The scam of "detox": Ritual purification by another name

"You need to detox."

How many times have you heard or read this? Maybe a friend of yours suggested it for the New Year. Maybe you saw it on a website, in a magazine, or as part of an ad. I like to say sometimes, "Toujours les toxines," because in many branches of alternative medicine the overarching idea behind the interventions used is that vague, unnamed "toxins" are somehow poisoning you and that the only way to fix what's wrong with you is to "detoxify." These "detox" interventions can take many forms, ranging from the relatively (but not completely) benign, such as "juice cleanses," to the downright dangerous, such as chelation therapy.

I've been meaning to return to the topic of "detoxification" in alternative medicine (or, as I now like to call it, fake medicine) since earlier this month, when Dr. Daniel Neides, the medical director of The Cleveland Clinic Wellness Institute, published a virulently antivaccine article for a local news website. He was, of course, widely condemned—and quite rightly so—for his article, which was loaded with tired antivaccine tropes that I've been battling at least since 2005, and the Clinic promised disciplinary action and loudly proclaimed its pro-vaccine bona fides. Unfortunately, Dr. Toby Cosgrove, CEO of The Cleveland Clinic later doubled down on his hospital's support for the pseudoscience and fake medicine that it has embraced through its Wellness Institute, Center for Functional Medicine, and traditional Chinese herbal medicine clinic. In his article, just as Capt. Renault in Casablanca was "shocked—shocked—to find that gambling is going on" in Rick's cafe, Dr. Cosgrove came across as "shocked" that there is antivaccine pseudoscience at his Wellness Institute. The key difference, of course, is that, in contrast to Renault, who was obviously cynically making up an excuse to shut down Rick's establishment at the bidding of the Nazi occupiers, Dr. Cosgrove seemed genuinely clueless how the sort of "detox" quackery his Wellness Institute had embraced led in a pretty straight line to antivaccine quackery, much of which is based on the same ideas, only with vaccines as the source of the "toxins." On the other hand, Dr. Mark Hyman's Center for Functional Medicine still exists at the Clinic, and Hyman still has an important position as its founder and titular head. Given that Hyman co-authored an antivaccine book of the thimerosal fear mongering variety (toxins!) along with Robert F. Kennedy, Jr. right around the time that the Clinic hired him and even appeared on The Dr. Oz Show with RFK Jr. to promote it ten days before his hiring was announced, maybe Dr. Cosgrove is more like Capt. Renault than I'd like to believe. In any event, if you're selling homeopathic detox kits on your online store, as The Cleveland Clinic was, you either believe in the pseudoscience or care more about money than good medicine.

I've discussed what I consider to be the "central dogma" of alternative medicine before, namely that wishing makes it so. If that's the central dogma, the belief that your body has been so overwhelmed by toxins that you need to remove to be healthy is one of the top—if not the top—additional dogmas, and I do mean dogma. As you will see, the belief in "detoxification" resembles a belief common in many religions that sinners (or those who do wrong in the eyes of the deity) are somehow "unclean" and must undergo ritual purification in order to be on the deity's good side again. The ideas behind "detox," more than anything else, resemble ideas undergirding those of ritual purification, with unnamed "toxins" rather than sins or impure thoughts and deeds being the cause of the taint producing the unclean state that must be purified.

Autointoxication: Beware the toxins within!

If there is someone who never wavers in promoting what I consider to be cancer quackery, it's Ty Bollinger. Bollinger, as you might recall, is the quack behind a video series entitled The Truth About Cancer: A Global Quest. My skeptical antennae always start a'twitchin' fiercely whenever I see something entitled "The Truth About..." and Bollinger's video series is no exception, given his history of promoting quackery and luring patients away from real medicine. Truth be told, I tried to watch the series, but the first episode contained so much misinformation, pseudoscience, and, yes, "alternative facts," that I didn't see how I could do the whole series justice without doing a blog post on each installment given my in-depth knowledge of why pretty much everything in the series was quackery. I sampled other episodes and found the same thing. Let's just put it this way, Bollinger interviewed a rogue's gallery of quacks, including Matthias Rath, Mike "Health Ranger" Adams, Joseph Mercola, Jonathan Wright, Rashid Buttar, Russell Blaylock, Stanislaw Burzynski, and Tullio Simoncini.

