Related Terms

• Alcohol addiction, alcohol detox, bupe, Buprenophex®, buprenorphine, chelation therapy, cleansing, colonic irrigation, detox, detox diet, detox facility, detox therapy, drug addiction, drug detox, EDTA therapy, exercise, fasting, hydrotherapy, liver, medical detox, medical drug detox, non-medical detox, non-medical drug detox, probiotics, sauna.

Background

• Detoxification, commonly called detox, is a broad term that encompasses many different ways of cleansing the body's internal systems and organs. The goal is to remove toxic substances from the body and/or assist organs that normally perform detoxification functions. These organs include the skin, liver, intestines, and kidneys.

• Drug detoxification is a process that applies to a person who is addicted to drugs or alcohol. The goal of alcohol or drug detoxification is to eliminate the drugs or alcohol from the body. Although it may take several months for certain drugs to be completed eliminated from the body, licensed detox centers generally provide support and care during the first 3-7 days of abstinence. Drug detox is performed in many different ways depending on many factors, such as where a person chooses to receive treatment, the type and severity of addiction, and the person's age and overall health. Many drug detox centers provide treatment to help reduce the symptoms of withdrawal. Withdrawal symptoms are the physical and mental symptoms that develop when a person who is physically dependent on a drug(s) suddenly discontinues or stops using the drug(s). Qualified detox facilities provide medical treatment, counseling, and therapy to help people cope with the psychological distress of withdrawal. Once detox is completed, rehabilitation programs that include group therapy, motivational interviewing, family therapy, and/or one-on-one counseling are recommended to help patients overcome their addictions in the long-term.

• Therapeutic forms of detoxification are thought to support or augment the body's natural systems of detoxification. The major methods used during therapeutic detoxification include chelation therapy (EDTA therapy), colonic irrigation, herbal medicine, dietary therapy, fasting, juicing, probiotics, hydrotherapy, sauna therapy, exercise, and vitamin and mineral supplementation. Four main types of toxins are addressed through therapeutic detoxification: 1) heavy metals, 2) chemical toxins (including drugs and alcohol), 3) microscopic organisms and compounds, and 4) byproducts from protein metabolism.

• Advocates believe that therapeutic detoxification cleanses the body, increases vitamin and mineral absorption, purifies the blood, reduces blood fat levels, reduces symptoms of toxicity, rejuvenates the body, and rests the organs. Proponents also believe that this therapy clears the skin, enhances the senses, aids in weight loss, slows aging, and improves fertility and flexibility.

Drug and Alcohol Detoxification

• General: Drug detoxification (detox) is a process that applies to a person who is addicted to drugs or alcohol. The goal of alcohol or drug detoxification is to eliminate the drugs or alcohol from the body.

• Although it may take several months for certain drugs to be completely eliminated from the body, licensed detox centers generally provide support and care during the first 3-7 days of abstinence. It is during this time that symptoms of withdrawal are the most severe and possibly life-threatening. Withdrawal symptoms are the physical and mental symptoms that develop when a person who is physically dependent on a drug(s) suddenly discontinues or stops using the drug(s). The severity of withdrawal symptoms varies among people, depending on many factors, such as the type and severity of the drug addiction and the person's age and overall health.

• Drug detox is performed in many different ways depending on many factors, such as where a person chooses to receive treatment, the type of addiction, and the person's overall health. Many drug detox centers provide treatment to help reduce the symptoms of withdrawal. Qualified detox facilities provide medical treatment and monitoring, counseling, and therapy to help the person cope with the psychological distress of withdrawal.

• Ideally, detoxification should be used in combination with rehabilitation programs that include group therapy, motivational interviewing, family therapy, and/or one-on-one counseling, to help patients overcome their addictions.

• Medical drug detox: Patients who are addicted to opiate drugs, such as methadone (a narcotic pain reliever that is also used to reduce withdrawal symptoms of heroin or other narcotic drugs), heroin, and prescription medications, generally require medical detox supervision. People with severe alcohol addictions may also require medical supervision. In addition, people who have diabetes, high blood pressure, or heart, liver, or kidney problems should also undergo detox at a medical facility. This is because patients may experience severe and potentially life-threatening withdrawal symptoms, such as seizures, fever, and delusions, vomiting, and violent cramps. At the medical detox facility, the patient's vital signs, including respiration, heart rate (pulse), and temperature, are closely monitored in order to prevent complications.

• Patients may receive medications to relieve withdrawal symptoms, such as sweating, shaking, headaches, drug cravings, nausea, vomiting, abdominal cramps, diarrhea, sleeplessness, confusion, agitation, depression, anxiety, and other behavioral changes. For example, clonazepam (Klonopin®) is a tranquilizer (also called a benzodiazepine) that helps reduce the physical symptoms of withdrawal. Methadone (Diskets®, Dolophine®, or Methadose®)is a narcotic pain reliever that has been used to treat withdrawal symptoms of heroin or other narcotics. Buprenorphine (Buprenophex®), commonly called bupe, is an anticonvulsant that may help prevent seizures and reduce the behavioral symptoms, such as irritability and agitation. These drugs should only be used under the strict supervision of a healthcare professional because they are habit-forming.

