In another fit of sloth, I am migrating one of my favorites over from my old blog. If you haven't read it, it's new to you! --PalMD
Many of my patients ask me about it; the TV is full of ads for it; you can't avoid it. "Detoxification" is apparently the pinnacle of modern health care, if you believe folks like Joseph Mercola and Gary Null, and the dozens of adds on late-night TV.
For me to explain to you why even the very idea is laughable, I have to teach you a bit of human biochemistry---just a little, I promise. My scientific readers will find this grossly oversimplified, but hopefully they will forgive me.
Detox sounds so simple, but in fact, human biology is more complex and beautiful than is dreamt of in the quacks' philosophies.
Your body is a complex biochemical machine, but not all that mysterious. Human biochemistry is a fascinating area of research, and has been for over a century.
In order to produce and use the energy that keeps us alive, the essential substances of life must be taken in or produced, utilized, and the byproducts of their metabolism removed. Among the substances essential to life are water, oxygen, lipids (fats), carbohydrates (starches and sugars), polypeptides (proteins), and nucleic acids (DNA and RNA).
There are other micro-nutrients that are essential to life, which early scientists named "vitamins". Vitamins aid in the metabolism of the various substances listed above. They are required in very small amounts to be effective.
The intake, utilization, and production of these essential substances is the meat of biochemistry.
Lungs
One of the most important byproducts of human energy metabolism is carbon dioxide (CO2). People think of the lungs as the "oxygen gatherers" of the body, but at least as important is their role in removing CO2 from the body. The kidneys may remove small amounts, but it really falls to the lungs. Failure to remove CO2 is one of the main reasons that a patient may end up on a ventilator, more so than lack of oxygen.
Kidneys
CO2 functions as an acid in the body, and the lungs and a blood buffering system keep the body's acidity closely regulated. Even small deviations of pH create a very, very sick person. The kidneys help remove various other acids produced by the body, and one of the effects of kidney failure is to be come "acidotic". The kidneys also remove excess water from the body, as water is a main by product of metabolism. Water also serves as a solvent, or vehicle, to removing excess electrolytes and other toxic metabolic wastes, such as urea.
Liver
The liver is a giant factory of necessary substances, and also serves as an organ of "detoxification". Once of the ways the liver does this is by taking toxic substances that are not soluble in water, and adding a molecule that allows them to dissolve in water and be excreted by the kidneys. The liver also produces bile, which eventually helps certain substances be excreted in the stool.
Colon
The colon is not so much a detoxifying organ as a waste removal and water reclamation unit. When a colon ruptures, it is not the toxins contained in the stool that makes someone sick, but the overwhelming infection due to colonic bacteria. These bacteria normally live peacefully, even benevolently, in the colon, but they are rather nasty if they reach the rest of the body.
People don't like poo, and the colon is seen as "dirty", but it is actually an efficient, complex hunk of machinery. Certain diseases can disrupt the machinery---certain infections (some caused by antibiotics), autoimmune diseases, trauma---but there is no inherently "toxic" condition in the colon. It's just a "poop chute", and does its job well.
Toxic states
When our own complex detoxification system breaks down, we become noticeably ill---not just "uneasy", but very, very sick. Failure of the lungs to remove CO2 lands us on a ventilator. Liver failure, which is more complex than just toxin removal, leads to death without transplant. Kidney failure leads to uremia, acidosis, electrolyte imbalances, and water overload. As mentioned above, the colon really only hurts us if other diseases attack it and thereby compromise its integrity.
Acid-base balance is so tightly regulated, that even very small variations create a very ill patient, so claims regarding pH and health are usually a bunch of hooey.
Detoxification
Detoxification refers to a host of interventions that supposedly rid your body of harmful toxins. This type of woo usually falls into a few specific categories, but since it isn't guided by science, there are wide variations. The only common thread is that none of these ideas are based on any real understanding of biochemistry, and none have been successfully tested and shown to be effective.
- Poo woo: Colon cleansing is a popular pastime. The only reason to completely empty a colon is so that a colonoscopist can see without being blinded by a shit storm, or so a surgeon can safely operate on the gut without worrying about soiling the abdominal cavity with colonic bacteria.
