Retoxification Reaction and Adrenal Fatigue Syndrome

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Your lungs are an important site of detoxification, vital to adrenal fatigue sufferersDetoxification is the process of removing toxins from the body. It is a fundamental process of our cells during its respiratory cycle. The most basic form of nutrition and detoxification is breathing. On each complete breath, oxygen as a nutrient is consumed as carbon dioxide, the common waste, is expelled. The body’s detoxification operates round the clock to keep unwanted compounds out.

If the body is overworked, exposed to a large number of toxic elements or if the body is damaged, as in the case of Adrenal Fatigue Syndrome (AFS), our detoxification process can be affected and become dysfunctional.

Many alternative practitioners advocate a regular program of detoxification as a way to maintain optimum health. Overly aggressive detoxification, however, can create a unique set of unpleasant symptoms, collectively called detoxification reactions. Those who are weak or in advanced stages of AFS however, suffer from a more severe form called retoxification reaction.

Detoxification 101

In alternative medicine, detoxification commonly refers to the removal of heavy metals, xenobiotics, cigarette smoke, medications, alcohol, caffeine, and pollutants from our body. This can be done through enemas, flushes, oral ingestion of certain herbs, intravenous therapy, heat therapy, fasting, and juicing, just to mention a few.

Detoxification is a process largely carried out by our liver, where it filters, oxidizes, reduces, and conjugates the metabolite byproducts for excretion out of out body by way of urine, air, sweat, and feces comfortably.

There are two phases of detoxification carried out by the liver cells on contact with toxins. Phase I liver detoxification is carried out by fifty liver enzymes known as the cytochrome P450 enzyme system. Glutathione is also produced which is then used during Phase II of the liver detoxification. It is during the Phase II detoxification that special processes such as methylation, glutathione conjugation, and sulfation takes place. These two phases though basically dissimilar are complementary biochemically and facilitate the body processes which keep it clean at all times in order for us to feel good. If the glutathione level is low, or if the liver’s P450 pathways are compromised or imbalanced, dysfunction will surface. Because the liver is a rather large organ with large reserve capacity, one may not detect any dysfunction until damage is well entrenched while laboratory test is still normal because they are not sensitive enough to detect early damages. One can also be in a subclinical state of liver dysfunction and be symptomatic but routine liver laboratory testing can be normal.

Your liver performs many detoxification processes important for adrenal fatigue/Generally, the actions of the enzymes during Phase I detoxification reduces the chemical toxicity of pollutants. Phase II is needed because some of the post Phase I metabolic byproduct compounds can be more toxic than the original compound. This phenomenon is called bioactivation. It is with the Phase II detoxification process that such chemicals are turned into harmless compounds and eliminated from the body. Any dysfunction or imbalance of Phase I and Phase II detoxification will lead to improper detoxification, resulting in increased toxin load within the body, triggering symptoms of endocrine, nervous system, immune, and other organ toxicities.

Bioactivation is a key concept to understand as its presence indicates increased toxic load and is a contributing factor of a more severe form of detoxification reaction called retoxification reaction.

Problems also arise when a normal liver has reached its maximum metabolic workload when stressed. Examples of stressors can include toxic chemical fumes, infection, or medications. If stressors are not removed, a liver can start decompensating. This occurs during advanced stages of AFS. Unprocessed toxins waiting for breakdown may accumulate as a result, and partially metabolized and bio-activated toxic load buildup causes havoc within our body.

Detoxification Reaction

Remember that the body is constantly undergoing a detoxification process. Only when there is a sudden imbalance in this process will a detoxification reaction be triggered. This usually occurs when the body has reached its maximum detoxification level. Three common triggers are:

  1. Administration of antibiotics or certain diet regimes can cause a sudden large-scale die-off of bacteria. A significant amount of toxins stored within the actual bacteria is released. This sudden flood of toxins can trigger a detoxification reaction.
  2. Detoxification programs that cause the organs of the body (particularly the liver, which is a warehouse of drug and poison residues and metabolites) to purge their stored poisons and toxins can be a trigger. Our cells suddenly have an opportunity to release an even greater than normal quantity of stored toxins, metabolic wastes, pathogens and unwanted material. Examples include colon cleansing, liver flushes, aggressive use of anti-viral herbs, immune enhancers, and pathogen destroyers can all trigger bacterial detoxification reaction, especially if one is weak.
  3. Weight loss programs such as fasting or the use of weight-loss herbs can cause a rapid breakdown of fat cells (which are a storehouse for toxins) and trigger detoxification reaction.

