The Detox Myth: What your alternative health provider isn’t telling you

Happy New Year to my regular readers! Today’s post revisits some old material, repackaged and updated.

New Year, New You, right? 2014 is the year you’re finally going to get serious about your health. You’re winding down from a week (or more) of celebrations and parties. You’re pretty much recovered from New Year’s Eve by now. It’s time to make some resolutions. Conveniently, there is no shortage of solutions being advertised to absolve you of your sins while overhauling your body and soul for 2014: What you need to do is “detox”. You’ll see the detox kits at your local Whole Foods (or even your local pharmacy). Books, boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths all promise detoxification. The advertising suggests you’ll gain a renewed body and better health – it’s only seven days and $49.95 away. Or try to cleanse yourself with food alone: Dr. Oz is hyping his Holiday Detox plan. Bon Appetit is featuring their 2014 Food Lover’s Cleanse. Or what about that old standby, the “Master Cleanse”? It’s the New Year – wouldn’t a purification from your sins of 2013 be a good idea to start the year? After all, the local naturopath sells detoxification protocols, including vitamin drips and chelation. There must be something to it, right?

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.

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:

Constipation Myths and Facts

When it comes to health issues, bowels are big business. Bowel movements are part of everyday life, and we notice immediately when our routine changes. Constipation, from the Latin word constipare (“to crowd together”) is something almost everyone has some experience with. In most cases, it’s an occasional annoyance that resolves quickly. For others, particularly the elderly, constipation can be a chronic condition, significantly affecting quality of life. Depending on the question and the sample surveyed, prevalence seems to vary widely. It’s estimate that there are 2.5 million physician visits per year in the USA, and the costs of management are estimated at about $7.5 billion annually. It’s not a trivial issue.

One of the biggest challenges in interpreting both individual patient situations, as well as the literature overall, is understanding what’s defined as “constipation”. One person’s regular routine may be another person’s constipation. From my dialogue with patients, personal definitions seem to vary. Some panic after a single missed bowel movement, while others may be unconcerned with daily (or even less frequent) movements. What’s the optimal frequency? It depends. Infants may be 3x/day. Older children may be once daily. Adults may be daily or less frequently. The literature generally, though not consistently, defines constipation as a delay or difficulty in bowel movements ( usually less than 3 per week) lasting two weeks. Symptoms can include infrequent, painful bowel movements, straining, and lumpy or hard stools. When these problems last for more than three months, it’s termed chronic constipation. When constipation is accompanied by other symptoms like bloating, diarrhea, and abdominal pain, it may be termed irritable bowel syndrome (IBS).

There are multiple causes of constipation. It may be a consequence of other illnesses (e.g., high/low thyroid, diabetes, cancer, and neurological diseases like multiple sclerosis). Drugs, both prescription and over-they-counter, can also cause constipation. Primary or idiopathic constipation is a diagnosis of exclusion, after other causes have been ruled out. If there are no signs of a more serious underlying condition, treatments can be considered.

Many have firmly-held opinions about their colon and their bowel movements: what’s normal, and what’s not. And there are equally strong opinions about the causes of, and solutions to, constipation. But despite the ubiquity of constipation and the firmly-held opinions on treatments, there’s a sizable chasm between practice and evidence. This is an area with crappy (sorry) data, and it’s hard to sort out what are true treatment effects. But an absence of evidence isn’t evidence of absence, so we’re challenged to make the best decisions possible, despite a disappointing evidence base. Here are some common statements I’ve encountered, and an evidence check on their veracity.

The Drugstore Detox Delusion

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.