"Detoxification" Schemes and Scams
Stephen Barrett, M.D.
Many quacks and product marketers tell people they have accumulated toxins and need "detoxification." The method they choose depends on what they want to sell and, if they have a license, the scope of their license. Naturopaths, for example, are prone to claim that:
Toxins damage the body in an insidious and cumulative way. Once the detoxification system becomes overloaded, toxic metabolites accumulate, and sensitivity to other chemicals, some of which are not normally toxic, becomes progressively greater. This accumulation of toxins can wreak havoc on normal metabolic processes .
Some detoxification proponents claim that intestinal sluggishness causes intestinal contents to putrefy, toxins are absorbed, and chronic poisoning of the body results. This "autointoxication" theory was popular around the turn of the century but was abandoned by the scientific community during the 1930s. No such "toxins" have ever been found, and careful observations have shown that individuals in good health can vary greatly in bowel habits.
Marketers also suggest that fecal material collects on the lining of the intestine and causes trouble unless removed by fasting, laxatives, colonic irrigation, special diets, and/or various herbs or food supplements that "cleanse" the body. The falsity of this notion is obvious to doctors who perform intestinal surgery or look inside the large intestine with diagnostic instruments. Fecal material does not stick to the intestinal lining.
(Note: Standard medical practice uses the word "detoxification" to describe programs to minimize withdrawal symptoms for people who stop habitual abuse of alcohol or controlled drugs. Such detoxification is not relevant to this article.
Colon cleansers are marketed as powders to which water is added before use. The ingredients vary from one product to another, but the basic ingredients include fiber (e.g. psyllium, flaxseed, bentonite) and laxatives such as cascara and magnesium oxide. Other ingredients include vitamins, minerals, amino acids, herbs, and probiotics, all of which are variously claimed to promote detoxification, boost the immune system, promote weight loss and restore helpful bacteria. Magnesium oxide is claimed to release nascent oxygen. The laxative ingredients may be included in the powder or as a separate herbal tea. Users are generally instructed to drink 6-10 glasses of water daily. The recommended duration of use varies from a few days to several months. Some people have reported expelling large amounts of what they claim to be feces that have accumulated on the intestinal wall. However, experts believe these are simply "casts" formed by the fiber contained in the "cleansing" products. In the absence of constipation, concern about regularity should be met with reassurance. If hard stools are a problem and no underlying pathology is suspected, increasing dietary fiber or using a stool softener should help. “Cleansing” products offer no additional benefit, and some can cause unnecessary bloating, cramps and diarrhea.
"Cleansing" for Weight Reduction
Some marketers claim that accumulated toxins somehow interfere with digestion or nutrient absorption and cause people to become overweight—and that cleansing of the alleged toxins will cause people to lose weight.
Other Powders and Potions
Various herbal and dietary supplement concoctions are claimed to detoxify through metabolic action that is vaguely described or simply assumed to take place. One product, for example, is claimed to "promote balanced activity of the Phase I and Phase II detoxification pathways." The substances such products supposedly remove are seldom identified, and no studies have demonstrated that they actually detoxify anything. Testing any such products would be simple: Merely take a few blood samples from volunteers and measure whether any identifiable toxin is eliminated from the body faster than normal. No such studies exist because such products have no real detoxification effects.
Colonic irrigation (also called colon hydrotherapy) is intended to flush the entire length of the colon. It is done both at home and in commercial offices. The fluid may be plain water or contain enzymes, coffee, probiotics, ozone, and/or herbs. Various web sites indicate that the amounts used range from a few gallons up to as much as 30 gallons, a few pints at a time. The fluid is delivered through a tube or speculum inserted into the rectum. Most devices depend on gravity to deliver the water and peristalsis to expel the fluid and debris. Home kits (colonic boards) enable the user to flush gradually from a 5-gallon tank. Closed-system colonic machines have one tube for delivering the fluid and another for its removal. Open-system devices use a smaller tube connected to a water tank and a built-in basin to receive the waste. Sessions generally last between 25 and 50 minutes and may include abdominal massage. Some systems have disposable specula and tubing. Reusable components are sterilized after each patient. Colon irrigation has a few legitimate medical uses, such as preparation for surgery or radiological endoscopy and for treating fecal incontinence, but its use for “detoxification” is irrational .
Two types of quack detoxification devices are widely promoted: ionic cleansing devices and detox foot pads. During ionic cleansing, sessions, the customer's feet are bathed in a container in which salt water is subjected to a low-voltage current. During the process, the water typically turns reddish brown. Proponents claim that the process draws toxins from the body and that the color is due to the toxins entering the water. However, investigations have revealed that the color change is the result of precipitation of rust (oxidized iron) created by corrosion of the device's electrodes and that the water would change color whether or not a foot was placed in it .
