SCIENTIFIC FOUNDATION OF THE DETOXIFICATION METHOD DEVELOPED BY HUBBARD

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Scientific Foundation of the Detoxification Method Developed by Hubbard

The detoxification program developed by L. Ron Hubbard was designed to mobilize and enhance the elimination of fat-stored xenobiotics. The Hubbard program was specifically developed to reduce levels of drug residues but has proven to be applicable to the reduction of other fat-stored compounds. The program has gained widespread support due to its effectiveness and the fact that it is well supported by the medical literature. Each component of the program is in alignment with current research on the mobilization of fat stores and the facilitation of toxin elimination.

The Rationale for Detoxification:One hypothesis for the efficacy of the detoxification regimen is the reduction of persistent toxic chemicals in body tissues. An alternative or complementary hypothesis is that the method of detoxification is a rehabilitative intervention, assisting the body to regain homeostasis, healing residual damage after the original xenobiotics are eliminated. This would be detoxification in the broad sense of “removing the effects of a toxin.” An ideal treatment would function as an antidote to the exposures 32; for instance, supplemental niacin has been found to reduce the toxicity of paraquat 33. Restorative therapeutic measures utilized in the Hubbard regimen, including exercise, heat, sweating along with key nutritional supplements including anti-oxidants, may reduce pain, fatigue and inflammation, and improve function.

Many xenobiotics are persistent because they are lipophilic and sequester in adipose tissue34; resist biotransformation34; are deposited in tissues such as bone35; have affinity for components of endogenous molecules such as enzymes36; are sequestered in lysosomes 37; combinations of the above; or other unidentified kinetics 12. The Hubbard program, empirically developed in 19783, is designed to gradually increase the rates at which the body can both mobilize and excrete lipophilic and other xenobiotics, in combination with several components that promote healing of body processes. A precise regimen described elsewhere 38, it combines gradually increasing doses of niacin, 20 to 30 minutes of aerobic exercise, two to four hours of sweating in a moderate temperature sauna, electrolytes, polyunsaturated oils and multivitamins/minerals to support the process itself and for biochemical repair. The standardized regimen is done daily for an average length of 33 days, taking into account individual needs. It has been found by those administering it regularly that altering the elements of the regimen will slow or prevent the benefits. There is a substantial body of supportive literature for each of the elements of the regimen.

Specific Elements of the Detoxification Method:

Niacin (Vitamin B3):Niacin administration is a vital component. The following is a summary of niacin’s functions that may account for its benefit.  Niacin affects adipocytes, initially inhibiting lipolysis for one hour, then causing a dramatic increase in free fatty acid (FFA) release from adipose tissue for over 24 hours39 40,41. Release of free fatty acids has been shown to be accompanied by a release of fat-stored toxins in animal studies,42,43 as well as of  PCBs in human studies after weight loss44. Xenobiotics can then be distributed to hepatic enzyme biotransformation, and biliary or renal excretion processes. Also, prostaglandin D2 release causes vasodilation in the skin45,46, niacin potentially increasing movement of xenobiotics from deeper circulation through the dermal tissues for redistribution into sebum and/or into sweat gland. This normally relatively minor excretory route is increased with increased sweating in the sauna.

An equally important function of niacin, unrelated to potential mobilization of lipophilic chemicals, is the requirement for nicotinamide adenine dinucleotide phosphate (NADPH) in order to regenerate reduced glutathione (GSH) 47. Recent work with cultured human aortic endothelial cells found that niacin increased NADPH levels by 54% and GSH by 98%48. Additionally, niacin inhibits vascular inflammation by decreasing production of reactive oxygen species and inflammatory cytokines48. This in vitro work may explain some of the benefits of the Hubbard regimen, alleviating symptoms associated with inflammation such as pain. Niacin also was found to reduce the fibrinogen concentration in plasma and stimulate fibrinolysis in men49, which could improve a hypercoaguable state found in some Gulf War Veterans50.

