Last summer, I stumbled onto a research paper indicating that HDAC inhibitors might help repair and protect GABA receptors. That fascinated me. Since then, I’ve been on a quest to discover three things: what causes benzodiazepines to damage some, but not all, what exactly is the nature of that damage, and how to best repair that damage. It’s been quite a journey—frustrating and exhausting at times. I’m making headway, though.

It is the gut microbiome and the function of detoxification that I am most curious about when it comes to benzodiazepine damage. Even though the damage is believed to be down-regulated GABA receptors, something allowed that damage to occur. Is a gene mutation responsible? Perhaps. But I think there is more to the story. I believe that some of the withdrawal symptoms are tied to an unhealthy gut and sluggish detoxification process. 

Our liver does a fantastic job of breaking down the bad guys in our bodies. Detoxification occurs in three phases, Phase 1, Phase 2, and elimination, which starts in the liver and then heads out to either our urination or defecation processes. The phases are essential yet can be faulty due to genetics, medications, stress, toxins, etc. Research shows that cancers, Parkinson’s, fibromyalgia, chronic fatigue, autoimmune disorders, immune dysfunction, insomnia, brain fog, aches, pains, etc., may be caused by defective detoxification. 

Phase 1
Phase 1 of detoxification uses a group of enzymes referred to as CYP, the cytochrome P450 family. These enzymes protect our cells from damage by breaking down toxins into smaller substances for future detoxification and making fat-soluble toxins more water-soluble to enter Phase 2.

Benzodiazepines such as Valium and Ativan use the CYP pathway. (Ativan and Klonopin use a different path). Phase 1 is called into action by the presence of toxins and is also activated in a positive way by:

  • Herbsmilk thistle, sassafras, caraway, and dill
  • Citrus: tangerines and oranges (grapefruit shuts down Phase 1)
  • Vitamin C rich foods like strawberries and bell peppers
  • Cruciferous veggies (also called Brassica): Brussel sprouts, broccoli, cabbage, cauliflower, collard greens, kale, and turnips, broccoli sprouts 
  • Vitamins: C and most of the Bs
  • Lipotropics: compounds that break down fat in metabolism (cysteine, methionine, choline, and inositol)
  • Minerals: magnesium and iron

Note that Phase 1 detoxification creates free radicals. Eating extra helpings of foods that are antioxidants is essential. Foods high in polyphenols are a good idea: berries, grapes, apples, cherries, and pears. Foods high in flavonoids such as tea, citrus fruits, apples, and legumes are important too.
A quick list of nutrients needed for proper Phase 1 detoxification: 

  • B2
  • B6
  • B9 (folate)
  • B12
  • Glutathione
  • Branched Chain Amino Acids
  • Flavonoids
  • Phospholipids 

Phase 2 of detoxification
There are several pathways for detoxification for Phase 2: Sulphation, glucuronidation, glutathione conjugation, methylation, acetylation, and glycation. Except for Klonopin, which is broken down through acetylation, most commonly prescribed benzodiazepines go through glucuronidation. During glucuronidation, the liver attaches another molecule to chemicals to make them less harmful. 

Several foods that support Phase 2 glucuronidation are:

  • Cruciferous veggies (high in sulforaphane), broccoli sprouts.
  • Some citrus fruit peels (limonene).
  • Rooibos tea.
  • Astaxanthin in algae. 

Phase 3
The third phase of the detoxification process is the elimination of toxins. In this phase, Phase 2 matter is routed to your kidneys for more filtration then on to your bladder and out of your body through urination, or through your bile and into your small intestine, down through your GI tract for removal in your stool.

You need proper hydration for both urination and defecation. You also need a healthy gut microbiome so that your GI system is working optimally for appropriate elimination.

The Gut Microbiome
I’ve been in a class taught by Dr. Will Bulsiewicz, a leading gastroenterologist and New York Times best-selling author. (Fiber Fueled is his book.) His research into the gut microbiome blows my mind. Who knew that our bodies are home to 39 trillion (that’s the equivalent to 100 galaxies!) living microbes in our gut? And those microbes need food, just like you and me. What do they eat, you ask? Plants! Or, more specifically, plant fiber. Why should we care about their diet? Because when we feed them properly, they release short-chain fatty acids (butyrate, acetate, propionate), and you *want* short-chain fatty acids! They are potent healers. 

If we don’t properly feed the microbes, we will experience dysbiosis, an overgrowth of the “bad guys” microbes, and end up with not enough beneficial “good guys” bacteria. Stress, trauma, medications, toxins, lack of exercise, alcohol, etc., are also drivers of dysbiosis. (If we think about the stress of benzo withdrawal, the drug, the lack of exercise, “benzo belly,” and our often unhealthy eating in withdrawal, we can surmise that many have dysbiosis.) Dysbiosis causes toxins to enter the bloodstream and damages the protective blood brain barrier. It also negatively impacts the immune system, nervous system, creation of hormones, neurotransmitters, etc. 

The research shows our health rests on the health of our gut microbiome, as it is intertwined with our primary body functions. Heal your gut, and you are on the road to healing your brain, nervous system, immune system, etc. We must fuel the gut with what it prefers, what truly nourishes it, so that it can protect and heal our body. When we are properly nourished, the miraculous process of our body’s defense against toxins, Phase 1, 2, and the third phase of elimination, occurs correctly.

If you are concerned about your detoxification pathways and gut health, you may want to consider working with a medical professional who is trained in these areas. Ask if they are knowledgeable about the gut microbiome and how to test for impaired detoxication pathways. 

It’s not a good idea to attempt a DYI liver detox, bowel cleanse, or to begin taking a lot of supplements. It is, however, a good idea to eat a wide variety of plants while reducing animal products, sugar, additives, chemicals, preservatives, colorants, and processed foods. A whole-food, plant-based diet is best for our gut and detoxification pathways. Supplements can help, but due to the nature of our nervous system during benzo withdrawal, we need to be careful with them. If you start a supplement, take less than the recommended dose and work your way up. (If you take more than a few supplements, there is no way to know how they are working with one another, and the effects on your body.)

I’ll end on an exciting note: I am communicating with a doctor researching the role of detoxification in benzo withdrawal. I’ll keep you posted with any lab work or ideas he shares that are helpful to the benzo community. I’ll continue my passionate pursuit of the answers to the questions, why do benzodiazepines harm some but not all, what is the exact nature of that harm, and how can we heal that damage as quickly as possible. 

From my heart to yours,