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Niacin for Detoxification: A Little-known Therapeutic Use

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Abstract

Niacin (nicotinic acid) has a number of well-established clinical uses and the potential for additional clinical applications. To date, its therapeutic application for enhancing detoxification has not been systematically reviewed. The use of niacin for the purpose of enhancing detoxification was popularized by L. Ron Hubbard (i.e., the founder of the Church of Scientology) in 1977. He developed a comprehensive detoxification method using niacin and other treatments to remove lipid-stored xenobiotics. Niacin is also used among individuals attempting to mask urine drug screens; presumably, a result of its favourable therapeutic effect upon liver detoxification. All pub-lished reports using niacin as part of a detoxification regimen are summarized in this manuscript, along with several reports of attempts to misuse niacin to mask urine drug testing. The results demonstrate that niacin, as a component of the Hubbard regimen, does augment detoxification by lowering the body burden of lipid-stored xenobiotics. With respect to niacin's role in masking the results of urine drug testing, the data from several published reports have not shown niacin to be capable of this.
Review Article
JOM Volume 26, Number 2, 2011 85
Niacin for Detoxication: A Little-known
Therapeutic Use
Abstract Niacin (nicotinic acid) has a number of well-established clinical uses and the potential
for additional clinical applications. To date, its therapeutic application for enhancing detoxification
has not been systematically reviewed. e use of niacin for the purpose of enhancing detoxification
was popularized by L. Ron Hubbard (i.e., the founder of the Church of Scientology) in 1977. He
developed a comprehensive detoxification method using niacin and other treatments to remove
lipid-stored xenobiotics. Niacin is also used among individuals attempting to mask urine drug
screens; presumably, a result of its favourable therapeutic effect upon liver detoxification. All pub-
lished reports using niacin as part of a detoxification regimen are summarized in this manuscript,
along with several reports of attempts to misuse niacin to mask urine drug testing. e results
demonstrate that niacin, as a component of the Hubbard regimen, does augment detoxification by
lowering the body burden of lipid-stored xenobiotics. With respect to niacin’s role in masking the
results of urine drug testing, the data from several published reports have not shown niacin to be
capable of this.
Introduction
Niacin (nicotinic acid) has a number of
well-established clinical uses and the poten-
tial for additional clinical applications. is
was recently the subject of a comprehensive
review by this author in a collaborative pa-
per, “Pharmacologic Use of Niacin.”1 While
numerous medical conditions (e.g., arthritis,
cancer, depression, dyslipidemia, migraine
and tension-type headaches, pellagra, and
schizophrenia) potentially benefit from nia-
cin supplementation, its therapeutic appli-
cation for enhancing detoxification has not
been systematically reviewed.
e use of niacin for the purpose of
enhancing detoxification was popular-
ized by L. Ron Hubbard (i.e., the founder
of the Church of Scientology) in 1977. He
developed a comprehensive detoxification
method using niacin and other treatments,
which he referred to as “e Sweat Program
to rid the body of fatty residues of d-lysergic
acid diethylamide.2 Because this regimen
took many months to complete, Hubbard’s
detoxification method was refined to pro-
duce quicker results in treatment duration of
about 2-4 weeks. e Hubbard regimen has
evolved into a comprehensive treatment that
removes lipid-stored xenobiotics containing
illegal drugs (e.g., cocaine, heroine, and mari-
juana), legal drugs (e.g., aspirin and codeine),
and chemicals used in the commercial, agri-
cultural, and industrial industries. e cur-
rent Hubbard regimen consists of aerobic
exercise, prescribed sauna therapy, dietary
modifications, general vitamin and mineral
Jonathan E. Prousky, ND, MSc1,2
1 Chief Naturopathic Medical Officer, Professor, Canadian College of Naturopathic Medicine, 1255 Sheppard
Avenue East, Toronto, Ontario, M2K 1E2, Tel: 416-498-1255 ext. 235, email: jprousky@ccnm.edu
2 Editor, Journal of Orthomolecular Medicine, email: editor@orthomed.org
Journal of Orthomolecular Medicine Vol 26, No 2, 2011
86
supplementation, polyunsaturated oils sup-
plementation, and niacin. e overarching
mechanism of action of the Hubbard regi-
men is to enhance extra-renal excretion by
sweat or sebum, and to reduce problematic
clinical manifestations believed to be associ-
ated with lipid-stored xenobiotics.
