I saw a chart this morning that summed up my experience this week nicely:
Here’s the problem: I think in the CAM community, our conception of “detoxification” has slipped out of a mechanistic / descriptive sense, and into a bit of mysticism. I am working on trying to put together a framework of understanding at a purely mechanistic level, and banging my head against the wall pretty badly.
I think this is partly because the concept of detoxification is also the concept of bioactivation and signaling control. Same enzymes, same organs, same controls, just different substrates. As such, if you start intervening with one process, you’ve gotten into all three. The level of complexity once you’ve gotten here is well beyond our current research understanding.
Second, it seems pretty clear to me, at least this morning, that the phase II level of detoxification is a much more safe place for intervention than the phase I level. But the phase II pathways are so redundant, overlapped, and genetically variable that understanding in a targeted manner where and when to intervene is not at all clear as a clinician. This leaves shotgun prescribing for each phase II substrate as the only viable and scientifically sound strategy in most situations. Which takes us back to the first point - increasing clearance of everything may have unintended consequences that counterbalance the benefits of elimination of xenobiotics.
This is giving me a headache.