Various adhesive pads and patches are claimed to detoxify the body when users apply them to the soles of the feet and leave them on overnight. By morning, they claim, the pads will absorb toxins and turn muddy brown or black. However, investigators have found that the darkening had nothing to do with toxins; the pads contain a chemical that reacts to moisture by becoming darker .
Sweating Out Alleged Toxins
Some recommendations for "detoxification" are based on blood tests that can detect chemicals in concentrations of parts per billion. This enables levels too low to be clinically significant to be misinterpreted as dangerous. If any "toxin" level is interpreted as abnormal, the patient may be advised to use exercise, sauna treatments, showers, massage, herbal wraps, and/or high doses of niacin (which can increase blood flow to the skin). Real detoxification of foreign substances takes place in the liver, which modifies their chemical structure so they can be excreted by the kidneys which filter them from the blood into the urine. Sweat glands in the feet can excrete water and some dissolved substances, but its minor role in ridding the body of unwanted substances is not changed by anything done to the skin.
A small but vocal group of dentists, physicians, and various other "holistic" advocates claim that amalgam fillings are a health hazard and should be replaced. Anti-amalgam dentists sometimes use a mercury vapor analyzer to persuade patients that "detoxification," is needed. To use the device, the dentist asks the patient to chew vigorously for ten minutes, which may generate tiny amounts of mercury from the fillings. Although this exposure lasts for just a few seconds and most of the mercury will be exhaled rather than absorbed by the body, the machine gives a falsely high readout that the anti-amalgamists interpret as dangerous. However, scientific testing has shown that the amount of mercury absorbed from fillings is too small to be significant . Removing good fillings is not merely a waste of money. In some cases, it results in tooth loss because when fillings are drilled out, some of the surrounding tooth structure will be removed with it.
Chelation therapy involves the administration of a substance that combines with metallic chemicals to increase their excretion by the kidneys. The most common form is a series of intravenous infusions that contain a chelating agent (EDTA) and various other substances. Doctors who offer chelation therapy as part of their everyday practice typically claim that it is effective against autism, heart disease and many other conditions for which it has no proven effectiveness or plausible rationale .
"Provoked" testing" is used to trick people into thinking that they have lead or mercury poisoning. To do this test, the patient is given a chelating agent before the specimen is obtained. This artificially raises the levels of lead, mercury, and/or other heavy metals in the urine. The test report, a copy of which is given to the patient, states that its "reference values" are for non-provoked specimens. However, if a test level exceeds the reference values—which it usually will—it is reported as "elevated" even though it should be considered insignificant. The patient is then advised to undergo "detoxification" with chelation therapy, other intravenous treatments, dietary supplements, or whatever else the practitioner happens to sell . This advice is very, very, very wrong. No diagnosis of lead or mercury toxicity should be made unless the patient has symptoms of heavy metal poisoning as well as a much higher non-provoked blood level. And even if the level is elevated—as might occur in an unsafe workplace or by eating lead-containing paint—all that is usually needed is to remove further exposure.
"Detoxification" as described in this article is an array of practices based on quack notions that are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. The danger of these practices depends upon how much they are used and whether they are substituted for necessary medical care. The harm can be economic, physical, and/or emotional. For example:
- Whereas a 1-day fast is likely to be harmless (though useless), prolonged fasting can be fatal.
- "Cleansing" with products composed of herbs and dietary fiber is unlikely to be physically harmful, but the products involved can be expensive.
- Colonic irrigation is not only therapeutically worthless but can cause fatal electrolyte imbalance. Cases of death due to intestinal perforation and infection (from contaminated equipment) have also been reported.
- Unrealistic fears can lead people to replace good amalgam fillings unnecessarily.
- Chelation therapy occasionally leads to electrolyte imbalances and organ damage. The biggest danger arises from the fact that it is marketed as a substitute for coronary bypass surgery. People who use chelation instead of necessary medical or surgical care put their life at risk.
- Pizzorno JE, Murray MT. Textbook of Natural Medicine. London: Churchill Livingstone. 1999, p 437.
- Colon cleansing. The Medical Letter on Drugs and Therapeutics 51:39, 2009.
- Barrett S. The Aqua Detox scam. Device Watch, Dec 28, 2004.
- Barrett S. The detox foot pad scam. Device Watch, Feb 5, 2009.
- Position paper on amalgam fillings. National Council Against Health Fraud, 2002.
- Green S. Chelation therapy: Unproven claims and unsound theories. Quackwatch, July 24, 2007.
- Barrett S. How the "Urine Toxic Metals" test is used to defraud patients. Quackwatch, Feb 18, 2009.
This article was revised on June 8, 2011.