Niacin is also used among individuals
attempting to mask urine drug screens; pre-
sumably, a result of its favourable therapeu-
tic effect upon liver detoxification. A simple
search on Google using the terms, “niacin”
and “masking urine drug testing,” resulted in
911,000 links (on May 12, 2011). In their
editorial on the subject, Heard and Mendoza
delineate their concerns, including potential
toxicities, when niacin is used for the pur-
poses of masking urine drug screens.3
is article will focus on published stud-
ies and reports describing the use niacin for
stimulating detoxification, and on attempts to
misuse niacin to mask urine drug testing. e
findings will be summarized in tabular form.
Methods
A search for articles describing the uses
of niacin for detoxification and masking urine
drug screens was undertaken. To be included
in the final review the articles had to (1) re-
port on the use of niacin for detoxification, or
for masking urine drug screens, either alone
or in combination with other medicines; and
(2) describe the method of administration. A
hand search was also conducted for articles not
indexed in databases, such as Medline. Twelve
articles were found to meet the inclusion cri-
teria and were included in this review.4-15 Nine
articles reported on the benefits of niacin as
part of a detoxification program to eliminate
fat-stored xenobiotics.4-12 ree articles re-
ported on the misuses of niacin to mask the
results of urine drug testing.13-15
Results
e number of published reports is in-
sufficient to warrant a meta-analysis. As
such, all published reports using niacin as
part of a detoxification regimen, and to mask
the results of urine drug testing, are summa-
rized in Tables 1 and 2 (p.89-92).
Discussion
e results of this review demonstrate
that niacin, as a component of the Hubbard
regimen, does augment detoxification by low-
ering the body burden of lipid-stored xeno-
biotics. e daily doses of niacin used during
treatment were not typically reported in the
summarized studies. In one study, the range
used on adults was 800-6,800 mg/day (aver-
age being 3,285 mg/day) during treatment.4
For a child in one of the reported studies,
the dose of niacin used during treatment was
25-212 mg/day.10 While the precise mecha-
nism of action that niacin has upon liver de-
toxification has yet to be elucidated, several
possibilities do exist. Niacin might facilitate
the elimination of lipid-stored xenobiotics
as a result of its therapeutic effect upon free
fatty acids. e initial reductions in liver-
mobilized free fatty acids from taking niacin
are followed by short-lived increases in the
release of free fatty acids from the liver.16,17
When niacin is combined with other thera-
pies that facilitate extra-renal excretion (as in
the Hubbard regimen), the niacin-induced
release of free fatty acids might therefore lib-
erate lipid-stored xenobiotics from the liver
and allow their removal through the skin.
Niacin supplementation also increases
the production of nicotinamide adenine
dinucleotide phosphate (NADPH), which
supports both phase I and II detoxification
(i.e., biotransformation) pathways within
the liver.18 e phase I pathway is composed
mainly of the cytochrome P450 (CYP450)
supergene family of enzymes, and is by and
large the first enzymatic defense against for-
eign compounds.19 NADPH serves as the
main donor of reducing equivalents in xe-
nobiotic oxidations by the CYP450 system,
and therefore serves a vital role in the phase I
pathway.18,19 NADPH also supports the glu-
tathione redox cycle within the liver. is has
a net effect of maintaining a negative redox
potential of glutathione, permitting its phase
II functions to occur.18 e phase II path-
way essentially transforms a xenobiotic into
a water-soluble compound that can be ex-
creted through the urine or bile.19 Impaired
detoxification is associated with diseases,
87
Niacin for Detoxification: A Little-known Therapeutic Use
such as Parkinson’s disease, fibromyalgia, and
chronic fatigue/immune dysfunction.19 One
of the advantages of the Hubbard regimen (as
reported in many of the cited publications)
was an improvement, and sometimes com-
plete clearing of chronic symptoms reflective
of xenobiotic burden. e evidence therefore
seems to support niacin’s therapeutic role, and
the other treatments of the Hubbard regimen,
in normalizing or perhaps optimizing the de-
toxification pathways in the liver.