So it's not surprising that Bollinger promotes "detoxification," and the article I came across over the weekend thanks to my being on his mailing list is the epitome of "thinking" about detox, if you can call it that. In his article entitled "Fact Over Fad: Why Body Detoxification is Essential for Vibrant Health" Bollinger lays out one of the central premises of a lot of alternative medicine quackery (but I repeat myself):

Growing older is unavoidable. It’s a reality that each and every one of us will one day have to face as part of the collective human condition. And yet, while nobody can escape the aging process entirely, the good news is that we can avoid some of the worst effects by simply making the right lifestyle choices.

Wherever you currently fall on the age spectrum, there are immense benefits to be had from properly maintaining your body. Even if you’re just now starting down the path to better health. Just like your car requires regular maintenance in the form of routine oil changes, new tires, fresh coolant, and a thorough washing and detailing… so is regular body detoxification a necessity for optimal health.

I hate this analogy. The body is not a car; it is orders of magnitude more complex than a car. More importantly, a car is not designed to fix itself or replenish its own fluids. In contrast, the human body has evolved over billions of years, all the way back to the simplest one cell organisms, to be self-sustaining and self-"detoxifying," needing little more than adequate nutrition (fuel), water, and activity to maintain itself. Yet quacks like Bollinger often make this analogy, selling "detox" pseudoscience as "routine maintenance" of the body.

Before I go into Bollinger's flawed analogy more, I can't help but ask: Where do all these "toxins" come from? What are they? There are commonly two sources. One is internal and is known as "autointoxication." The basic idea behind autointoxication is that our bodies are constantly building up waste "toxins" that are slowly poisoning us. While it is true that our bodies constantly produce waste, some of which can be toxic, it is also true that our bodies have a number of systems of disposing of them, including the kidneys (which eliminate waste through urine), the lungs (which eliminate the CO2 produced by the "burning" of nutrients for energy), the liver (which can chemically transform many toxins to render them harmless and able to be excreted), and of course the colon, which houses and eliminates the solid waste from digesting our food.

The colon, of course, is the focus of a lot of "detox" quackery, based on the mistaken belief that feces are constantly building up in our colons to the point that a typical adult has ten or even twenty pounds of waste built up in their colons that is slowly leaching out into the bloodstream to poison the rest of the body. Just Google "death begins in the colon," which is a common saying among believers in this sort, and you'll get the idea. This concept is the rationale for "colon cleanses" and "liver cleanses," which often involve juices, purgatives, and enemas, including coffee enemas. Of course, any surgeon who's ever operated on the colon or performed colonoscopy on patients with unprepped bowel (which is sometimes necessary in emergencies), as I used to do before I specialized in breast cancer, knows that this is an utterly fantastical claim. Except in the case of colon obstruction or toxic megacolon there is nowhere near that much feces in a typical colon, and the colon is quite good at containing it and eliminating it. That's what it evolved to do.

