May 2008

Spring Cleansing: Assessing the Benefits and Risks of Detox Diets
By Juliann Schaeffer
Today’s Dietitian
Vol. 10 No. 5 P. 34

Research on faddy juice diets and other toxin-ridding regimens is going nowhere fast, and skeptics even question their safety. Those hell-bent on detoxing should do so under professional supervision and with an understanding of its potential dangers.

April showers bring a warmer May, longer days, and spring cleaning—accompanied, for some, by spring cleansing. Detox diets: The name may sound reassuring to many clients, as detoxify is defined as “removing a harmful substance (as a poison or toxin) or the effect of such.” But putting aside the frivolities of just another fad diet, can the promises of detoxing or fasting lead clients into dangerous nutritional terrain?

Although detox diets have little scientific evidence supporting their efficacy, fasting has been around for ages and has deep roots in religious tradition. Many religions have at least one type of fasting ritual (think Lent, Ramadan, Yom Kippur), and the Chinese have used fasting as a part of preventive healthcare.

But detoxing in the United States has taken on a more varied meaning, with detoxing signifying anything from a three-day juice fast to a 10-day jaunt down starvation lane with cayenne pepper, maple syrup, and salt water as a guide.

Generally, a detox diet is said to be a dietary regimen involving a change of consumption habits in an attempt to remove toxins from the body, with proponents claiming benefits ranging from improved health, energy, and digestion to decreased inflammation and weight loss.

Lona Sandon, MEd, RD, a spokesperson for the American Dietetic Association (ADA), explains the detox phenomena. “By eating certain foods or drinks or perhaps eliminating them from your diet, you will decrease the ‘toxins’ stored in your body that cause inflammation and disease,” she says.

Yet part of the conundrum in defining the possible dangers of detox dieting “is that I think it means quite a few different things to different people,” says Amy Joy Lanou, PhD, senior nutrition scientist with the Physicians Committee for Responsible Medicine. “With the concept of detox dieting, oftentimes a person or group will be recommending starting off [a weight loss program] with a fast or some sort of modified fast that helps to clear toxins out of the body.”

Lanou describes these toxins as substances that have entered the body accidentally through bad habits such as smoking or pesticides or additives in foods “that might get stuck in cells that aren’t functioning particularly well, especially cells related to the fast turnover cells [such as] cells in the lungs and the GI [gastrointestinal] tract. And then they’ll move to a very clean diet such as one built from whole plant foods after a detox stage and continue that detoxification, ideally starting with healthier, newly made, clean cells in the lungs and GI tract.”

All the Rage
Partly made popular by Beyoncé Knowles attributing her near 20-pound weight loss for the movie Dreamgirls to this detox diet, the Master Cleanse is also known as the Lemonade Diet. First developed by Stanley Burroughs and appearing in The Master Cleanser, this diet has been around since the ‘70s.

For a minimum of 10 days, followers adhere to a strict diet of a lemon juice, maple syrup, water, and cayenne pepper concoction, drinking salt water and laxative tea as well. Side effects such as cravings, tiredness, irritability, hot bowel movements, and headaches are listed on the Master Cleanse Web site but are said to be symptoms of the body’s detoxification process.

Another modified fast that is gaining ground is the juice diet, a type of detox diet that usually involves the short-term intake of only raw vegetable and fruit juice and water. Juice fasting supporters suggest fasting only during the warmer months of the year, with spring said to be the best time for this detox.

Between 32 and 64 ounces of freshly juiced fruits and vegetables is usually recommended per day during the fast, with typical vegetables including celery, carrots, kale, cabbage, spinach, beets, and greens and apples, pineapples, and cranberries for fruits. Citrus fruits are often avoided, and organic fruits and vegetables are usually recommended.

Some also believe that strict water fasting—the deletion of everything but water from the diet for a period of a few days to weeks—can detox and purify the body.

Although some proponents say they feel lighter and “cleaner” and have more energy after detoxing, Christine Gerbstadt, MD, RD, CSSD, CDE, a spokesperson for the ADA, doubts detoxing’s merits and coughs it up to just plain quackery. “These diets range in nature from being both ineffective and extremely dangerous to just ineffective,” she says. “The body needs to be detoxed if you are exposed to radioactivity or heavy metal or poisons, not food. Eating a healthy, balanced diet based upon variety and moderation such as less saturated fat, sodium, and simple sugars and more plant-based [foods] is the best way to stay healthy.”

The Science Beneath
Lanou says that although scientific evidence regarding detox dieting is scarce at best, the theory behind it makes a lot of sense. “The theory behind fasting or detoxing is really interesting. By giving the GI cells a rest and allowing them to re-create themselves while they’re not working and not avoiding toxins, they potentially can come through stronger and healthier. But the evidence is limited as to how effective that really is,” she says.
Gerard E. Mullin, MD, MHS, CNS, CNSP, FACN, FACP, AGAF, ABHM, director of integrative GI nutrition services at Johns Hopkins Hospital, says the lack of scientific research on detox dieting leaves much to the imagination in regard to efficacy. “People don’t write on these things; there are no published studies,” he says. “People go through these protocols, and nobody really publishes their ups or downsides. People write about their experiences, about how to do it—certainly on the bookshelves—but at least in the medical literature, there’s not much about it.”