Outside of liver detoxification, the cu-
taneous skin reactions produced by niacin
likely contribute to the removal of lipid-
stored xenobiotics. Niacin causes peripheral
vasodilatation and cutaneous flushing by in-
ducing the production of prostaglandin D2
(PGD2) in the skin, leading to a marked
increase of its metabolite, 9α, 11β-PGF2, in
the plasma.20 When niacin is administered
orally in amounts of 500 mg or topically via
a 6-inch patch of 10-1 M aqueous methyl-
nicotinate on the forearm, PGD2 is mark-
edly released in the skin and its metabolite
appears in high amounts in the plasma.20,21
With increased peripheral vasodilatation,
there would presumably be increased blood
flow to the skin. When niacin is therefore
combined with the other treatments in the
Hubbard regimen, there would be enhanced
diaphoresis and removal of lipid-stored xe-
nobiotics through the skin or sebum.
With respect to niacin’s role in mask-
ing the results of urine drug testing, the
data from several published reports have not
shown niacin to be capable of this. Not one
individual has been able to “fool” urine drug
testing by taking niacin. e only unfortu-
nate outcome has been adverse drug reaction
reports since the cutaneous flushing and pe-
ripheral vasodilatation that result from nia-
cin require proper education and guidance
prior to use. When individuals take niacin
without proper instruction, they and their
unknowing clinicians believe these overt
reactions to be evidence of serious adverse
drug reactions.
First-time users of niacin typically expe-
rience marked skin warming (the medically-
harmless niacin flush) which can last for 30
to 60 minutes and seem unpleasant, surpris-
ing and even unsettling to the point that
people may think they are having a severe al-
lergic reaction. e take home message here
is simple: niacin cannot mask the results of
urine drug testing, but it can easily lead indi-
viduals to seek emergency care for cutaneous
reactions that are normally self-limiting and
without serious clinical consequences.
Conclusion
Published reports about using niacin as
part of the Hubbard regimen suggest that
therapeutic doses of niacin can facilitate de-
toxification by reducing the burden of lipid-
stored xenobiotics. ree reports have not
shown niacin to be capable of masking the
results of urine drug testing. Niacin might
help to remove lipid-stored xenobiotics by
inducing the release of free fatty acids from
the liver, by supporting phase I and II de-
toxification pathways, and/or by cutaneous
reactions and peripheral vasodilatation that
increase diaphoresis. Future analysis and re-
search into the capabilities of niacin to en-
hance the body’s detoxification capabilities
may clarify niacin’s mechanism of action and
encourage the further refinement of detoxi-
fication protocols.
Acknowledgements
I thank Mr. Bob Sealey for his helpful
editing suggestions and input on the con-
tents of this paper.
Competing Interests
e author declares that he has no com-
peting interests.
References
1. Prousky J, Millman CG, Kirkland JB: Pharmaco-
logic use of niacin. JEBCAM, 2011; 1: 1-11.
2. Hubbard LR: Clear Body Clear Mind. Los Ange-
les, CA. Bridge Publications, Inc. 2002; 13-75.
3. Heard K, Mendoza CD: Consequences of at-
tempts to mask urine drug screens. Ann Emerg
Med, 2007; 50: 591-592.
4. Schnare DW, Denk G, Shields M, et al: Evalua-
tion of a detoxification regimen for fat stored xe-
nobiotics. Med Hypotheses, 1982; 9: 265-282.
5. Schnare DW, Ben M, Shields M: Body burden
reductions of PCBs, PBBs and chlorinated pesti-
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6. Schnare DW, Robinson PC [abstract]: Reduction
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7. Kilburn KH, Warsaw RH, Shields M: Neurobe-
havioral dysfunction in firemen exposed to poly-
chlorinated biphenyls (PCBs): possible improve-
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8. Tretjak Z, Shields M, Beckmann SL: PCB reduc-
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man contamination and detoxification: medical
response to an expanding global problem. Environ
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10. Wisner RM, Shields M, Beckmann SL: Treat-
ment of children with the detoxification method
developed by Hubbard. Proceedings of the American
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Diego, CA. 1995.
