The detox diaries

Do so called detox diets work? Tarig Babiker and Alexander Hamilton spent a week on one and describe the highs and the lows

Despite reports in the press denying any scientific evidence in support of the benefits of detox diets,w1 we thought we might see for ourselves what all the fuss was about. The aim was not to lose weight, but to see how feasible it would be to exclude additives, wheat, meat, dairy foods, and preservatives from our diets. We hoped the experience might give us personal insight; help us to better advise our future patients; and let us explore a more holistic approach to practice-a concept often viewed sceptically by Western medicine.

Being a medic often predisposes you to uncertainty when faced with treatments that claim physical benefit that lie beyond our textbooks. We certainly felt that without our medical backgrounds we might be able to derive spiritual benefit from the detox experience as well as physical changes. We were both willing subjects for an experiment, but were we inherently biased before we had even begun?

Furthermore, we wanted to examine the detox without the scruples of a study, and without dubious evidence from lay people or celebrity endorsed sources. Our report takes into account the practicalities of the diet, as well as the science, and the ideas, concerns, and expectations you might have about a given treatment while experiencing it. Many colleagues have expressed surprise at our experiment, which shows an apparent lack of medical experience with these diets as well as unwillingness to attempt the unorthodox.

The diet works on the principle that everyday foods are filled with excess sugar, salt, and preservatives, and thus are full of toxins that the body has to work hard to get rid of. In addition, it is thought that, in times of stress or in cases of dehydration, toxins are not adequately removed from the body via sweat, urine, and faeces, and their lingering can cause symptoms such as fatigue, acne, nausea, and headaches.^w2The detox diet gives the body "a rest," in theory, leading to a more invigorated, energised, and harmonious system.

Although many accept this as the truth, some theorise that the beneficial effects are simply a result of healthy eating, the avoidance of caffeine (and other stimulants or depressants), and eating less. On the other hand, the influence of self declared experts or celebrities such as Gillian McKeith and Carol Vorderman cannot be denied, who promise the diet will "do everything from helping you to lose weight, get rid of cellulite and feel more energetic to banishing colds, making you feel calmer and lowering blood pressure and cholesterol levels."^w3

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Would you be better off eating these books?

Let the experiments begin

Having no knowledge of detox diets, we did not know what to expect, but we had heard anecdotal evidence about the gruelling days that lay ahead. We decided that although we wanted to do this diet properly, we would not be too regimented about it if we found it difficult. A colleague reinforced this view because she had to stop the diet on day two when she got generalised malaise.

Some advocates of detox go so far as to dry fry vegetables, with olive oil added later, rather than fry vegetables directly in oil. This is because frying changes the nature of the oil,w4 making it unsuitable for detox. We decided we would not adopt this extreme approach-as long as we had the right ingredients, we would cook with them normally. We adapted our menu from Vegetarian Cooking Without: Recipes Free from Added Gluten, Sugar, Yeast, Dairy Products, Meat, Fish, Saturated Fat by Barbara Cousins (box 1).

The good, the bad, the ugly

With a cursory glance at the menu (box 2), you might be under the illusion that the food is edible. But it is not. It takes a great deal of time to prepare, and the food is bland and watery, and the ingredients are difficult to come by and often costly. There were various culinary low points of the week (vegetable soup can never be appetising when it resembles rice-water stools); the various seeds, although a good way to boost the calorie intake (125 g of sunflower seeds contains 600 kcal) are fussy to consume. In contrast, the best meal was undoubtedly the butternut and carrot soup-the seal of approval being that we would happily consume it again, outside of the detox.

Although we both felt frustrated and quite hungry at times, the feeling of eating "pure goodness" was most definitely satisfying. Watching other people consuming junk food made us feel quite smug. Physically we felt more refreshed and more alert in the mornings and less tired throughout the day. This could potentially be the result of the body not having to metabolise so many toxins, but in reality the body probably has to work much harder during the detox. This is because we are unused to eating so much fruit and so many vegetables, with high cellulose contents, and fibrous, tough coats. Our bodies seem pretty good at metabolising these so called toxins-after all, we consume them every day.

In terms of negative changes, the detox diet plays havoc with the digestive system. Now we truly appreciate what it feels like to have irritable bowel syndrome-frequency, urgency, bloating, and trapped wind, and mad rushes to the loo during clinic.