• Non-medical drug detox: Non-medical detox is a detoxification process that occurs without the aid of medications. Patients are encouraged to undergo detox at a licensed non-medical alcohol and drug detox center. These centers should have 24-hour staff that is trained in CPR, first aid, and basic emergency medical procedures in case complications develop.

Integrative Therapies

• Note: The various therapeutic modalities of detoxification are thought to support or augment the body's natural systems of detoxification. These systems and their related detoxification functions include the skin (perspiration), the liver (filtration of blood, secretion of bile and enzymes), the intestines (mucosal detoxification, excretion of feces), and the kidneys (excretion of urine).

• Practitioners of natural medicine believe that the accumulation of toxins in the body is a major cause of disease. According to proponents, toxins ingested into the body from the air, water, and food contribute to the growing prevalence of chronic and degenerative diseases.

• Therefore, advocates of therapeutic detoxification believe that it cleanses the body, clears the skin, enhances the senses, helps weight loss, improves fertility, improves flexibility, increases vitamin and mineral absorption, purifies, reduces blood fat levels, reduces symptoms of toxicity, rejuvenates, rests organs, and slows aging.

• Herbal approaches use "detoxifying herbs" to support the body's detoxification systems, bind to toxins to aid in their excretion, or aid the breakdown of toxins. However, traditional herbal uses for detoxification vary. Western herbal practitioners tend to use herbs for their biochemical properties, while Eastern herbal practitioners tend to think in terms of the energetic qualities of the herbs.

• Strong scientific evidence:

• Calcium: Calcium is the most abundant mineral in the human body and has several important functions. More than 99% of total body calcium is stored in the bones and teeth where it supports the structure. The remaining 1% is found throughout the body in blood, muscle, and the intracellular fluid. Calcium is needed for muscle contraction, blood vessel constriction and relaxation, the secretion of hormones and enzymes, and nervous system signaling. A constant level of calcium is maintained in body fluid and tissues so that these vital body processes function efficiently. Hyperphosphatemia (high phosphate level in the blood) is associated with increased cardiovascular mortality in adult dialysis patients. Calcium carbonate or acetate can be used effectively as phosphate binders. Use may increase calcium-phosphate products in blood. Treatment of high blood phosphorous levels should only be done under the supervision of a qualified healthcare professional.

• Calcium gluconate is used in the treatment of hypermagnesemia (high magnesium level in the blood). Case studies suggest intravenous calcium can aid in the improvement of symptoms. Treatment of magnesium toxicity should only be done under the supervision of a qualified healthcare professional.

• Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

• Good scientific evidence:

• Calcium: Calcium gluconate may aid in antagonizing the cardiac toxicity and arrhythmia (abnormal heart rhythm) associated with hyperkalemia (high potassium level in the blood), provided the patient is not receiving digitalis drug therapy. Treatment of hyperkalemia should only be done under the supervision of a qualified healthcare professional.

• Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

• Chelation: EDTA chelation became well known during the 1950s, when it was proposed as a method to cleanse the blood and blood vessel walls of toxins and minerals. For many years, chelation therapy has been used with calcium disodium EDTA to treat heavy metal toxicity. It is still an accepted medical therapy for lead toxicity, and several studies report lower levels of lead in the blood and slower progression of kidney dysfunction. Chelation therapy may also be used to treat iron, arsenic, mercury, or cobalt poisoning. However, some research results are mixed. More studies are needed to clarify.

• Avoid in patients taking anticoagulants or antiplatelets. Avoid during root canal therapy. Avoid if pregnant or breastfeeding.

• Rhubarb: In laboratory studies, rhubarb has been shown to have positive effects on chronic kidney failure. These studies show promise for human use. In some studies, rhubarb is more effective than captopril, and rhubarb combined with captopril is more effective than either substance alone. Higher quality studies are necessary to confirm this hypothesis.

• Avoid if allergic or hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, kidney disorders, ulcerative colitis, or urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children younger than 12 years old. Use cautiously with bleeding disorders, cardiac conditions, or constipation. Use cautiously with a history of kidney stones or thin or brittle bones. Use cautiously if taking anti-psychotic drugs, anticoagulants, or oral drugs, herbs, or supplements (including calcium, iron, and zinc) with similar effects. Avoid if pregnant or breastfeeding.

• Vitamin B1 (Thiamine): Thiamine is a B-vitamin that may decrease problems associated with acute alcohol withdrawal. Patients with chronic alcoholism or experiencing alcohol withdrawal are at risk of thiamine deficiency and its associated complications.

• Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.

• Yoga: Preliminary research suggests that yoga may be beneficial when added to standard therapies for the treatment of substance abuse. Additional studies are needed before a strong recommendation can be made.

• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

• Unclear or conflicting scientific evidence:

• 5-HTP: Early study suggests that 5-HTP may lessen alcohol withdrawal symptoms. Further research is needed to confirm these results.

• Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down's syndrome, and mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications such as TCAs, MAOIs, SSRIs, nefazodone, trazodone, venlafaxine, mirtazapine, bupropion; 5-HTP receptor agonists such as sumatriptan, rizatriptan, naratriptan, zolmitriptan, eletriptan, imotriptan, and frovatriptan; and carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with renal (kidney) insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, and/or with a history of mental disorders. Avoid if pregnant or breastfeeding.

• Acupressure: The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Shiatsu means finger (Shi) pressure (Atsu) in Japanese. Shiatsu can incorporate palm pressure, stretching, massaging and other manual techniques. Early study indicates that auricular acupressure (pressure to points on the ear) may help with smoking cessation. Preliminary evidence also suggests that acupressure may be a helpful adjunct therapy to assist with prevention of drug addiction.

• With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles"), carotid dissection, and retinal and cerebral artery embolism, cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.

• Acupuncture: Acupuncture is commonly used to treat various forms of substance abuse such as alcoholism, opiate addiction, and cocaine dependence, although clinical studies have reported mixed results. Clinical study compared the readmission rates of a six-month treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients). Acupuncture clients were less likely to be readmitted for detoxification within six months.

• There has been limited research on acupuncture for the treatment of kidney disorders, such as gouty kidney damage. At this time, there is inadequate available evidence to recommend for or against the use of acupuncture for these indications. More research is needed.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.

• Alpha-lipoic acid: Alpha-lipoic acid (ALA) may provide some benefit in kidney disease, but there is not enough evidence to make a conclusion.

• Avoid if allergic to ALA. Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.

• Arabinogalactan: Although early results of arabinogalactan's effect in patients with chronic kidney failure are promising, more studies are needed.

• Avoid if allergic or sensitive to arabinogalactan or larch. People who are exposed to arabinogalactan or larch dust may have irritation of the eyes, lungs, or skin. Use cautiously in people with diabetes, digestive problems, or immune system disorders, and in people who consume a diet that is high in fiber or low in galactose. Arabinogalactan should not be used during pregnancy or breastfeeding.

• Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Study results are mixed as to whether arginine as a therapy by itself directly helps with certain kidney diseases or kidney failure. Arginine may be a helpful adjunct for kidney disease related conditions such as anemia in the elderly. Additional research is needed in this area.

• Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.

• Aromatherapy: Aromatherapy may be as effective as some types of acupuncture in treating alcohol withdrawal symptoms. More study is needed in this area.

• Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.

• Astragalus: Astragalus (Astragalus membranaceus) is commonly used in traditional Chinese medicine (TCM). Limited available study has reported positive benefits in smoking cessation and liver protection. Several animal and human studies report that kidney damage from toxins and kidney failure may be improved with the use of astragalus-containing herbal mixtures. Overall, this research has been poorly designed and reported. Astragalus alone has not been well evaluated. Better quality research is necessary before a conclusion can be made.

• Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplants, or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.

• Black pepper: Sensory cues associated with cigarette smoking can suppress certain smoking withdrawal symptoms, including the craving for cigarettes. Inhalation of black pepper essential oil may reduce cravings and physical symptoms associated with cigarette smoking cessation.

• Avoid if allergic or hypersensitive to black pepper (Piper nigrum), its constituents, or members of the Piperaceae family. Use cautiously if taking anti-asthmatic drugs, cholinergic agonists, cyclosporine A or digoxin, cytochrome P450 metabolized agents, oral herbs or drugs, phenytoin, propranolol, rifamipicin (rifampin), or theophylline. Use cautiously with gastrointestinal disorders. Avoid if pregnant or breastfeeding.

• Borage seed oil: Borage oil may help treat or prevent alcohol-induced hangovers, although additional study is needed in this area. Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or in those taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or in those taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid in pregnant patients as borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as GLA, present in borage oil. Avoid if breastfeeding.

• Calcium: A chelating treatment of calcium has been suggested to reduce blood levels of lead in cases of lead toxicity. Reduced symptoms have been observed in most, but not all, patient case reports and case histories. Adequate calcium intake appears to be protective against lead toxicity. Treatment of lead toxicity should only be done under supervision of a qualified healthcare professional.

• Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

• Chitosan: Limited evidence suggests that chitosan may be useful during long-term hemodialysis for patients with kidney failure. Further studies are needed to determine safety and efficacy.

• Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.

• Chlorophyll: Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants, and is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussels sprouts, cabbage, lettuce, and spinach), algae (Chlorella and Spirulina), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley).

• Chlorophyll may act to improve the detoxification of toxins involved in cancer promotion. However, more research is needed in regard to protection from aflatoxins. It may also inhibit the absorption of dietary heterocyclic aromatic amines, which may act as potential carcinogens. The results of one clinical trial suggest that prophylactic interventions with chlorophyllin or diet supplementation with chlorophyll-rich foods may be a practical means to prevent the development of hepatocellular carcinoma or other environmentally-induced cancers. Additional large scale clinical research is needed in this area before a clinical recommendation can be made.

• Yusho poisoning is caused by ingestion of rice oil contaminated with polychlorinated biphenyls, specifically polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs). A chlorophyll-rich diet may increase PCDF and PCB elimination, but further high quality research is needed.

• Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressants or antidiabetes agents. Avoid if pregnant or breastfeeding.