11. Tsyb AF, Parshkov EM, Barnes J, et al: Rehabili-
tation of a Chernobyl affected population using a
detoxification method. Proceedings of the 1998 In-
ternational Radiological Post-Emergency Response Is-
sues Conference. Washington, DC. 1998.
12. Cecchini MA, Root DE, Rachunow JR, et al:
Chemical exposures at the world trade center: use
of the Hubbard sauna detoxification regimen to
improve the health status of New York City rescue
workers exposed to toxicants. Townsend Lett Doc-
tors Patients, 2006; 273: 58-65.
13. Paopairochanakorn C, White S, Baltarowich L.
Hepatotoxicity in acute sustained-release niacin
overdose [abstract]. J Toxicol Clin Toxicol, 2001;
39: 516.
14. No author: Use of niacin in attempts to defeat urine
drug testing--five states, January-September 2006.
MMWR Morb Mortal Wkly Rep, 2007; 56: 365-366.
15. Mittal MK, Florin T, Perrone J, et al: Toxicity
from the use of niacin to beat urine drug screen-
ing. Ann Emerg Med, 2007; 50: 587-590.
16. Carlson LA, Orö L, Ostman J: Effect of a single
dose of nicotinic acid on plasma lipids in patients
with hyperlipoproteinemia. Acta Med Scand,1968;
183: 457-465.
17. Nye ER, Buchanon B: Short-term effect of nico-
tinic acid on plasma level and turnover of free fatty
acids in sheep and man. J Lipid Research, 1969; 10:
193-196.
18. Sies H, Brigelius R, Wefers H, et al: Cellular redox
changes and response to drugs and toxic agents.
Fundam Appl Toxicol, 1983; 3: 200-208.
19. Liska DJ: e detoxification enzyme systems. Al-
tern Med Rev, 1998; 3: 187-198.
20. Morrow JD, Parsons WG 3rd, Roberts LJ 2nd:
Release of markedly increased quantities of pros-
taglandin D2 in vivo in humans following the
administration of nicotinic acid. Prostaglandins,
1989; 38: 263-274.
21. Morrow JD, Awad JA, Oates JA, et al: Identifica-
tion of skin as a major site of prostaglandin D2
release following oral administration of niacin in
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89
Niacin for Detoxification: A Little-known Therapeutic Use
Table 1. Use of niacin as part of a detoxification regimen* to enhance the elimination of fat-
stored xenobiotics
4
5
6
Adult male volunteer
subjects having
samples of adipose
tissue taken pre- and
post-regimen, and 4
months post-regimen
Case series; 7 20
Average
number of
days on
regimen
Design;
sample size
Results Reference
Sample
Adult volunteer
subjects exposed
to recreational
(abused) and
medicinal drugs,
occupational, and
environmental
chemicals
Case-control
series; 103 pro-
vided regimen
and 19 controls
were not
Post-regimen patients with initial
hypertension had a mean
reduction in systolic blood
pressure of 30.8 mm Hg and
diastolic blood pressure of 23.2
mm Hg; post-regimen patients
had mean reduction in total
cholesterol of 19.5; post-regimen
improvements in various psycho-
logical test scores, and in a wide
range of unrelated medical
conditions (e.g., myopia, bursitis/
fibromyositis, and irritable bowel);
absence of improvements in various
psychological test scores
among subjects in the control
group; medical complications
occurred in < 3% of treated subjects
30.5 ±
16.2
Statistically significant
reductions in 7 of 13
organohalides post-regimen
(ranging from 3.5-47.2%);
mean reduction overall of
16 chemicals (21.3% ± 17.1);
and 4 months post-regimen
mean reduction overall of
16 chemicals (42.4% ± 17.1)
with 10 reductions being
statistically significant
Electrical workers
having samples of
adipose tissue taken
pre- and post-regi-
men, and 3 months
post-regimen
Case-control
series; unknown
how many
subjects in the
treatment group
and how many
subjects in the
control group
21 Hexachlorobenzene body burdens
were reduced by 30% at post-reg-
imen and by 28% 3 months post-
regimen; mean reduction of poly-
chlorinated biphenyl congeners was
16% at post-regimen and 14% at 3
months post-regimen; all reductions
were statistically significant
* Denotes a medically-supervised programme consisting of: physical exercise, forced sweating by sauna followed
by physical exercise, broad-spectrum vitamin supplementation, calcium and magnesium