Thirdly, more than 500 enzymes require niacin 51. In particular, niacin is required to maintain the co-enzymes nicotinamide adenine dinucleotide (NAD) and NADPH involved in biotransformation 52. NAD/NADPH concentrations in tissues can be increased with high dose niacin or niacinamide 53. NAD is the coenzyme for all dehydrogenase enzymes such as those for metabolism of alcohol, acetaldehyde and other xenobiotics. NADPH and GSH are required for biotransformation and elimination of many compounds, including foreign compounds such as drugs or contaminants 54. Glutathione detoxification pathways depend on availability of NADPH47, required to regenerate GSH. Thus if xenobiotic metabolizing enzymes are dependent on NAD/NADPH, there must be a continuous, adequate supply.

Fourthly, NADH is the major redox carrier in mitochondria and energy production fails if there is insufficient NAD. NAD is a substrate for repair of DNA strand breaks due to damage from xenobiotics55. Here is an intriguing possibility that directly links the benefits of niacin and recovery from exposure to xenobiotics.  Insufficient NAD could then result in local, intracellular failures in xenobiotic biotransformation as well as reduced availability of GSH. Xenobiotics may in fact set up intracellular pellagra (pellagra is a classic vitamin B3 deficiency disease characterized by dermatitis, diarrhea, and dementia) in susceptible tissues. This could be analogous to recent work showing that HIV infection induces a state of decreased intracellular NAD and nicotinamide referred to as intracellular pellagra56. Cognitive changes, rashes and pathogen free diarrhea, the cardinal features of pellagra, are found in patients with HIV infection, similar to symptoms of Gulf War Illness. Thus, it is possible that a nonpersistent xenobiotic could become ‘persistent’ if it sets up a local pellagragenic effect inhibiting the NAD(NADPH) redox and detox reactions necessary for its own metabolism. NAD/NADPH concentrations in tissues can be increased with high dose niacin 53. Such flooding of the affected tissues with niacin may allow detoxication steps to proceed. It is of note that many drugs are capable of inducing niacin deficiency or pellagra, including carcinogenic alkylating agents, izoniacid and other hydrazines, tricyclic antidepressants and the anti-convulsant carbamazipine57.

Fifthly, recent research has identified a wide array of signaling pathways that involve NAD and NADPH. Both NAD and NADPH represent precursors of intracellular calcium-mobilizing molecules which trigger muscle contraction, neuronal ion fluxes, catecholamine secretion, insulin secretion and T-cell activation52. A xenobiotic-induced intracellular depletion of NAD/NADPH could dysregulate key functions, and be restored by high doses of niacin as provided in the detoxification regimen.

Exercise:Twenty to thirty minutes of aerobic exercise, which may be low impact, is done at the beginning of each daily session, immediately after taking the daily dose of niacin. It is begun gradually depending on fitness level. Aerobic exercise results in doubling of adipose blood flow and a substantial post exercise lipolysis and lipid mobilization from adipose tissue beginning ~ 1 hr post exercise and continuing ~ 3 hrs 58. Mobilizing free fatty acids has been shown to mobilize fat stored pesticides 42,43 and PCBs59 . “As reported by Kang the RAC report (2008), 35% of ill GWV said vigorous exercise made their symptoms worse, while 18% said light exercise made symptoms worse, but 16% found light exercise helpful. Thus the exercise component of the detoxification protocol will have to be provided at whatever level the veteran can find tolerable, and increased very gradually, as tolerated.

Sauna/sweating: The tradition of sauna use is very old, especially in northern latitudes. Sweating is promoted for 2.5 to 4.5 hours daily in a well-ventilated Finnish style sauna 60, with short breaks for hydration, cool showers 61 and electrolyte replenishment as needed to offset losses. The sauna temperature is moderate, from 140’ to 180’F, which is lower than that used in health clubs, and is well tolerated. Physiologic effects have been well described in the literature. The sauna is a form of heat stress whereby the increased thermal load activates heat loss mechanisms including increased circulation through the skin and sweating62. The blood flow to the skin increases from a baseline of 5-10% to 60-70% of the cardiac output 63. Maximal sweating occurs within 15 minutes and the fluid loss may be as high as 2 liters per hour in an acclimatized person 64. Sweating is mediated by the hypothalamus and is associated with an increase in noradrenaline 65,66. Recent research has reported that sauna therapy improves endothelial dysfunction in subjects with hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking 67. The sauna has been found to be safe for persons with stable coronary heart disease, and may lower blood pressure in persons with hypertension and improve congestive heart failure68,69.

