Science-Based Medicine: Happy New Year! Today’s post was some old material, dusted off, repackaged, and updated for 2015.
New Year, New You, right? We’re just into 2015, and you’ve resolved to finally get serious about your health. Starting today. But first need to cleanse yourself, eliminating last year’s lifestyle and dietary sins. You’ve seen the ads and the Facebook links, all suggesting you need a “detox”, “cleanse” or “flush” to be healthy. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths promise you a detoxified body. Amazon has entire detox and cleansing categories in supplements and books.
The descriptions all suggest detoxing will deliver a renewed body and better health – it’s only seven days and $49.95 away. Dr. Oz has several detox plans – you just need to decide which one. The local naturopath sells detoxification protocols, including vitamin drips and chelation. Even your pharmacy probably has a wall of products for sale. Wouldn’t a purification from your sins of 2014 be a good idea to start the year? Unfortunately, there’s something very important that detox promoters aren’t telling you.
“Detox” isn’t real
“Detox” is a legitimate medical term that has been turned into a marketing strategy – all designed to treat a nonexistent condition. Real detoxification isn’t ordered from a menu of alternative health treatments, or assembled from ingredients in your pantry. Actual detoxification is provided in hospitals under life-threatening circumstances – usually when there are dangerous levels of drugs, alcohol, or other poisons in the body. These are not products you can purchase in a pharmacy for personal use. What you’re seeing promoted as “detox” is using medical terminology, but only to give the perception of scientific legitimacy to medically-useless products and services. Fake detox is built around a number of easily-debunked premises. Once you can spot the flaws, it’s easy to tell fact from fiction.
Premise one: Our bodies are accumulating toxins, so we need to detoxify
There’s a reason we fall for the marketing of detoxification – we seem hardwired to believe we need it, perhaps related to our susceptibility to ideas of sympathetic magic. Purification rituals date back to the earliest reaches of recorded history. The idea that we’re somehow poisoning ourselves and we need to atone for our sins seems to be a part of human nature, which may explain why it’s still a part of most of the world’s religions. It’s not miasmas or perhaps sin that we’re as worried about today, however. As our knowledge of biology grew, these fears manifested as “autointoxication.” Clean out the bowels, went the theory, and you could cure any illness. Science discarded autointoxication by the 1900’s as we gained a better understanding of anatomy, physiology, and the true cause of disease. Yet the term persists today, but now it’s used to sell useless products and services. Today’s version of autointoxication argues that some combination of food additives, salt, meat, fluoride, prescription drugs, smog, vaccine ingredients, GMOs, and perhaps last night’s bottle of wine are causing a buildup of “toxins” in the body. And don’t forget gluten. Gluten is the new evil and therefore, is now a toxin. So what is the actual “toxin” causing you harm? Detox kits and treatments never name the toxins that they remove, because they’ve never been shown to remove toxins. For example, Renew Life promises you:
CleanseSMART is a 2 part, 30 day, advanced herbal cleansing program. It is formulated to stimulate the detoxification process of the body’s 7 channels of elimination: the liver, lungs, colon, kidneys, blood, skin, and lymphatic system. In today’s toxic world, cleansing and detoxification is a necessity. Toxins enter our body daily through the air we breathe, the food we eat, and the water we drink. Over time, these toxins build up and slowly start to affect our health in a negative way.
Through cleansing and detoxification, you enable your body to better process this toxic load. Reducing the toxic load in your body decreases the risk of developing chronic health problems, improves overall health and immune response, and can increase energy levels. CleanseSMART works to cleanse and detoxify the entire body, but with focus on the body’s two main detoxification pathways – the liver and the colon. CleanseSMART is essential for helping eliminate constipation and improving bowel health.
Note the vague language. Toxins are alluded to – but not named. It sounds somewhat plausible, but is non-specific. Note that even if you’re well (and presumably toxin free?) a detox is still recommended.
The colon remains ground zero for detox advocates. They argue that some sort of toxic sludge (sometimes called a mucoid plaque) is accumulating in the colon, making it a breeding ground for parasites, Candida (yeast) and other nastiness. Fortunately, science tells us otherwise: mucoid plaques and toxic sludge simply do not exist. It’s a made-up idea to sell detoxification treatments. Ask any gastroenterologist (who look inside colons for a living) if they’ve ever seen one. There isn’t a single case that’s been documented in the medical literature. Not one.