- Chelation: Chelation is a very popular form of quackery. It has been purported to do almost every kind of good, and is especially popular among cranks who believe in the mercury-vaccine-autism hypothesis. It's killed a few people, but that doesn't stop the quacks.
- Liver detox: another load of crap. See article.
The final myth, about which Orac knows more, is this "oxidation" business. Free radicals are oxidative compounds formed in our bodies. Some are waste products, some are used by the immune system to kill invaders---it's rather complex. This complexity can be seen in the offers of woo-peddlers. Some try to sell you "anti-oxidants", while others try to sell you oxygenated drinks or "hyperbaric oxygen"---they can't seem to decide which is better--- more oxygen or less oxygen. The truth is the human body pretty much takes care of this stuff, and more research is being done on the whole "free radical" issue. It's not as simple as the quacks make it sound.
Except in the context of substance abuse treatment, the term "detoxification" is wholly unmedical, unscientific, and quasi-religious. Nearly everyone who offers it tacks on a Quack Miranda Warning. If you aren't feeling well, medical science has much to offer---sometimes there are no easy answers, but they certainly won't be found on late-night TV.
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Thanks for that, that's a very informative post.
Thanks for your blog. Good reading and it helps to cure woosters at the same time. Thanks.
David Lee
www.3dsciencenews.com
Whenever I hear someone mention detoxifying the body, I always want to demand they name the toxins their stuff removes. I'm betting they couldn't name a single one, and I know no controlled study was ever done on the efficacy of their product.
Most people have vague gooey ideas about everything about science, so much so that it scares me. One TV advertisement starts off saying that scientists believe REM is the most beneficial kind of sleep, and here is an REM skin cream for sale. How is rapid eye movement incorporated into skin cream? The whole idea is batshit crazy.
BTW, regarding liver detoxing: There used to be Carter's Little Liver Pills and Sal Hepatica, both of them advertising on primetime TV in the US. And in Europe there are still mineral water treatments for 'liver ailments'.
What about claims that massage or yoga or physical exercise in general detoxifies your muscles? Sports people sometimes talk about flushing out lactic acid, but I don't know how much of that is true and how much is common wisdom.
... and how much of a role do sweat glands play in removing "toxins" ?
As far as is known, the primary function of sweat is temperature regulation.
If you have a lactic acidosis or a rhabdomyolysis, you have some bigger fish to fry than detox.
But is there any biochemical "cleansing" benefit to exercise or physical manipulation of muscles?
There is a big difference between natural bodily functions of lactic acid building and then dissipating in muscles and what these "detoxifiers" claim to remove toxins that are attributed to the environment of the person.
Herb, you'd have to define "biochemical cleansing". We know that exercise is good. As far as "cleansing", well, there is no operational definition to check.
The parameters we measure in laboratory tests, and most others, are very tightly regulated in the human body.
Acid/Base is an area where I feel that the woo has overtaken the current scientific understanding. I frequently see pH kits for sale in order to ensure proper balance. But then I read articles related to sports performance that talk about eating enough alkalizing foods to balance acid/base load and to prevent loss of calcium (I think the paleo diet is in vogue now). I didn't see a post about pH in your archives but was wondering if you had a source to separate woo from fact as it seems that there is a lot of research in this area, at least from a brief glance through the Pubmed literature.
Sorry I'm being very loose here. I guess I'm asking whether there is any way in which exercise or physical manipulation aids or supplements what the liver and kidneys do.
The simple answer is "no".
One thing people should use as a handy red flag is anything using the word "toxins" and prescribing relief. And the more times per page the word "toxins" appears, the faster you should run.
And the running is good for your heart and bones, too. So quackery can be good for you, if approached correctly -- "approached correctly" meaning running away.
1. RE: PooWoo - we're down to 1.5 reasons to cleanse the colon, as the benefits of pre-op mechanical bowel prep are somewhat ambiguous; no decrease in anastamotic leak or abcess, slight decrease in mortality or the need for reoperation as a result of complication.
2. My personal favorite Woodetox is the gallstone cleanse: some concoction of various salts followed by a big slug of olive oil. The oil congeals and actually passes through the bowel; devotees claim these are "gallstones" which have been purged.
3. An interesting side-note on the lactic acid flushing issue is some postings I've seen in the exercise physiology literature suggesting that lactic acid accumulation is not the actual fatigue-inducing culprit we've thought; it's (apparently, and I am open to correction if I'm wrong) calcium depletion...
