Detox isn’t something done as a one-week “cleanse.” The liver remains busy detoxing 365 days a year, so it needs to be supported every day.

People likely encounter toxins such as pesticides and air pollutants daily in the food and the environment. Other toxins are generated internally by normal bodily processes and microbes.

If your patient decides to do a liver detox, and it isn’t working well, harmful compounds can pile up in their body. This could lead to symptoms like headaches, fatigue, and nausea. And over the long run, toxins increase their risk of disease. (1, 2)

To help keep detox running smoothly, individuals need to support their liver because of its essential detox functions.

The liver isn’t the only site of detox in the body, but it’s the main one. In a two-step process, it converts fat-soluble toxins into water-soluble forms that can be eliminated from the body. (3)

It’s crucial to understand the types of toxins that could harm your patient’s health so you can help support their two phases of liver detox.

Why Is It Important to Detox the Liver?

The liver handles a lot of toxins that people need to detox. These toxins need to keep moving out of the liver and the rest of the body regularly to minimize their negative effects. 

If toxins pile up, it could lead to liver damage and disease in other parts of the body. For example, toxins may contribute to cancer, dementia, and obesity. These could be a factor in complex chronic illnesses such as fibromyalgia. (1, 2)

As you know, there are many ways the body gets rid of toxins. This is based on what type of toxins they are: (1, 4)

  • Fat-soluble toxins are first metabolized in the liver to make them water-soluble and then are excreted via the urine or bile.
  • Water-soluble toxins can be sent directly to the kidneys and excreted in the urine.

One of the body’s safeguards against toxins is that the blood collected from the gut goes to the liver first. The blood from the gut may be especially high in toxins if the gut is leaky. (5) 

The liver acts like a shield for other organs. By tackling toxins first, it can significantly reduce the number of toxins that reach other organs, such as the brain and heart. (5) 

Some toxins in the body are man-made. Others are created by biological processes inside the body and the microbes people are exposed to. Here’s a closer look at these toxins. (6)

Man-made toxins

Environmental health experts say we’re in the midst of a “colossal toxicological experiment.” Tens of thousands of chemicals have been used over the last few decades, but they haven’t been adequately tested for safety. (1)

The liver bears the brunt of the burden of getting rid of these toxins since many of them are fat-soluble. The body tends to hold onto fat-soluble toxins in the fat tissue and accumulate them over time. (6)

Some sources of man-made toxins include: 

  • Alcohol — No matter what form alcohol is in — beer, hard liquor, or wine — the liver has to detoxify it. The International Agency for Research on Cancer classifies alcohol as a carcinogen. It increases the risk of breast, colon, and liver cancers, among other types. (7, 8, 9, 10)
  • Environmental pollutants — These include car exhaust, industrial pollutants, cigarette smoke, and pesticides like glyphosate. Besides chemicals, some pesticides and fertilizers contain toxic heavy metals. These can contaminate the air, soil, and water. (1, 11, 12)
  • Food — Some food toxins are added, such as preservatives and artificial colors. Others are created in the cooking process. People create toxins when they char meat on the grill. Mercury contamination is common in seafood. Pesticides taint many foods too. (13, 14, 15)
  • Healthcare products — This includes prescription, over-the-counter, and recreational drugs, which are chemical concoctions. It also includes dental materials. Some of these are still made with toxic heavy metals, including mercury. (1, 16)
  • Home-based toxins — A few examples are bisphenol A (BPA) in plastics and perfluorinated chemicals (PFCs) in nonstick cookware. Other examples are flame retardants in sofas and formaldehyde in the glue of particleboard used in some furniture. (1, 17)
  • Personal care and cleaning products — The majority of these items contain artificial fragrances and other potentially toxic chemicals. These include phthalates, which can disrupt hormones and block the uptake of iodide. (1, 18) 

If man-made sources of toxins weren’t enough of a challenge, the liver also has to process biological toxins and other compounds.