Journal of Orthomolecular Medicine Vol 26, No 2, 2011
90
Average
number of
days on
regimen
Design;
sample size
Results Reference
Sample
7
Firemen exposed
to environmental
chemicals in a
transformer fire
given neuro-
physiological and
neuro–psycholog-
ical tests 6 months
after the fire and
6 weeks following
regimen
Case-control
series; 14 pro-
vided regimen
and 14 controls
were not
14-21 At 6 weeks post-regimen there
was reversibility of cognitive
impairment as demonstrated
by statistically significant
improvements in pre-regimen
scores on several neurobehav-
ioral tests (i.e., three memory
tests, block design, trails B,
and embedded figures); self-
appraisal scores for depression,
anger, and fatigue (that were
elevated pre-regimen) and
for vigour (that was reduced
pre-regimen) did not change
across the treatment period;
the control subjects were not
re-tested at study conclusion
and no statistical comparisons
were provided
Female worker
from a capacitor
factory exposed
to polychlorinated
biphenyls and
other lipophilic
industrial chemi-
cals
Case report; 1 23 8
9
Regimen reduced polychlorinat-
ed biphenyl levels in adipose tis-
sue and serum by 63% and 49%
respectively; nipple discharge
ceased and the symptoms
improved; the excretion of intact
polychlorinated biphenyls in
sebum was appreciable before
regimen and was enhanced by
up to five-fold during regimen
Adult subjects
with various envi-
ronmental and/or
industrial chemi-
cal exposures
Case series; 5 Unreported,
but likely
around 14-28
All patients had post-regimen
reductions in compounds
measured from adipose tissue
and blood; all patients had sig-
nificant resolution of numerous
physical and neuropsychiatric
complaints
Table 1. (cont’d) Use of niacin as part of a detoxification regimen to enhance the elimination
of fat-stored xenobiotics
91
Niacin for Detoxification: A Little-known Therapeutic Use
Average
number of
days on
regimen
Design;
sample size
Results Reference
Sample
Adults (both men
and women)
exposed to World
Trade Center con-
taminants
Case series; 484
(273 firefighters,
52 sanitation
workers, 19
paramedics, 23
police officers,
and 117 others)
Children (4-21 years
of age) who became
ill following known
chemical exposures
Case series; 18
Adult males (20-40
years of age) from
Chernobyl (i.e.,
radioactively con-
taminated areas)
Case series; 24
Unreported,
but likely
around 14-28
Around 14-21
33 (ranged
from 23-106
days)
Improvements post-regimen in
subjective symptoms, and percep-
tion of health; considerable reduc-
tions in days of work missed; 84%
of subjects were able to discontinue
their medications post-regimen; 72%
of the subjects needing pulmonary
medications became free of them
post-regimen and had improved
pulmonary function; statistically sig-
nificant improvements post-regimen
in thyroid function, various cognitive
function tests, and vestibular function
Marked post-regimen improvement
in the symptom profiles of all chil-
dren covering main body systems
(e.g., haematological, cardiovas-
cular, and gastrointestinal). On
follow-up 89% reported long-term
improvements
Positive changes in various immune
system parameters 1-year post-
regimen; normal levels of antioxi-
dants post-regimen and increased
levels (2-3 fold over baseline) when
assessed 1-year later; normal levels
of thyroid hormones when assessed
1-year later; no acceleration of
Cesium-137 elimination was found
during the regimen; statistically
significant changes in the psycho-
emotional status of all subjects
(anxiety decreased from 23.48% to
9.09%, activity increased from 40.9%
to 46.96%, and “ability to work”
increased from 60.24% to 80.36%);
9-months post-regimen chronic
diseases present at the start of the
study were essentially in remission
and an increased resistance to acute
respiratory diseases was noted
10
11
12
Table 1. (cont’d) Use of niacin as part of a detoxification regimen to enhance the elimination
of fat-stored xenobiotics
Journal of Orthomolecular Medicine Vol 26, No 2, 2011
92
