This isn’t an exciting post but we have to stop throwing the word ‘detox’ around. If you do not define what you mean by it, the term is meaningless, and the vast majority of people are using the term as a symptom catch-all and that is simply not how detoxification works.
DETOX. For such a little word, it is sure used a lot in dietary supplement claims and reports.
Starting a new supplement & you’re feeling bad? You must be detoxing!
How does supplement X work? It detoxes you!
Have a headache? You are detoxing!
Do you have gas & bloating? You are detoxing!
Constipation? Diarrhea? You are detoxing!
You have a rash? You are detoxing!
Not losing weight? Your fat cells need to detox!
Blah, blah, blah.
Let’s start by detoxing the term detox!
I really don’t like the word DETOX. I think it has become highly overused, and most people don’t have a clue what it means or what they are actually referring to when they use the term. So in effect, it has become a vague term that people use when they don’t have anything better to say. In fact, in one British study, a network of 300 career researchers investigating ‘detox supplements and products’ found that no two companies even used the same definition of “detox” and most companies made vague claims without even referencing what “detox means or proof that it actually works.”1
Do I believe that the body accumulates toxins which impair health? Absolutely. Can I think of any science proving or even suggesting that a specific supplement can detox the body of all of these environmental toxins? Absolutely not.
To be clear, this isn’t an exciting blog post. There is nothing exciting about detoxification, especially when so many people have it so spectacularly wrong. First, let’s review some basic physiology. Everything your body ever comes in contact with, and everything you ever breathe in or consume needs to be processed through either your liver, your kidneys, your lungs, your bowels, or through your skin. Water soluble substances don’t pass through the skin readily but are filtered by the kidneys fairly efficiently. Oil-soluble substances can be absorbed readily through the skin and are processed by the liver, and sent through the bowels for elimination. Gaseous substances, like anesthetic, are cleared directly from the lungs. Most of the toxins you are exposed to will be via your mouth in the form of what you eat and drink. Looking at the digestive tract for a moment, consider it a ~30 foot tube connecting your mouth to your anus. Approximately 80% of your immune system is centered in and along that tube, and maintaining its balance is a single, fragile layer of cells only one-cell thick. If this layer of cells is damaged, the selective barrier loses its selectivity, and foods, toxins, and other substances that would normally pass through your system with little consequence, can now be absorbed directly into your system (where your body can mobilize antibodies and inflammation for protection against this onslaught). In addition, there is an intricate balance of over 500 different types of bacteria (about 3 pounds worth all together) that live along is this tube which form part of a collective ecosystem to help you digest food, produce vitamins, make nutrients available, regulate hormones, and excrete toxic byproducts of your metabolism. When this lining or bacterial ecosystem become impaired, then you suffer from a wide variety of health complaints because your organ systems simply cannot operate at full function. Now, your body being the masterpiece of engineering it is, it tries to maintain an equilibrium, or ‘steady state’. So it takes these substances that it recognizes as foreign and it walls them off or stores them in the tissues it deems less critical for survival. As far as your body is concerned, your fat stores are less critical to your immediate survival needs than the health of your ligaments, nerves, and muscles. So initially, your body packs away these metabolites and toxins in fatty tissues and this can lead to cysts, lipomas, or benign tumors. Next in the line of potential storage spots, your body likes the myelin sheath – that fatty layer of insulation that surrounds your nerves and aids with nerve conduction. Connective tissues like ligaments, bones, and blood, and then tissues such as nerve and muscle tissue come next. Areas bathed in fluid, like joints are always prime targets for metabolite deposition (an example would be uric acid crystals depositing in joints in people with gout). If toxic and metabolite exposure goes on long enough, entire organ systems can be affected and thereby become dysfunctional.
Getting back to your gut, many supplement companies do not take into consideration actual human physiology when they talk ‘detox’. I swear that most people think the word detox is synonymous with the word poop. Let me be very clear, just because something makes you have a bowel movement – that doesn’t mean you are detoxing. Every symptom you have is not a sign of detoxing, nor is it a sign you need to detox. Nothing gets me more wound up than all of these ambiguous posts online that blame every negative side effect or symptom on toxins. And please, don’t get me started on all of these posts where people come to a group forum and ask a legitimate health question, only to have their symptoms brushed off or minimized by some well-intentioned but ill-informed individual under the guise that “all is fine, you are just detoxing!” As a health care professional, when I see someone referring to the word ‘detox’, I read their statement as “I don’t know what I’m talking about and have nothing better to say, so I am going to baffle them with BS”.