Ironically, autointoxication as the cause of disease was mainstream medicine as recently as the early 20th century, and it's a concept that dates back to the ancient Egyptians, possibly earlier. Egyptian priest-physicians (Egyptian medicine originated in the priesthood) believed that a putrefactive principle associated with feces was somehow absorbed by the body, where it acted to produce fever and pus. Later, the ancient Greeks extended the idea beyond digestive waste in the colon to include the four humors and incorporate the concept into the humoral theory of medicine. Even so, it was also a concept promulgated by proponents of scientific medicine as late as the early 1900s. The concept was very much like what I've described so far, namely that putrefactive products of digestion remained in the colon, there to leach into the bloodstream and sicken patients due to autointoxication. Indeed, some surgeons, chief among them Sir W. Arbuthnot Lane, advocated total colectomy for the autointoxication that was thought to be the cause of diseases ranging from lassitude to epilepsy. I even remember the concept showing up in an episode of The Knick, a series that portrayed a fictional 1900-era hospital in Manhattan, in which the wife of one of the surgeons at the Knick was treated for severe depression by Dr. Henry Cotton (an actual doctor from the period), who removed all her teeth because he believed that “all mental disorders stem from disease and infection polluting the brain." If she didn't respond, he was then going to remove her tonsils and adenoids, and, if that still didn't work, her colon.

Given that there were no antibiotics back then, intestinal surgery was fraught with peril due to the high rate of postoperative sepsis and death, making this approach reckless indeed. Eventually, even Sir Arbuthnot Lane came to the same conclusion and by the 1920s had changed his mind, deciding that diet was the answer. Also by the 1920s, science had shown that the various symptoms observed in patients with chronic constipation were largely due to distension of the bowel and were not due to autointoxication. Unfortunately, the belief that mental illness was caused by focal infection persisted longer and it took investigations in the 1920s, which found that Cotton exaggerated his success rates and downplayed his mortality rates, before the practice was finally abandoned, although Cotton was never punished. Quite the contrary, in fact. Thus, as is its wont, scientific medicine did eventually move on from a failed hypothesis, although at a pace that, from the vantage of 2017, appears frustratingly slow. In marked contrast, as is their wont, alternative medicine practitioners clung all the more tightly to this failed hypothesis, an embrace that continues to this day and show no signs of changing. Some of them would have been quite at home with the priest-physicians of ancient Egypt.

Toxins here, toxins there, toxins everywhere!

Bollinger doesn't really focus that much on autointoxication. Although he does allude to it, he concentrates more on external toxins:

Detoxification is about a whole lot more than just a superficial notion of feeling “clean” as part of some trendy dieting fad. It’s about protecting your body against the very real and damaging effects of toxic buildup. For instance, did you know that peer-reviewed science continues to show that harboring toxins inside your body can trigger a wide array of health conditions – including everything from chronic fatigue and muscle and joint pain to brain disease and cancer?

Chronic toxic exposure is also a leading cause of obesity, which now afflicts more than one-third of Americans. A 2012 study published in the journal Environmental Health Perspectives explains how so-called “obesogens” are a major contributor to the American obesity epidemic, which more often than not is erroneously blamed solely on people eating too much rather than walking around with polluted, poor-functioning bodies.

As they say, quacks use the medical literature in much the same way a drunk uses a streetlight, for support rather than illumination. That's just what Bollinger is doing here. Of course, like most quacks, he doesn't actually provide a link to the reference. Fortunately, it wasn't too hard to discover the reference, namely this article, which wasn't a study but rather a commentary that didn't provide any significant evidence to back up Bollinger's claim. Certainly it didn't conclude that "obesogens" are a major contributor to the American obesity epidemic. Reading the article, I was struck, more than anything else, by how speculative it was, at how little hard evidence its author could present to support the concept of obesogens, and, most of all, how there was almost no evidence of obesogens in humans. Pretty much all of the putative obesogens mentioned were implicated as such based on rodent experiments, with a handful of not-particularly-convincing epidemiological studies. A more recent article on the topic states the problem succinctly right in the blurb after its title: "Low doses of environmental chemicals can make animals gain weight. Whether they do the same to humans is a thorny issue", which it is. A PubMed search I did also produced animal experiments and a lot of commentary, but no convincing evidence in humans that I could find.

Oddly enough, Bollinger also failed to back up his claim that "peer-reviewed science continues to show that harboring toxins inside your body can trigger a wide array of health conditions – including everything from chronic fatigue and muscle and joint pain to brain disease and cancer."

