You can’t cleanse away a smoking addiction

For every challenging medical issue, there’s a quick fix that exists in alternative medicine – and disappointingly, sometimes it’s sitting on a pharmacy’s shelf. This week I spotted an advertisement targeting an addiction, one that is the single biggest preventable cause of death worldwide: smoking. We associate smoking with lung cancer, but smoking kills in two other ways as well: cardiovascular disease, and chronic obstructive pulmonary disease. Tobacco kills 6 million people per year, causing hundreds of billions of dollars worth of pain, suffering, and economic damage. [PDF]  Stopping smoking reduces the risk of dying – the damage lessens over time in those that quit completely.

Despite the known harms, quitting smoking is very difficult: 70% of active smokers say that they want to quit, 40% tried to quit over the last year, yet only 3-7% are smoke free after one year of quitting. With support and treatment, abstinence rates can climb to 30%+ (at best) but few seek medical attention and support. Some may be enticed by advertisements like the one I spotted. The website and ad have the same message:

Smokers Cleanse is a 3 part, 30 day program that works!!

Part 1 – Lung Support: This works to help expel mucous from the respiratory system, as well as soothe inflamed tissue and bronchial passages. Lung Support also contains powerful antioxidants that help to protect the respiratory system, allowing it to repair and rebuild faster.

Part 2 – Craving Support: This formula works to reduce cravings. By using a therapeutic dose of green tea extract, cravings are significantly reduced. Green tea extract has been shown in clinical studies to have a positive impact in helping people quit smoking. Craving Support also contains the amino acids GABA and L-Tyrosine, which work to curb the effects nicotine addiction have on the brain. “Keeping the supply of GABA at high levels has the potential to reduce the pleasurable effects of smoking, in terms of duration and intensity – American College of Neuropsychopharmacology (ACNP) Annual Meeting”.

Part 3 – Stress Relief: This formula helps to promote restfulness and relaxation. This is very important as two common problems associated with quitting smoking are anxiety and trouble sleeping.

I’ve blogged about cleansing and detoxing before. Popular with alternative providers like naturopaths, there’s no medical rationale for cleansing or drug store detox kits. Outside of detox units in hospitals, detox and cleansing are marketing slogans – not medical treatments. So what does a Smokers’ Cleanse do? To determine this, we’ll look at the ingredients, and the evidence that exists to support their inclusion. The cleanse is 3 different products:

Smokers’ Cleanse 1: “Lung Support” (2 per day)

  • N-Acetyl L-Cysteine: 250mg
    • NAC is an approved drug for Tylenol (acetaminophen) overdose, and has been studied treat lung disease in those with diseases like cystic fibrosis, but its role as a supplement has not been established in smokers. There is no published evidence demonstrating it helps expel mucous or reduce inflammation secondary to smoking.
  • Thyme Leaf (Thymus vulgaris) 4:1 Extract 125mg
    • Thyme is an herb with a long history of use for lung conditions, but there is no evidence to demonstrate it is effective.
  • Fenugreek Seed (Trigonella foenum-garecum) 10:1 Extract 100mg
    • Fenugreek seeds are used in cooking, but there’s no published evidence suggesting any role for smoking cessation or lung disease.
  • Mullein Leaf (Verbascum thapsus) 50mg
    • Also used traditionally to treat respiratory tract inflammation, but there is no evidence available to evaluate the dose or its effectiveness.
  • Vitamin C (ascorbic acid) 40mg

Smokers’ Cleanse 2: “Craving Support” ( 2 per day)

  • Green Tea Extract – 70% catechins (Camellia sinensis) 325 mg
    • As I have blogged before, green tea is a product with a long list of claims but little evidence to substantiate them. While the manufacturer claims that “Green tea extract has been shown in clinical studies to have a positive impact in helping people quit smoking”, no published evidence was found in a search of the medical literature.
  • L-Tyrosine 125 mg
    • Tyrosine is a nonessential amino acid that the body synthesizes. Supplementing is unnecessary, except for those with phenylketonuria. There is no scientific rationale to think it has any value in modifying withdrawal effects from nicotine, or repairing damage done by smoking.
  • Bilberry Extract (Baccinium myrtillus) 4:1 Extract 100 mg
    • There is no published evidence to demonstrate or even suggest that bilberry extract has any effect at affecting “cravings” related to nicotine.

