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The Detox Scam: How to spot it, and how to avoid it

The Detox and Cleanse Scam

Note to SBM’s regular readers: Today’s post revisits some older material you may have seen before. Happy New Year!

New Year, New You, right? 2014 is the year you’re finally going to get serious about your health. You’re winding down from a week (or more) of celebrations and parties. You’re pretty much recovered from New Year’s Eve by now. It’s time to make some resolutions. Conveniently, there is no shortage of solutions being advertised to absolve you of your sins while overhauling your body and soul for 2014: What you need to do is “detox”. You’ll see the detox kits at your local Whole Foods (or even your local pharmacy). Books, boxes or bottles, with some combination of “detox”, “cleanse” or “flush” in the product name. Supplements, tea, homeopathy, coffee enemas, ear candles, and footbaths all promise detoxification. The advertising suggests you’ll gain a renewed body and better health – it’s only seven days and $49.95 away. Or try to cleanse yourself with food alone: Dr. Oz is hyping his Holiday Detox plan. Bon Appetit is featuring their 2014 Food Lover’s Cleanse. Or what about that old standby, the “Master Cleanse”? It’s the New Year – wouldn’t a purification from your sins of 2013 be a good idea to start the year? After all, the local naturopath offers complete detoxification protocols, including vitamin drips and chelation. There must be something to it, right?

Wrong. “Detox” is a case of a legitimate medical term being turned into a marketing strategy – all designed to treat a nonexistent condition. In the setting of real medicine, detoxification means treatments for dangerous levels of drugs, alcohol, or poisons, like heavy metals. Detoxification treatments are medical procedures that are not casually selected from a menu of alternative health treatments, or pulled off the shelf in the pharmacy. Real detoxification is provided in hospitals when there are life-threatening circumstances. But then there are the “toxins” that alternative health providers claim to eliminate. This form of detoxification is simply the co-opting of a real term to give legitimacy to useless products and services, while confusing consumers into thinking they’re science-based. Evaluating any detox is simple: We need to understand the science of toxins, the nature of toxicity, and how detox rituals, kits, and programs claim to remove toxins. With this framework, it’s a simple matter to spot the pseudoscience and be a smarter consumer.

Premise one: Our bodies are accumulating toxins

There’s a reason we fall for the marketing of detoxification – we seem hardwired to believe we need it, perhaps related to our susceptibility to ideas of sympathetic magic. Purification rituals date back to the earliest reaches of recorded history. The idea that we’re somehow poisoning ourselves and we need to atone for our sins seems to be a part of human nature, which may explain why it’s still a part of most of the world’s religions. It’s not miasmas or perhaps sin that we’re as worried about today, however. As our knowledge of biology grew, these fears manifested as “autointoxication.” Clean out the bowels, went the theory, and you could cure any illness. Science led us to discard autointoxication by the 1900′s as we gained a better understanding of anatomy, physiology, and the true cause of disease. Despite the science, however, the idea persists among alternative practitioners. Today’s version of autointoxication argues that some combination of food additives, gluten, salt, meat, fluoride, prescription drugs, smog, vaccine ingredients, GMOs, and perhaps last night’s bottle of wine are causing a buildup of “toxins” in the body. But what is the actual “toxin” causing harm? It’s nothing more than a meaningless term that sounds scientific enough to be plausible. A uniform feature of detox treatments is the failure to name the specific toxins that these rituals and kits will remove. For example Renew Life promises you:

CleanseSMART is a 2 part, 30 day, advanced herbal cleansing program. It is formulated to stimulate the detoxification process of the body’s 7 channels of elimination: the liver, lungs, colon, kidneys, blood, skin, and lymphatic system. In today’s toxic world, cleansing and detoxification is a necessity. Toxins enter our body daily through the air we breathe, the food we eat, and the water we drink. Over time, these toxins build up and slowly start to affect our health in a negative way.

Through cleansing and detoxification, you enable your body to better process this toxic load. Reducing the toxic load in your body decreases the risk of developing chronic health problems, improves overall health and immune response, and can increase energy levels. CleanseSMART works to cleanse and detoxify the entire body, but with focus on the body’s two main detoxification pathways – the liver and the colon. CleanseSMART is essential for helping eliminate constipation and improving bowel health.

Note the vague language. Toxins are alluded to – but not named. It sounds somewhat plausible, but is non-specific. Note that even if you’re well (and presumably toxin free?) a detox is still recommended.