Obesogens (whether they will be found to exist or not or be a major cause of human obesity or not), aside, Bollinger lists all the "toxins" that you have to avoid:

1. Endocrine-disrupting chemicals (EDCs)
2. Pesticides
3. "Soft" and "heavy" metals
4. Fluoride
5. Food additives, preservatives, and growth hormones
6. Electronic smog
7. Pharmaceutical drugs

There's even a graphic (click to embiggen):

Let's just dispense with one of these right away. "Electronic smog" might as well be renamed "miasma." Miasma theory, if you'll recall, was the idea that disease was caused by miasma (μίασμα, ancient Greek: "pollution"). It was basically an attempt to explain how contagious diseases could spread in a population, which is why it rapidly lost favor after Louis Pasteur's discoveries and the germ theory of disease was postulated. It went beyond just infectious diseases, though, with some claiming, for example, that one could become obese by inhaling the odor of food. Electrosmog is basically the concept that low level electromagnetic fields (EMFs) are causing disease, with EFMs in essence functioning as a miasma. Believers in electrosmog sometimes also add the concept of EMF hypersensitivity, with sometimes tragic results.

Among the others, fluoride is safe at the levels used, no matter how much cranks try to convince us otherwise, and, although pesticides can be harmful at high concentrations, neither those consuming food nor agricultural workers are likely to be exposed to levels high enough to cause harm. There is also surprisingly little evidence that food additives, preservatives, and the like cause harm. Endocrine disruptors, of course, are sometimes touted as The One True Cause of many disorders. It's true that they might pose a health risk to humans, but the evidence is nowhere near what I would call clear, with most of the studies being in animals and not a lot of convincing human data collected yet, particularly at the very low concentrations humans encounter. Let's just say that the studies are conflicting and inconclusive. If the evidence for adverse health effects in humans due to these compounds at the concentrations encountered is relatively weak, there's practically no evidence at all that avoiding them or "detoxing" to get rid of them will have any health benefits.

Not surprisingly, it is also an article of faith among people like Bollinger that pharmaceutical drugs are more toxic than beneficial and that natural is always better; so it's not surprising to find drugs on the list. And don't even get me started on "heavy metals," which are one of the most common "toxins" implicated by naturopaths and others promoting "detox" quackery and lead to dangerous therapies like chelation therapy and the wasting of tens of millions of dollars to study chelation therapy as a treatment for cardiovascular disease.

The bottom line, from Bollinger's line of thinking (if you can call it that) is that the products of modern life are leaving toxins here, toxins there, toxins everywhere that are slowly killing you, and if you don't "detox" first trying to lose weight might kill you:

The problem with trying to lose weight before detoxifying is that toxins tend to live inside fat tissue. This means that the minute you start burning off that spare tire, those toxins will immediately start flooding your system. Depending on your personal level of toxicity, this process might overwhelm your vital organs.

Many holistic practitioners recommend doing a series of detox cleanses before trying to actively lose weight. This isn’t to say that you should intentionally hold off trying to clean up your diet out of fear of toxic overload. Rather, you should do a few things first before embarking on a major dietary overhaul that could cause you to lose a lot of weight very quickly.

This is, of course, nonsense, as is Bollinger's implication that you can never be healthy unless you "detox."

But how do you detox?

Elsewhere on Bollinger's website, there is a video promoting his three DVD documentary series on The Truth About Detox. Right at the beginning, Bollinger asks:

What if I told you that disease doesn't just strike at a whim? What if I told you that you've been lied to about what's really going on? I'm going to show you the reasons why cancer, autoimmune diseases, cardiovascular disease, diabetes, degenerative brain diseases like Alzheimer's and dementia, as well as host of life-destroying symptoms like hair loss, skin outbreaks, unwanted weight gain, depression, and fatigue are on such a dramatic rise today and you are at serious risk. You're about to discover that all these diseases and symptoms have toxic causes that you aren't being told about. Sadly, you're also not being told about the true solutions to these life-destroying diseases and symptoms.