Table 2. Misuses of niacin to mask the results of urine drug testing
Two patients (a 22 year-old
male and a 23 year-old
female) were abusers of
cocaine and marijuana and
demonstrated self-limiting
cutaneous reactions to
immediate-release niacin;
the remaining 2 patients
(a 14 year-old male and a
17 year-old female) had
severe reactions following
niacin, involving nausea,
vomiting, dizziness, and coag-
ulopathy; both patients had
initial hypoglycemia
that evolved into hyperglycemia,
and a high-anion-gap metabolic
acidosis; hepatic enzymes were
only elevated in the 14 year-old
male due to timed-release
niacin, who had marked
neutrophilia and was
subsequently misdiagnosed as
having diabetic ketoacidosis;
both patients improved during
several days in supportive care
Both patients ingested
sustained-release niacin
and developed increased
liver enzymes,
a mild coagulopathy,
and a high-anion-gap
metabolic acidosis;
all resolved within
72 hours of ingestion
Case series; 2 13
Adults experienced
adverse drug
reactions following
niacin ingestion
Sample Design; sample size Results Reference
Adults (15-50 years of
age) reported adverse
drug reactions
following niacin
ingestion
Data collection of adverse
reaction reports; 28 (8
used niacin to mask urine
drug testing; 10 possibly
used niacin for similar
reasons; and the remaining
10 offered no reason for
their niacin use)
The most common adverse
drug reactions were
tachycardia, flushed skin,
rash, and nausea;
13 patients were treated
at, or referred to a
health care facility; no
deaths were reported
14
Teenagers and Adults
experienced adverse
drug reactions follow-
ing niacin ingestion
Case series; 4 15
Chapter
Niacin (CAS: 59-67-6) is a water-soluble B vitamin required to form NAD⁺ and NADP⁺ in the body tissue. It is most often used as a nutritional supplement for the adjunctive treatment of dyslipidemia and niacin deficiency, known as pellagra. Most commonly, niacin has been known to induce acute vasodilation. Chronic megadoses have been associated with hepatotoxicity.
Article
Objectives: To report a case of hepatotoxicity when niacin was used by a patient with HIV to pass a drug test. Methods: Niacin is a soluble pyridine derivative widely used in the management of dyslipidemia. Common adverse effects include flushing, nausea, gastrointestinal discomfort, and hepatotoxicity. The use of niacin for nonmedical purposes has been increasing in prevalence in recent years, particularly in attempts to alter or mask results of urine drug tests. Although there is no scientific evidence that niacin can alter a urine drug screen result, easily retrievable information exists on the Internet touting niacin as a potential way to prevent detection of tetrahydrocannabinol (THC). The following report describes a case of hepatotoxicity in an HIV-infected adult who reported using niacin to mask THC in urine drug screen results. Results: The patient developed marked elevations in his liver enzymes (aspartate aminotransferase greater than 25 times the upper limit of normal and alanine aminotransferase greater than 3 times the upper limit of normal) that resolved after discontinuation of the drug. Because of the patient's self-reported use and discontinuation of niacin, the Naranjo Adverse Drug Reaction Probability Scale demonstrated a "definite" relationship between the development of hepatotoxicity and the ingestion of over-the-counter sustained-release niacin. The patient did not develop further clinical abnormalities proposed to be secondary to niacin toxicity in previously published case reports, including glucose abnormalities, coagulopathies, metabolic acidosis, QTc prolongation, and myalgias. Conclusion: Health care providers should be aware of this nonmedical use of niacin to alter or mask a drug test, especially when discerning the cause of hepatotoxicity. In addition, pharmacists in the community setting should be aware of this use of niacin when encountering patients purchasing over-the-counter niacin, particularly in patients who may be more likely to use illicit substances.