• Clay: Clay lozenges have been used historically in the treatment of mercuric chloride poisoning and were officially mentioned in several European pharmacopoeias, including the Royal College, until the middle 19th Century. However, there is not enough scientific evidence to recommend the use of clay by mouth for mercuric chloride poisoning at this time, as there is a risk of clay itself containing contaminants.

• Phyllosilicate clay has been shown to adhere to aflatoxins in laboratory study, and HSACS clay in animal diets may diminish or block exposure to aflatoxins. However, the risks of chronic clay exposure likely do not justify the potential benefit of protection from aflatoxins.

• There is a lack of reports of allergy to clay in the available scientific literature. However, in theory, allergy/hypersensitivity to clay, clay products, or constituents of clay may occur. Avoid if pregnant or breastfeeding.

• Coenzyme Q10: Coenzyme Q10 (CoQ10) is produced by the human body. It is needed for the basic functioning of cells. A combination of Coenzyme Q10 and L-carnitine has been studied for reduction of cocaine dependence, but results are inconclusive. More research is needed in this area.

• Early research also supports the use of CoQ10 supplements for the treatment of kidney failure. However, additional study is needed before a firm conclusion can be made.

• Allergies associated with Coenzyme Q10 supplements have not been reported in the available literature. However, rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.

• Colon therapy/colonic irrigation: Colon therapy is the use of herbs or water to clean out the colon or large intestine to treat certain health conditions. Limited available study of unclear methodology suggested that colonic irrigation employing Chinese herbs may augment dihydroetorphine (DHE) and methadone therapy in heroin addicts going through drug withdrawal, possibly resulting in more rapid detoxification. However, the data provided are insufficient for making any definitive conclusions. More studies are needed.

• Excessive treatments may allow the body to absorb too much water, which may cause electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms, or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or if recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to a lack of scientific data.

• Cordyceps: Cordyceps is a parasitic fungi that has been used as a tonic food in China and Tibet. In traditional Chinese medicine (TCM), cordyceps is used to strengthen kidney function. Studies indicate that cordyceps may improve kidney function in patients with chronic kidney failure or drug-induced nephrotoxicity. Early study results are promising, however, additional research is needed.

• Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, bleeding disorders, or prostate conditions. Use cautiously if taking immunosuppressants, anticoagulants, hormonal replacement therapy, or birth control pills. Avoid with myelogenous type cancers. Avoid if pregnant or breastfeeding.

• Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Although early evidence is promising, it is unknown whether danshen is a safe and effective treatment for kidney disease. Early studies suggest that danshen may speed dialysis and ultrafiltration rates when added to dialysate solution. Although this evidence seems promising, it is not known whether danshen is safe for this use.

• Avoid if allergic or hypersensitive to danshen. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensive agents. Avoid with bleeding disorders, low blood pressure, and following cerebral ischemia (inadequate blood flow to the brain). Use cautiously if taking sedatives, hypolipidemics (blood pressure-lowering medications), cardiac glycosides, CYP-metabolized agents, nitrate ester, steroidal agents, or some anti-inflammatories (such as ibuprofen). Use cautiously with altered immune states, arrhythmia (irregular heartbeat), compromised liver function, or with a history of glaucoma, stroke, or ulcers. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures that have bleeding risks. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.

• DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Preliminary study shows that DHEA is not beneficial for cocaine withdrawal, but further study is needed before a firm conclusion can be drawn.

• Avoid if allergic to DHEA. Use cautiously with adrenal or thyroid disorders, depression, panic disorder, bipolar disorder, psychotic disorders, heart disorders, polycystic ovary syndrome, anovulatory infertility, steroid 21-hydroxylase deficiency, gynecomastia, overactive thyroid, bacterial infections, or diabetes. Use cautiously if at risk for prostate cancer, liver cancer, breast cancer, or ovarian cancer. Use cautiously in HIV patients with Kaposi's sarcoma or in patients who have received flu shots. Use cautiously if taking alprazolam, amlodipine, anastrozole, benfluorex, beta-adrenergic antagonists, calcium channel blockers, canrenoate, danazol, diltiazem, growth hormone, methylphenidates, metopirone, nitrendipine, or hormones or dietary supplements with hormone-like effects (e.g. chromium picolinate). Avoid if pregnant or breastfeeding.

• Eucalyptus oil: Nicobrevin is a proprietary product marketed as an aid for smoking cessation that contains quinine, menthyl valerate, camphor, and eucalyptus oil. Despite use of this product, there is currently a lack of evidence suggesting benefit for smoking cessation.

• Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.

• Eyebright: Aucubin, a constituent of eyebright (Euphrasia officinalis), may aid in liver protection. However, there is currently insufficient evidence for the use of eyebright for this indication.

• Avoid in individuals with a known allergy or hypersensitivity to eyebright. Hypersensitivity to members of the Scrophulariaceae family may lead to a cross-sensitivity reaction. Use cautiously as an eye treatment, particularly homemade preparations, due to the risk of infection if not sterile. Use cautiously with diabetes and drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.