The colon remains ground zero for detox advocates. They argue that some sort of toxic sludge (sometimes called a mucoid plaque) is accumulating in the colon, making it a breeding ground for parasites, Candida (yeast) and other nastiness. Fortunately, science tells us otherwise: mucoid plaques and toxic sludge simply do not exist. It’s a made-up idea to sell detoxification treatments. Ask any gastroenterologist (who look inside colons for a living) if they’ve ever seen one. There isn’t a single case that’s been documented in the medical literature. Not one.

Premise two: Illness is the result of toxins

Marketing materials for detox treatments typically describe an array of symptoms and diseases linked to toxin buildup: A few that are general enough to apply to anyone (e.g., headache, fatigue, insomnia, hunger) with a few specifics to frighten you (cancer, etc.) Which toxins cause which disease is missing, and how the toxins cause the symptoms is never actually explained. Here again we see the contrast with real science. To establish that even a single chemical can cause disease requires a significant amount of research (i.e., the entire field of epidemiology). Despite the variety of toxins that are claimed to be causing your illness, marketing claims for detox treatments will uniformly fail to link specific toxins to specific symptoms or illnesses.

The reality is that our bodies are constantly being exposed to a huge variety of natural and synthetic chemicals. The presence of any chemical in the body, (natural or synthetic) does not mean that it is doing harm. Many naturally-derived substances can be exceptionally toxic, and consequently the human body has evolved a remarkable system of defenses and mechanisms to defend against, and remove unwanted substances. The skin, kidneys, lymphatic system, our gastrointestinal system, and most importantly, the liver make up our astoundingly complex and sophisticated intrinsic detoxification system. Importantly, the dose makes the poison – even water can be toxic (dilutional hyponatremia) when consumed in excessive amounts.

Advocates for detox typically describe the liver and kidney as acting like filters, where toxins are physically captured and retained. It’s argued that these organs to be cleaned out periodically, like you’d rinse out a sponge, or change the air filter in your car. But the reality is the kidney and liver don’t work this way. The liver performs a series of chemical reactions to convert toxic substances into ones that can be eliminated in bile, or the kidneys. The liver is self-cleansing – toxins don’t accumulate in it, and unless you have documented liver disease, it generally functions without any problem. The kidney excretes waste products into the urine – otherwise the substance stays in the blood. To argue that either organ need a “cleanse” is to demonstrate a profound ignorance of human physiology, metabolism, and toxicology.

Premise three: Detox treatments remove toxins

A search of the medical literature for clinical studies of detox kits provides the following result:

No Items Found

There is no credible evidence to demonstrate that detox kits do anything at all. They have not been shown to remove remove “toxins” or offer any health benefits. The same can be said for quackery like coffee enemas – there is no credible evidence to support claims that coffee enemas help the body to “detoxify” compounds, or help the liver function more effectively. Vitamin injections are another treatment that fail to offer meaningful benefits to consumers, and have no beneficial effect on the ability of your liver or kidneys to work effectively. Chelation injections are touted as a cure-all for all kinds of illnesses, but unlike real chelation that’s administered in hospitals for real cases of poisoning, naturopath chelation is not science-based and doesn’t seem to do much of anything.

Can Detoxing be harmful?

If they provide no benefit, is there the potential for detox treatments to harm?

When it comes to simple dietary changes, there’s little evidence of harm. Eating more quinoa and kale, and less processed and refined foods is reasonable dietary advice for everyone. Homeopathic “detox” is also likely safe – with no active ingredients, homeopathy is an elaborate placebo system. As you get into more unorthodox detox treatments that actually contain active ingredients, it’s clear that some approaches are demonstrably risky. Coffee enemas are considered unsafe and should be avoided. Harms such as septicemia (bacteria in the bloodstream), rectal perforation, and electrolyte abnormalities have been reported. Even deaths. Vitamin injections don’t seem as risky, as long as you trust the sterile technique of your alternative provider. However, given some naturopaths seem to be willing to inject products intended for oral use, you might want to think carefully about taking a vitamin injection or chelation treatment, especially when there’s no reasonable expectation of any benefit.