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With human exposure to environmental contaminants inevitable despite the best application of environmental laws and protection technologies, interest has grown in the potential to reduce the levels of contamination carried in the human host. This study demonstrates the promise of a comprehensive treatment for reduction of body burdens of polychlorinat ed and polybrominated biphenyis (PCB and PBB) and chlorinated pesticides. Adipose tissue concentrations were determined for seven individuals accidentally exposed to PBB. These patients underwent the detoxification treatment developed by Hubbard to eliminate fat-stored foreign compounds. Of the 16 organohalides examined, 13 were present in lower concentrations at post-treatmen t sampling. Seven of the 13 reductions were statistically significant; reductions ranged from 3.5 to 47.2 percent, with a mean reduction among the 16 chemicals of 21.3 percent (s.d. 17.1 percent). To determine whether reductions reflected movement to other body compartments or actual burden reduction, a post-treatment follow-up sample was taken four months later. Follow-up analysis showed a reduction in all 16 chemicals averaging 42.4 percent (s.d. 17.1 percent) and ranging from 10.1 to 65.9 percent. Ten of the 16 reductions were statistically significant. Future research stemming from this study should include further investigation of mobilization and excretion of xenobiotics in humans.
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Adipose-tissue concentrations of hexachlorobenzene (HCB), four other pesticides and 10 polychlorinated biphenyl congeners were significantly reduced by enhanced mobilization and excretion through the method developed by Hubbard. Electrical workers paired by age, sex and potential for polychlorinated biphenyl exposure were divided into treatment and control groups. Adipose-tissue concentrations were determined pre- and post-treatment, and 3 months post-treatment. Daily treatment was provided for 3 weeks, consisting of heat stress and niacin administration to enhance mobilization and polyunsaturated-oil administration to enhance excretion, with other components administered to provide protection from mobilized chemicals. Adjusted for re-exposure as represented in the control group, HCB body burdens were reduced by 30% at post-treatment and 28% 3 months post-treatment. Mean reduction of polychlorinated biphenyl congeners was 16% at post-treatment and 14% 3 months post-treatment. Analysis of variance indicates these reductions are statistically significant (f less than 0.001). Enhanced excretion appeared to keep pace with mobilization, as blood-serum levels in the treatment group did not increase during treatment. Post-treatment remission of symptoms associated with chemical exposure has been summarized according to reports from related studies.
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Cellular metabolism and, in particular, oxidation-reduction systems are linked to responses to drugs and toxic agents in several ways. Major connections are given by the NADPH/NADP system and the GSH/GSSG system. Intracellular reductive pathways generally use NADPH as the electron donor. From a toxicological point of view, NADPH can be considered both as a “detoxicant” and as a “toxicant”. In the former case, NADPH supports the glutathione redox cycle by maintaining a negative redox potential of GSH to permit its detoxication functions to occur. NADPH is also the main donor for reducing equivalents in drug oxidations by the cytochrome P-450-dependent monooxygenase system which, with some notable exceptions, serves important purposes in detoxication. The sources of NADPH reducing equivalents depend on the nutritional state: major sources in the fed state are represented by the cytosolic pentose phosphate shunt dehydrogenases, whereas mitochondrial sources linked to isocitrate dehydrogenase provide the bulk of NADPH reducing equivalents in the fasted state. As a “toxicant”, NADPH supports redox cycling reactions involving various drugs and other compounds of quinoid structure, aromatic nitro compounds and iron chelates with formation of superoxide anion radicals and subsequent formation of other oxygen derived radical species. This presentation focuses on recent work carried out with isolated hepatocytes and perfused rat liver with respect to “oxidative stress”. The noninvasive techniques of measurement of low-level chemiluminescence and of volatile hydrocarbons(ethane, pentane) as well as glutathione release and calcium release have been employed.
