The Drugstore Detox Delusion

14Feb09

detox

How ineffective products treat non-existent conditions

They may line the shelves of your local pharmacy. Boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name.  The label promises you a renewed body and better health – only seven days and $21.95 away.

Detoxification is a legitimate medical term: It refers to procedures to treat dangerous levels of drugs, alcohol, or poisons, like heavy metals.  Detoxification treatments are conducted by trained medical staff in a hospital or clinic- it’s not a do-it-yourself endeavor. So what’s with all the detox products in the drugstore?

For some reason, “detoxification” has been widely embraced in popular culture, and it’s now applied to all sorts of products and processes:  Diets, fasting, supplements, homeopathy, colonic irrigation, scrub brushes and foot baths are all referred to as detoxification. This review will focus on detox products that you’ll find at your local pharmacy: the seven- to thirty-day kits promising a whole new you. To evaluate the value of these detox kits, we need to understand the science of toxins, the nature of toxicity, and how detox kits remove toxins. With this framework, it’s a simple matter to sort out fact from fiction.

Premise One: Our bodies are accumulating toxins

The idea that we can be poisoned from within is not a new one; it’s been around since the time of Ancient Egypt. Called “autointoxication,” it drew a link between our bowels and other health problems. Clean out the bowels, went the theory, and you could cure any illness. Science led us to discard autointoxication by the 1900s as we gained a better understanding of anatomy, physiology, and the true cause of disease. Despite the science, however, the idea persists among the alternative health crowd. Today’s version of autointoxication argues that some combination of food additives, salt, meat, prescription drugs, smog, genetically modified foods, and perhaps last night’s bottle of wine are causing a buildup of “toxins” in the body. But what is the actual “toxin” causing harm?  There’s no accepted definition for toxin in the scientific community, so in this setting, it’s nothing more than a meaningless term that sounds vaguely scientific.  A uniform feature of detox kits is the failure to name the specific toxins that the kits will remove. For example Renew Life admonishes you,

“As the world we live in becomes more and more polluted, cleansing and detoxification has become vital to ensure good health and to guard against disease. One of the most important things you can do to improve your health is to cleanse and detoxify regularly. It is suggested that everyone cleanse the body 2-4 times a year. Remember, if you breathe, you should cleanse!”

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 some sort of toxic sludge (sometimes called 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 plaque and toxic sludge simply do not exist. It’s a made-up idea to sell detoxification kits. Ask any gastroenterologist (who look inside colons for a living) if they’ve ever seen one. The fact is, there isn’t a single case that’s been documented in the medical literature.

Premise Two: Illness is the result of toxins

Marketing materials for detox kits 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 missing, 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 kits will uniformly fail to link toxins to specific symptoms or illnesses.

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 astounding complex and sophisticated intrinsic detoxification system.

Advocates for detox kits typically characterize the liver and kidney as acting like filters, where toxins are physically captured and retained. It’s argued that these organs to be cleaned out periodically, like you’d rinse out a sponge, or change the air filter in your car. But the reality is, 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 through the bile or the kidneys. The liver is self-cleansing – toxins don’t accumulate in it, and unless you have documented liver disease, it generally functions fine. The kidney excretes waste products into the urine – otherwise the substance stays in the blood. To argue that either organ need a “cleanse” is to demonstrate a profound ignorance of human physiology, metabolism, and toxicology.

Premise Three: Detox kits remove toxins

A search of the medical literature for clinical studies of detox kits provides the following result:

No Items Found

Interpretation: There is no evidence to demonstrate that detox kits do anything at all. We can be comfortable concluding that marketing claims of toxin removal with detox kits are unsubstantiated. There is simply no credible evidence to support this assertion.

Can Detox Kits Cause Harm?

So we’ve failed to find any legitimacy behind the premises of Detox which calls for any ethical health professional to ask:  If they provide no benefit, is there the potential for harm?

What exactly do these kits contain?

Contents vary, but typically contain two categories of ingredients:

A liver “booster” – typically milk thistle (Silibum 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.  Milk thistle has been studied in patients with alcoholic liver disease, and in patients with hepatitis B or C, and to no surprise, it has not been found to demonstrate any meaningful effects.  What this means is that there is no reason to conclude that consuming milk thistle will significantly improve your liver’s ability to remove 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 the detox ends. Some people experience post-detox effects like nausea and diarrhea. Advocate call these “cleansing reactions” and assure you it’s just toxins leaving the body. A more plausible, science-based explanation is that this is a consequence of restarting the digestion process after a period of catharsis, where, depending on the extend and duration of fasting, little to no digestion occurred. 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.

Weight loss is not uncommon after a detox. Unfortunately this is usually due to losses in water and possibly muscle tissue, depending on the diet followed during the program. Fat loss is unlikely. Once the detox is over and the pre-detox diet is resumed, the weight will creep back.

Conclusion

The detoxification theory is implausible and has no basis in reality. There’s no published evidence detox kits have any direct effects to speed up or change the elimination of toxins in any way.  Detox kits are ridiculous products that make meaningless claims and do not perform as advertised. Yet, there is a real potential for these kits to do harm.

Pharmacists, do your professionalism and credibility a favour. Keep the detox kits out of your pharmacy. These products reinforce faulty impressions about how the body works. They focus attention on irrelevant issues, and give your patients the impression that they can undo lifestyle decisions with a simple quick fix. Improved health isn’t found in a box of laxatives and herbs. The lifestyle implications of a poor diet, lack of exercise, smoking, lack of sleep, and drug use cannot be flushed away. Provide your patients with legitimate, science-based information to improve their health.