Smokers’ Cleanse 3: “Stress Release” (1 per day)

  • Hops (Humulus lupulus) 4:1 Extract 150 mg
    • While hops are consumed for anxiety, stress and other conditions, there’s no published evidence to suggest it has any meaningful effects.
  • Skullcap (Scutellaria lateriflora) 4:1 Extract 150 mg
    • Like hops, Skullcap is believed to be useful for anxiety and stress, but there is no persuasive evidence to demonstrate that it is effective.
  • Lemon Balm (Melissa officianalis) 75 mg
    • Also used traditionally for anxiety, there is an absence of evidence to suggest that has any effects.
  • L-5-HTP (Griffonia simplicifolia) 25 mg
    • Again, there is a lack of evidence to support any effectiveness claims. There is no established medical rationale to supplement Concerns have been raised about the safety of HTP, with some suggesting the risks outweigh the benefits of supplementing.

The manufacturer makes the following claims [PDF] about Smokers’ Cleanse:

Address the three main ‘triggers’ that cause people to fail in their attempt to quit smoking:

Reduce periods of intense cravings, reduce anxiety and promote restful sleep, and expel mucous and soothe bronchial passages

Based on a review of the evidence, we can conclude that there is no published evidence that substantiates these claims. While there are no obvious safety concerns with the ingredients,  the data also suggest that this product will have no meaningful effects on nicotine withdrawal or any other consequences of quitting smoking. Furthermore, while this product is sold in Canada, it does not appear to be approved for sale in Canada by Health Canada’s Natural Health Products Directorate. While the approval requirements NHPD are embarrassingly low, an approval for sale would at least provide some additional degree of assurance that the ingredients are not harmful.  Without such approval, there is no externally validated assurance of product quality or safety.

It’s a seductive idea to think that a 30-day “cleanse” can undo the damage of smoking, or ease the challenge of quitting. Unfortunately, there’s no published evidence demonstrating the ingredients in Smokers’ Cleanse will have any meaningful effects. Nicotine is a potent drug. Effective therapies for smoking cessation do exist: they include behavioral treatments (counselling) and drug treatments, such nicotine replacement. Smoking cessation programs are effective. Smoking cessation cleanses are not. If you’re a smoker and thinking about quitting, here’s a resource to get you started.  Speak to your medical doctor or your pharmacist about science-based programs and treatments available.  And ignore the quick fixes promised by cleanses.

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25 thoughts on “You can’t cleanse away a smoking addiction

  1. Sadly there are too many people looking for a quick and easy way to fix a serious problem, added to which there are many who are fearful of prescription drugs, doctors, etc. so even with the knowledge that it is total woo, they take the easy route.

    Barring the receptionist for an appointment, sometime in the next two weeks, a long wait in the surgery waiting room, being quite by a doctor, a string of follow up appointments, time off work…… or five minutes. in the pharmacy to buy a cure in a box, what do you think the average person will go for? The path of least resistance!

  2. Will it ever end? I hate to tell you, but “no published evidence” falls on deaf ears. The believers only hear anecdotes and go by “experience”. I know that you are aiming at fence-sitters, but I wish there was a way to start chipping away at the edifice of “belief” as well!

    At the end you advise those who wish to quit to see their doctor and get real pharmaceuticals. That’s all well and good in Canada, but a bit cruel to us down here in the States. My son tries to quit periodically, but since he has anxiety anyway, it gets really bad when he quits, but he has no insurance for doc or rx. I know he can pay the doc (or I could), but you wouldn’t believe how difficult it can be to even find a doc here if you are not established with some kind of HMO or other Managed Care. Nevertheless, you’ve prompted me to try harder.

    Anyway, my point is that many people are first drawn to alt med for lack of insurance. Next step is to buy into the “they (Big Pharma) don’t want you to know that these humble herbs can cure you because they can’t patent them and make $$$”. Then they find a book–in the public library on the same shelf with real medical books, mind you–written by an MD about some magical diet that will cure ______ and by now they are completely “wooed”by anti-establishment, magical thinking.

    I think we need to think about prevention of this scenario. In the US, this would mean universal access to health care to start with. Also, books that challenge well-established science and medical practice need to carry a strong disclaimer–on the front cover, not in tiny print somewhere easily glossed over and in weak language.

    Of course, crash courses in critical thinking at all levels of education would help, but I can’t tell you how many teachers my children have had who go to naturopaths and recommend all manner of woo.

