How to Maximize the Benefits of Sauna for Detoxification

by Jessica Bonovich RN, BSN

We have been recommending sauna therapy for detoxification to many of our patients who have high levels of various chemicals found in their GPL-TOX, Glyphosate, or Metals test results.  The fundamental principle that governs detoxification is that heat liberates toxins from fats, which then gets flushed out by the sweat and carried off by the blood to the liver, kidney, and GI tract. Many people are familiar with the Hubbard Protocol for sauna detoxification, which has been shown to be effective for those with serious toxic load issues, and was even used with success on emergency workers who were exposed to chemicals at the World Trade Center 9/11 disaster site.  The Hubbard Protocol is quite intense and requires a great deal of time spent in the sauna on a regular basis.  The sauna detoxification protocol that follows is perhaps more reasonable for the average patient and is designed to maximize detoxification without causing undue stress to the patient.  Sauna should be started after other metabolic supports have been implemented (such as those indicated by the results of the Organic Acids Test (OAT) and GPL-SNP1000 genetic test.

The Case for Sauna Therapy

The use of sauna for liberating toxins from the adipose tissue has been fairly well established as being effective for the treatment of toxicity for many years. The studies that I have read were all published before infrared technology existed.  So, it is safe to say that sauna of any sort is likely to benefit patients with toxicity. Infrared technology claims that it is able to cause a more vigorous sweat at lower temperature, which may create a more comfortable experience for the user (less time needed and at a less high temperature).  Infrared technology also claims that it can penetrate deep within the tissue for effective elimination. While visceral fat (the fat surrounding the organs) is certainly capable of housing toxins, it is the adipose tissue found in the subcutaneous layer that is viewed as the primary culprit for toxin accumulation. To reach the subcutaneous tissue, you simply need heat. Heat can be generated internally. Consequently, exercise is an excellent way to generate heat and burn the fat housing the toxin to begin with. Many patients are too sick to consider this as an option but patients who can tolerate exercise should be encouraged to do so. Better yet, do both exercise and sauna therapy.

 Here is a very thorough article about sauna detoxification, including an interview with Dr. George Yu, who has worked for many years with Gulf War veterans and 9/11 site workers to help them detox with sauna.

Niacin Flushing

Heat helps to destabilize lipophilic compounds just enough so that they can become mobilized by the fluids that are simultaneously released during heat exposure. Some compounds can be liberated directly into the sweat while others will be transported by the blood stream into the liver for metabolization and/or conjugation. The vasodilatation that is induced by heat exposure provides an increased blood flow to these organs.  Nicotinic acid (niacin or niacinamide) can induce flushing in doses above 50 mg which will subsequently increase blood flow to the liver and kidney. It is often used as a part of detoxification protocol because of what is referred to as rebound lipolysis. High dose niacin is used therapeutically to inhibit free fatty acid release, decrease LDL, and increase HDL. This effect is soon compensated for and free fatty acids return to normal and in some cases above normal. The rebound effect varies from study to study but is generally considered mild. It is the release of free fatty acids that also causes the release of toxins in the body. Practitioners are hoping to achieve a greater degree of toxin release through this rebound effect that niacin can have about two hours after administration.

In addition to the rebound lipolysis and vasodilatation, niacin also inhibits oxidation in the vasculature which is an important factor with detoxification. It is worth exercising caution with niacin in patients with diabetes, history of gout, on blood thinners, and who have MTHFR/methylation gene mutations. The rebound effect is associated with insulin resistance in many studies. Patients who are already diabetic tend to have the greatest difficulty with this.  High dose niacin can also cause elevations in uric acid, increased prothrombin time, and decreased platelet counts. It can also cause stress to the methylation pathway because this compound requires methylation to be eliminated. In fact, there are documented cases of hyperhomocysteinemia occurring in patients taking 1000 mg of niacin per day, which is the standard dose for a flush. I typically only recommend niacin as part of the detoxification protocol in patients who have demonstrated their ability to tolerate it or who have minimal risk for methylation pathway disruption.

