detoxification therapies

It's an irrational concept, yet an intriguing idea, that modern life so fills us with poisons from polluted air and food additives that we need to be periodically "cleaned out" ("detoxified"). Never mind that natural chemicals in our foods are thousands of times more potent than additives, or that most Americans are healthier, live longer, and can choose from the most healthful food supply ever available. -- Frances M. Berg, M.S. Real detoxification of foreign substances takes place in the liver, which modifies their chemical structure so they can be excreted by the kidneys which filter them from the blood into the urine. --Stephen Barrett, M.D. "Toxin" is classic pseudoscience terminology." --Ben Goldacre, M.D. "...these detox programs amount to a large quantity of excrement, both literally and figuratively.” --Peter Pressman, M.D.

A detoxification therapy claims to remove toxic substances from the body. Toxic substances may be natural or synthetic, and occur in a wide variety of strengths. Plants, for example, produce toxins that ward off or kill pests. Synthetic insecticides also kill pests. Most foods have toxins occurring in small amounts that are not likely to be harmful to most people. Many toxic substances occur naturally in foods, e.g., arsenic, but in doses so small as not to be worthy of concern. (There is no way to know that a particular dose of a toxic substance could never harm anyone.) Some toxins, like botulinum or the venom of an inland taipan or box jellyfish, are deadly. Botulinum toxin, produced by the bacterium Clostridium botulinum, is the most dangerous toxin to humans. Oddly, botulinum toxin can also heal, demonstrating an important point: not all dangerous toxins are always dangerous to your health.The dose makes the poison.

Some toxins come from environmental pollution, e.g., PCBs (polychlorinated biphenyls), phthalates, and asbestos.* Some toxic substances, like lead or methyl mercury, can cause irreversible neurological damage. Chelation therapy is a scientific treatment for the removal of heavy metals such as lead. Chelation therapy is sometimes used to treat coronary artery disease, but there is scant evidence that the treatment removes plaque buildup in the arteries. Most detoxification therapies are probably as ineffective as chelation is for removing plaque from arteries.

Insofar as drugs can destroy the brain or the liver, they are toxic and the expression "drug detox" is not a misnomer. Overcoming an opiate addiction, however, may not involve the removal of a poisonous substance from one's body and most of us probably do not think of alcohol, tobacco, heroin, or cocaine as poisons. Even so, some substances are toxic and therapies to eliminate them from usage are rightly called detoxification therapies.

Outside of being treated for poisoning or certain kinds of addiction, the word 'detox' has no meaning, according to a pamphlet published by a group of thirty-six people calling itself Sense About Science (SAS). (A summary of the group's findings may be found on their website.) There are thousands of products that use the claim of detoxification as their main selling point. SAS investigated 15 representative products and found that none of the products identified a single toxic substance as one their product removed, none of the manufacturers of the products could provide compelling scientific evidence that the product removes toxic substances, none of the sellers had a clue what the products actually do, and nobody involved in making or selling these detox products could provide a comprehensive definition of 'detox.'

Detox in a Box

One detoxification product not evaluated by the Sense About Science group is called Detox in a Box. The promoters of this product made the grave mistake of agreeing to appear with Dr. Ben Goldacre on Today, a BBC Radio 4 program. Goldacre suffers no fools and he brought with him a copy of a page from the Detox in a Box website, which claims the product would be beneficial for detoxification of heavy metals such as lead, mercury, cadmium, nickel, arsenic, and aluminum. Appearing with Dr. Goldacre was Nas Amir-Ahmadi - MD (the MD stands for managing director, of course) who lied and laughed as she told Goldacre he must have confused her site with another one. (Goldacre has posted links to the audio.) Within an hour the website was changed and soon all references to Detox in a Box on the Wayback Machine were removed. However, the evidence was there and the BBC announced the lie (though they didn't call it a lie since that kind of direct reporting isn't done). The Detox in a Box folks posted the following on their website after it was apparent that their MD had been caught lying. I post the whole mess because I imagine it will be deleted soon.

Following Nas Amir-Ahmadi’s appearance with Dr Ben Goldacre on this morning's Today programme, the company would like to make the following statement: “We acknowledge that Dr Ben Goldacre was correct at the time of interview that the Detox in a Box website did contain the words 'One of the most complex detoxification functions is against heavy metals such as lead, mercury, cadminium [sic], nickel, arsenic, and aluminum' and apologise for not confirming this at the time. The website has now been amended to avoid any further confusion.” Over the past four years we have been delivering healthy meals to many happy clients, and they have reported back to us many benefits & positive experiences. We have relied on their word of mouth to promote our business as we have been unable to fund large advertising campaigns. We strive to be a happy & vibrant lifestyle company, promoting healthy eating in a “fast food” nation, because we are passionate about food and feeling good. Much of what we do is common sense, but we provide an efficient service delivering meals to people who may not have the time or cooking experience to do it for themselves, or who may prefer to achieve their weight loss goals with real food and a structured eating plan. Our food is delicious with a Middle Eastern influence; we use an abundance of fresh herbs and spices rather than artificial flavourings. We do not use red meat, wheat, dairy products or artificial sugars, colouring, flavourings or additives our meals are all low in salt, but we aim to make them full of flavour. For everyone the benefits and experiences of a meal plan are individual, listed below are some client comments.... [accessed January 12, 2009]