Detoxification reaction also goes by different names including healing reactions, healing crises, die-off, Herxheimer reactions, and cleansing reactions.

Clinical Presentation

As mentioned above, the normal detoxification process is automated by the body and works continuously without us knowing. If aggressive detoxification modalities are administered and the body is not ready, there may be a sudden surge of toxic metabolic load in the body. In a normal healthy person, the body rebalances itself automatically by increasing its excretion mechanism to help get rid of toxin overload. No symptoms are felt.

Sometimes you may hear of healthy people feeling drained or exhausted after a hot yoga or sauna session, or after taking part in a liver cleanse, enema, or fasting protocol. It may take them anywhere from a few hours to a day or two to regain their composure. This is an early warning sign that the body’s detoxification process may be reaching its maximum workload. More rest is needed and usually the body fully returns to baseline function within a few days.

Those who are weak, or in early stages of AFS, fare worse as the body’s detoxification process is strained. A full-fledged detoxification reaction may occur, with symptoms that include fatigue, brain fog, anxiety, skin eruptions, diarrhea, bloating, stomach cramps, joint pain, low-grade fever, gastric discomfort, and headache. These generally resolve over time, but it can take upwards of one to two weeks. The first one to two days may be incapacitating.

Retoxification Reaction

Retoxification is common in advanced adrenal fatigue/The term retoxification or retox is generally used in the general public when a person resumes the consumption of alcohol, caffeine or other addictive substances after undergoing detoxification for those who are healthy. In a setting of Adrenal Fatigue Syndrome, it refers to the body becoming retoxified as it is undergoing the normal automated detoxification process mentioned previously. In other words, additional insults above and beyond that of the normal detoxification process are levied on the body.

Retoxification reaction is a more severe form of detoxification reaction. This is seldom experienced by normal healthy people or those in mild or early stages of AFS because the body possesses adequate reserves to compensate and adjust for the increased toxic load automatically. This, however, is a common occurrence for those in advanced stages of AFS or who are chronically ill and weak.

For example, sauna or hot yoga is a good detoxification modality, which uses heat. With heat, the blood vessels tend to dilate and toxins are released in the form of sweat. Normal people feel relaxed during sauna, invigorated afterwards, and come away energized. Those in early stages of AFS don’t do quite as well. The toxic load within increases, and improper or slowed speed of toxic clearance from the body may lead to a brief period of mild fatigue, headache, and lethargy. This detoxification reaction usually is self-limiting. After a few hours of rest, the body regains its posture and full energy returns.

The same cannot be said for those in advanced stages of AFS (stages 3 and 4). For these, even a few minutes within a sauna or under direct sunlight may be too much. Most are unaware of the damage within until they either stay too long or after the session is over. They experience what is called a retoxification reaction. Instead of feeling good, heart rate goes up and continues to stay up for hours. Headache, fatigue, and lethargy can last for days. Insomnia and hypoglycemia may be triggered that can go on for weeks or even months. In severe cases, one could be incapacitated.

Retoxification reaction therefore may be considered a severe form of detoxification reaction afflicting primarily those who are weak. Both are part of the toxic continuum, but have important distinctions.

The term retoxification reaction denotes the underlying pathophysiology process of a body under multiple insults and repeated damage from toxin overload. In addition to the increased release of normal metabolic byproducts during a detoxification process, the body is further damaged by the onslaught of highly toxic bio-activation of partially metabolized components not properly funneled to the next level of the normal detoxification process for neutralization. On top of that, there is usually significant congestion at the extracellular matrix that leads to retarded recovery.