Further Supporting the Detoxification Process

Heat allows toxins to become reintroduced into circulation and there is an increased potential for oxidative damage. For this reason, I recommend that patients take antioxidants before and after sauna therapy. Liposomal glutathione is an obvious choice because it is not only an antioxidant but an important substrate required for conjugation of many toxic compounds by the liver. I recommend a teaspoon before and a teaspoon after sauna treatment. This equates to approximately 400 mg twice a day. I also recommend taking plenty of vitamins E, A, C, D, and K.

The lipophilic, toxic compounds that find their way to the GI tract should ideally be flushed out through fecal elimination. To ensure the greatest possible chance for this to occur, patients should first and foremost be eliminating bowels every day. To prevent the reabsorbtion of these compounds, bile acid sequesterants and binders can be used and there is evidence to support their use. Bile acid sequesterants are just that - agents that sequester the bile, essentially making it unavailable to bind with other lipids. The prescriptive agent that is most commonly used is called cholestyramine. This agent has a very short half life (6 minutes) and is capable of binding up to 80% of bile in that short time. This short half life also means that taking cholestyramine before sauna will not interfere with the absorption of nutrients at meal time. This is an excellent choice for patients who can tolerate this prescription. Fiber is also capable of binding bile acid, but to a lesser extent. Both soluble and insoluble fibers like lignan, alfalfa, bran, and guar can bind between 10%-30% of bile acids. Cellulose does not effectively bind with bile, so it should not be considered as an option for this particular application. Binders are agents that prevent reabsorbtion by adhering to the toxin itself. Examples of binding agents are bentonite clay and activated charcoal. GI elimination is the only way for the extremely lipophilic, toxic compounds to be eliminated. When doing sauna therapy, any toxic compound in tissue has the potential to be eliminated, so taking these measures to ensure proper elimination via stool is important.

Electrolyte monitoring is an equally important consideration when detoxifying patients. To an extent, the minerals K, Na, Ca, and Mg will be lost during dieresis. Binders used to prevent the absorption of toxins will also prevent the reabsorbtion of certain minerals that are in the gut, so a good multi-vitamin/mineral supplement such as Spectrum Mate should be taken throughout the detoxification process.

Other Factors Impacting Results

The degree that a patient is likely to respond to sauna therapy depends on several things. The amount of toxin accumulated in tissue and the ability of the liver to safely mobilize toxins are two major factors. Toxic compounds that are not conjugated are either extremely hydrophilic or extremely lipophilic (to the extent that they cannot be measured in the urine). Some compounds are more toxic when they have been metabolized and others actually become more stable. The more time exposed to heat, the more toxins will be liberated, but the body can only do and handle so much of this at once. For this reason, I recommend that when patients are in crisis, they start sauna therapy very slowly and work their way up in time spent per session and how often they do sessions, as they become more tolerant.

What Types and Brands of Sauna Are Best?

As previously mentioned, infrared technology claims to have additional benefits over traditional sauna, but there doesn’t seem to be any research directly comparing the two types of saunas.  If infrared rays allow for profuse sweating at lower temperatures than a traditional sauna, then an infrared sauna might provide a more comfortable option (similar results at a lower temperature) for those sensitive to the heat.  If you’re looking for an infrared or other sauna, it is important to consider brands whose wood is not treated with toxic chemicals that will off-gas while in use or that emit large amounts of electromagnetic (EMF) radiation.  Some of the better options for booth-style, wooden saunas are Clearlight and Heavenly Heat.  There are also more portable infrared saunas available that have been shown to be effective and Relax Saunas is a good example.

 If you find purchasing a sauna to be cost-prohibitive, the portable versions are less expensive.  Another option is to find a spa or health club in your area that has a sauna you may use for a particular fee per session or as part of a membership package.  Many integrative healthcare practitioners who are invested in helping their patients detoxify also have saunas in their offices for use.

