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It’s mid-January and some of you are finishing up your New Year’s detox or cleanse. Congratulations. Taking steps to a healthier lifestyle isn’t always easy. It probably wasn’t pleasant. It may have cost you some money. And you may have lost some weight.
You’re now wondering what should come next – how to be healthier in 2020, and how to recover from some of the lingering effects of the detox. While there are hundreds, perhaps thousands of “detox” regimens, products, and approaches, most of them have similar components and have similar effects. Understanding what they are, and what they do may help you with your choices in 2020.

What is a detox, exactly?

Your detox plan may have come from a website, or even a box. It may be celebrity endorsed or it could be the classic “Master Cleanse” of lemon, cayenne, and maple syrup. Pharmacies and health food stores have aisles of “detox kits” all promising to suck the toxins out of your body. The approaches may differ but there is one constant to the marketing: Detoxing will deliver a renewed body and better health. But you’ll never find a description of what the detox actually detoxes – what’s being removed? And that’s because deliberately vague marketing is used, to imply health benefits that don’t exist. And it starts with the term “detox”.

“Detox” is a legitimate medical term that has been co-opted to promote products that don’t actually remove toxins. Real detoxification isn’t ordered from a menu at a juice bar, or assembled from supplies in your pantry. Real detoxification is provided in hospitals under life-threatening circumstances — usually when there are dangerous levels of drugs, alcohol, or other poisons in the body. Drugs used for real detoxification are not ingredients in a smoothie. What’s being promoted commercially as “detox” is little different than eons-old religious rituals of cleansing and purification. Framing detoxification in religious terms won’t have the appeal in a world where science is king. So use the word “toxin”, not sin, and call the ritual a “detox” – and suddenly the program has a veneer of what sounds scientific. Fake detox is marketed based on three easily-debunked ideas. Once you can spot the flaws, it’s easy to spot the spin and misinformation, and to make smarter, healthier decisions.

But toxins!

There’s a reason we can be sucked in by 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 sin that we’re as worried about today, however. As our knowledge of biology grew, these fears manifested as “autointoxication“, to be treated with colonics and purgatives. Clean out the bowels, went the theory, and you could cure any illness. Science discarded autointoxication by the 1900s as we gained a better understanding of anatomy, physiology, and the true cause of disease. Yet the term persists today – but now it’s marketing slogan. Today’s version of autointoxication argues that our environment is increasingly toxic, and it’s making us ill. Man-made chemicals are absolutely in our environment, so the reasoning goes that it must be making use sick. Depending on who you ask, some combination of food additives, salt, meat, fluoride, prescription drugs, smog, vaccine ingredients, GMOs, not “eating clean”, or perhaps not “eating paleo” are causing a buildup of “toxins” in the body. So what is the actual “toxin” that is causing you vague but apparently real harm? Detox kits and treatments never name the toxins that they remove, because they’ve never been shown to remove toxins.

But my colon!

The colon remains ground zero for detox advocates. Advertisements may 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 of mucoid plaque that’s been documented in the medical literature. Not one. The same can be said for rope worms. They do not exist.

Will detoxing improve my organs?

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 (e.g. cancer) 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. 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.

If you’ve completed a detox, you may feel very different from when you started. You could be dehydrated. You may have disrupted the normal bacterial in your colon. Your body could be in a fasted state due to a lack of calories – it all depends on the approach taken. But no detox plan or kit will have any meaningful effects on your organs, or your ability to remove toxic substances from your body.

The reality is that our bodies are constantly being exposed to a huge variety of natural and synthetic chemicals. Air is chemicals. Food is chemicals. Drugs are chemicals. Herbs are 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, gastrointestinal system, and most importantly, the liver make up our astoundingly complex and sophisticated intrinsic detoxification system.

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 squeeze out a sponge, or change the air filter in your car. But 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 that they don’t understand basic anatomy or physiology.

Is there any evidence to support detoxing?

A 2014 review of detox diets in the Journal of Human Nutrition and Dietetics provides a good summary of the evidence supporting detox diets:

To the best of our knowledge, no rigorous clinical investigations of detox diets have been conducted. The handful of studies that have been published suffer from significant methodological limitations including small sample sizes, sampling bias, lack of control groups, reliance on self-report and qualitative rather than quantitative measurements.

The authors could find only a single detox product has been evaluated in the literature. Ultra Clear is a supplement that is claimed to detoxify the liver. The “evaluation” of Ultra Clear, was not blinded, and lacked any controls. The research subjects were 25 naturopathy students. Perhaps not surprisingly, the students reported improvements on a number of measures – but without a properly designed trial, the results don’t provide any evidence that the product is effective.

In general, there was no credible evidence to demonstrate that detox kits do anything at all. While they can be very unpleasant, they have not been shown to remove “toxins” or offer any health benefits. Coffee enemas are commonly promoted as toxin-removers. Coffee enemas offer no medical benefits. Vitamin injections are a popular naturopathic offering that has not been shown to provide meaningful benefits to consumers, as it has 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, “naturopathic” chelation is not science-based and doesn’t seem to do much of anything (except enrich its proponents).

There is just as little evidence for detox programs. One I have found evaluated is via L. Ron Hubbard and the Church of Scientology, called the Hubbard Purification Rundown. It involves niacin supplements, saunas, exercise, polyunsaturated oil consumption, and vitamins, minerals, and electrolytes. The protocol was used on a small group of firefighters after 9/11. With small sample sizes and no control groups, any critical evaluation of the results is impossible. Another evaluation with firefighters was equally limited by a lack of proper randomization and blinding. The same protocol was also used in healthy volunteers. Owing to a lack of blinding and placebo, the results are not credible, which is probably why the paper ended up published in Medical Hypotheses.

Have I harmed myself with a detox?

If you’re reading this post-detox, probably not. When it comes to simple dietary changes, there’s little evidence of harm. A detox can be a dietary reset – so take advantage of that. Eating a healthier diet and less processed and refined foods is reasonable dietary advice for everyone. (But avoid quinoa – no level of purported health benefits is worth quinoa.) 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 a detoxification process that has a real risk of harm. From a medical perspective, coffee enemas are considered unsafe. Rare but serious adverse events like septicemia (bacteria in the bloodstream), rectal perforation, and electrolyte abnormalities have been caused by coffee enemas. Deaths from the administration of coffee enemas have also been reported. Take your coffee by mouth – not any other orifice.

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 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 evidence they do anything meaningful. Glutathione injections, while often touted as a “hangover cure” (among other uses) actually has very little published safety information available to support its use.

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 not recommended 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 – just in 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 colonies of bacteria 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 for digestion 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 go back to pre-detox levels.

There are no quick fixes

Any product or service advertised with the words “detox” or “cleanse” in the name is only truly effective at cleansing your savings – 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. If you’ve detoxed, take advantage of this opportunity to understand what’s happened and how to prevent yourself from ever detoxing again. And in the future, if anyone suggests a detox or cleanse to you, remember that you’re hearing a marketing pitch for an imaginary condition.

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Posted by Scott Gavura