Premise two: Illness is the result of chemical toxins
Marketing materials for detox treatments typically describe an array of symptoms and diseases linked to toxin buildup: A few that are general enough to apply to anyone (e.g., headache, fatigue, insomnia, hunger) with a few specifics to frighten you (cancer, etc.) Which toxins cause which disease is left out, and how the toxins cause the symptoms is never actually explained. Here again we see the contrast with real science. To establish that even a single chemical can cause disease requires a significant amount of research (i.e., the entire field of epidemiology). Despite the variety of toxins that are claimed to be causing your illness, marketing claims for detox treatments always fail to link specific toxins to specific symptoms or illnesses. That’s because they can’t – there is no scientific evidence to show that detox treatments have any useful medical effects.
The reality is that our bodies are constantly being exposed to a huge variety of natural and synthetic chemicals. The presence of any chemical in the body, (natural or synthetic) does not mean that it is doing harm. Many naturally-derived substances can be exceptionally toxic, and consequently the human body has evolved a remarkable system of defenses and mechanisms to defend against, and remove unwanted substances. The skin, kidneys, lymphatic system, our gastrointestinal system, and most importantly, the liver make up our astoundingly complex and sophisticated intrinsic detoxification system. Importantly, the dose makes the poison – even water can be toxic (dilutional hyponatremia) when consumed in excessive amounts.
Advocates for detox typically describe the liver and kidney as acting like filters, where toxins are physically captured and retained. It’s argued that these organs need to be cleaned out periodically, like you’d rinse out a sponge, or change the air filter in your car. But the reality is that the kidney and liver don’t work this way. The liver performs a series of chemical reactions to convert toxic substances into ones that can be eliminated in bile or urine . The liver is self-cleansing – toxins don’t accumulate in it, and unless you have documented liver disease, it generally functions without any problem. The kidney excretes waste products into the urine – otherwise the substance stays in the blood. Anyone that suggests these organs need a “cleanse” is demonstrating their ignorance of human physiology, metabolism, and toxicology.
Premise three: Detox treatments remove toxins
A search of the medical literature for clinical studies of detox kits provides the following result:
No Items Found
There is no credible evidence to demonstrate that detox kits do anything at all. They have not been shown to remove “toxins” or offer any health benefits. The same can be said for alternative medicine treatments like coffee enemas – there is no credible evidence to support claims that coffee enemas help the body to “detoxify” compounds, or help the liver function more effectively. Vitamin injections are another treatment that fail to offer meaningful benefits to consumers, and have no beneficial effect on the ability of your liver or kidneys to work effectively. Chelation injections are touted as a cure-all for all kinds of illnesses, but unlike real chelation that is administered in hospitals for real cases of poisoning, naturopath chelation is not science-based and doesn’t seem to do much of anything. The onus is on promoters of detox to show their kits and potions actually deliver as promised – but they don’t, because they haven’t done the studies.
Is detox harmful?
If they provide no benefit, is there the potential for detox treatments to harm?
When it comes to simple dietary changes, there’s little evidence of harm. Eating more quinoa and kale, and less processed and refined foods is reasonable dietary advice for everyone. Homeopathic “detox” is also likely safe – with no active ingredients, homeopathy is an elaborate placebo system. As you get into more unorthodox detox treatments that actually contain active ingredients, there is the potential for harm. Coffee enemas are considered unsafe and should be avoided. Harms such as septicemia (bacteria in the bloodstream), rectal perforation, and electrolyte abnormalities have been reported. Even deaths have occurred. Vitamin injections won’t provide you with any medical benefits but don’t seem as risky, as long as you trust the sterile technique of your alternative provider. However, given some naturopaths seem to be willing to inject products intended for oral use, you might want to think carefully about taking a vitamin injection or chelation treatment, especially when there’s no upside – only risk to your health and to your wallet.
