Pulp Fiction

Everywhere you look on any given day of any given week, you're constantly bombarded with an assortment of never-ending products that claim to change your life. There are supplements that are 3000-percent better than creatine; advertisements, endorsements and celebrity interviews for obtaining Jennifer Aniston’s abs; methods for dropping 15 pounds with Beyoncé’s Master Cleanse Lemonade; and infomercials promising the new revolution to diet and exercise.

In the last several years, the growth and invasion of detoxes, juices and body cleanses has exploded like many other trends in nutrition and training. Due to high-powered celebrity endorsements, dubious testimonials, books, and those creating their own versions of 15-day, 30-day and 5-week detox and cleanse programs, the American public has become sucked into the detox and juice cleanse business like fruit flies. But what is a detox? Do they even work? How does the body rid itself of toxins? Why such a conglomerate of and reliance on these products? Let’s dive deeper. Welcome to Pulp Fiction!

Detox History 101

The concepts of body cleansing and detox approaches that are heavily marketed through dubious testimonials and conjecture in our modern era are nothing new. In fact, they have been around for centuries, and the popularity of these practices is cyclical, returning in overabundance quite frequently.

Many detoxification diets were based on religious beliefs and typically involved fasting. Historically, many attribute detoxification diets to Ayurveda, meaning “the science of life.” This system of Hindu medicine, a form of alternative medicine, began in India around 3500 BC. A major highlight of this practice is panchakarma, which involves gradually eliminating certain foods from the diet, taking spiritual walks and cleaning out the colon and nasal passage. The primary objective of panchakarma is to extend life and preclude disease while enticing spiritual and emotional growth and development. Although well established in the integrated Indian national health care system, with state hospitals for Ayurveda established across the country (13), the practice of Ayurveda in the United States is only licensed in complementary heath care. There aren't any states in the United States with licensed Ayurvedic practitioners, although a few states have approved Ayurvedic schools (12).

What is detox?

Traditionally, and in real life medicine, detoxification primarily describes treatments for dangerous levels of drugs, alcohol, or poisons, including heavy metals. These detox treatments are actual medical procedures that aren't carelessly selected from a dropdown menu or carted off the shelf in your local pharmacy or Target store. These specific programs are provided by either hospitals and/or non-profit organizations when there are life-threatening circumstances. They are not used to drop 20 pounds in four days by drinking magic lemonade from a cardboard box. Unfortunately, this legitimate medical “detox” term has been gyrated into a glorified marketing strategy designed and intended to treat a non-medical condition. In recent years, the detox term has developed into a household name within the consumer marketplace and has come to include juices, cleanses, nutritional supplements aimed to detox your system, hot tubs, infra-red saunas, colon cleanses and extreme methods of oral and rectal agents as well as purging, fasting and exercise (5). The shift from a legitimate medical usage to supplying exaggerated claims through power of suggestion, hyperbole, reliance on the emotional triggers of zealous testimonials and celebrity endorsements has created erroneous behavior and false thinking by using a real term (detox) to provide legitimacy to inadequate products and services while confusing consumers into thinking that they’re evidence- or science-based. Before we move forward, it’s important to know and understand that the entire premise of detox/detoxification programs is centered on what we currently refer to as “toxins.”

What are toxins?

It’s true that our bodies repeatedly undergo natural detoxification through various excretory functions, mainly through the liver and kidneys and even sweat (although less pronounced). So what are these toxins? In its simplest form, toxin means a biologically produced poison. In a broad sense, it includes worldwide dissemination of industrial chemicals, pesticides, heavy metals and radioactive elements (5). For the overwhelming majority, it’s discussed within the confounds of food toxins. However, for whatever reason, through bias, narrow mindedness and possibly even greed, we only like to converse on food-related toxins and purposely dismiss other aspects of toxins like environmental toxins (2, 10), which may include lead and mercury exposure, air pollution and other organic compounds. Many of these environmental exposures are linked to an increased risk of cardiovascular disease (2). Exposure to air pollution from automobile emissions, power plants and other sources is yet another environmental risk factor for cardiovascular disease resulting in tens of thousands of deaths annually in the United States (2). Additional exposure to other environmental toxins, particularly bisphenol A [(8) a compound found in common consumer products like plastic water bottles] and phthalates (substances added to various plastics to enhance their flexibility and durability) are also apparent.