Still, Mullin says the concept could have benefits, if only someone would take the time to research it. “But then who’s going to pay for it?” he asks. “If pharmaceutical firm X is not going to make money out of it, why would they fund it? I think these are the kind of things that are probably helpful and beneficial, but unfortunately, this is the world we live in.”

Detoxing may not be well researched, but Lanou says some scientists have taken an interest in the merits of fasting. “There is some interesting work that’s been done on fasting—both fasting with only a water fast and fasting with only specific liquids—that have shown real benefits to people with chronic conditions and also some real benefits for people trying to break an addiction, like a smoking habit or an alcohol consumption habit,” she says.

Sandon says fasting has also been shown to help those with rheumatoid arthritis, at least in the short term. “There is some science behind fasting diets sometimes used for people suffering from rheumatoid arthritis,” she says. “However, the benefits of pain and stiffness relief are short lived as people cannot fast for extended periods of time without experiencing nutrient deficiencies that will result in further health problems. Eventually, the body needs to eat and supply itself with much-needed nutrients.”

Although she notes that detoxing is not particularly good for weight loss, Lanou says detoxing or fasting can be used as a motivational tool for clients who are looking to take on healthier eating. “I think an ideal weight loss method is one where you are choosing a new way of eating that you’re going to be able to maintain rather than doing something for a short period of time and then returning back to your old habits,” she explains.

“And one of the neat things about doing some kind of fast or having a detoxification period before you start into this new, healthier way of eating is that it gives you a break from your habits,” Lanou continues. “Sometimes, I think having a break from your habits—especially bad habits related to food, drinking, and smoking—can help you reset in an easier way.

“There are some interesting studies that have looked at stepwise changes or making a really big change,” she adds. “And oftentimes, people who make a really big change—if they’re successful at making that big change—can stick to it better than people who make small, incremental changes. It’s easier to make a small, incremental change, but it’s also easier to go backwards from a small, incremental change.”

Safety and Side Effects
So how safe is detoxification or fasting? That depends on whom you ask. Gerbstadt says a long-term detox diet done without the consultation of a healthcare professional can cause serious, life-threatening electrolyte imbalances. She says it can lead to cardiac failure at worst and be ineffective at best.

Sandon says the danger in detox dieting stems from the lack of medical supervision of people who detox by themselves. “Nobody really knows,” she says of detoxing’s safety profile. “The fad-type detox diets have not been scientifically studied for safety or efficacy. As with any type of diet, taken to the extreme, they can lead to nutrient deficiencies. Also, these diets are not medically supervised. People who try them often do not report it to their doctor or dietitian, so safety issues are unknown.”

Lanou says detox dieting or fasting is rather safe if carried out under the supervision of a healthcare practitioner, although it can have some side effects. “Potential side effects might be anything from loss of energy to an inability to focus, particularly if you’re on one that’s very low calorie. Sometimes that will affect people’s critical thinking abilities,” she says. “It’s sort of like when you get hungry after not eating for six or seven hours. If you don’t add something to your system, there’s going to be an effect on your brain and your ability to concentrate.”

Lanou adds that people may also “feel the effects of the toxins that they’re trying to detox from moving out of their body. Sometimes, people get extreme runny noses or sneeze a lot. So if a person has a lot of allergies or if they’ve been taking a lot of medication for allergies, they may find that they’ll have what seems like a really strong allergy attack.

“Sometimes people will find that they get diarrhea,” she continues. “It’s a similar reaction that’s happening in the gut. It’s a flushing through of … toxins that are actually in the cells in the GI tract. If you continue, you’ll see a big decrease in the amount of defecation because you’re not putting any solids into the body. But that’s the idea behind [detoxing]—to give your gut a rest so that if it’s not working on digesting, then it can work on repairing itself.”

If clients are determined to try a detox or fasting program, Lanou recommends a run-in phase, as well as a coming-out-of-it phase. “It’s important not to go from drinking [the Master Cleanse liquid] for four days to eating fast food. Your body is going to feel terrible, and it’s going to respond badly,” she says. “Typically, they say that the same number of days you use for the fast, you should have a run-in phase that’s as long and a coming-off phase that’s as long. So if you were going to fast for three days, you would want to take three days to get to the fast—maybe stop eating processed foods, then eat only fruits and vegetables, then eat only liquids, and then go to water.”

Not for Everyone
Although many clients may feel free to decide on their own whether detoxing is the right choice for them, there are certain people for whom detoxing or fasting can be downright dangerous. Sandon lists people with diabetes, low blood sugar, and eating disorders and growing children, teens, pregnant women, and older adults as those who should avoid these diets.

“Detox diets can affect our ability to maintain blood sugar levels within normal,” she says. “If you are taking diabetes medications, you may put yourself in danger of too low of blood glucose by cutting out food groups but continuing to take your medication. You should never alter your diabetic medications or make drastic changes in your diet without consulting your doctor or dietitian. Medications must be balanced with the food you eat.