Summary

In summary, patients should be given metabolic supports and be eliminating bowels every day prior to initiating a sauna detoxification program. Heat therapy is effective at removing many toxic compounds from the body and sauna therapy is a passive form of heat therapy. Advise your patients to take antioxidants before and after the heat therapy (liposomal glutathione, if possible). Give binders and bile acid sequesterants prior to heat (sauna) therapy. Make sure that patients remove as much sweat as possible during and immediately after sauna sessions. Monitor your patients’ serum electrolytes. Finally, have patients start with sauna therapy slowly and progress toward longer and more frequent (even daily) sessions until complete elimination of the toxin is observed through testing.

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References

Evidence for sauna treatment:

PMID: 20400489, 2143911, 220089658, 7144634, 20621793, 17234251, 23844383

Evidence in support of fiber and cholestyramine for binding bile acids.

PMID: 956912, 3008573, 30273, 24499150, 17438377

Evidence in support of binders:

PMID: 16019795, 18286403, 22069658, 15781206, 11439224, 17092826, 16095665, 16782537, 17561436, 11245394, 23710148

Bioaccumulation and elimination of toxins:

11572612, 11834080, 17296488, 16924830, 15513954

Niacin flushing:

21386057, 18375237, 18047854, 17996241, 10893322, 4883477, 17368274

Detoxifying Your Body - Water Filtration 101

Jessica Bonovich, RN, BSN

Hello, and welcome back to the GPL Blog.  Today we are talking about water filtration, which is a subject a lot of clients have asked about since we introduced our GPL-TOX test.  What we have seen through our studies, and those of other labs is that many of the toxins assessed by GPL-TOX have been found in many water supplies.  Any treatment plan needs to encompass a plan to prevent re-exposure. 

I recently reached out to over 12 water filter distributors and manufacturers to learn about the best filtration system for removing volatile organic compounds (VOC’s) from water and why. I was very transparent about the needs of our patients and the company I work for. I also reviewed information provided by The Environmental Working Group, who offers this Water Filter Buying Guide.  In addition, I contacted the Industrial Wastewater Management Center, the Department of Natural Resources, NSF Public Health and Safety Organization, and the Environmental Protection Agency.  Here is what I learned:

Carbon Block Filters

Carbon block is the commercially available standard for removing VOC’s. These very small compounds adhere to a surface of carbon (a process called adsorption) but will not be removed through reverse osmosis, ceramic, deionization, ozone, or ultraviolet light filtration. Factors that affect adsorption include the concentration of the compound, surface area, and the contact time between the water and the carbon. Of these factors, filters control the latter two.

The surface area of the carbon refers to the size of the pores in the carbon filter. This is where the “block” comes in. The filtration companies pack the carbons in very tightly which creates a very small pore size. The smaller the pore size the greater the chance of catching very small molecules like the VOC’s. The pore size of carbon block filters is generally measured in microns and ranges from 0.5 up to 1 micron.  This is sometimes also called submicron filtration. These tiny pores also remove lots of other small molecules like bacteria and particulate matter. Our main concern here is the removal of VOC’s because the carbon is the only filtration that will eliminate these compounds. Many other kinds of filters are available to remove the other materials. It’s a bonus but not a big selling point.

The contact time equates to how much water can contact the filter over a given period and directly affects the gallons per minute (gpm) of filtration. Companies intentionally build in methods to restrict the water flow to increase the amount of contact time the water has with the filter. The water restriction lowers the gpm which can slow the water flow. Consumers tend to want higher gpm for greater water pressure but this can affect the removal of contaminants.  The size of the filter also influences the removal. So, if you want high water flow (gpm) you need a larger filter that will handle the larger volume. This will cost you a bit more. If budget is your main concern, low gpm is the priority. Whole house filtration systems are not as effective at removing VOC’s because they are geared toward optimizing the water flow, in other words, fast filtration. The size of the filter needed to overcome the pressure drop on whole house filters is cost prohibitive for most people. Several companies do make carbon block filters for your shower head which is a nice option for reducing the VOC contaminants in your shower water. The under-the-sink and counter top units are often called point of use (POU) filters. The industry standard for good carbon block filters is between 0.5 and 1 gpm. The filter size that is needed to accommodate the larger gpm and still remove VOC’s can be deduced by looking at the performance data sheets that companies provide. This is what people should focus on to determine how robust the filter really is.

