathways become overloaded, there will be a build up of toxins in the body. Many of these toxins are fat soluble and incorporate themselves into fatty parts of the body where they may stay for years, if not for a lifetime. The brain and the endocrine (hormonal) glands are fatty organs, and are common sites for fat-soluble toxins to accumulate. This may result in symptoms of brain dysfunction and hormonal imbalances, such as infertility, breast pain, menstrual disturbances, adrenal gland exhaustion and early menopause. Many of these chemicals (eg. pesticides, petrochemicals) are carcinogenic and have been implicated in the rising incidence of many cancers.
Bitter herbs to improve phase 1 and 2 detoxification
Bitter herbs are the corner stone of herbal medicine. A range of physiological responses occurs following stimulation of the bitter receptors of the tongue. The bitter taste stimulates the specific bitter taste buds at the back of the tongue to stimulate the parasympathetic nervous system to trigger a number of reflexes. These reflexes are important to the digestive process and general health.
Specifically in relation to digestion herbal bitters;
Sialogogues – stimulate saliva to digest carbohydrates.
Orexogenics – stimulate hydrochloric acid to digest protein.
Chologogues – Stimulate bile flow to digest fats.
The stimulation of the flow of digestive juices from the exocrine glands of mouth, stomach, pancreas, duodenum and liver, aid in digestion, absorption and assimilation of foods and nutrients. There is also a very mild stimulation of endocrine activities, especially insulin and glucagon secretion by the Islets of Langerhans in the pancreas therefore used to treat of non-insulin dependent diabetes. By promoting the flow of bile, bitters assist the liver in its detoxifying capacity.