What about the detox kits? Contents vary, but typically contain two categories of ingredients:

  1. A liver “booster” – typically milk thistle (Silibum marianum). If the liver can’t be wrung out and rejuvenated, can it be boosted to do a better job? Milk thistle is the most popular product purported to “boost” the liver’s effectiveness. There are no published studies that demonstrate milk thistle has a detoxifying effect on the liver. Milk thistle has been studied in patients with alcoholic liver disease, and in patients with hepatitis B or C, and it has not been found to exhibit any meaningful effects. There is no evidence to suggest that consuming milk thistle will cleanse you of unnamed “toxins”.
  2. A laxative – Typically magnesium hydroxide, senna, rhubarb, cascara, etc. Laxatives are the ingredients in detox kits that give you the effect you can see (and feel). However, these ingredients can cause dehydration and electrolyte imbalances if not used carefully. Regular use of stimulant laxatives, like senna and cascara, are ill-advised for most healthy adults due to the risk of dependence and electrolyte depletion. They’re among the most potent laxatives, usually used for short periods to alleviate significant constipation or to clear out your bowels before a medical procedure. With regular use, your bowel can grow accustomed to the effects of laxatives which may result in constipation once you stop using them. It’s a perfect case of the treatment causing the illness: After the detox, you get could conceivably become constipated: Time for another detox!

Side effects can continue once a detox ends. Some people experience post-detox effects like nausea and diarrhea. Advocate call these “cleansing reactions” and will assure you it’s “toxins leaving the body”. A more plausible, science-based explanation is that this is a consequence of restarting the digestion process after a period of catharsis, where, depending on the extent and duration of fasting, little to no digestion occurred, and the normal gastrointestinal flora may have been severely disrupted. It’s the same effect seen in hospitalized patients who have difficulty initially digesting food after being fed intravenously. The detox ingredients, and resulting catharsis, may irritate the colon to such an extent that it may take time to return to normal.

Immediate weight loss is not uncommon after a detox, especially one that involves a laxative. Unfortunately this is usually due to losses in water and possibly muscle tissue, depending on the how disruptive the detox was to normal body function Regardless of the weight loss, the body will move back to its pre-detox weight over time if diet and activity levels remain the same.

Conclusion

Any product or service with the words “detox” or “cleanse” in the name is only truly effective at cleansing your wallet of cash. Alternative medicine’s ideas of detoxification and cleansing have no basis in reality. There’s no published evidence to suggest that detox treatments, kits or rituals have any effect on our body’s ability to eliminate waste products effectively. They do have the ability to harm however – not only direct effects, like coffee enemas and purgatives, but the broader distraction away from the reality of how the body actually works and what we need to do to keep it healthy. “Detox” focuses attention on irrelevant issues, and gives consumers the impression that they can undo lifestyle decisions with quick fixes. Improved health isn’t found in a box of herbs, a bottle of homeopathy, or a bag of coffee pushed into your rectum. The lifestyle implications of a poor diet, lack of exercise, smoking, lack of sleep, and alcohol or drug use cannot simply be flushed or purged away. Our kidneys and liver don’t need a detox treatment. If anyone suggests a detox or cleanse to you, you’d do well to ignore the suggestion, and question any other health advice they may offer.

Posted in: Health Fraud, Herbs & Supplements, Homeopathy, Naturopathy

Leave a Comment (101) ↓

101 thoughts on “The Detox Scam: How to spot it, and how to avoid it

  1. The Midwesterner says:

    “There is no credible evidence to demonstrate that detox kits do anything at all.” Of course, not quite true. They expertly separate foolish but likely well-meaning people from their money, which I’m cynical enough to think is the primary – but unstated – reason they are marketed, especially at this time of year.

  2. Liz de Laperouse says:

    Could Detox products and kits lead to health conditions like kidney stones and anemia?
    Liz

    1. Andrey Pavlov says:

      @liz de laperouse:

      That is too broad a question. So-called “cleanses” and “detoxes” come in a wide variety. You’d have to ask about a specific one. I don’t know them all off the top of my head, but I do know some involve purgatories and/or laxatives which could lead to dehydration and potentially kidney stones. Same with the ones that cause electrolyte disturbances, particularly in phosphate metabolism. As for anemia – also possible by any number of mechanisms. Some detox/cleanses are very strict on intake, particularly red meats, and could potentially lead to iron deficiency. Some of the colonic cleanse ones could lead to smallish amounts of bleeding which could lead to anemia. And, of course, some of the naturopathic and Chinese traditional medicine decoctions contain heavy metals which could interfere with many bodily functions, in particular red blood cell synthesis (more specifically heme synthesis).