Customers seeking detox products are likely to be receptive to pharmacist advice: They’ve already identified that they want to improve their health. It’s a perfect opportunity to discuss a range of meaningful lifestyle changes, such as:

  • Weight loss if warranted
  • Smoking cessation as required
  • Eating more fruits, vegetables and whole grains
  • Minimizing meats, saturated fats, and heavily processed foods
  • Going easy on the alcohol
  • Exercising more

It’s reasonable to conclude that any product with the words “detox” or “cleanse” in only going to be effective at cleansing your wallet of cash. Walk away from anyone, pharmacist or not, that recommends a detox kit to you.

References/For More Information

Dr. Rachael Dunlop  debunks  detoxification claims in Episode #13 of The Skeptic Zone podcast and in the affiliated blog. She points to the excellent detox deconstruction by the Australian group Choice.

Rambaldi A, Jacobs BP, Iaquinto G, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003620. DOI: 10.1002/14651858.CD003620.pub3.

Skeptoid has an excellent podcast on detox, Brian delves into the mucoid plaques in more detail.

Harvard Health has an excellent article on detox. Subscription required.

Sense about Science did a superb analysis of detox in January, 2009.

The always rational Quackwatch has a nice summary of detoxification.

The New York Times had an excellent article on detoxification and colonic fixation in January 2009.



11 Responses to “The Drugstore Detox Delusion”

  1. Hi there,

    I found your blog via a Google alert for the Skeptic Zone. This is a really great resource. Well researched and thorough. I am thrilled that you are a pharmacist since in Australia we see so much quackery sold through pharmacies with pharmacists seemingly turning a blind eye. From ear candles to homeopathy, we have it all. See my blog here http://tinyurl.com/byk5v8. Do you work as a pharmacist in a chemist?

    Anyway thanks for referencing my report. I will be certain to subscribe to this blog to keep up with your great posts.

    I have another blog here http://www.scepticsbook.com where I also whinge about alt. med.

    Cheers!

    Rachie

  2. Educative and entertaining. I’ve occasionally wondered if some people watch crime series with autopsies and watch the gruesome parts either wondering where the mucoid plaque is or believing that its very existence has been censored from our TV screens.

    Dr Ben Goldacre had rather a to-do with some detox people in early January (and again).

    There seems to be a need to believe that the environment or our lifestyles are poisoning us but that they can be purged. Secular form of earlier physical and spiritual cleansing rituals?

  3. 3 not a gator

    “For some reason”…

    I’m probably posting too late for you to read this, but I would posit that the reason is the fear of carcinogens in the environment, perhaps set off by the cyclamate scare and the FDA switch to the rat tests to determine was was G.R.A.S. It manifested in the hysteria (or is it?) about toxic exposure around incinerator, chemical plant, and other industrial sites. Also pesticides and other environmental pollutants.

    Many adults in the US at least are convinced that they are being slowly poisoned by thousands of toxins in the environment. There’s a kernel of fact to it but the fears have taken on a neurotic-paranoic aspect. Woo-sters have capitalized on this by offering numerous “treatments”, like wrapping you in hot towels in a spa, to “rid your body of toxins”. This is combined with some nonsense about how obesity is due to toxin buildup–a nice fantasy!

    I’m no biologist, but I do know that the liver and kidneys are there to rid by body of toxins. I also know that small children are much more susceptible to environmental exposures than adults … and that, despite everything, humans are fairly resilient. I also know that a principle of toxicology is “the poison is in the dose.”

    OTOH, I share the feeling–however overblown–that repeated small exposures aren’t necessarily benign. Repeated small exposures to sunlight will eventually result in carcinoma for my extremely fair skin, even if I do not burn. And hasn’t the EPA recently started grumbling about lowering the safe level of Arsenic in water–levels already far to low to result in (immediate) death? Or take colon cancer. There’s evidence that eating certain kinds of meats, over many years, helps contribute to risk of cancerous polyps. What didn’t kill you didn’t necessarily make you stronger.

    As far as the environment goes, I don’t know who to believe, although despite the clear industry money flowing towards the so-called skeptical side in some of these environmental dump lawsuits, parsimony (too many different kinds of illness, not statistically significant) and knowledge of the various ways we fool ourselves has convinced me that at least some of these celebrated court cases were decided on the wrong side. With so much ideology and money flowing around, and a lot of the work in understanding the human body (or any kind of animal) woefully incomplete, it’s hard for me to know.

    I think I digressed, but anyway, that’s where that idea comes from. It was pernicious enough, but with that “you’re full of toxins, and toxins make you fat” twist, it will never go away. Add in the fact that causing water shedding will, easily, convince silly people that they’ve shed fat, and you’ve got a woo-ster’s dream.

    • Detox kits are the easiest alt-health product for advocates to prove their claims.

      1. Name the toxins that are being eliminated.
      2. Provide evidence that the toxins are being removed (perhaps through blood levels before/after, etc).

      (I would not even be concerned about whether the “toxin” is in fact harmful – that we can discuss once the first two are proven.)

      There is zero published evidence that these products are effective, or have even been properly evaluated. Consequently, a cautious consumer, or skeptical pharmacist, should question how manufacturers can attach grandiose claims to their products.

  4. 5 Stephanie

    This is a very biased article and I am no scientist – however I do know that a regular cleansing and replenishing program has transformed my health (and yes, measurable by my doctor improvements).

    I would say that pharmaceutical drugs can do more harm than natural remedies (over prescribing is the issue I am talking about – I am not against drugs).

    I was in a very bad place 6 years ago – in pain, exhausted, in the dumps, lethargic and mentally foggy, not to mention overweight. My old doctor wanted to put me on pain pills and prozac – I decided to do a nutritional cleanse program and I feel better in my fifties than I did in my forties.

    Respectfully,
    Stephanie

  5. You missed out my favourite detox product: bentonite, aka mineral cat litter!


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