On a very simplistic level, when we were embryos and our guts formed, one collection of nerves, the ‘neural crest’, forms and divides with one section becoming the central nervous system and the other section becoming the enteric nervous system. These two nervous systems are connected by the longest of your cranial nerves – the vagus nerve. This vagus nerve starts in the brain and terminates in the gut and this is the source of the brain-gut connection that you read about. It is also why you have ‘gut feelings’, why eating certain foods are addictive or simply make you feel good, why you want to eat when you are stressed, why food sensitivities can cause behavioral changes, and why medication such as antidepressants can cause stomach upset or nausea.
When most people refer to detoxification they are referring to liver function, or to Phase 1 and Phase 2 conjugation in the liver specifically. This is truly your major site of detoxification and it is the organ most intimately connected to hormone balance. In Phase 1, blood carrying toxins enters the liver, and the liver prepares these toxins , usually moving them towards being water soluble, and makes them more accessible to Phase 2. In Phase 2, there are a sophisticated set of reactions involving a multitude of things, including Cytochrome P450. In all, there are 6 main types of reactions that occur in the liver – with each one being completely chemically different. That is why there is no magic detoxifying agent that can clean you out entirely. Of these 6 main reactions, 3 (glucuronidation, methylation, and sulfation) are the most likely to be impaired, and the other three are more likely to affect your hormone levels.
- During sulfation, your body adds sulfur groups to certain toxins so they can be removed. Your body requires sulfur-bearing amino acids like cysteine and methionine, and B-vitamins like B12 and B6, and folic acid for these processes.
- During methylation, your body requires methyl donors to facilitate the toxin removal. Up to 40% of the population may carry genetic anomalies which hinder this process.
- During glucuronidation, your body requires glucuronic acid, various B vitamins and a significant amount of specific magnesium ions to work properly.
This all leads to glutathione conjugation, where your body then uses master antioxidants like glutathione, superoxide dismutase, and catalase, along with the antioxidant vitamins A, C, E, and selenium.
OK, so have I bored you to death yet? This is as exciting as watching paint dry, right? But if you have stuck with me this long, you might be asking me what this really means? In a nutshell, it means that there is no single supplement or product that can act as a total detoxing agent. Anyone who suggests otherwise, is steering you wrong and just doesn’t understand basic physiology. CBC Marketplace (click link to watch the video) , Canada’s version of 20/20 style news exposè , recently did a show where they had a group of sorority girls from my alma mater follow Dr. Oz’s popular 48 hour detox or act as a control group. Extensive blind testing was provided by a team of medical specialists before and after the ‘detox’, and would you be surprised by their conclusion that they could discern absolutely no differences between the two groups upon the completion of the detox program? This leads us to a very important point, if you can’t find any biochemical proof that toxin levels are decreasing, then what are you really doing? There is an incredible lack of scientific literature that supports most detoxification claims; not only can people not agree what detoxification is, but they can’t prove that they are causing it.
You can take specific supplements or combinations of supplements to pull, chelate, or adsorb (not absorb) specific toxins from the body, like using chlorella to bind with excess mercury you may have in your body from consuming shellfish or having amalgam fillings; using EDTA to pull lead from environmental exposure; or using N-acetyl-cysteine to detoxify from acetaminophen exposure. But (big BUT) when it comes to detoxification, there is no magic bullet. You can’t go around claiming that every supplement under the sun is ‘detoxing’. They just don’t work that way, and even if a substance supports a step of detoxification, it doesn’t cause detoxification in its own right, and blaming all negative symptoms on detoxification is haphazard and potentially dangerous.
I have kept a running list of the ‘detox’ references I have seen in the online groups I follow over the past few weeks. Here is a list of symptoms that I have seen people blame on supplementation:
- fatigue
- hives and other skin rashes
- weight gain
- gas
- bloating
- nausea, vomiting
- dizziness
- insomnia
- inability to concentrate, mental fog
- headaches/migraines
- diarrhea
- constipation
- heart palpitations
These are not symptoms of supplement-induced detoxification!!! These are symptoms of dehydration and starvation. When many people undertake a detox plan or a new diet, they dramatically cut their caloric intake and unfortunately the do not consume enough water, or consume substances with diuretic properties which therefore increase their odds of becoming dehydrated. On day one of a typical ‘detox ‘/ diet, people often feel bad. They are hungry, may experience dizziness or irritability, and feel fatigued. By day two, their body starts breaking down muscle mass to provide them with energy and they may experience additional mood swings, difficulty sleeping, or overwhelming fatigue. By the third day, they are likely having headaches, muscle pain or stiffness, and even dizziness or nausea. Rolling into the fourth and fifth days (if they have lasted that long), their body has started to adapt to the new situation and slowed down your metabolism so they don’t feel the same degree of hunger, but they still may be dealing with altered mood, headaches, and nausea. Many people who report a 6-8lb weight loss during the initial period of any detox or diet are truly losing water and a small degree of muscle mass. They are not losing fat! You will notice that when you look at symptoms in this light, they are nearly all truly the result of dehydration and lack of calories, they have nothing to do with ‘detoxing’.
