Yesterday, the real-life mailbox brought the Pharmboy household the Fall 2009 issue of DukeMedicine connect, a biannual publication on current news from the Duke University Health System. Produced by DUHS Marketing and Creative Services, it “strives to offer current news about health topics of interest” to its readers. This issue is not yet online but you can see the Spring 2009 issue here.
What caught my eye was a cover teaser titled “Detox Delusion” and an article on detoxification diets focusing on an interview with Beth Reardon a nutritionist with Duke Integrative Medicine.
The article focuses on the fallacy of detoxification diets, extreme and sometimes dangerous regimens of purges, enemas, supplements, herbs, with the misguided goal of clearing one’s body of “toxins.” These amorphous toxins are never named, much less denoted with an IUPAC chemical name, but prey upon the fears of our “chemical” environment.
The article refers to the current “Master Cleanse” craze, known also as the Lemon Cleanse or Maple Syrup Diet. Not mentioned in the article is that the diet was developed in 1941 by an unlicensed practitioner named Stanley Burroughs and popularized most recently in the 2005 Peter Glickman book, Lose Weight, Have More Energy and Be Happier in 10 Days and his MasterCleanse/Raw Food website.
So, I was very pleased to see this:
The evidence supporting detox diets is slim to none, but they’re often touted as holistic and popularized by celebrities small and smaller. Scores of slender starlets can’t be wrong – can they?
Beth Reardon, MS, RD, nutritionist for Duke Integrative Medicine, gives us the skinny on a recurring diet craze:
It’s not merely the lure of plummeting pounds that draws people to detox diets. There’s powerful appeal in the promise that these diets will cleanse our body of toxins, observes Reardon. “We are bombarded by our food supply, what’s in it, what’s not. We hear about additivies, preservatives, dioxins, carcinogens; we see horrific pictures on the Internet of something that supposedly came out of a colon; and we’re just overwhelmed. The fear factor is pretty convincing. People are grasping to do what makes sense, and the notion of detoxifying the body sounds right. But there just isn’t good science behind detox diets.
Fear. The propagation of fear – fear of the unknown or fear propagated by faulty risk/benefit considerations – drives much of the market for these approaches. Fear also even drives other areas of pseudoscience and denialism
From the article, again:
Most detox diets are awash in fluids; the Master Cleanse’s liquid-only regimen includes, in addition to six to 12 eight-ounce daily servings of lemon drink, a quart of water with added sea salt – the “saltwater flush” – as well as herbal laxative teas to combat the constipation that can result from the lack of food intake. Reardon warns that overuse of these electrolyte mixes or laxatives can “disturb our natural balance, causing dehydration, nausea, cramps, dizziness. And excessive fluid intake can lead to hyponatremia: low sodium in the blood.” She says that people who are taking medication for their heart or to regulate blood sugar are at great risk for this serious complication.
BINGO! We are often critical of so-called alternative or integrative medicine programs at our most-revered academic medical centers, but this may be where such centers are truly legitimate: by bringing in patients who want to use alternative approaches but who are protected from doing so by people trained and licensed in science-based medicine and allied health professions.
Here’s how I think about it, without being privy to any of the discussions at such institutions: large health systems like Duke’s pay a collective price if one of their heart disease or diabetes patients suffers complications from use of alternative practices like Master Cleanse, as alluded to in the last sentence of the above quote. By having an “integrative medicine” arm, these patients are attracted by the philosophy in such centers but then receive proper medical treatment. With Ms Reardon, diabetic patients who wish to lose weight will then be counseled and prescribed a dietary regimen that won’t complicate their disease.
Of course, I’m not giving carte blanche to all integrative medicine centers – Duke’s center was endowed by a reiki master – a very wealthy reiki master – and continues to offer other unsupported practices such as acupuncture. There are many more examples of where such organizations are buying into practices not supported by science – Orac keeps a nice list entitled, “The Academic Woo Aggregator.”
However, I’m seeing that major health systems have realized that integrative medicine programs supported by science-based medicine can mitigate patient risk and improve health by intervening with healthy practices under the rubric of something perceived as alternative.
Finally, here is where Reardon closes the deal in garnering my utmost respect: she points out how we have evolved Phase I (e.g., cytochrome P450 monooxygenases) and Phase II (e.g., UDP-glucuronyltransferases) xenobiotic-metabolizing enzymes as our body’s natural detoxification mechanisms:
Finally, says Reardon, you just don’t need to go to extremes to cleanse your body of toxins. “Give your body more credit. We have evolved over two-and-a-half million years with highly effective detoxification systems – such as the liver and the kidney. We naturally detox most substances that could be harmful. Our bodies are designed to do this – if we give them proper food and hydration and don’t stress out our systems by eating a diet that includes a disproportionate amount of processed foods.”
In fact, Reardon’s suggestion of a plant-based, whole-foods diet means that one will be exposed to naturally-occurring chemicals known to induce the activity of some Phase II detoxification enzymes.
Once the Fall 2009 issue of DukeMedicine connect is online, I’ll put up a link so you can read more.
Disclosure: For eight months in 2001, the author drew 50% of his salary from the organizational precursor to Duke Integrative Medicine as a dietary supplement educator and consultant.