In current nutrition and training culture, we often like to narrow down and categorize specific foods as “toxins” and completely disregard everything else that could be categorized as a toxin. A prime example is water because overconsumption of water leads to water intoxication. Many who lack significant knowledge and application of evidence-based science simply use opinion as fact without the respect and appreciation for actual evidence. In other words, we often categorize the following as “toxins,” blaming these types of foods for everything from the common cold to complex disease, obesity and diabetes, and create the “good foods” and “bad foods” argument, which creates propaganda and misleading information:

• Cereal grains (specifically refined flour)
• Omega-6 oils (corn, cottonseed, safflower, soybean)
• Sugar (i.e. high fructose corn syrup)
• Processed soy (soy milk, soy protein, soy flour)

There really isn't any such thing as “good foods” or bad foods,” just the application and context for which you are referring. Yes, many of these foods in excess have been known to create metabolic havoc on physiological systems. However, the point is this: “Because some food toxins cannot be removed from foods and others may be created during processing or cooking, consumption of small quantities of food toxins is unavoidable” (6).

Elimination Chamber

There are three primary methods by which the disposal of toxins occurs in the body. These methods can be rather complex, so let’s break it down more simply.

1) Liver: A major function of the liver is to metabolize, detoxify and inactivate both endogenous compounds and exogenous substances (16). The liver provides an important filtering mechanism for circulation by removing foreign particulate matter, including bacteria, endotoxins, parasites and aging red blood cells (3, 16). The liver detoxifies harmful substances from a variety of sources by burning sugars, fats, protein and/or other sources like medications, drugs, food additives, preservatives, food colorings, sweeteners, flavor enhancers, chemicals used in agriculture, alcohols, fumes and air pollution. Disposal of toxins occurs in two phases—oxidations and conjugation. Essentially, it’s the process by which free radicals are eliminated due to the assistance of antioxidants.

2) Kidneys: Similar to the liver, the kidneys also assist in the disposal of toxins. The kidney contains many small, crucial structures called glomeruli, which filter foreign substances (such as toxins and waste products) out of the blood where they become concentrated into the urine, resulting in excretion. Some toxins don’t get filtered out by the glomeruli and are instead actively secreted by the kidneys into the urine. Nonetheless, the kidneys' ability to secrete waste products and toxins into the urine is one of the primary ways in which toxins are eliminated from the body (7, 16).

3) Sweat: Regardless of what anybody tells you (yes, including Dr. Oz and Beyoncé), you can't “sweat out” toxins or “cleanse your system” through sweating. Although skin is classified as a major organ, it isn't connected to other major systems of the body. There are two main types of sweat glands—eccrine and apocrine. They both assist in thermoregulation. Eccrine glands are triggered to produce moisture, helping to cool the body both during training and in a hot, humid environment. Apocrine glands (mainly in the armpit and navel) are activated in response to stress or stimulation. I could go into much more detail here, but suffice it to say that the liver and kidneys are the main players in the disposal of toxins, not sweat.

Detox Claims

Do you wake up in the morning and say, “Gee, I really need to clean out my bowels.” Well, if you do, perhaps heavy squats will solve all your nightmares. There’s a reason why people fall prey to the marketing of detoxification. It’s likely that we just seem hardwired to believe we need it or that we “think” we need something to believe in.

The argument that combinations of food additives, gluten, salt, meat, prescription drugs, L.A. pollution, GMOs and last night’s gourmet pizza are creating metabolic madness, causing a buildup of “toxins” in the body, is very exaggerated. Do you ever stop to think what is causing actual harm? It has to be the pizza dough, right? What about the sausage or green chili? I got it—it’s the gluten, right? Not likely. You can read more about the truth about gluten in my recent article.

A common feature among detox treatments shown on television or on a cardboard box is the failure to name the specific toxins that these rituals and take-home kits will remove, which brings me to the “claims.”