Phamacokinetic effects have been minor for the orally administered drugs which have been studied (e.g. midazolam, ephedrine, propranolol and tetracycline). Systemic absorption of subcutaneously administered drugs (insulin) is increased 70. Only two published observational articles were found on use of the sauna as a sole modality to detoxify or to enhance elimination of xenobiotics. One described elimination of mercury via sweat for mercury exposed workers 71 and the other, in Russian, stated “sauna increased excretion with sweat fluid of toxic substances (lead, thiuram, captax, sulphenamide C) that penetrated the body during work” 72. Lipophilic contaminants such as PCBs and dioxins have been identified in sebum 73,74 and numerous xenobiotics have been identified in sweat including heavy metals 71,75, antibiotics 76, cocaine and heroin 77 , and other drugs of abuse 78. Some loss of toxins via sweat is thus probable, given sufficient sweating, if these can be mobilized from tissue storage compartments. Water, electrolytes and trace elements lost during exercise plus sweating must be appropriately replaced 79,80.

Sweat is frequently reported as black or colored during the regimen, for instance in approximately 30 percent of all World Trade Center cases (personal communication New York Rescue Workers Detoxification Project physician, Dr. Gelb). A published case report of a worker exposed to soot and ash from cleaning filters from an oil-fired generator found she exuded an oily black substance from her skin for 3 weeks during treatment with the sauna detoxification protocol 81 (author’s note: this was later analyzed and found to be a 12-carbon chain terpene). A published case report of a highly PCB exposed woman with severe symptoms including chloracne was determined to have a PCB content of 66 ppm (total of 17 congeners) measured in exuded skin lipids82.

Supplemental Polyunsaturated Oils :Two or more tablespoons of a cold-pressed blend of walnut, peanut, soy, and safflower oils along with lecithin as a source of phosphatidylcholine are provided daily. Walnut and soy oils are rich in omega-3 fatty acids, while safflower, soy and peanut oils are rich in omega-6 fatty acids. Oils have 3 roles: (1) early animal trials with mineral oil 83 and later human trials with the sucrose-polyester olestra84 enhanced gut excretion of lipophilic toxins. Polyunsaturated oils present in the gut can act to prevent re-uptake of xenobiotics being eliminated through bile (which may be reabsorbed via enterohepatic recirculation) as well as enhance passive diffusion across the intestinal mucosa 34. (2) Dietary fats can induce modifications in membrane lipid composition that are associated with changes in the rates of membrane-linked cellular processes 85. (3) It has been recently shown that an oily meal that increases triglyceride levels will draw the lipophilic compound DDT from peripheral tissues into the blood compartment 86. In those cases where allergies preclude the use of the stated blend of oils, others may be substituted, including olive oil.

Supplemental Micronutrients:Supplementation with vitamins, minerals, and electrolytes offsets losses due to sweating and provides amounts more than adequate for increased metabolic demand as well as for antioxidant protection. Presuming that the regimen is effectively mobilizing xenobiotics, induction of the cytochrome P450 enzymes could potentially contribute to chemical toxicity. It is vital to protect against toxic effects and reactive oxygen species via an antioxidant defense system that is fully functional and includes enzymes, antioxidants and free radical scavengers, together with the antioxidant vitamins C, E and A, and trace elements iron, zinc, magnesium, selenium, copper, and manganese. The individual components get utilized and require replenishment 87-90. Vitamins and minerals in the regimen are administered in a five-stage schedule based on the dose of niacin, which gradually increases.

Preliminary Data on the Hubbard Sauna Detoxification Regimen:Early uses and studies of the Hubbard sauna detoxification method addressed such persistent lipophilic xenobiotics as PCBs, PBBs, DDT and HCB, showing both reduction in adipose or serum levels, and reduction in symptoms. Later studies included outcome measures such as neurobehavioural tests and functional status/quality of life measures such as the SF-36.

