The Detox Delusion

 It’s January which means it’s detox season. Not surprisingly, the scientific evidence supporting “detox” and “cleansing” hasn’t changed since this post was originally written in January 2009:

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. It’s the New Year – wouldn’t a detox from your sins of 2012 be a good idea to start the year? After all, the local naturopath offers detoxification protocols, so there must be something to it, right?

Wrong. This is a case of a legitimate medical term being turned into a marketing strategy. In the setting of real medicine, detoxification means treatments for dangerous levels of drugs, alcohol, or poisons, like heavy metals. Detoxification treatments are medical procedures that are not casually selected from a shelf or from a menu of alternative health treatments. They’re provided in hospitals when there are life-threatening issues.

So what’s with all the detox products in the drugstore?

To given the impression of science, “detoxification” is a term that has been widely embraced by alternative practitioners, and pharmacies simply want their share of the business. Anything can be a “detox” now, especially at the beginning of January: Diets, fasting, supplements, tea, homeopathy, colon flushes, scrub brushes and foot baths all mention detoxification. Let’s look at the most common product in the 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 claim to remove toxins. With this framework, it’s a simple matter to spot the pseudoscience and be a smarter consumer.

Premise One: Our bodies are accumulating toxins

The idea that we are being poisoned from within is not a new one; it’s a historical concept rooted in ideas of  sympathetic magic.  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 practitioners, who don’t base their treatments on scientific evidence. Today’s version of autointoxication argues that some combination of food additives, gluten, salt, meat, prescription drugs, smog, vaccine ingredients, GMOs, 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? It’s nothing more than a meaningless term that sounds scientific enough to be plausible. 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,

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.

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. There isn’t a single case that’s been documented in the medical literature. Not one.

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 credible 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 the evidence that detox kits and treatments remove toxins.

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:

1. 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 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. What this means is that there is no reason to conclude that consuming milk thistle will significantly improve your liver’s ability to function, or to remove unnamed “toxins”.
2. 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 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. 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.

Conclusion

Alternative medicine ideas of detoxification have no basis in reality. There’s no published evidence detox kits have any beneficial effects. Yet, there is a real potential for these kits to do harm.

Detox kits have no place in pharmacy practice.  These products reinforce faulty impressions about how the body works. They focus attention on irrelevant issues, and give consumers 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 simply be flushed away.

The beginning of January is an ideal time for pharmacists to connect with patients who may have misguided ideas about detox. Instead, focus on credible lifestyle changes that have real benefits:

• 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 regularly

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. If anyone suggests a detox or cleanse to you, you’d do well to ignore any other health advice they may offer.

For More Information

• Skeptoid has an excellent podcast on detox and one on cleansing diets.
• The Detox Scam from Neurologica.
• Detox: flushing out poison or absorbing dangerous claptrap? The alternative-medicine version of detox has real-world side-effects that outweigh its imaginary benefits. Edzard Ernst, writing in The Guardian.
• The Great Detox Deception from Science-Based Life.
• Sense about Science did a superb analysis of detox.
• For a sensible take on weight loss without detox, diet gimmicks, or demonizing food, check out How I lost 40lbs doing everything wrong.
• Quebec spa detox treatment leaves woman dead. Not related to detox kits, but this is a consequence of beliefs that we need “detoxification”
• The Journal of Family Practice: The Dangers of Colon Cleansing

Photo from flickr user MRaichelson used under a CC licence.