Biological toxins

Microbes create toxins, sometimes called biological toxins or biotoxins. Humans also produce toxins in the course of normal bodily functions or metabolism. These could harm patient’s health if they are unable to detoxify them or break them down. (19)

Here are some examples of biological toxins and other compounds the liver processes: 

  • Ammonia — Some amino acids humans consume are used to make body proteins. People break down the rest for other uses. Ammonia is a byproduct of this process and can be toxic in high amounts. Also, some bacteria and parasites create ammonia, adding to the toxin load. The liver converts ammonia into urea to be excreted from the body. (20, 21, 22, 23)
  • Bacterial toxins — Harmful bacteria in water-damaged buildings and in the gut produce toxins. That includes endotoxins called lipopolysaccharides. These are from the outer membrane of bacteria, which can trigger inflammation in the body. (24, 25, 26, 27)
  • Hormones — Everyone’s hormones must be in proper balance. For example, excess estrogen is linked to problems like breast cancer and obesity. The liver converts excess estrogen into a form that can be excreted. Poor liver health can lead to excess estrogen. (28, 29) 
  • Mycotoxins — Mold can produce harmful chemicals called mycotoxins. These contaminate water-damaged buildings, as well as some foods. Mold can also grow inside people and produce mycotoxins in the body. (30, 31, 32)

Without good liver health, these and many other toxins could significantly accumulate in your patient’s body. Check to make sure that patients do not have toxins building up in their body due to inadequate liver detox.

Signs Liver Detox Is Impaired

At first, you may not notice symptoms of your patient’s liver function slipping or signs of toxin overload. But over time, they could develop physical and mental symptoms that point to an overwhelmed liver.

Some possible symptoms of impaired liver function and detoxification include: (33, 34, 35)

  • Clammy hands 
  • Depression
  • Difficulty tolerating exercise
  • Digestive symptoms
  • Disturbed sleep
  • Extreme tiredness
  • Fluid retention (edema), such as in the abdomen
  • Headaches
  • Itchy skin
  • Irritability
  • Jaundice (eyes and skin may look yellow; an extreme sign)
  • Muscle pain or cramp
  • Nausea
  • Oversensitivity
  • Trouble breathing

Genetic factors and toxin burden play a role in the liver’s ability to detox. So does age. Babies have less capability to detox compared to older children. At the other end of the age spectrum, older adults have less detoxification capacity too. The ability to detox starts to decline after the mid-forties. (5, 36)

Moreover, chronic inflammation and infections can also stand in the way of detox. These may lead to lower levels of the liver enzymes patients need to detoxify harmful compounds. (37)

For these reasons, it’s helpful to have a deeper understanding of how detox works. Your patient’s diet and lifestyle can play a big role in liver health and how well they detox — regardless of genetics or age.

Two phases of liver detox, Phase 1 and Phase 2, are essential for the health of the body.

Phase 1 Liver Detoxification

To do its job, the liver has toxins and other molecules that it needs to detoxify or metabolize. That way, they can’t create problems for the rest of the body.

The liver is particularly watching out for fat-soluble toxins. These may come from the gut after digestion, or they may be released into the blood from fat stores. (4)

Fat-soluble toxins are not as easily eliminated than water-soluble ones. Once the liver picks up a fat-soluble toxin, it puts it through Phase 1 detoxification, which is necessary before it can be made water-soluble in Phase 2. (4)

Purpose of Phase 1 Liver Detox

The main purpose of Phase 1 liver detox is to modify toxins so they can work with enzymes in Phase 2 of detoxification. (5, 38)

A family of enzymes called cytochrome P450 drive the majority of Phase 1 detox reactions. For example, they handle about 75% of the drugs that people may take. (39)

The liver has the most cytochrome P450 enzymes. This vital organ is the main laborer in detoxification. Still, the brain, heart, lungs, skin, small intestine, and other tissues also contain these enzymes and help with detox. (40)

Phase 1 enzymes modify fat-soluble toxins via certain chemical reactions. Among these are oxidation, reduction, and hydrolysis. These reactions are what add or expose a place on the toxin for Phase 2 enzymes to interact with. (40, 41) 

These reactions are beneficial, but there’s a caveat. Phase 1 reactions produce lots of free radicals. 

The free radicals can disrupt cellular function and damage cells. If there’s too much damage, the liver cells could be triggered to self-destruct. (39, 40, 42, 43)

On top of that, sometimes the intermediate molecules from Phase 1 liver detoxification are more dangerous or reactive than the original substances. (39)

Some of these intermediates can bind to DNA, possibly acting as carcinogens. And some may bind to proteins, potentially triggering an unwanted immune response. (4)

Individuals need to minimize liver damage during detox. So, they need to move the intermediate molecules to Phase 2 of liver detox efficiently. One way to do that is to minimize their exposure to toxins. That could help prevent driving Phase 1 too hard. (1, 4)

Supporting Phase 1 Liver Detoxification

A healthy diet and lifestyle can support Phase 1 liver detoxification. However, unhealthy habits can also hinder it. (44)

Consider these nutrients and other factors to aid Phase 1 liver detox:

  • Antioxidants — Phase 1 liver detox generates free radicals that could damage cells. Be sure that patients include plenty of antioxidant-rich foods and herbs in their diet. Some examples are berries, broccoli, nuts, garlic, green tea, and turmeric. (45)
  • B vitamins — Some Phase 1 enzymes need the help of B vitamins, including riboflavin (B2) and niacin (B3). If patients avoid dairy products — a top source of riboflavin — seek other sources. Riboflavin is in almonds, eggs, and quinoa. Niacin is found in meats, poultry, and sunflower seeds. (46, 47, 48, 49)
  • Kidney and liver herbs — Several herbs could support kidney and liver detox. For example, milk thistle, one of the ingredients in KL Support, may promote antioxidant defense in kidneys and liver. It may also help reduce liver inflammation. (50, 51)
  • N-acetyl cysteine (NAC) — This is made from the amino acid cysteine. NAC, also in KL Support as well as Advanced TUDCA, can act as an antioxidant by neutralizing free radicals directly. But it also helps the body make more glutathione, a potent free-radical quencher, which helps protect the liver. (52, 53)
  • Organic food — Opting for organic food reduces exposure to pesticides like glyphosate. This weed killer impairs cytochrome P450 enzymes needed for detox. Glyphosate also disrupts the function of mitochondria, which make energy cells need for detox. (1, 54, 55, 56)
  • Oxygen — A good supply of oxygen supports the chemical reactions in liver detox, including cytochrome P450 enzymes. Encourage patients to get plenty of fresh air and minimize indoor air pollutants by using natural cleaning products. (57, 58)
  • Zinc — Patients need this vital mineral for Phase 1 detox, as it’s required for cytochrome P450 activity. Some good sources of zinc are cashews, chicken (mainly dark meat), oatmeal, pumpkin seeds, and red meat.

Furthermore, the Comprehensive Protocol has detox-supporting supplements that will help patients detox their liver effectively and minimize liver damage.

Phase 2 Liver Detoxification

Phase 2 of liver detox is so named because it works on the products of Phase 1. However, in some cases, toxins may enter the liver ready for Phase 2. In that case, they skip Phase 1. But more commonly, Phase 1 is necessary first. (5, 38, 40)

The chemical processes of Phase 2 are called conjugation reactions. Phase 2 involves joining products from Phase 1 with other molecules. This makes the toxins less reactive. It also makes the toxins more water-soluble. That way they can be excreted more easily into blood or bile for elimination. (38, 45, 62)

These conjugation reactions can be simple. But oftentimes they are more complicated and may require several steps to make end products that are ready for excretion. (5)

Pathways of Phase 2 Liver Detox

The major Phase 2 detox pathways and some of the toxins they help with include:

  • Acetylation — This pathway helps detoxify carcinogens, such as those in  car exhaust, cigarette smoke, and diet. It also helps clear histamine and caffeine. That’s why the effects of a morning cup of coffee fade overtime. (4, 63, 64)
  • Amino acid conjugation: Certain amino acids can attach to toxic molecules to be excreted. For example, the amino acid glycine can bind with benzoate, a common food preservative. (45, 65)  
  • Glucuronidation: This is one of the most common Phase 2 pathways. It helps clear about 1 in 10 of the top 200 prescribed drugs. It also detoxifies some chemicals, such as BPA used in many plastic containers. The end products of glucuronidation are commonly excreted via bile. (38, 63, 66)
  • Glutathione conjugation: Glutathione isn’t “just” an antioxidant. In Phase 2 detox, it helps remove heavy metals (like mercury), mold toxins, and pesticides. This pathway can also be used to detox a chemical in neoprene (synthetic rubber). This is used in everything from laptop cases to lunch bags to wetsuits. (63, 67, 68, 69)
  • Methylation: Some people have genetic variants related to this pathway. Methylation helps clear histamine. This is produced in the body and is also high in some foods, such as fermented items. If histamine builds up, it can lead to headaches, nausea, rashes, and other issues. (63, 70, 71)
  • Sulfonation: This is considered another major Phase 2 pathway. Sometimes it’s also called sulfation, but sulfonation is more accurate. It detoxifies acetaminophen and some carcinogens. Toxins that go through the sulfonation pathway are commonly excreted in the urine. (38, 45, 72) 

Many of these reactions involve nutrients from diet. So a healthy diet could help Phase 2 liver detox run smoothly and promote liver health. (14, 45)

Supporting Phase 2 Liver Detoxification

Ensuring Phase 2 of liver detox keeps pace with Phase 1 is critical. If Phase 1 is working too fast, the harmful intermediate substances could overwhelm the liver cells and damage them. (4)