Filter Specifications

Understanding filter specifications can be a learning curve in itself. Companies will have third parties test the amount of contaminant coming in (called influent) and the amount going out (called effluent) through a company called NSF. The data sheets do not report the actual effluent, but instead report the “maximum permissible product water concentration” established by the EPA. This number will be the same on all data sheets. This testing is an important factor because we know that the concentration of the compound influences the ability of the filter to adsorb. NSF spikes water samples with a known amount of a compound and then measures the amount that is still in the specimen after filtration. These reports vary considerably and range from very well-organized to quite confusing. Some performance data sheets list these figures as a chart, while others use graphs. The only real difference is the percent reduction. This is the amount that was eliminated during the testing. I have asked multiple companies why they do not provide the actual effluent data and even contacted NSF about this. No one has been able to tell me why they don’t provide the raw data.

Filter Housing Options

Choosing the housing for your filter is the final step. Most of the companies use stainless steel, aluminum, or polypropylene plastic housing. Polypropylene is considered nontoxic by the Environmental Working Group. However, it can be oxidized when exposed to stress like heat and UV.  On top of this, many of our patients have developed severe chemical sensitivity. Once this acute phase has established itself, it can be difficult to predict what the patient will react to. I recommend the stainless steel option to remove any concern about plastic toxicity. Once your water has been filtered, do not store water in a container for more than 24 hours. Without chlorine, the water becomes a target for microbes to take up residency. 

Testing Your Water

Most filtration companies recommend that you have your water tested prior to getting a filtration system so you know exactly what you need. I have focused on single stage filtration designed to remove VOC contaminants. If you have heavy metals or bacterial contamination, you will need a multistage filter that will remove all the other contaminants. To find a laboratory in your area that can test your water, the EPA suggests that you start with your local municipality. I contacted the local water department here in Johnson County, KS to test this theory and they provided me the names of three local laboratories that can test water for contaminants.  Only one of these companies responded to my request and they offered to test for 29 VOC’s for $140.

An acceptable level of contamination has not been established for every chemical compound. The VOC’s that do have a limit are listed on pages 257-533 of this document.  According to the most current information available on the EPA website, municipal water suppliers must test the water for these VOC’s four times per year. If there are no contaminants reported for three years, the municipality can test just once per year. Municipalities can go a step further and apply for a waiver that exempts them from testing any VOC’s for up to six years. If a contamination is found, quarterly monitoring is required. If the municipality does not comply with this, there are no stated penalties or further requirements, which is a bit disconcerting. If you find that your water exceeds any of these standards, you should report this contamination to your state EPA office.  

Final Thoughts

The company (and person) that was the most helpful to me by far on this journey was Ron at Water2drink.com. All of their filter performance sheets are disclosed here. Individual requirements will vary based on price and available space. If you want my personal opinion for a good filter to remove VOC contaminants, this is a great place to start.

Oxalates

Hello. Welcome back to the GPL-Blog.  My name is Jessica Bonovich, RN, BSN.  I’m the nurse consultant here at The Great Plains Laboratory.  Today I’m going to be discussing oxalates, which are one of the many things that are tested for in the Organic Acids Test (OAT). Oxalates are of particular interest to patients who have pain and in non-verbal children with behavioral issues. Frequently, these individuals are experiencing pain as the result of oxalate crystals precipitating with minerals in tissue, including the formation of kidney stones. The Organic Acid Test is well suited to determine if this is likely occurring. When determining the best course of action we look at the proportion of the oxalate, the metabolite of oxalate, and the patient’s symptoms.

As the nurse consultant at the lab, it is my primary job to review test results with people. and as a result, I see a lot of Organic Acids Tests. Doctors and patients are often surprised to learn that Candida and Aspergillus species can produce oxalates. These species have certain enzymes that allow them to use glyoxalate as a means of making energy (it is an intermediate in their TCA cycle).  Individuals with elevations in Candida or Aspergillus frequently have a subsequent elevation in oxalate metabolites. The degree of elevation may or may not be proportional to the yeast/mold overgrowth and this is an important distinction when evaluating the significance of the markers.  If the elevation is proportional, I can easily point toward yeast as the culprit. If the oxalates are disproportional, it can be related to several other factors.