What about the detox kits? Contents vary, but typically contain two categories of ingredients:
- A liver “booster” – typically milk thistle (Silybum marianum). If the liver can’t be wrung out and rejuvenated, can it be boosted to do a better job? Milk thistle is the most popular product purported to “boost” the liver’s effectiveness. There are no published studies that demonstrate milk thistle has a detoxifying effect on the liver. Milk thistle has been studied in patients with alcoholic liver disease, and in patients with hepatitis B or C, and it has not been found to exhibit any meaningful effects. There is no evidence to suggest that consuming milk thistle will cleanse you of unnamed “toxins”.
- A laxative – Typically magnesium hydroxide, senna, rhubarb, cascara, etc. Laxatives are the ingredients in detox kits that give you the effect you can see (and feel). However, these ingredients can cause dehydration and electrolyte imbalances if not used carefully. Regular use of stimulant laxatives, like senna and cascara, are ill-advised for most healthy adults due to the risk of dependence and electrolyte depletion. They’re among the most potent laxatives, usually used for short periods to alleviate significant constipation or to clear out your bowels before a medical procedure. With regular use, your bowel can grow accustomed to the effects of laxatives which may result in constipation once you stop using them. It’s a perfect case of the treatment causing the illness: After the detox, you get could conceivably become constipated: Time for another detox!
Side effects can continue once a detox ends. Some people experience post-detox effects like nausea and diarrhea. Advocate call these “cleansing reactions” and will assure you it’s “toxins leaving the body”. A more plausible, science-based explanation is that this is a consequence of restarting the digestive process after a period of catharsis, where, depending on the extent and duration of fasting, little to no digestion occurred, and the normal gastrointestinal flora may have been severely disrupted. It’s the same effect seen in hospitalized patients who have difficulty initially digesting food after being fed intravenously. The detox ingredients, and resulting catharsis, may irritate the colon to such an extent that it may take time to return to normal.
Immediate weight loss is not uncommon after a detox, especially one that involves a laxative. Unfortunately this is usually due to losses in water and possibly muscle tissue, depending on the how disruptive the detox was to normal body function. Regardless of the weight loss, the body will move back to its pre-detox weight over time if diet and activity levels remain the same.
Red flags for detox quackery
I’ve pulled a few advertisements from some of the most popular proponents of health quackery, and circled the red flags for quackery:
Homeopathy is an elaborate placebo system. Heel is a homeopathy manufacturer recently ceased operations in Canada and the USA under threat of a class action lawsuit. Now a new manufacturer is reselling the same products. They have no medicinal ingredients in them. Dana Ullman is a homeopathy proponent who often contributes to The Huffington Post, a site that more often than not gets the science wrong. In this advertisement from Ullman’s site, the Heel “Homeopathic Detox Kit” is now just called a “Cleanse Kit”:
Mike Adams of Natural News is a conspiracy theorist and purveyor of pseudoscience and bad health information. It’s wise to ignore anything you read at Natural News. Here Adams uses the naturalistic fallacy to promote the idea that GMOs are toxic, when there’s zero evidence that’s the case:
The Food Babe
Vani Hari also promotes the nonsensical idea of “detox”. Her writing suggests she lacks an understanding of medicine, nutrition, and basic biology.
Any product or service with the words “detox” or “cleanse” in the name is only truly effective at cleansing your wallet of cash. Alternative medicine’s ideas of detoxification and cleansing have no basis in reality. There’s no published evidence to suggest that detox treatments, kits or rituals have any effect on our body’s ability to eliminate waste products effectively. They do have the ability to harm however – not only direct effects, like coffee enemas and purgatives, but they also distract and confuse people about how the body actually works and what we need to do to keep it healthy. “Detox” focuses attention on irrelevant issues, giving the impression that you can undo lifestyle decisions with quick fixes. Improved health isn’t found in a box of herbs, a bottle of homeopathy, or a bag of coffee flushed into your rectum. The lifestyle implications of a poor diet, lack of exercise, smoking, lack of sleep, and alcohol or drug use cannot simply be flushed or purged away. Our kidneys and liver don’t need a detox treatment. If anyone suggests a detox or cleanse to you, remember that you’re hearing a marketing pitch for an imaginary condition.