Efficacy Studies:  (1) Reductions in body burdens of lipophilic xenobiotics:  It has been demonstrated in several trials that the regimen does reduce body burdens of several persistent organohalides. Importantly, these xenobiotics may be mere markers for others, or for a composite effect that has not per se been measured. There is no straightforward correlation between particular chemicals and particular symptoms. However, it has been demonstrated that the regimen is indeed a detoxification process, as detailed in Table 1.
Table 1: Reduction of Body Burden

 

Study Sample Organohalide Tests Key Findings Comments
Schnare, 198491 Healthy males (n=7) age 20-30 Adipose levels of 6 PBB congeners, 7 PCB congeners, DDE, heptachlor epoxide and dieldrin pre, post and at 4-month post treatment follow-up Reduction total PBBs of 34% and total PCBs of 34% (p<0.05) with 58% at and 38% at follow-up (p<0.01). Persistence in humans of PBBs well established. Lean body mass before and after showed a 0.45% reduction in body fat(n.s.), demonstrating true body burden reductions rather than compartment shift.
Schnare, 198692, Healthy male electrical workers (n=10) with ongoing occupational exposure to HCB and  PCBs, treated (n=5), matched controls (n=5) Adipose, serum and skin oil levels of HCB, 5 chlorinated pesticides and 9 PCB congeners pre, post and at 3-month follow-up. Participant serum levels measured at 4 day intervals during treatment. Adjusted for re-exposure as represented in the control group, HCB body burdens were reduced by 30% post and 28% at 3 months. Mean reduction of PCBs was 16% post and 14% at 3 months. 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. Lack of increase in serum levels during treatment suggests mobilization keeping pace with excretion.
Tretjak,199093 Symptomatic male capacitor workers (n=11) and male matched co-workers as controls (n=13) with high exposures to PCBs in Semic, Yugoslavia Adipose and serum levels of 18 PCB congeners, before, after and at 4-month post treatment follow-up. Adipose levels ranged from 22-562 ppb in serum and 2-77 ppm in fat. For 6 treatment group A adipose PCBs decreased 30% (n.s.) and serum PCBs 42% (p<.05). Improvement in chloracne, rashes, dry thickened skin, conjunctivitis and eyelid swelling. Treatment group composed of 2 sub-groups, one (B) of which had concomitant disease which had less adipose reduction. Exposure levels were high and all participants had long term symptoms of poor health.
Tretjak, 199082 Case report female capacitor worker highly exposed to PCBs PCBs in adipose, serum, skin oils and nipple discharge. Adipose 102 ppm reduced to 37 ppm; serum 512 ppm reduced to 261 ppm; skin lipids measured 66 ppm; nipple discharge 712 ppm – ceased during treatment. Multisymptom illness resolved at end of treatment.
Dahlgren, 200794 Personnel (n=7) exposed due to the collapse and subsequent fire of the World Trade Center (WTC) September 11, 2001. Serum PCBs and dioxins 23.4% mean reduction by weight (lipid based) of all halocarbons. WHO-TEQ for mono-ortho PCBs was decreased by 24.4%.

 

 (2) Symptoms, function and quality of life:  Neurocognitive tests were assessed in 3 studies with consistent and significant improvements. (See Table 2.) The first (1982) study of the program included 2 neurobehavioral tests. On the Wechsler Adult Intelligence Scale IQ there was a mean increase in of 6.7 points (p<0.001). On the Minnesota Multiphasic Personality Inventory profiles decreased on most scales with large reductions on scale 3 and 4 (p<0.01)38. In 1989 a peer reviewed study of 14 firemen who had been exposed to PCBs and byproducts at a transformer fire and explosion had poorer neurocognitive test scores than control firemen from the same city95.