We have certainly become more appreciative of food in its more flavoursome varieties and have learnt much more about the vegan world. In the United Kingdom, our attitudes to food are changing. A recent news article highlighted the shift in Britain towards olive and sesame oil as opposed to traditional lard.^w5It may take more to alter Britain's drinking habits, but we are certainly more health conscious than we used to be when it comes to food.

Here comes the science

Detoxification used to be a procedure carried out in clinics in which patients were detoxified as part of treatment for alcohol or drug dependence. Current connotations of the term are more holistic-detoxing not only helps your body, but your mind and life in general, or so it is believed.

The idea of detox arose in the 1900s, when the idea spread that constipation gives rise to inefficient peristalsis, meaning that collections of gut flora were producing harmful poisons, leading to local decay.^w6

Some say that the process of detox reflects a modern day paranoia associated with environmental pollutants^w7-the idea of carcinogens damaging our bodies, the byproducts of industry and technology. This underpins the current aversion to artificial colourings, flavourings, and preservatives-a hallmark of the diet.

The rapid uptake of new health programmes such as detox diets poses the question of how they should be handled by the healthcare team.^w8Ought they be included in medical curriculums, so we can advise patients on the risks and benefits? In certain groups, there could be dire consequences from embarking on such a diet-for example, iron deficiency anaemia. Pregnant patients may risk neural tube defects and other congenital abnormalities by avoiding specific food groups.

Note the de-skilling of doctors and other healthcare providers in relation to alternative treatments. Lay people are empowering themselves with knowledge of diets, a field that is often delegated in general practice to a specific dietitian. In addition, celebrities are increasingly seen as authorities on health-they offer themselves up to public scrutiny and this increasingly extends not only to what they wear but what they eat. The BBC website has a specific detox section in its lifestyle pages,^w9 where you can read Kate Thornton's tip of the day-she "recommends drinking two litres of water a day all year round to flush out your system." Clearly this lay perception, although a reflection of the NHS guideline to drink eight glasses of water a day,^w10 has little actual basis in medicine or science.

The detox is a short term diet that is, in essence, a fast. Foods are restricted, and slowly reintroduced. Because of our body's normal expectation of intake of, for example, caffeine, a certain amount of withdrawal-like symptoms are to be expected. Moreover, many of the permitted foods are diuretic in nature, leaving the body dehydrated, also meaning any weight-loss is transient. It is also much more difficult to realise the body's recommended daily allowance of calories without the high earners, such as meat. This can result in more lethargy than experienced before the detox.

Thanks, but no thanks

Overall, detox diets and their relatives represent a clash of ideas between medicine and the so called alternative therapies, one that has been present for many years and that is not likely to disappear in the near future. Medicine will always lose out because of the side effect profile of many treatments, but the rigour of the world of placebo controlled drug trials means that any side effect, however small, is reported. Sadly, because alternative treatments are only just beginning to undergo a similar method of testing, their side effects are either unknown or not adequately studied. At times it is frustrating that patients are not willing to start a new drug but are happy to take multiple herbal remedies to treat a condition.

Detox diets require much forethought and preparation, and are expensive. They also clash with work and exercise schedules. In short, the benefits do not offset the effort required. Certainly these two medics will not be redetoxing in the foreseeable future. Detox, no doubt, will remain controversial-at least we can now contribute to the debate with the benefit of personal experience.

1. http://news.bbc.co.uk/1/hi/health/4576574.stm
2. http://kidshealth.org/teen/food_fitness/dieting/detox_diets.html
3. Vorderman Carol, Carol Vorderman’s Detox for Life: The 28 Day Detox Diet and Beyond, Virgin Books, 2002
4. Changes in Phenolic Composition and Antioxidant Activity of Virgin Olive Oil during Frying Sergio Gómez-Alonso, Giuseppe Fregapane, M. Desamparados Salvador, and Michael H. Gordon J. Agric. Food Chem.; 2003; 51(3) pp 667 - 672
5. http://news.bbc.co.uk/1/hi/business/4608248.stm
6. "Detox", a mass delusion. The Lancet Infectious Diseases, Volume 5, Issue 5, Pages 261-261 B. Dixon
7. The meaning of detox. The Lancet, Volume 361, Issue 9351, Pages 94-94 M. Fitzpatrick
8. J Fam Health Care. 2003;13(3):65-7. Health and fitness series--3. Popular dietary fads: how should health professionals respond? Griffin J
9. http://www.bbc.co.uk/lifestyle/detox
10. http://www.nhsdirect.nhs.uk/en.aspx?printPage=1&articleId=123