    Sorry to go on like this, but while this is a great post, I fear this blog (and the others) doesn’t reach as far as would be needed to put these people out of business. They prey on the human psychological tendency to magical thinking. I’m sure many of them totally believe this rubbish themselves. This smoking remedy might possibly be a case where a placebo effect might help some to actually quit by causing them to think they are being helped by the herbs. More likely, however, they will buy it thinking that it will “repair” the damage they know they are doing to their body. “Cleanse” is a powerful word and is the basis for a lot of religious ritual, so it fits right in with magical thinking.

  3. My guess is that this program would not be very effective for smoking cessation. One correction to your analysis: Lemon balm (Melissa) does have some clinical research finding its use effective in anxiety. 75mg, depending on its extraction method of course, is much lower than the commonly accepted dose.

      • There are a few references Janet, sorry for not including them earlier.

        Melissa – review of clinical research

        Three DBPC trials came out of the University of Northumbria, and were led by David Kennedy, Dept. of Psychology and director of the Brain, Performance and Nutrition research center. His publications focus on nutrition and herbal medicine, as you might expect.

        The first study came in 2002 and was published in Pharmacology Biochemistry and Behavior. 20 healthy volunteers received single doses of 300mg, 600mg or 900mg and results included greater “calmness” and improved performance on attention tests. http://www.ncbi.nlm.nih.gov/pubmed/12062586
        The second piece from Dr. Kennedy’s team was published in Neuropsychopharmacology in 2003. With an n=20 and a maximum (and most effective) single dose of 1600mg, improvements in memory and mood were recorded. http://www.nature.com/npp/journal/v28/n10/full/1300230a.html
        The third piece was published in Psychosomatic Medicine, 2004. It documented an increase in “calmness” in 18 volunteers following lab-induced stress (via visual split-screen performance tests that were scored in real time) and a single dose of Lemon Balm of 300mg or 600mg, the latter being more effective. http://www.psychosomaticmedicine.org/content/66/4/607.long

        Another study looked at agitation in patients with mild to moderate Alzheimer’s disease, and came out of Tehran University, published in Neurology Neurosurgery and Psychiatry in 2003. It followed 42 patients for 4 months, using a daily dose of 2ml of a 1:1 hydroethnolic extract, representing roughly 2 grams of plant material. Substantial improvements in measures of cognitive performance and dementia were noticed, along with less agitation. http://jnnp.bmj.com/content/74/7/863.long

        The NHPD in Canada has approved a claim for oral use of Lemon Balm: “Traditionally used in Herbal Medicine as a sleep aid (in cases of restlessness or insomnia due to mental stress)” (EMEA 2007)

        There have been other trials looking at combinations of Lemon Balm and other herbs, such as Valerian and Lavender, for insomnia, anxiety, and agitation in dementia.

        Additionally, Lemon Balm essential oil as an inhalant has been studied in (supposed) double-blind fashion, which I find tricky to believe. Plus, we’re talking about ingestion here, not inhalation.

        There is no clinical research on Lemon Balm orally which finds it ineffective for the uses described above.

        Finally, I have recommended this plant either alone or in combination with other herbs numerous times in my practice, mostly as support for anxiety, agitation, and insomnia. Results are consistent and good. I know that doesn’t mean much, but it’s always nice to see the results of DBPC trials borne out in the clinic (my clients would agree).

      • Guido, I appreciate your careful and lengthy response and I don’t put your effort in the same boat with some of the people I’ve referred to in my original post. But I have to suggest that you read Ben Goldacre’s book, Bad Science, in which he carefully takes the reader through the types of studies and the quality and merits of each.

        The studies you cite are small (too small to be more than suggestive), seem to have used very subjective criteria and were possibly not even blinded–I can’t tell for sure. You are seeing what you want to see in these studies perhaps. I don’t know what your “practice” consists of, but it seems to me that a nice hot bath with some nice oils added would be as “calming” as lemon balm. The evidence doesn’t seem any better than that.

        Again, I do appreciate your taking the time to provide the data and I would be willing to look at it in more detail. You seem entirely sincere, however, I think you are attempting to find some sort of confirmation for what you already believe. I have learned quite a lot in the past few years from reading the ScienceBasedMedicine blog as well as this one and a few others. I’ve also been reading books such as Bad Science and learned much about how to read a study and how to judge the sources and methodologies. This experience leaves me skeptical of the studies you cite. If Scott refutes any of this or finds support for these claims, I am more than willing to change my mind–that’s the way science works.