I will spare the reader the glowing testimonials about the wonderful food this company provides. Yes, it provides food. The detox is a selling point; it's a lie, but it's a selling point nonetheless.

colon cleansing

Many proponents of detoxification therapies defend colon cleansing as the most important of all organ-cleansing programs. Despite the lack of scientific studies to support any benefit to periodically douching the colon, many people are self-medicating with colonic irrigation (colon hydrotherapy) in the hopeful belief that it will help them live longer and more healthily. Katherine Rauch of WebMD reports on one naturopath who prescribes colonics for "asthma, arthritis, sinus problems, chronic fatigue and constipation." The fact that there is no scientific evidence to support such treatment is little deterrent to true believers in "nature's remedies."

One practitioner of scientific medicine is quoted by Rauch as saying that the dangers from colonic irrigation "include spreading infection from contaminated equipment and harmfully altering the chemical balance of the colon." Dr. Ross Black notes: "A major function of the colon is to absorb minerals such as potassium and send them through the bloodstream. Colonics could wipe out these minerals and thereby cause deficiencies."

Dr. Stephen Barrett writes:

The theory of "autointoxication" states that stagnation of the large intestine (colon) causes toxins to form that are absorbed and poison the body. Some proponents depict the large intestine as a "sewage system" that becomes a "cesspool" if neglected. Other proponents state that constipation causes hardened feces to accumulate for months (or even years) on the walls of the large intestine and block it from absorbing or eliminating properly. This, they say, causes food to remain undigested and wastes from the blood to be reabsorbed by the body. Around the turn of the twentieth century many physicians accepted the concept of autointoxication, but it was abandoned after scientific observations proved it wrong. In 1919 and 1922, it was clearly demonstrated that symptoms of headache, fatigue, and loss of appetite that accompanied fecal impaction were caused by mechanical distension of the colon rather than by production or absorption of toxins. Moreover, direct observation of the colon during surgical procedures or autopsies found no evidence that hardened feces accumulate on the intestinal walls. Today we know that most of the digestive process takes place in the small intestine, from which nutrients are absorbed into the body. The remaining mixture of food and undigested particles then enters the large intestine, which can be compared to a 40-inch-long hollow tube. Its principal functions are to transport food wastes from the small intestine to the rectum for elimination and to absorb minerals and water.

The idea of the colon being a reservoir of toxins is not based on scientific knowledge, yet it is a mainstay among alternative health advisers. For example, a review of a leading colon cleanser by a leading promoter of detoxification doesn't name a single toxin that the colon allegedly retains or that the product allegedly removes. The review repeatedly says that the product "cleanses" or "purifies" but provides no evidence that it does either. In fact, it doesn't even provide a sense of what it means to cleanse or purify an organ. Nor, of course, does it provide any evidence that organs need cleansing or purification.

ionic foot baths

Here the main selling attraction is that the client can see the water change color from clear to "dirty" as electrodes are placed in a solution of water to which salt has been added. The dirty color, you are told, is proof of toxins leaving your body through your feet. If you try this without putting your feet in the water, you'll get the same result: "dirty" water. You're told that toxins are being "magnetically" or "ionically" drawn from the pores of your feet. Not true. The discoloration is from the metals and contamitants on the electrodes themselves. (Check out the Herb Allure non-scientific test: "In our non-scientific opinion, the lab analysis of the water samples collected from this experiment show no meaningful patterns of difference in the amount of heavy metals present between samples that had feet in them and samples that had no feet in them. We had to conclude that the foot spa did not remove any significant amount of heavy metals from the body....We did not observe—what we consider to be —any significant trends during the course of this experiment. As a result of this experiment, Herb Allure decided not to manufacture its own brand of foot spas, despite the considerable potential financial gains that would likely result from such a venture.)

whole body cleansing

Even more absurd than the claim that there is a general need to detoxify the colon is the claim that the whole body needs to be detoxified. If our bodies were full of toxins we'd be very sick or dead. That fact has not stopped the inventiveness of entrepreneurs with magic detoxification purges, lotions, or machines. One machine that's been around for some time is the Aqua Detox TM , which is said to be: " The most effective way to re-balance, re-energize and detoxify the body without special diets, funny drinks or sweaty exercise." How does it do this? By sending a small electrical current through water in which the patient is resting his feet. The evidence? The water changes color. Proof of toxins being released through the feet or of rust from the electrodes? You decide.