Here are some nutrients and phytochemicals that support Phase 2 liver detoxification:

  • Amino acids: In Phase 2, enzymes attach amino acids to some Phase 1 detox products to enable the body to excrete them. Examples of such amino acids are cysteine, glycine, methionine, and taurine. Top sources of amino acids are protein foods, such as eggs, meat ,nuts, and poultry. 
  • B vitamins: Several B vitamins — including folate, B6, and B12 — support methylation enzymes, as well as other aspects of liver detox. Folate is found in avocados, spinach, and sunflower seeds. Good sources of vitamin B6 are meat, nuts, and seeds. And vitamin B12 is found in meat, poultry, and eggs. If patients avoid all animal products, they’ll need a supplemental source of B12. (45)
  • Broccoli sprouts: These are a top source of sulforaphane. This phytochemical increases the production of glutathione. And it promotes the action of Phase 2 liver detoxification enzymes. 
  • Flavonoids: One key flavonoid is ellagic acid. Ellagic acid promotes the activity of Phase 2 enzymes while decreasing Phase 1 activity. This encourages a better balance between the activity of these two phases, which could help keep damaging intermediate products in check. Berries are a great source of flavonoids too. (14, 45, 74)
  • Magnesium: This mineral may increase glutathione production. Since glutathione provides antioxidant protection and Phase 2 detoxification, magnesium also supports methylation enzymes. Top sources of magnesium include almonds, amaranth, pumpkin seeds, and sesame seeds. 

With Phase 2 of liver detox covered, the last step is removing the toxins out of the liver.

Transporting Toxins Out of Your Liver

After Phase 1 and 2, the now water-soluble toxins are shipped out of the liver cells. Some people refer to this as Phase 3 liver detoxification. But this isn’t really one of the liver phases. That’s because it involves transporting molecules rather than altering their chemical structure. (4)

Purpose of Liver Drainage

Transport proteins help carry water-soluble toxins out of the liver. These transporters shuttle water-soluble toxins across membranes and out of the liver cells. (5)

These transporters need fuel to perform their duties. For energy, they use adenosine triphosphate (ATP) made within the cell’s mitochondria. (75) 

Once the water-soluble toxins are moved out of the liver cells, they are released into the bile or blood. From there: (38)

  • Toxins moved into the blood are filtered through the kidneys and eliminated in the urine. 
  • Toxins moved into the bile are ultimately released into the digestive tract where bile can become bound in the stools and excreted. 

Of course, the success of this process is only as good as the drainage system.

Supporting Liver Drainage

Finishing detox is just as important — if not more important — as starting it. You can help your patients do several things to help their liver get rid of the end products of detoxification. 

Here are some compounds and other strategies that could help support toxin elimination from the liver and the rest of the body:

  • Carbon Technology: These specialized extracts of fulvic and humic acid can bind some of the toxin-laden bile in the gut. That way the toxins will be excreted instead of recirculating. This is especially essential since the majority of the bile is recycled. 
  • Coffee enemas: Coffee enemas support liver drainage. It could trigger the bile ducts to dilate, which supports the release of toxin-laden bile and moves it out of the liver. (78)
  • Fiber: Some types of fiber people consume in foods may also help bind bile in the gut. So, fiber is another way to encourage toxin excretion in the stools. This includes soluble fiber, such as found in legumes, oatmeal, and prunes. (79) 
  • Good hydration: Patients need to consume enough water to support the elimination of toxins through the urine and stools. Good hydration helps the kidneys work better. Being well-hydrated also helps reduce risk of constipation. (44, 80)
  • Intestinal-moving herbs: Herbs such as aloe vera and ginger gently stimulate the gut to help prevent constipation. Ideally, patients should move their bowels two or three times a day during their detox journey, which supports toxin elimination.
  • TUDCA: This consists of water-soluble bile acids and is also known as tauroursodeoxycholic acid. Animal and lab studies suggest TUDCA promotes bile secretion, which is important to get rid of toxins. And when TUDCA is combined with NAC, Carbon Technology, and melatonin 

The Detox Lifeline

The process of liver detoxification is central to your patient’s overall health. It helps individuals get rid of the toxins taken in from the environment, as well as those produced in the body.

The liver filters out fat-soluble toxins and converts them into a less reactive, water-soluble form in two phases. That helps people get rid of the toxins via the urine and bile — assuming the drainage is working well.

If your patient’s liver detox is lagging or their drainage is backed up, they may feel unwell. Plus, they will be at an increased risk of chronic illness.

Supporting your patient’s liver detox with good nutrition and supplements will help your patients take charge in their health journeys.