Truth to Claim #1: These statements are flawed from the start and don't carry any scientific weight. Digestion typically attributes only about 10 percent of daily calories (7, 11, 14), which can vary depending on caloric needs and the thermic effect of the food. The fact is following any restrictive habit of eating will result in enhanced weight loss. The human body is an advanced machine that is designed to "detoxify your systems" naturally.

Truth to Claim #2: Luckily, science refutes this, and this “toxic sludge,” or mucoid plaques, does not really exist. It’s simply pseudoscience in order to promote and sell detoxification treatments. Mucus is a naturally occurring product of the digestive system and serves as an important regulator in protecting it from damage and infection (1, 15, 16). The intestinal tract contains mostly bacteria, which can assist in digestion. For those wishing to have an enema or laxative, this approach does not eliminate more ‘bad’ versus ‘good’ bacteria. In addition, even a thorough search through PubMed of colon and mucoid plaques generated zero results while there are copious amounts of detox websites. These sites are rather convincing to the overall uneducated public and promote a belief that doesn't have any fundamental basis of physiology, specifically gastrointestinal physiology.

Truth to Claim #3: Again, these are dubious approaches and opinions without real science, and they fail to explain which specific toxins(s) are causing disease. There are numerous diseases and disabilities that exist, and to say that these represent a cause and effect relationship from toxins is pseudoscience and exaggeration. In order to hone in on the specifics and even predictors of a single chemical in relation to a specific disease would require years of study. Thankfully, that’s why areas and entire fields of epidemiology exist. Despite the sexy claims and marketing strategies that toxins produce a variety of illnesses, these detox treatments will ultimately fail in the pursuit of associating any specific toxins with exclusive symptoms or illnesses.

Truth to Claim #4: Refer to the above paragraphs for details. Due to the wealth of available detox measures, it isn't yet possible to base their effectiveness with rigorous scientific evidence (5). Few programs are established to define what a “tox” is and there isn't any specific definition of “detox.” In addition, little (if any) documentation is available regarding the elimination of toxins and any associated outcome.

Detox Versions

Let’s shift gears for a brief moment. A variety of detox versions exist. Most are initiated with a cleansing phase (often termed juice cleanse), which is most often accompanied by a complete fast requiring only water and various spices (i.e. your own lemonade version). The diet is limited to strictly fresh vegetable and fruit juices and water for anywhere from a few days to several weeks. In its simplest form, it’s a starvation diet. Collectively, the two most common used detox diets are liquids progressing to solid foods. In short, a long-term, liquid-only diet almost always lacks critical and essential nutrients including dietary fiber, essentially fatty acids and protein, making individuals susceptible to vitamin and nutrient deficiencies and perhaps gastrointestinal problems. Crash diets only focus on quick and short-term weight loss, which results in loss of lean muscle tissue, instead of promoting lifetime accountability and success and strength.

With the juice cleanse craze (make sure you're near a bathroom regularly), there are similar claims that parallel the detox diet claims. These include:

• It’s a more convenient way to obtain added fruits and vegetables.
• You receive more health benefits from fruits and veggies in juice form.
• It's excellent for weight loss if you're overweight and/or obese
• You'll feel more energized, you'll gain an enhanced immune system, you'll reduce illness and disease and you'll have glow in the dark skin (which might be perfect for a Halloween costume).

Here’s the truth—many of these juice cleanses contain large amounts of sugar. Let’s not get bogged down with glucose versus fructose, but it certainly isn't an ideal situation to optimize body composition. However, some specific juices (i.e. orange juice—freshly squeezed is the best) have been suggested to exhibit anti-inflammatory properties and mediate the inflammatory response in plasma level and gene expression and in postprandial and chronic (≥7 consecutive days) periods (4). In addition, tart cherries are purported to have a number of beneficial health effects, including high levels of antioxidants and sleep promotion due to their high levels of melatonin. Tart cherries also contain antioxidant and anti-inflammatory chemicals that may influence sleep with the sleep–wake cycle (9).