      • http://www.naturalstandard.com/ , the Natural Standard database which has similar editorial review board for evaluating data (and is similarly behind a paywall) gives Lemon balm a “B” rating, meaning “Rigorous clinical data is lacking. Preliminary clinical studies demonstrate promising effects.” Just saying that’s different than “absence of evidence to suggest that it has any effects”, as is stated in the above post.

    • Thanks shawmutt. I’ve seen that site and will see if it’s still up, but even if it is, it’s just one tiny speck in a sea of woo. I applaud all the efforts of all the science based bloggers, but wish there was something “bigger” that could be done.

      I realize that I take this too personally; it’s just that I have lost numerous friendships over all this. I try to be tolerant and say, “to each his own”, but the people in my life have gone off the deep end with all this and have dead relatives to prove it–which doesn’t affect them! “She was sooooo happy (with all her New Age “light”) at the end”, is the response I got most recently. They can’t even see any harm when it stares them in the face.

  4. Janet, the scope of my original comment was very specific and limited. Though the limitations of the research I quoted indeed make it only suggestive, there is nevertheless more than an “absence of evidence” for Lemon Balm. None of the evidence involves bathtubs, and all trials are double-blinded. Beyond that, the product that is the focus of this page sounds like another of RenewLife’s plays on the fear and guilt of the population – often ineffective, and sometimes harmful (esp. when ingredients include purgative, habit-forming herbs).
    I have read Goldacre’s book and others, such as Trick or Treatment (Ernst&Singh). While its tone is polemical, it’s a good basic introduction to biostatistics, and covers a lot of the same points I’ve studied elsewhere. Rather than being ignorant of how to critically evaluate research, I simply find Goldacre’s epistemology incomplete, because it neither addresses context nor the problems that arise from trying to analyze the interactions of complex living systems.
    I must say I am a bit surprised by your final point. Isn’t the role of critical thinkers to make up their own minds? Why wait for someone else to tell you what to believe? That strikes me more as the tone of a believer waiting for a sign from the priesthood…

    • You confuse religion and the priesthood with science and scientists. You are making the common altmed argument that science is just another point of view. It’s not.

      And no, it is not my aim to “make up my own mind” on every bit of minutae–it is my aim to understand the basic principles of the scientific method and then to rely on others who have demonstrated through their education and published work that they have mastered their fields of expertise, whereupon I can take their word for something until proven (scientifically) otherwise.

      • I am making no such argument. In fact, my surprise should have indicated the exact opposite to you.
        Science is a way of doing things, not a belief system. What is a belief system is the idea that one can abstract pieces of the scientific corpus and thereby get at a “true” version of reality. Much in the alternative medicine field is based on this error – such as the common practice of extrapolating from basic pharmacological research. But Goldacre makes the same mistake at times, which is what I mean when I refer to his epistemology as incomplete. Worth considering if you’re a critical thinker.
        This discussion is complex and frankly huge – and I feel I have hijacked this comment thread long enough. I trust you understand my original point.

      • Not really, but I agree that enough has been said for now–NOT that my points are too complex.

        I do not think you have made the case that Goldacre is “polemic” or writes “epistemology”, but rather that you use these words because your beliefs disagree with his facts.

  5. I’m not going to join this debate in the sense that I’m going to argue with any specific facts, but I think with the whole science based is extremely useful and valid, but can also be quite arrogant and ignorant.

    My father is a PhD research scientist with the government, and my mother also runs research studies in a hospital. I have been through university as well, know what critical thinking is, and understand how to evaluate what is a “good research study”…

    Just for the record, there used to be no scientific evidence that smoking was harmful to your health. Must be a fact then! Lets ignore the millions of people coughing up a lung and showing signs of physical degradation, when many people knew that based on what they’ve seen its harmful. Science hasn’t proved it is, so it must not be… wait, years later science does show a cause and effect and wham! It is now bad for you!

    Accupuncture was practiced for thousands of years as a healing technique with good results in a lot of recipients for pain etc… but no study every proved it, so it was crap! Now studies show it does have an effect, and all of the sudden its partially legitmatized.

    I’m not saying the product does or doesn’t work. I’m saying that to use the fact that there is no supporting evidence in science as your basis for saying it something doesn’t work is ignorant. Great, you can analyze a study. Problem is, if pharmaceutical companies who just spent billions on putting out a drug to cure problem X and are charging you out the ying yang for it, do you really think they’re going to be putting much research into a commonly available herb/plant/whatever that may works just as well? Not if they can’t patent it. Why prove something cheap works as good as their expensive drug?