Symptoms of Retoxification Reaction

In addition to common characteristics of detoxification reaction mentioned previously, signs and symptoms of retoxification reaction include:

  • Severe nausea or dizziness that lingers on for days
  • Joint pain and muscle aches of unknown origin that migrate and are slow to go away
  • Skin eruptions requiring steroids to control,
  • A constant underlying simmering state of inflammation.
  • Lowered threshold to dermatograhia with a heightened sense of histamine release
  • Fatigue that can linger on for days or weeks
  • Anxiety made worse with medication and certain herbs like ashwagandha, rhodiola, and maca.
  • Low grade fever of unknown origin
  • Brain fog that lingers on and fails to resolve
  • Reactive hypoglycemia being triggered
  • Extreme craving for salty or fatty foods

There is no single symptom that stands out more than others, and the clinical picture varies greatly from person to person. Looking from afar, the body appears to function in a state of persistent discontent that refuses to improve back to baseline after a crash. The key differentiation clinically between detoxification and retoxification reaction lies in the overall severity of pathology underneath and thus the recovery time. Retoxification reaction symptoms may not be more severe than those of detoxification reaction, but they tend to linger on, and is much harder to recover. Even with rest and nutritional support, full recovery cannot be attained. Instead, there are frequent recurrences as the body gets weaker with time.

The clinical picture is clear from afar. The body is fragile and weak to start. It is unable to fully neutralize and metabolize toxins within. A residual load of toxins is ever-present internally and continually needs to be cleaned up. It’s a chronic problem rather than one-off. The body is tired. As the toxic load builds up symptoms surface from time to time. Triggers can be something as simple as ingesting cold water, watching an action movie, exposure to direct sunlight, taking a hot water bath, drinking a sugary drink, emotional stress, or over exertion. Many describe this as similar to a mini adrenal crash.

Advanced adrenal fatigue can cause retoxification, currently there are no laboratory tests for thisBecause there are no laboratory tests to diagnose this, a detailed history by an experienced clinician is needed to ascertain its presence.

If you are experiencing negative reactions from detox, make the distinction of whether you are suffering from a detoxification or a retoxification reaction. Most detoxification reactions are mild and self-limiting once the detoxification approaches are stopped, whether it be fasting, sauna, or liver flushes. Uses of additional nutrients may be indicated to help facilitate the recovery process. The body is usually stable and strong enough.

This is quite different from those who suffer from retoxification reaction, as they are usually much less stable and weak. Their symptoms can linger for a long time, and recovery is usually retarded and suboptimal. Most are at increased risk of adrenal crashes if not timely reversed. The more retoxification reaction is experienced, the weaker the body becomes and the harder is the overall recovery from AFS. Preventing this unstable vicious cycle from being entrenched is critical. It has to be an integral part in the overall planning of a comprehensive approach to AFS recovery.

As compared to a detoxification reaction where rest will normally suffice a full recovery, a comprehensive mind-body-neuroendocrine approach is needed here, especially for those with a history of repeated retoxification reaction. Aside from stopping all detoxification modalities, the key in turning the corner lies first with cleansing the ECM. Tools to consider include the use of charcoal, germanium, high resistance water, selected fermented herbal formulas, essential oil, acupressure and acupuncture as tolerated. The body may not tolerate any of these modalities and may get worse. This is especially prevalent if the body is close to or has reached its maximum retoxification level.

Recovery from retoxification reaction therefore is a very slow process and can take weeks to months. A lot of patience is required. One cannot push through this process quickly without risking backfire. A micro nutritional regiment may need to take a back seat temporarily and allow for adjustment accordingly. Some support may be needed, but it must be carefully matched with the state of the body’s clearance capacity at every point in time.

Everybody’s recovery speed and timeframe is different. Some trial and error is required even in the best of hands. Clinical experience is key, which is why most people who try to self-navigate through multiple retoxification reactions with a weak body usually fail to recover successfully from AFS but instead get worse over time.

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.