Table 2: Symptom Improvement

Study Sample Tests Key Findings Comments
Schnare, 198238 Group with mixed exposures including illicit drugs (n=103) and controls (n=19). Wechsler Adult Intelligence Scale IQ and Minnesota Multiphasic Personality Inventory On the Wechsler Adult Intelligence Scale IQ there was a mean increase in of 6.7 points (p<0.001). On the Minnesota Multiphasic Personality Inventory profiles decreased on most scales with large reductions on scale 3 (hysteria) and 4 ( amoral, asocial) (p<0.01).
Kilburn, 198995 Firemen exposed to PCBs and byproducts in a transformer fire and explosion (n=14) poorer neurocognitive test scores than non exposed matched firemen (n=14) from the same city Neurobehavioural test battery before and after protocol: memory, cognitive and perceptual motor speed via stories, visual images, & digits backwards, block design, embedded figures, Culture Fair, trail making and choice reaction time. Following treatment memory tests were improved. For both stories and visual reproduction, Trails B, a cognitive and motor performance test, and cognitive functions measured by block designs and embedded figures improved significantly (p<0.05), and the improvement in Culture Fair was just short of significant. Impairment in memory and cognitive function compared to controls had been protracted and was tested 6 months after exposure in the fire.
Tsyb, 199896 Males aged 20 to 40 yrs (n=24) randomly selected from a cohort with confirmed body burdens exceeding levels of 5,000 kilobecquerel (kBq) of radioactive cesium, residents in radiation contaminated Chernobyl district. Diagnostic psychological evaluations (including both objective and subjective evaluations of self-perception, activity, moods, and emotional reactions) were conducted. Evaluation of psychosocial states revealed a significant (p<0.05) positive change in the psychoemotional status of the program participants. Anxiety decreased from 23.48% to 9.09%, activity and ability to work increased from 40.9% to 46.96% and from 60.24% to 80.36%, respectively. It was stated that the HM “possesses a powerful psychotherapeutic potential that has been associated with significant improvement in the general health of the participant with increases in physical and mental endurance, activity level and resistance against stress.”
Unpublished, 2009 Rescue workers and individuals exposed to the WTC collapse/fire results from before and after HM (n=188) and at 6-month follow-up (n=25)  RAND SF-36 Substantial improvement in all domains of health related quality of life as measured by the RAND SF-36 after HM (n=188) and at 6-month follow-up (n=25) ( p <0.001) when comparing before/after scores.
Ross, 201297 Police officers (n=69) exposed to clandestine methamphetamine lab and related compounds during line-of-duty activities. Medical exam, SF-36, neurotoxicity score, symptom scores All SF-36 mean mean post-treatment scores were higher compared with mean pre-detoxification health scores

(p < 0.001); Substantial improvements were seen in the symptom scores and neurotoxicity scores (p < 0.001). The detoxification protocol was well tolerated, with a 92.8% completion rate.

 

Following detoxification memory tests were improved, both for stories and visual reproduction. Trails B, a cognitive and motor performance test, and cognitive functions measured by block designs and embedded figures also improved significantly (p<0.05), and the improvement in Culture Fair was just short of significant95.

In the 1998 report of the study of Chernobyl exposed residents, evaluation of psychosocial states revealed a significant (p<0.05) positive change in the psycho-emotional status of the program participants. Anxiety decreased from 23.48% to 9.09%, activity and ability to work increased from 40.9% to 46.96% and from 60.24% to 80.36%, respectively. It was stated that the program “possesses a powerful psychotherapeutic potential that has been associated with significant improvement in the general health of the participant with increases in physical and mental endurance, activity level and resistance against stress.” 96.

(3) Quality of life:SF-36:  Health-related functional status on 8 domains impacting quality of life was measured by the RAND SF-36 in persons exposed to the WTC collapse/fire results from before and after detoxification (n=188) and at 6-month follow-up (n=25) with p <0.001 when comparing before/after scores for all health categories (unpublished data).97.

(4) Symptom scores:  A case series of WTC Rescue Workers intervention cohort8 reported clear improvement in scores (see above) on symptoms and the SF-36 before and after the detoxification intervention. This cohort, now comprising over 900 New York firemen policemen, EMTs, paramedics and other WTC first responders, has similarities to the Gulf War cohort in that there was a complex exposure to multiple chemicals, with chronic sequelae in a significant proportion of the exposed.  Although the impact was predominantly respiratory from inhalation of smoke and highly alkaline dust, other systems/functions besides respiratory including neurocognitive, musculoskeletal and immune were also affected, and became persistent in a substantial proportion of the more highly exposed 98.

 

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