To some extent, all individuals will obtain oxalates from three sources: liver cells (endogenously), yeast species (exogenously), and food (also exogenous). The reference ranges on our test show the typical accumulation of oxalate metabolites from all three sources.

In humans and in yeast, glyoxalate is the parent compound that can be converted into the three metabolites measured on the Organic Acids Test (OAT): glyceric, glycolic, and oxalic acid (Figure 1).

Figure 1

It can also be converted into glycine which is not measured on the OAT. Individuals with primary, secondary, or tertiary hyperoxaluria have genetic deficiencies in the enzymes that drive these pathways and cause the distinguishing features of the disease. People who are predisposed to stone formation may or may not have deficiencies in these enzymes. The degree to which a person will favor each pathway depends on a number of metabolic factors (including available precursor and pH of the cell). Elevations in all three metabolites can occur because of yeast and endogenous production. Food and Aspergillus on the other hand, produce oxalate in the body directly. So, when these are the source of excess, only oxalate will be elevated on the test.

Patient symptoms are a key component to all of this. It almost goes without saying that we treat the patient and not the number. Low oxalate values do not rule out an oxalate issue and extremely elevated values are not always equated with pain (though the potential certainly exists).  

Let’s get back to the disproportional oxalate scenario. If a patient has mildly elevated yeast and moderately to highly elevated oxalate, what do you think would be the most likely cause?

a.      Endogenous production

b.      Yeast

c.       Food

d.      A combination of b. and c.

The correct answer is d. Food is a direct source of oxalate and the most common cause of disproportionately elevated oxalates. Yeast is contributing to the oxalates in this scenario but is not likely to be the only cause of the elevation. Patients like these should introduce calcium and magnesium supplementation with meals to help bind up excessive oxalates in the food (so they can be eliminated in stool). Many conventional doctors falsely believe that calcium supplementation should be avoided when oxalate stones are a problem. They forget that calcium levels are maintained at precise levels in the blood no matter what the intake is. This is because without calcium, the heart will not pump. So, several mechanisms are in place to ensure adequate levels are maintained at all times. Avoiding calcium is only likely to increase osteopenia and not at all likely to reduce stone formation.

Let’s walk through another scenario. An individual presents with extreme pain in the muscles and history of stone formation. The patient has very elevated Candida and eats a high oxalate diet. All of the oxalate metabolites on the OAT are normal. What is the most likely scenario?

a.      Oxalates are not a problem

b.      Endogenous production

c.       Food and yeast are not a problem

d.      None of the above

The correct answer is d. This is a scenario that I refer to as hidden oxalate toxicity. This patient should have elevated oxalate metabolites.  Based on their history and lab results, oxalates would be expected. It is likely that oxalates are present in the body. However, they are precipitating in tissues before they ever make it into the urine. These patients are usually the most extreme cases of pain. They are also the people who do very well once all of the sources of oxalate have been eliminated. It is important to remember that when patients are in pain, removing oxalates should be done SLOWLY. Otherwise the patients are likely to experience an increase in pain as a result of “oxalate dumping”. When oxalate crystals are already in the tissues, mobilizing them can cause irritation. I recommend that patient introduce therapies one at a time, thoughtfully, over several weeks to months.

Okay, last one. This is a patient with moderately high yeast metabolites, a diet rich in fruits and veggies, and severely elevated oxalate metabolites.  To give this some perspective, the reference range for oxalates is 100 mmol/mol. This patient has close to 1000. The patient has symptoms of yeast overgrowth and fatigue as the chief complaints. What is the most likely cause of the extremely elevated oxalates?

a.      Yeast

b.      Diet

c.       Endogenous production

d.      All of the above

If your answer was d, you are correct. This patient has disproportional oxalates beyond what would be expected in diet. The patient certainly has the potential to accumulate oxalates in the tissues. However, since she is eliminating it effectively, it is not causing her pain at this time. Measures should still be taken to decrease the oxalate burden. We have much more to learn about the tendency for a person to form oxalate crystals.  Several genes (AGXT, GRPHR, and HOGA1) have been implicated (all of which are identified on the GPL SNP1000 test). Even if these genes are not mutated, some individuals still have a tendency toward oxalate stone formation. The high glyoxalate production is only one factor. 