• Folate (folic acid): Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food, and folic acid is the synthetic form of this vitamin. Folate may lower blood arsenic concentrations and thereby contribute to the prevention of arsenic poisoning. Additional research is needed in this area.

• Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents or with anemia or seizure disorders. It is recommended that pregnant women consume 400 micrograms of folate daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.

• Ginkgo biloba: Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States. It is not clear whether ginkgo is helpful in treating cocaine dependence. More study is needed.

• Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.

• Ginseng: There is currently a lack of sufficient evidence to recommend either American ginseng or Panax ginseng as an agent for hepatoprotection. Laboratory study investigated compound K, a ginseng metabolite that shows promise in protecting against liver injury. Additional human studies are warranted in this area.

• For kidney dysfunction, a combination of herbs that included ginseng was not better than treatment with a conventional medicine plus traditional Chinese medicine. More research is needed because the effects of ginseng alone are unknown.

• Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.

• Globe artichoke: Globe artichoke (Cynara scolymus) may help the digestive system to function better. An extract of artichoke has been used and marketed as a remedy for alcohol-induced hangover. However, there is insufficient available evidence to form a clear conclusion in this area. Artichoke extract may be taken immediately before and following consumption of alcohol.

• Do not use artichoke with gall bladder or liver problems, unless under the supervision of a doctor. Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae family (e.g., chrysanthemums, daisies, marigolds, ragweed, arnica), due to possible cross-reactivity. Use cautiously with cholelithiasis or biliary/bile duct obstruction or kidney disease. Avoid if pregnant or breastfeeding.

• Guided imagery: In contemporary times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Based on early study, guided imagery in addition to education and counseling sessions may be helpful for long-term smoking cessation and abstinence in adult smokers. Further study is needed to confirm these results.

• Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.

• Hypnotherapy: Hypnosis is associated with a deep state of relaxation. Although used by psychotherapists, there is inconclusive evidence for the use of hypnotherapy in alcohol dependence and drug addiction. Additional research is needed in this area.

• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.

• Iron: Iron deficiency may increase the risk of lead poisoning in children. However, the use of iron supplementation in lead poisoning should be reserved for those individuals who are truly iron deficient or for those individuals with continuing lead exposure, such as continued residence in lead-exposed housing.

• Iron is a trace mineral, and hypersensitivity is unlikely. Avoid with known allergy/hypersensitivity to products containing iron. Avoid excessive intake. Avoid iron supplements with blood disorders that require frequent blood transfusions. Use iron supplements cautiously with a history of kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, alcoholism, or with a history of heart disease. Use cautiously in those who plan to become pregnant, or in those older than age 55. Pregnant or breastfeeding women should consult their healthcare professionals before beginning iron supplementation.

• Kudzu: Kudzu (Pueraria lobata) is well known in the southern United States as an invasive weed. Research indicates that extracts of kudzu may be effective in treatment of alcoholism, such as with decreasing the cravings of alcohol. Clinical studies report positive benefits when using kudzu for alcohol craving. However, more research needs to be performed.

• Use caution with anticoagulants/anti-platelet and blood pressure lowering agents, hormones, antiarrhythmics, benzodiazepines, bisphosphonates, diabetes medications, drugs that are metabolized by the liver's cytochrome P450 enzymes, mecamylamine, neurologic agents, and methotrexate. Well designed studies on the long-term effects of kudzu are currently unavailable. Avoid if allergic or hypersensitive to Pueraria lobata or members of the Fabaceae/Leguminosae family. Avoid if pregnant or breastfeeding.

• L-carnitine: L-carnitine (also known as acetyl-L-carnitine) is an antioxidant and may help blood flow, as well as neurological function. Early studies suggest that acetyl-L-carnitine may be of benefit in the treatment of alcoholism. Well-designed clinical trials are required before recommendations can be made in this field.

• Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

• Massage: Massage shows promise as an adjunct to traditional medical detoxification for alcohol dependence. Further research is needed to confirm these results.

• Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.

• Meditation: Available evidence does not indicate conclusively whether meditation can help with smoking cessation, cocaine dependence, or alcoholism. More studies are needed.

• Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.

• Melatonin: Melatonin is a hormone produced in the brain and is involved in the sleep wake cycle during light and darkness. Levels of melatonin in the blood are highest prior to bedtime. A small amount of research has examined the use of melatonin to reduce symptoms associated with smoking cessation, such as anxiousness, restlessness, irritability, and cigarette craving. Although preliminary results are promising, due to weaknesses in the design and reporting of this research, further study is necessary before a firm conclusion can be reached. Early research has also examined the use of melatonin to assist with benzodiazepine tapering, such as with diazepam (Valium®) or lorazepam (Ativan®).

• Melatonin is not to be used for extended periods of time. Melatonin can cause drug interactions, and healthcare professionals recommend not using in pregnancy or breastfeeding.

• Milk thistle: Milk thistle (Silybum marianum) has been used medicinally for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. Several clinical studies suggest possible benefits of milk thistle to treat or prevent drug or toxin induced hepatotoxicity. Results of this research are not clear, and most studies have been poorly designed. More research needs to be performed in this area. Milk thistle has been used traditionally to treat Amanita phalloides mushroom toxicity and poisoning. However, there are not enough reliable studies in humans to support this use of milk thistle.

• Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used during pregnancy or breastfeeding unless otherwise directed by a doctor.

• Modified citrus pectin: Modified citrus pectin (MCP) may increase the excretion of metals, such as arsenic, cadmium, and lead, and has been studied as a chelating agent for detoxification therapy. Additional study is needed in this area before a recommendation can be made.

• Avoid if allergic or hypersensitive to modified citrus pectin. MCP may cause gastrointestinal discomfort in patients allergic or sensitive to MCP. Use cautiously if taking chelating medications or if under treatment for cancer. Use cautiously if taking oral drugs, herbs, or supplements, as MCP may reduce or slow their absorption. Use cautiously in geriatric patients or patients with gastrointestinal disorders. Avoid if pregnant or breastfeeding due to a lack of scientific data.

• Nopal cactus: Limited available clinical study found that nopal cactus (Opuntia ficus-indica) may prevent alcohol-induced hangover, likely due to nopal's ability to inhibit the production of inflammatory mediators. More clinical studies are needed to confirm this finding.

• Avoid if allergic/hypersensitive to nopal (Opuntia spp.), any of its constituents, or to members of the Cactaceae family. Use cautiously if taking medications that alter blood sugar, cholesterol, or blood pressure. Use cautiously with thyroid dysfunction and rhinitis (runny or congested nose), or asthma. Avoid with immunosuppression or impaired liver function. Avoid if pregnant or breastfeeding. The nopal plant should be handled cautiously, as it is covered in long sharp spines and shorter soft-appearing barbs of glochids, which may be painful and difficult to remove once they are imbedded in the skin. It is recommended that oral doses of dried nopal be taken with at least eight ounces (250mL) of water.

• Prayer: Traditional forms of prayer have been widely used for alcohol or drug dependency and smoking cessation. However, early study results are unclear. Additional research is needed to make a conclusion.

• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies.

• Psychotherapy: Several studies suggest that psychotherapy may be beneficial for smoking cessation, alcohol abuse, or drug abuse. However, there is not enough available evidence to make a conclusion. More research is needed to better determine effectiveness.

• Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire about the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.

• Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. A recent study looked at the effectiveness of Qi gong therapy versus medical and nonmedical treatment for heroin detoxification. Results showed that Qi gong may be beneficial in heroin detoxification without side effects, although the possibility of the placebo effect cannot be completely eliminated. Other treatments have been better studied for heroin detoxification and are recommended at this time. Qi gong may be used as an adjunct therapy.

• Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders. In cases of potentially serious conditions, Qi gong should not be used as the only treatment instead of more proven therapies, and it should not delay the time it takes to see an appropriate healthcare provider.

• Reishi: Reishi mushroom (Ganoderma lucidum), also known as ling zhi in China, grows wild on decaying logs and tree stumps. Reishi occurs in six different colors, but the red variety is most commonly used and commercially cultivated in East Asia and North America. Ganoderma lucidum has shown a beneficial effect in treating Russula subnigricans (RSP) poisoning in limited study. Further well-designed clinical trials are needed to confirm these results.

• Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Reishi is likely safe when consumed in amounts generally found in foods in non-allergic pregnant or breastfeeding women.

• Relaxation therapy: Early research reports that relaxation with imagery may reduce relapse rates in people who successfully completed smoking cessation programs. Better study is needed in this area before a firm conclusion can be reached.

• Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time to diagnosis or treatment with more proven techniques.

• Safflower: Based on preliminary study, safflower (Carthamus tinctorius) oil may effectively remit the symptoms of neurotoxicity from lithium. However, more studies are needed to better understand safflower's effect on lithium toxicity.

• Avoid if allergic/hypersensitive to safflower, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, low blood pressure, liver problems, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

• SAMe: Preliminary evidence from meta-analyses and randomized clinical trials suggests that SAMe may normalize levels of liver enzymes in individuals with liver disease. Well-designed clinical trials, with appropriate subject number in homogenous populations are required before a definitive conclusion can be made.

• Avoid if allergic or hypersensitive to SAMe. Use cautiously with diabetes and anxiety disorders, or women in their third trimester of pregnancy. Avoid with bipolar disorder. Avoid during the first trimester of pregnancy or if breastfeeding.

• Schisandra: The efficacy of schisandra as a hepatoprotective agent has been demonstrated in multiple studies. Based on these observations, schisandra has been suggested as a potential treatment for liver disease. Future studies are warranted to assess the long-term efficacy and safety of schisandra compared to standard therapies.

• Use cautiously during pregnancy or lactation or in patients with bleeding disorders, seizure disorders, high intracranial pressure, high blood pressure, skin diseases, gastoeseophageal reflux or peptic ulcer disease, neurological disorders, or diabetes. Avoid in patients allergic to schisandra, any of its constituents, or other members of the Schisandraceae family. Allergic skin rashes and urticaria has been reported in some patients.

• Selenium: Selenium supplementation has been studied in various liver disorders, including hepatitis, with mixed results. Further research is needed to establish selenium's effects on liver disease.

• Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

• Soy: Due to limited human study, there is not enough evidence to recommend for or against the use of soy in the treatment of kidney diseases, such as chronic renal failure. Patients with kidney disease should speak to their healthcare providers about recommended amounts of dietary protein, as soy is a high protein food.

• Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there are limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore, are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens (e.g. increased risk of blood clots). The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or prostate cancer. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs (e.g. warfarin) should check with their doctors and/or pharmacists before taking soy supplementation.

• Spirulina: The term spirulina refers to a large number of cyanobacteria or blue-green algae. Spirulina extract plus zinc may be useful for the treatment of arsenic poisoning. Additional research is needed to confirm early study findings.

• Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria, autoimmune diseases, bleeding disorders, diabetes, osteoporosis or if taking products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp. Use cautiously in underweight patients or in those taking antiobesity agents or appetite suppressants. Use cautiously if consuming a high-protein diet. Avoid in children and pregnant or breastfeeding women.

• Taurine: Early studies have found that taurine supplementation has the potential to modify the conjugation of bile acids, potentially modifying the disease. Furthermore, taurine has been examined as an adjunct to ursodeoxycholate (UDCA) in the treatment of liver disease. Results from these early studies suggest that conjugation of bile acids can be modified and that taurine as an adjunct to UDCA does not offer more benefits. More recent studies are investigating the effect of tauroursodeoxycholate (TUDCA) in liver disease treatment. As of yet, however, the evidence in support of taurine in liver disease is minimal and well-designed clinical trials with positive results are needed before a firm conclusion can be made.

• Taurine is an amino acid and it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, coagulation disorders, potential for mania, or epilepsy. Avoid consuming alcohol or exercising after consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.

• Thymus extract: Preliminary evidence suggests that thymus extract may offer benefit to individuals with liver disease. More well-designed clinical trials are required.

• Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.

• Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) may provide protection for liver disease. However, more studies are needed before recommendations can be made.

• Chinese herbs can be potent and may interact with other herbs, foods, or drugs. A qualified healthcare professional should be consulted before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources.

• Turmeric: In traditional Indian Ayurvedic medicine, turmeric has been used to tone the liver. Early research suggests that turmeric may have a protective effect on the liver. More research is needed to better determine the effectiveness of turmeric for hepatoprotection.

• Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.

• Zinc: Limited available study has shown that a combination of spirulina extract plus zinc may be useful for the treatment of chronic arsenic poisoning with melanosis and keratosis. More research is needed to confirm the effects of zinc alone.

• Preliminary research suggests that zinc may improve uremia in patients with kidney disorders. Further research is needed to confirm the effectiveness of zinc for kidney function. Zinc supplementation may be recommended only in patients with proven zinc deficiency, whereas its use for all chronic renal failure patients is questionable.

• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

• Fair negative scientific evidence:

• Acupuncture: Numerous studies of acupuncture for smoking cessation have been conducted, and the quality of studies has varied widely. There may, however, be some benefit in reducing side effects of withdrawal such as irritation, cigarette craving, and headache. Additional research is needed.

• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding (e.g. anticoagulants). Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (e.g. asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers because therapy may interfere with the device.

• Arginine: Animal studies report that arginine blocks the toxic effects of cyclosporine, a drug used to prevent organ transplant rejection. However, results from studies in humans have not found that arginine offers any protection from cyclosporine toxicity.

• The contrast media or dye used during angiography to map a patient's arteries (or during some CT scans) can be toxic to the kidneys, especially to people with pre-existing kidney disease. Clinical study has examined the use of L-arginine for kidney protection during angiography in patients with chronic renal failure. Researchers found no evidence that injections of L-arginine protect the kidney from damage due to contrast. Other therapies, such as N-acetylcysteine (NAC), have been found beneficial at protecting the kidneys from contrast-induced damage, particularly in patients at high-risk (e.g. diabetics).

• Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.

• Hypnotherapy: Hypnotherapy involves suggestion by therapists during periods of deep relaxation. Although used for smoking cessation with some positive results, there is currently a lack of scientific evidence for hypnotherapy as a valid treatment for this indication.

• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.

• Traditional or theoretical uses lacking sufficient evidence:

• Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs, (e.g. liver and kidney). Although copper has been suggested as a potential treatment for pyrrolizidine alkaloid toxicity and may theoretically decrease cadmium absorption, reliable studies are currently lacking.

• Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.

• Detoxification therapy: Detoxification is a broad concept that encompasses many different modalities and substances used in cleansing the body's systems and organs. Many different techniques, including chelation therapy, colonic irrigation, supplementation, herbs, foods, and cleansing diet, hydrotherapy, probiotics, sauna, and exercise, may be used during detoxification therapy. Detoxification therapy has been suggested as a potential treatment for heavy metal toxicity, alcoholism, and drug addiction, but research is currently lacking in this area.

• In cases of illness the various forms of detoxification should be used under professional guidance.

• Exercise: Exercise is considered to aid detoxification by increasing the blood flow through the body's various filtration systems, as well as releasing toxins through sweat (perspiration).