“Pregnant women, children, and teens need enough calories and protein every day for proper growth and development,” she adds. “And older adults have unique nutrition needs that are sometimes difficult to meet, even on an unrestricted diet.”

But Lanou argues that some older adults may benefit from detoxing and/or fasting. “As for older adults, you wouldn’t want to start a detox diet undernourished,” she says, “but it wouldn’t necessarily be a problem for a 65-year-old person who’s been overeating and having two-martini dinners and is trying to figure out how to reset and is trying to eat more healthfully to use a fast to jump-start that process.”

In general, Mullin recommends that anyone on medication steer clear of detox deprivation. “It’s really meant for people who are otherwise healthy as a way of rejuvenation. People who have medical conditions and [are] under the care of a doctor, you have to be very careful with that,” he says.

Toxins Pass Here
Advocates of detox dieting and fasting say that toxins are released through the body during the detoxification process. But what do these toxins entail? Because of the lack of scientific evidence, no one knows for certain.

“Proponents of detox diets do not tell you which toxins are being removed,” Sandon says. “Some argue that junk foods cause toxins to build up. Others might be referring to environmental toxins such as pesticides on foods or air pollution.” However, she says that the body’s digestive system is quite good at eliminating toxins on its own through vomiting, urine, or feces.

Lanou likes to think of toxins as “the stuff that we eat that isn’t food that our body doesn’t know how to digest. It might be medication, pesticides or herbicides, or heavy metals in the environment like mercury or lead. It can be all sorts of chemicals that are in our food supply that aren’t food.

“Just how effective fasting or one of these [detox] plans is at helping get those toxins out of the body, I think the evidence is pretty limited that it works,” she admits. “At the same time, most people who fast or go through a cleanse will experience some sort of purging—[such as] having a bad runny nose or having your gut contents moved through more quickly than you’re accustomed to.”

Lanou likens this process to massaging tight neck or shoulder muscles. “One of the things that massage therapists will tell you to do is drink a lot of water because there are substances stored in the cells that they’ve released that are now getting into the bloodstream, and sometimes people get headaches from those. It’s sort of that same idea: Stuff that gets kinda ‘stuck’ through the process of detoxification or through body work can make it into the bloodstream where you’re going to notice the effects of it more, and hopefully they’ll move on out. The idea is that those nonnutritive substances will move on out of the body,” she says.

Possible Pros?
Because the research on detox dieting is lacking, its benefits are unknown at best, but Lanou believes that if fasting or modified fasting is done in the proper manner and under the supervision of a healthcare professional, it can be beneficial. “Although I have not personally experienced any benefits from it, I have seen and read about quite a number of people who have experienced really amazing effects through detoxification in conjunction with a physician—everything from being able to break addictive cycles to people who have been occupationally poisoned with some type of toxic chemical being able to recover function [that was lost] due to that toxic chemical,” she says.

“There’s some pretty amazing evidence with chronic disease as well,” Lanou continues, citing cancer, heart disease, and diabetes as examples. “People have successfully used fasting to reduce the severity of those conditions. The evidence that I am most aware of is the water fast version because I think those are more commonly done under the supervision of a physician and more commonly would be researched right. That doesn’t mean that juice fasting wouldn’t also provide some benefits, but there’s less evidence on [it].”

Client Recommendations
Although wary of its purifying capabilities, Sandon says detoxing may help some clients reach their long-term health goals. “A three- to five-day detox diet plan is not likely to lead to problems and may even help motivate someone to make dietary changes in a healthier direction, such as eating more fruits and vegetables. Remind them that this is not a long-term solution to a weight problem or disease prevention,” she says.

“Skip the use of herbal laxatives, enemas, and syrup and saltwater solutions, as these are not proven methods to remove toxins from the body and they are just unpleasant,” Sandon recommends. “Instead, gradually increase fiber and water intake and perhaps try some probiotic yogurt drinks for improving intestinal health.”

Lanou stresses, though, that fasting in itself will not solve weight issues. “Keep in mind that fasting itself is not particularly good for weight loss,” she says. “It’s what you do after the fast or after the cleanse period that ends up affecting your overall body weight. It’s only going to really benefit you if you follow it with healthy eating afterwards.”

Many other professionals, including Gerbstadt, say detoxing has no place in nutrition care. “Eating a healthy meal plan based upon variety and moderation is the way to keep the body healthy,” she says.

Whether or not detoxing or fasting is a viable answer, Lanou says the consumer concerns that are driving many to detox techniques are real, noting that detoxing may appease this apprehension. “I think a big piece of it is coming from there being just so many concerns about environmental pollutants [eg, food additives, pesticides, secondhand smoke]. We hear every day about something else that we breathe, drink, eat—microwaves to mercury in fish to secondhand smoke.

“So I think there’s a real recognition that there’s a lot of stuff in our environment that shouldn’t be in our bodies,” she concludes. “I think that’s probably part of the appeal. If there’s some way that we could become clean from the inside out, that has real appeal.”

— Juliann Schaeffer is an editorial assistant at Today’s Dietitian.