But, but, but....I just bought a lifetime supply of detoxifying foot pads (just pay shipping and handling!) Do you mean to say that that my feet don't filter out toxins? OMGWTFBBQ?
Why do you think detoxification is either complete and perfect, or else a total failure resulting in severe illness? Isn't it usually somewhere in between? As we get older, with our relatively unhealthy lifestyles, doesn't it seem possible that toxins might build up? Is it so completely unimaginable that some alternative treatments might help the body eliminate certain toxins?
Yes, pec, it is unimaginable that any of these treatments do anything. Really, they've been tested, and they really do nothing for you. Your body will eliminate the toxins just fine on its own, and if it doesn't you need to be in a hospital quickly. The other garbage is just that.
We don't think detoxification is a total failure, we know it is. It is only an uneducated (or mis-educated), fevered imagination that leads people to think otherwise.
What "toxins" and "alternative" treatments are you talking about? Bear in mind that "alternative" means "unproven."
"Your body will eliminate the toxins just fine on its own, and if it doesn't you need to be in a hospital quickly."
I doubt it's that black-and-white. People with unhealthy lifestyles (most of us, to some degree), as they get older, probably do not detoxify perfectly. Crud builds up and health suffers moderately. It isn't a question of either you are a perfectly functioning machine or you are at death's door. Mostly it's somewhere in between.
It does not seem far-fetched at all to think that certain naturally-occurring substances, certain forms of exercise or massage, etc., could be somewhat cleansing and healing.
Oh, pec...you're always so dependable.
What you "doubt" is of no consequence. It's about science and data, not the opinion of one "pec". Who cares if you think that older people "probably do not detoxify perfectly."
And whether or not something "seems far-fetched" to you is also irrelevant.
Pec wrote: "I doubt it's that black-and-white. People with unhealthy lifestyles (most of us, to some degree), as they get older, probably do not detoxify perfectly. Crud builds up and health suffers moderately. It isn't a question of either you are a perfectly functioning machine or you are at death's door. Mostly it's somewhere in between."
May I ask, just what is "crud"? Where does it "build up?" How (specifically) does it impact health? I am a surgical PA, have been involved in hundreds of surgeries, and I've never found this "crud" to which you are referring. Can you please tell me where it builds up so that I can look for it on Monday during my next operation? I'd be happy to report back...
I think arguments like this come from an ignorance of human anatomy, physiology and disease, combined with a fear-of-the-unknown/fear-of-death. My personal favorite "crud" argument was brought to me when working in primary care. It went something like this: Over time, "crud" builds up in the colon, analagous to a sewer pipe becoming clogged as fatty and proteinacous deposits build up. This leads to problems with absorption of "nutrients". Because we are then deficient in "nutrients", we overeat to compensate, which leads enexorably to weight gain. The treatment? http://www.renewlife.com/Cleansing/ Clearly the perpetrators of this myth need these products, because they are clearly FOS (full of sh*t).
"It's about science and data"
How much research has actually been done on this? Can you say with confidence that detoxification treatments, in general, are not effective, based on controlled experiments?
Or are you basing your negative claim mostly on lack of evidence either way?
I'm saying that when you are the one making a patently stupid and ridiculous claim, it's up to you to back it up. If I claim that my magic tennis shoes cure gout, I don't then get to say, "prove me wrong, pec".
Pec wrote: "It's about science and data"
How much research has actually been done on this? Can you say with confidence that detoxification treatments, in general, are not effective, based on controlled experiments?
Or are you basing your negative claim mostly on lack of evidence either way?"
I can't comment "in general" based on controlled experiments, because they are not done "in general." "Controlled experiments" (I assumed you mean double-blind RTC's) are done to answer SPECIFC questions about SPECIFIC drugs/treatments/etc. Only when multiple specific studies point to the same conclusion can you begin to make generalizations. If you would like me to comment on the volume of research, please give me more specific information about the "toxins" you are concerned about (crud is just way too nebulous), and I would be happy to do a literature search.
"when you are the one making a patently stupid and ridiculous claim, it's up to you to back it up."
Ok, you decided detoxification treatments, in general, are worthless because, in your opinion, their claims are stupid and ridiculous. Not because of any scientific evidence.