exercise and sauna

What about exercise and sauna? Don't we excrete toxic substances when we sweat? Yes, we do. (Some of the substances in sweat don't come from the sweat directly; they're produced by bacteria that digest our sweat. That's where body odor comes from. Thus, a shower or bath might be considered detoxification!) And we excrete toxic substances when we urinate and defecate, all in small amounts. You're not going to be poisoned to death, for example, if you drink a glass of your own urine or sweat. There may be some health benefits to sweating in moderation through exercise or sauna, and some of those benefits might be due to the removal of toxins. Sweating evolved mainly to regulate temperature, not to remove toxins. I have been unable to find studies that provide evidence of specific health benefits from the removal of toxic substances by sweating. Too much sweating could lead to dehydration and death. People with high blood pressure are often advised by their doctors to stay away from saunas and hot tubs. And, of course, you must have proper ventilation and use non-toxic water (if you pour liquid on hot stones in your sauna) or the results could be tragic. I'll leave it to others to discuss the pros and cons of using antiperspirants.

The American Academy of Dermatology (AAD) says that perspiration is 55 percent to 60 percent fluid, mainly water. Perspiration also contains salt (sodium chloride), as well as trace amounts of other substances, such as ammonia, calcium, chloride, copper, lactic acid, phosphorous, and potassium. These substances, called electrolytes, help to regulate the balance of fluids in the body. The most abundant electrolytes are phosphorous and sodium, which cause sweat to sting the eyes and give sweat its salty taste. The loss of excessive amounts of salt and water from the body can quickly dehydrate a person and can lead to circulatory problems, kidney failure, and heat stroke. So, although it's literally cool to sweat, it's also important that people drink fluids when exercising or when outside in high temperatures.

we're all toxic

The fact is that most of us are carrying around in our bodies traces of many toxic substances. The Centers for Disease Control and Prevention published a study in 2005 that evaluated more than 2,000 people across the country. Traces of more than 60 toxic compounds were found in the blood and urine of participants. Nobody really knows what these substances are doing to our bodies, including the many people who want to sell us products promising to get rid of these allegedly nasty things. Thus, we should take with a grain of salt what the folks selling infrared saunas say about their product:

Detox from a Sunlight Sauna is 7 to 10 times greater than conventional saunas because it operates more effectively at temperatures 60 to 80 degrees lower than conventional saunas. In a Sunlight Sauna, the average person sweats out 20% toxins and 80% water! In conventional saunas the average person sweats out 3% toxins and 97% water.

How they know this is anybody's guess. Again, no specific toxin is mentioned as having been identified, much less measured. The website does say, however:

....it is estimated that one in every four Americans suffers from some level of heavy metal poisoning, including mercury, lead, cadmium and aluminum. Toxins in the body also include chemical pollutants such as pesticides, DDT, PCB (polychlorinated biphenyls) and food additives. Drugs and alcohol also have toxic effects in the body.

The source for the above claims is given as Zane R. Gard, M.D., developer of the bio-toxic reduction sauna. It might be true that most bodies have some traces of many toxins in their cells and cell membranes, but it is not true that Dr. Gard or anyone else knows for a fact just what the specific health effects of this might be or that removing some of these toxins by sweat provides any specific relief from any specific disorder.

naturopathy and detoxification

One group of people particularly fond of detoxification are naturopaths. Peter Bennett N.D. for example, thinks that "everyone should detox at least once a year."* He also says that "scientific studies show that a detox is beneficial for health," though he doesn't cite any by name. Linda Page N.D. says "it's critical to detox" these days because there are more toxins in the environment than ever. There may be more toxins than ever, but it doesn't follow from that fact that detoxification is good, much less necessary. Page recommends detoxification "for symptoms such as unexplained fatigue, sluggish elimination, irritated skin, allergies or low-grade infections; bags under the eyes; a distended stomach even if the rest of your body is thin; menstrual difficulties; or mental confusion." She provides no scientific evidence that toxins cause any of these symptoms.

So, do the naturopaths recommend sweating or herbs or some natural foods to detox? No. They recommend things like eliminating alcohol, coffee, cigarettes, refined sugars, and saturated fats. Does this mean that since alcohol and tobacco contain toxins, by not ingesting them you are detoxing? I guess it does. In other words, the first step in detoxing is to avoid toxins. Hmmm. Also, these naturopaths consider stress hormones to be toxins, so if you reduce stress by meditating then you are detoxing. Bennett thinks that a proper detox program takes a week and involves cleansing the blood. In other words, he thinks that things like food, herbs, vitamins, water, breathing, meditation, and exercise can perform the function of the liver and kidneys. There is no compelling scientific evidence that any particular toxins are removed by these methods that wouldn't be removed by the liver and kidneys anyway.