Article
1. A detoxification trial was administered to a female worker from a capacitor factory who had been exposed to polychlorinated biphenyls (PCBs) and other lipophilic industrial chemicals. 2. The patient presented with severe abdominal complaints, chloracne, liver abnormalities, and a spontaneous nipple discharge of approximately 50 ml d ⁻¹ . 3. PCB levels were high in adipose tissue (102 mg kg ⁻¹ ), serum, (512 μg 1-1), skin lipids (66.3 mg kg ⁻¹ ), and in the nipple discharge (712 μg I ⁻¹ ). 4. The patient's history, the medical evaluation and prior unsuccessful symptomatic treatments were indicative of consequences elicited by occupational exposure to chemicals. 5. Detoxification treatment reduced the PCB levels in adipose tissue to 37.4 mg kg ⁻¹ and in serum to 261 μg 1-1, a 63% and 49% reduction, respectively. 6. The nipple discharge ceased and the symptoms improved. 7. Excretion of intact PCBs in sebum was appreciable before treatment and was enhanced by up to five-fold during detoxification. 8. This therapeutic approach appears promising for cases involving occupational exposure to lipophilic chemicals.
Nicotinic acid (niacin) is a B which is also a potent hypolipidemic agent. However, intense flusing occurs following ingestion of harmacology doses of niacin which greatly limits its usefulness in treating hyperlipidemias. Previous studies have demonstrated that niacin-induced flusing can be substantially attenuated by pre-treatment with cyclooxygenase inhibitors, suggesting that the vasodilation is mediated by a prostaglandin. However, the prostaglandin that presumably mediates the flush has not bee conclusively determined. In this study we report the finding that ingestion of niacin evokes the release of markedly increased quantities of PGD2 in vivo in humans. PGD2 release was assessed by quantification of PGD2 metabolite, 9α 11β-PGF2, in plasma by gas chromatography mass spectrometry. Following ingestion of 500 mg of niacin in three normal volunteers, intense flushing occurred and plasma levels of 9α, 11β-PGF2 were found to increase dramatically by 800, 430, and 535-fold. Levels of 9α,11β-PGF2 reached a maximum between 12 and 45 min. after ingesting niacin and subsequently declined to near normal levels by 2-4 hours. Levels of 9α, 11β-PGF2 in plasma correlated with the intensity and duration of flushing that occurred in the 3 volunteers. Release of PGD2 was not accompanied by a release of histamine which was assessed by quantification of plasma levels of the histamine metabolit, Nτ-methylhistamine. The suggests that the origin of the PGD2 release is not the mast cell. Only a modest increase (approximately 2-fold) in the urinary excretion of the prostacyclin metabolite, 2,3-dinor-6-keto-PGF1α, occurred following ingestion of niacin and no increase in the excretion of the major urinary metabolite of PGE2 was found. These results indicate that the major vasodilatory PG released following ingestion of niacin is PGD2. The fact that markedly increased quantities of PGD2 are released suggests that PGD2 is the mediator of niacin-induced vasodilation in humans.
Article
Fourteen firemen exposed to polychlorinated biphenyls (PCBs) and their byproducts generated in a transformer fire and explosion had neurophysiological and neuropsychological tests 6 mo after the fire. They were re-studied 6 wk later after undergoing 2-3 wk of an experimental detoxification program consisting of medically supervised diet, exercise, and sauna. A case-control comparison with firemen matched from the same department, but who did not participate in controlling the transformer fire, had shown significant impairment of memory for stories, visual images, and digits backwards. Cognitive function was impaired for block design, identifying embedded figures, and design association and recognition using Culture Fair. Making of trails and choice reaction time, which measured cognitive function and perceptual motor speed, were also impaired. These signs of protracted neurobehavioral impairment were attributed to PCBs and heat-produced byproducts. No relationship, however, was found between the firemen's serum or fat levels of PCBs as Arochlor 1248 and their type or degree of neurobehavioral impairment. Retesting following the detoxification program showed significantly improved scores on: three memory tests, block design, trails B, and embedded figures. Thus, there was significant reversibility of impairment after the detoxification interval. However self-appraisal scores for depression, anger, and fatigue--which were initially elevated--and for vigor--which was reduced--did not change across this interval.