Yes, we can take steps to reduce our intake of toxins, and that may be the most practical approach to detoxification, but we can also take supplements which reduce inflammation or support optimal liver functioning so that our livers are best equipped to deal with the chemicals we assault them with. For anyone interested in detoxing, it should be clear that this isn’t a process you undertake in a few days or weeks, it should be a lifestyle change where you eat ‘clean’ and provide your body with a variety of fresh fruits and vegetables, along with vitamins and minerals, and other key nutrients to ensure that our systems are always handling toxins adequately. When someone tells me that they want to ‘detox’, my number one question is what they want to accomplish. Most commercial detox programs are nothing more than fancily packaged bowel stimulants. They make for expensive laxatives, and have no proven, measurable results, and for that reason, I do not recommend them.
While I am at it, I want to tackle ‘gluten sensitivity‘ and ‘candida overgrowth’. As these are two other catch-alls that get as much ill-informed press as detoxification. First, let’s look at gluten. Do I believe that gluten is an issue? Yes. Do I think it is anywhere as prevalent as what people like to say? No. In fact, a recent study2 found that people with self-reported (and to be fair, the gluten sensitivity tests are horribly unreliable) gluten sensitivity actually had no physical reactions from consuming gluten and instead experienced a total elimination of all of their GI symptoms by eliminating FODMAP’s (Fermentable Oligo-Di-Mono-saccharides and Polyphenols, or rather fermentable, poorly absorbed, short-chain carbohydrates) from their diet. FODMAP’s are what we would traditionally consider to be high-residue foods, things that linger in the gut and prove a fertile ground for bacteria to grow and feed off of. When bacteria thrive in disproportionate quantities or in imbalanced ratios, people can experience significant gas, bloating, cramping, constipation, diarrhea, etc. So what are these FODMAPS? The most common ones are fructose containing substances such as fruit, agave, honey, and HFCS. Oligosaccharides such as beans, lentils, wheat, onions, cabbage, and the other cruciferous vegetables. Disaccharides like dairy (particularly in unfermented dairy products), and sugar alcohols like xylitol, malitol, and sorbitol, which are found in many diet products. So looking at this list, you can be eating what you think is a perfectly healthy diet but causing undue havoc with your gastrointestinal tract and immune system. A lot of people are jumping on the gluten-free bandwagon as of late. In fact, I have colleagues who make their living being gluten-free gurus. I have sat down with internationally known scholars in the field and I just don’t see that gluten is the whole answer. Face it, we were all raised on gluten, and while there were a small portion of the population that have celiac disease and cannot metabolize gluten, the majority of us, for hundreds of generations, did just fine with it. It was the advent of genetic modification that heralded the onset of all of this gluten fuss. It countries that do not allow GMO wheat, they do not have the same gluten issues that we face in the United States. I will say that in the allergy blood tests I run on people, I frequently see wheat as an allergic agent but infrequently see gluten, so my personal experience supports the findings of this and other studies.
Lastly, I have received a bunch of questions lately about candida, and specifically the validity of the candida saliva test. I am of the professional opinion that everyone has candida, it is just a matter of whether your immune system keeps it in check or not.
Truthfully, candida is like Epstein-Barr virus; if you go looking for it you are going to find it. It may be more advantageous and easier on your wallet to simply treat for candida if you believe you have symptoms of candida overgrowth. Now, the candida saliva test (where you spit a mouthful of saliva into a glass of distilled water and look for ‘strings’) isn’t overly accurate.3 It can be better said that it is a test of saliva viscosity or thickness, it isn’t reproducible, nor is it specific. Yes, some people have oral candida (also called thrush) and will produce a positive spit test, but many people have candida-free mouths but may have candida over growths on their skin, or in their intestines or vagina’s. Yeast is an equal-opportunity offender. You can spend hundreds of dollars having blood, stool, or skin tests done, but does that really change your course of treatment? If you believe you have it, it may be a lot easier and cheaper just to treat for it, and treat for the appropriate length of time* (*most treatments need to be for a minimum of six weeks to be truly successful). Now I am officially on the record as saying I feel the candida saliva test is a no-harm-no-foul test. You can do it if you want, it doesn’t cost you anything but 10 minutes of your time, and it may or may not help you confirm that you have an issue. I do not think it is fool-proof or diagnostic by any means, but some people need to see things in order for them to believe them, and this is a tangible test that anyone can do but it should not be something you bet the bank on!
1. Detox Dossier. Retrieved 1/24/14 : http://www.senseaboutscience.org/data/files/resources/48/Detox-Dossier-Embargoed-until-0001-5th-jan-2009.pdf
2. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Retrieved 1/24/14 from http://www.ncbi.nlm.nih.gov/pubmed/23648697
3. http://www.acneeinstein.com/candida-spit-test-unreliable/
