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Note to SBM ’s regular readers: Today’s post revisits some older material you may have seen before. Happy New Year!

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 offers complete detoxification protocols, including vitamin drips and chelation. There must be something to it, right?

Wrong. “Detox” is a case of a legitimate medical term being turned into a marketing strategy – all designed to treat a nonexistent condition. 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 menu of alternative health treatments, or pulled off the shelf in the pharmacy. Real detoxification is provided in hospitals when there are life-threatening circumstances. But then there are the “toxins” that alternative health providers claim to eliminate. This form of detoxification is simply the co-opting of a real term to give legitimacy to useless products and services, while confusing consumers into thinking they’re science-based. Evaluating any detox is simple: We need to understand the science of toxins, the nature of toxicity, and how detox rituals, kits, and programs 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

There’s a reason we fall for 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 perhaps sin that we’re as worried about today, however. As our knowledge of biology grew, these fears manifested as “autointoxication.” Clean out the bowels, went the theory, and you could cure any illness. Science led us to discard autointoxication by the 1900’s as we gained a better understanding of anatomy, physiology, and the true cause of disease. Despite the science, however, the idea persists among alternative practitioners. Today’s version of autointoxication argues that some combination of food additives, gluten, salt, meat, fluoride, 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 treatments is the failure to name the specific toxins that these rituals and kits will remove. For example Renew Life promises you:

CleanseSMART is a 2 part, 30 day, advanced herbal cleansing program. It is formulated to stimulate the detoxification process of the body’s 7 channels of elimination: the liver, lungs, colon, kidneys, blood, skin, and lymphatic system. 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. CleanseSMART is essential for helping eliminate constipation and improving bowel health.

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 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 that’s been documented in the medical literature. Not one.

Premise two: Illness is the result of toxins

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 (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 treatments will uniformly fail to link specific 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 astoundingly complex and sophisticated intrinsic detoxification system. Importantly, the dose makes the poison – even water can be toxic (dilutional hyponatremia) when consumed in excessive amounts.

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 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 in 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 without any problem. 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 treatments remove toxins

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

No Items Found

There is no credible evidence to demonstrate that detox kits do anything at all. They have not been shown to remove remove “toxins” or offer any health benefits. The same can be said for quackery like coffee enemas – there is no credible evidence to support claims that coffee enemas help the body to “detoxify” compounds, or help the liver function more effectively. Vitamin injections are another treatment that fail to offer meaningful benefits to consumers, and have 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’s administered in hospitals for real cases of poisoning, naturopath chelation is not science-based and doesn’t seem to do much of anything.

Can Detoxing be harmful?

If they provide no benefit, is there the potential for detox treatments to harm?

When it comes to simple dietary changes, there’s little evidence of harm. Eating more quinoa and kale, and less processed and refined foods is reasonable dietary advice for everyone. 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, it’s clear that some approaches are demonstrably risky. Coffee enemas are considered unsafe and should be avoided. Harms such as septicemia (bacteria in the bloodstream), rectal perforation, and electrolyte abnormalities have been reported. Even deaths. Vitamin injections don’t seem as risky, as long as you trust the sterile technique of your alternative 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 reasonable expectation of any benefit.

What about the detox kits? 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 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. There is no evidence to suggest that consuming milk thistle will cleanse you of unnamed “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 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 digestion process after a period of catharsis, where, depending on the extent and duration of fasting, little to no digestion occurred, and the normal gastrointestinal flora 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 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 remain the same.

Conclusion

Any product or service with the words “detox” or “cleanse” in the name is only truly effective at cleansing your wallet 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 the broader distraction away from the reality of how the body actually works and what we need to do to keep it healthy. “Detox” focuses attention on irrelevant issues, and gives consumers the impression that they 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 pushed 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. Our kidneys and liver don’t need a detox treatment. If anyone suggests a detox or cleanse to you, you’d do well to ignore the suggestion, and question any other health advice they may offer.