Remediation of high oxalates is a multi-step process. Elimination of yeast is always important and not only because of excessive production. Pathogenic yeast can also cause an imbalance in beneficial bacteria that help to degrade oxalates.  Many studies have demonstrated that oxalobacter can reduce oxalate stone formation (hence the name). As of right now, testing for oxalobacter is available primarily in research settings and supplements are not widely available to the public (though I expect that they will be soon). Fortunately, there are other beneficial bacteria species shown to reduce oxalic acid. Many of these are already available probiotic form. These include Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium breve, and Bifidobacterium lactis all of which are available in Lactoprime and Ther-biotic Complete probiotic formulas.

Awareness of oxalates in food and elimination of those foods highest in oxalate (like spinach, soy, almonds, sweet potatoes, and raspberries) is important. Keep in mind that a low oxalate diet should only be done with the help of a practitioner and only when there is a clear need. The foods that contain oxalate are healthy and provide many nutrients that our bodies need to maintain healthy homeostasis. People forget that the oxalate content alone is not the only factor in oxalate absorption. The oxalate to calcium/magnesium ratio should be taken into account when we consider the potential for oxalate accumulation. If a food has equal amounts of both calcium and oxalate, it is likely that neither one will be absorbed very well. Plenty of bile acid needs to be available to prevent fats from binding with calcium. Both taurine and glycine strengthen bile acid but glycine increases oxalate. Glycine is where our endogenous production of glyoxalate starts. Keep this in mind when you are choosing supplements.

Lastly, sufficient B6 is required to help with the conversion of glyoxalate to glycine in the body. Maintaining sufficient levels of vitamin B6 will help with the endogenous production. However, the active form (P5P) is poorly absorbed.  I recommend that patients in pain start with low doses of pyridoxine hydrochloride (10 mg) and work up to higher doses as tolerated. The upper limit is 100 mg per day. Patients without pain can usually safely start at 50 mg per day.   

Wow, so that was a lot. Oxalates are a topic of much interest in our patient population so I want to be as thorough as possible. If in doubt, call the lab and speak with a consultant. We have lots of experience looking at tests results and can provide insight into the patterns that are occurring on the results.

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References:

Finkielstein, V., Goldfarb, D., (2006). Strategies for preventing calcium oxalate stones. Canadian Medical Association Journal , 174 (100). Published online doi: 10.1503/cmaj.051517

Herb, Nutrient, and Drug Interactions. (1st edition). (2008). St. Louis, MO, Mosby, Elsevier

Liebman, M., Costa, G. (2000). Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. Journal of Urology, 163(5): 1565-1659.

Matkovic, V., Heaney, R.P., (1992). Calcium balance during human growth: evidence for threshold behavior. The American Society for Clinical Nutrition, 55(5): 992-996.

Pennistion, K., Nakada, S. (2009). Effect of Dietary Changes on Urinary Oxalate Excretion and Calcium Oxalate Supersaturation in Patients With Hyperoxaluric Stone Formation. Urology, 73(3):484-489.

Physicians Desk Reference for Nutritional Supplements. (2nd edition). (2008). Montvale, NJ: Thomson PDR

Rushton, HG., Spector, M. (1982). Effects of magnesium deficiency on intratublar calcium formation and crystalluria in hyperoxaluric rats. Journal of Urology, 127(3): 598-604.

Poore, R.E., Hurst, C.H., Assimos, D.G., Holmes, R.P. (1997). Pathways of hepatic oxalate synthesis and their regulation. Cell Physiology. 272(1), C289-C294

Shaw, W. (2009). Autism: Beyond the Basics. Self Published, USA.

Weaver, C. (1994). Age related calcium requirements due to changes in absorption and utilization. Journal of Nutrition, 124(8): 1418S-1425S.