Nonetheless, juicing fruits and vegetables actually removes many of the nutrients from these foods. There isn't any reliable scientific evidence to support claims that juicing your fruits and veggies is any healthier than actually eating them. The fiber content and some of the antioxidants (and many flavonoids) found in fruits and vegetables are often reduced in the process. Furthermore, the level of satiety is significantly reduced compared to consuming actual solid food, and they lack adequate amounts of protein and essential fats necessary to carry out both physiological function and maintain lean body mass (i.e. protein). This sets the stage for macronutrient and vitamin deficiencies.

Side effects

As far as side effects, when engaging in these approaches and upon completion, some people experience nausea and diarrhea. Proponents of the “cleanse and detox” train call these “cleansing reactions.” In other words, you experience these symptoms due to the “toxins leaving the body.” Ha! Right! Obviously, a main side effect is immediate, especially involving liquid diets and liquid calories and in combination with a laxative. Other side effects may persist such as dehydration; fatigue from the caloric restriction and decreased availability of glucose and glycogen, proteins and fats; and overall weakness.

Regardless of how much weight you might lose or how much you “think” you lost (which will be more muscle tissue than body fat percentage), rest assured that the weight will come back precipitously before your next detox retreat.

Detox This!

Although these quick-fix diets garner so most attention and excitement, you can't sustain these types of diets for any prolonged period of time. If you have a specific digestive disease (i.e. colitis or diverticulitis), you should discuss these approaches with a qualified medical professional. As previously discussed, there is little published evidence or clinical implications to suggest that these treatments have a significant benefit to your body and dispose of waste products in any effective manner. They might be safe for a day or two, but following them for a specific time frame provides consumers the impression that they can undo lifestyle decisions with quick fix methods, which deliver nothing more than unrealistic expectations.

In the meantime, here are some more effective tips to consider:

1. Drink some water, lots of it (perhaps a splash of apple cider vinegar).
2. Let your kidneys and liver do their damn job.
3. Have some fiber (like oatmeal, fruits and maybe some veggies).
4. Consume live culture yogurt, kefir, and probiotic supplements.
5. Squat and deadlift heavy (this alone will certainly solve many of your problems).

References

1. Allen A, Flemstrom G (2005) "Gastroduodenal mucus bicarbonate barrier: Protection against acid and pepsin." Am J Physiol Cell Physiol 288:C1–19.
2. Anthony D, George P, Eaton CB (2014) "Cardiac risk factors: Environmental, sociodemographic, and behavioral cardiovascular risk factors." FP Essentials 421:16–20.
3. Brooks G, Fahey, Baldwin (2005) Exercise Physiology: Human Bioenergestics and Its Application.
4. Coelho RC, Hermsdorff HH, Bressan J (2013) "Anti-inflammatory properties of orange juice: Possible favorable molecular and metabolic effects." Plant Foods for Human Nutrition 68:1–10.
5. Cohen M (2007) "Detox: Science or sales pitch?" Aust Fam Physician 36:1009–10.
6. Dolan LC, Matulka RA, Burdock GA (2010) "Naturally occurring food toxins." Toxins 2:2289–32.
7. Farrell J, Caiozzo (2012) ACSM’s Advanced Exercise Physiology. 2nd ed. Lippincott Williams & Wilkins: Philadelphia.
8. Gao X, Wang HS (2014) "Impact of bisphenol a on the cardiovascular system – epidemiological and experimental evidence and molecular mechanisms." International Journal of Environmental Research and Public Health 11:8399–13.
9. Howatson G, Bell PG, Tallent J, Middleton B, McHugh MP, Ellis J (2012) "Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality." European Journal of Nutrition 51:909–16.
10. Liu J, Lewis G (2014) "Environmental toxicity and poor cognitive outcomes in children and adults." Journal of Environmental Health 76:130–8.
11. McArdle K, Katch (20090 Exercise Physiology: Energy, Nutrition, and Human Performance.
12. Organization WH. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review.
13. Sareen S, Gropper JLS (2012) Advanced Nutrition and Human Metabolism. 6th ed. Cengage Learning.
14. Schenk M, Mueller C (2008) "The mucosal immune system at the gastrointestinal barrier." Best Practice & Research Clinical Gastroenterology 22:391–409.
15. Walter B (2011) Medical Physiology. 2nd ed. Saunders.