• Patients should talk to their doctors before starting new exercise programs, especially if they are pregnant, elderly, or have critical illnesses or physical injuries. Avoid high-impact forms of exercise with osteoporosis, nerve injuries, or if pregnant.

• Fasting: Fasting is defined as the voluntary refusal of food for a predetermined period of time. When a person fasts, the body uses non-essential tissue (e.g., fat, digestive enzymes, muscle fibers, and glycolytic enzymes) for fuel. In naturopathic medicine, fasting is considered a rapid way to eliminate fat-soluble toxins from the body. It has also been suggested that it can enhance the healing processes of the body. Despite a variety of books on the method and health benefits of fasting, clinical trials evaluating the effectiveness of fasting for detoxification are currently lacking.

• It is not recommended that anyone limit his or her intake of fluids during a fast. Fasting too frequently or for periods of more than several days may have unwanted side effects. A qualified healthcare provider should be consulted before making decisions about therapies and/or health conditions. Children, teenagers, pregnant and nursing women, the elderly, and those with serious health disorders should not fast.

• Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, or ice) for healing purposes. It may include immersion in a bath or body of water, such as the ocean or a pool. Therapy may also involve the use of water jets, douches, or the application of wet towels (wraps) to the skin. Hot water is believed to stimulate blood circulation, thereby stimulating filtration through the liver. Hydrotherapy is also believed to be effective for liver disorders by ridding the body of toxins through sweat (perspiration). Hydrotherapy practitioners propose that immersion treatments and body wraps made from warm or hot dressings may help detoxify the blood.

• Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.

• Omega-3 fatty acids: Omega-3 fatty acids have been suggested as a possible therapy for alcoholism. Alcoholics have been reported to have decreased amounts of the omega-3 essential fatty acids, particularly DHA or docosahexaenoic acid. Omega-3 fatty acids, such as found in fish oils, may be used as a supplement to the diet.

• Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).

• Probiotics: Probiotics are thought to aid in detoxification by preserving the intestinal lining's protective barrier and preventing harmful bacteria that produce toxins from growing inside the colon. However, studies evaluating the effectiveness of this therapy are lacking.

• Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.

• Red clover: Red clover (Trifolium pretense) has been used historically for "blood purification" by herbalists, however, human clinical or laboratory evidence supporting this use is currently unavailable. Additional high quality research is needed before a clinical recommendation can be made.

• Avoid if allergic to red clover or other isoflavones. Use caution with hormone replacement therapy (HRT) or birth control pills. Use caution with history of a bleeding disorder, breast cancer, or endometrial cancer, or with drugs that thin the blood. Avoid if pregnant or breastfeeding.

• Selenium: Selenium has been proposed as a potential treatment for arsenic poisoning, although reliable evidence is currently lacking in this area.

• Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

• Yellow dock: Yellow dock has been used traditionally for "blood purification" and liver protection, however, very few laboratory or human studies have been conducted to confirm these uses. High-quality human clinical research is needed in the area.

• Avoid if allergic or hypersensitive to yellow dock, its constituents or members of the Polygonaceae family. Use cautiously with compromised renal (kidney) or hepatic (liver) function. Avoid if pregnant or breastfeeding.

Safety

• General: The safety of detoxification varies depending on the methods being used, as well as the overall health of the person. Patients should talk to their doctors before enrolling in serious detoxification programs. People with certain medical conditions, such as diabetes, high blood pressure, or heart, liver or kidney problems, should seek medical advice before beginning any type of detoxification program.

• Use cautiously in patients taking medications (prescription or over-the-counter), herbs, or supplements because these agents may increase the risk for certain side effects or they may interact with herbs or drugs used during detoxification therapy. Therefore, patients should tell their doctors if they are taking any drugs, herbs, or supplements.

• Medical supervision and monitoring: Patients who are addicted to opiate drugs, such as methadone (which is also used to treat opiate addiction), heroin, and prescription medications, such as oxycodone (e.g., OxyContin®, Endocodone®, or Percolone®) or acetaminophen and hydrocodone (e.g., Vicodin®), require medical detox supervision. People with severe alcohol addictions may also require medical supervision. Furthermore, people who have diabetes, high blood pressure, or heart, liver, or kidney problems, should also undergo detox at a medical facility. This is because these patients have a greater risk of experiencing severe and potentially life-threatening withdrawal symptoms. Medications used to treat withdrawal symptoms, such as methadone and clonazepam (Klonopin®), should only be used under the strict supervision of a healthcare professional because they have been shown to be habit-forming.

• Side effects: Specific side effects of detoxification vary depending on many factors, including the type of therapy used, the patient's age and overall health, as well as the type of toxins that are targeted. During some detoxification therapies, the toxins released from tissues build up in the bloodstream before they are excreted. As a result, patients may experience a worsening of symptoms until the toxins are completely eliminated from the body. In general, these side effects may include, but are not limited to: headaches and other aches and pains, fatigue, skin eruptions (raised bumps, blisters, sores, or pimples), irritability, gas, tight muscles, yawning, temporary stopping of menstruation, and constipation or diarrhea. In addition, some therapeutic detoxification therapies, such as colon therapy or fasting, may cause dehydration or depletion of essential nutrients.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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