    I could get into the whole debate much further, but it’s pointless. You’re looking at only scientific studies and evaluating their merit. You need to use a bit more of your critical thinking to figure out why the majority of studies are being done in the first place… for instance, why was a vaccine for malaria not developed until recently when bill gates charity used their the money to get it done? Cause malaria is a problem in Africa and guess what African people affected by it don’t have a ton of? Money.

    At the end of the day, you need to take a closer look at why studies are being done etc, not just the ones that have been done. It would be much more convincing to cite studies that show that certain ingredients were tested for the specific purpose they’re claiming and that those studies show they do not work… Once again, I’m not saying this product works. If this company did the same amount of research as pharmaceutical companies, the product would be leaps and bounds more expensive. I think when you use something like this you should be assuming what they say is not substantiated, but is probably based on traditional thoughts etc.

    Let’s face it, the body is an extremely complex system which we as humans like to believe we know everything about, yet we know extremely little. I’m all for science, but I think there is nothing more ignorant than thinking only things proved in science can actually work. If I hit my thumb with a hammer and it breaks, do I really need a double-blind scientific study to prove that it was the hammer hitting my finger that broke it? If I get wet when it rains, do I need a study to also prove it was the rain getting me wet?

    Like I said, I’m all for science, just can’t stand the ignorant people who think they know everything, because 10 years down the road someone may study this product, find it works and then all of the sudden you won’t want to be putting these people out of business.

    • Accupuncture was practiced for thousands of years as a healing technique with good results in a lot of recipients for pain etc…

      Not true–go to sciencebasedmedicine.org and put acupuncture in the search box. The modern form of acupuncture is fairly new and was promoted by Mao as a cover for lack of medical care. Tell me–what needles were they using “thousands of years ago”? Bone? Ivory?

  6. Great blog, Scott!

    And Calvin. There is a good reason why we insist things should be scientifically tested. Over the course of history we had people dying in thousands because we thought the treatments worked or it made sense.

    For example, We used to have babies sleep on their tummies thinking it would help them if they throw up.We don’t need a study to show that right bcos it’s common sense. Guess what, it was shown in studies later that this advise probably killed thousands of infants due to sudden infant death syndrome. So the lesson is be skeptical.

  7. Ahh the technocrat and his “published scientific evidence” fetish.I’m sure we can all agree that while cleanses like this might be a cash grab. However, if the placebo effect can help someone butt-out for 30 days, I’m not sure I see the harm in encouraging someone to try a product like this. The body begins to heal after a few hours of not smoking, and the benefits of not smoking for a month are fantastic. Furthermore, not smoking for 30 days is sure to increase the likelihood of prolonged, and possibly permanent abstinence.

    While I appreciate the critical thinking behind this post, I question not only the Western thought process that seeks to denigrate traditional knowledge, but also the overarching theme that threatens to discourage smokers from quitting. It reminds me of reports that reveal the risks of practicing yoga or participating in certain exercise routines; do we really want to discourage people from exercising? Similarly, do we really want to discourage people from doing whatever it takes to quit smoking?

    People will always fall back on what is most comfortable, and posts like this encourage apathy over action.

    • I’m not a “technocrat” nor is my interest in the natural world (science) a “fetish”.

      Thought processes are neurological, not “western”. It’s difficult to take this post seriously at all with so many silly assumptions.

  8. Whether there is evidence to support or not this smokers cleanse is the ONLY thing that helped me quit smoking. I tried cold turkey, those vapor cigarettes, nicotine patches and gum, all these to no avail. Within the first week of using the cleanse, my cravings stopped. I didn’t even need to finish the entire package. I have been smoke free for 3 months now!!

    • Congratulations, but there is no way to know based on a sample of one. It’s likely the placebo effect–which usually lasts about three months. That might be long enough for you to stay with it on your own, but we have no idea how many people who bought this stuff may or may not have had your experience.

  9. My acupuncturist just recomended the cleanse and i bought the thing. I am a skeptical person and a heavy smoker(more than 20 years a pack a day). Went to him for chronic back pain and that condition is “magicaly” improving.We talked about my smoking habit and when i told him that i was smoking a pack a day with a nicotine patch on my shoulder and while chewing nicorette gum, he asked if i still want to quit.
    Now i said i’m rather skeptical so i started to lookup the product on the internet before jumping into trying it. Placebo or real deal, i have yet to find out its worthiness.
    I will come back here 30 days from now to let you know.
    Meanwhile you all keep doing what you’re doing which is debate on whether the big pharmas have the people at their interest or only the money.

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