Later, he claims that in this day and age that we're being "bombarded with more chemicals than ever before in the history of mankind," a claim that is full of hyperbole. All you have to do is to compare photos of the pollution 50 or 100 years ago to realize that the environment, at least in developed countries, is way cleaner now than it was then. Just the removal of lead from gasoline did wonders for reducing exposure to toxic lead, and that's not the only example. However, the whole concept behind "detox" is an old one, namely that modernity is killing us and that things were better when humans lived close to nature. (That must be why life expectancy back then was so poor.) Bollinger even says that there are some "crazy" detox schemes out there as a way of portraying his as rational.

So, to find out how to detox, you have to buy Bollinger's DVD, although he does have an article on how to detox from chemotherapy. In it, Dr. Veronique Desaulniers recommends "detoxing" from chemotherapy using broccoli, beta glucans, curcumin, chorella, and hyperthermia. Lovely. Of course, this particular doctor goes by the name "Dr. V" and promotes a veritable cornucopia of cancer quackery, including laetrile, bio-Energetics, thermography, meridian stress analysis, homeopathy, and chiropractic.

In reality, there is so much "detox" quackery that it's really hard to summarize it all. Indeed, pretty much any alternative medicine treatment can claim to be "detox." I've even seen ridiculous claims that acupuncture works through "detox," thanks to a claimed diuretic effect. However, most "detox" falls into one of these categories:

• Dietary. Often this involves juices, supplements, and the like. The Gerson protocol incorporates a lot of this, along with a whole lot of supplements.
• Enemas and laxatives. If you're going to purge yourself of those autointoxication toxins, you have to get rid of all the nasty feces supposedly hiding out in your colon. Often, the enemas use coffee or other substances, not water.
• Sweat. Often "detox" involves "sweating out" the toxins, through sweat lodges, saunas, including infrared saunas.
• Chelation therapy. If "heavy metals" are poisoning you, the only way to get rid of them, if you believe naturopaths and other practitioners of fake medicine, is to use chemicals that bind to the metals and allow you to pee them out. A lot of antivaccine quackery involves chelation therapy.
• Activated charcoal. When medically indicated, doctors use activated charcoal to treat acute poisoning. It is not absorbed from the gastrointestinal tract, but it does absorb a wide variety of chemicals and prevent the GI tract from absorbing them. Usually a nasogastric tube has to be inserted to pour the slurry of activated charcoal into the stomach because most people can't swallow it, particularly if their consciousness is impaired. It's also being added to juice detoxes in amounts far below what is really necessary to do real detoxification (were there any actual poisons ingested) as more of a marketing gimmick than anything.

These methods are, of course, mixed and matched, depending on the specific protocol, and there are many variants.

Detox is a scam

There is a role for detoxification in science-based medicine, but it is very limited. Specifically, some detoxification treatments, like chelation therapy or activated charcoal, are used in the case of acute poisonings. Hemodialysis is used to replace the detoxifying function of the kidneys. There is no good evidence that "toxins" of the sort that Bollinger blames for virtually all disease actually do cause all the diseases attributed to them or that routine "detox" regimens will maintain "vibrant health." Indeed, the very concept of "detox" is based on one or both of two very old ideas, autointoxication or miasmas. Indeed, the concept behind detoxification is very ancient indeed and resembles in concept, more than anything else, purification rituals found in many religions through many cultures throughout history designed to eliminate uncleanliness as defined by the religion. I can't help but conclude that the religion behind the purification rituals of detox is a form of modernized nature worship.

It saddens me that so many academic medical centers, like The Cleveland Clinic, are embracing forms of medicine that rely on such prescientific and mystical concepts. I wonder if we can find a way to convince the woo-friendly that vaccines are a powerful talisman to ward off miasmas and toxins.