  3. goodnightirene says:

    In addition to your comprehensive discussion, there are all the “detox” or “cleanse” diet fads, such as various types of fasting or juicing. Many of these are tied into the weight loss scams–sorry for the “tone”, but they ARE scams or sCAMS, however you look at it.

    I go to Whole Foods or the CoOp in the winter once my lacinato kale finally totally freezes (and this year it is now completely under snow) to buy it as no other market carries this variety. Inevitably someone will be standing nearby discussing her new “cleansing diet” with another shopper. They buy a whole cart full of kale at $3.99/lb just to make green goo that cannot actually taste good–unlike my kale-beet salad or nifty kale chips.

    I have no problem with people drinking kale “juice” if they can stomach it, but it’s usually just one part of some very questionable “program” of “cleansing” or fasting that it just another attempt at weight loss or an even more nebulous effort to “get healthy”. I happen to LIKE kale as part of a varied, mostly plant-based diet (chocolate IS a plant!), and it’s dead simple to grow, but it won’t help me if I consume too much of the beloved chocolate/sugar concoctions. I will be happy when the snow melts and I can get the new kale going so I don’t have to visit these markets anymore.

    1. CHotel says:

      Seriously, how good are Kale chips? I’m not sure how you prepare yours, I’m a fan of oven baked after shaking it in a bag with as little oil as possible to coat and crisp. A bit of coarse sea salt and a good dusting of black pepper right when they come out. I’m salivating at my desk thinking about them. I’ve never tried kale with beets before; most of the beets I’m used to eating are either pickled or in borscht.

      On topic: Such good timing. Last year I saw so many social media posts regarding juices and cleanses as part of New Years Resolutions, looking forward to countering with a link to this article if they pop up again.

      And from one Pharmer to another Scott, thanks for all you do to promote science and reason in our profession as the quacks move to infiltrate our aisles further (Well, not my aisles, hospital, but you know what I mean). Happy New Year!

      1. Nashira says:

        Try tossing the kale chips into the tortilla with cocoa-spiked beef in a basic tomato-chile sauce. (Or a hunk of your frozen mole rojo, if you’re me.) It’s extra good if you add cubed sweet potato to the filling, and doesn’t need cheese or sour cream to be delicious.

      2. windriven says:

        “I’m a fan of oven baked after shaking it in a bag with as little oil as possible”

        Sesame oil. And a little salt. Mmmmm.

        “I’ve never tried kale with beets before”

        Why use kale when you’ve already got beet greens?

        1. CHotel says:

          (Replying to both of you at once)

          @Nashira: Welp, now my keyboard is soaked in spittle. IT department is not going to be happy with me, especially since I just broke a mouse a couple weeks ago…

          @windriven: I’ll have to try the sesame oil, it tastes delicious in my head. I’ve honestly never tried to work with the greens of beets before. Like I said they’re usually either pickled when they get to me, or I just get the roots alone for borscht without looking for ones with good quality green on the other end. Local grocery doesn’t always have the best selection, and this past summer I always seemed to be busy when the farmers market was open unfortunately. I’m very excited to start my own garden this year though, beets included.

          1. goodnightirene says:

            To all who ask about beets: late reply but maybe some of you will look back occasionally as do I.

            I use the golden beets (shredded or grated) along with shredded lacinato kale. Add a handful of dried cranberries, maybe some slivered almonds and toss with a vinegrette of your own concocting. I also use beet greens and chard, but in other recipes.

            Thanks for all the tips on kale and kale chips! I never thought of adding pepper, which I love.

            1. Andrey Pavlov says:

              @goodnightirene:

              My sister is the queen of salads and makes a killer one with avocado, corn, tomato, onion, a little bit of frise, and then tossed with olive oil and red wine vinegar and seasoned with salt, pepper, and plenty of cumin. One of my faves. She also often adds lentils to salads which is great. Tonight my dinner will be a simple salad of iceberg lettuce with some added veg and plenty of flaked smoked salmon that I just took out of the smoker. Dressing TBD.

    2. Gemman Aster says:

      No need to be sorry for your tone goodnightirene!!! You speak the truth as it is known beyond all doubt to be.

      The barefaced deceit perpetrated by these fad carpetbaggers FAR, far outweighs any perhaps untempered but thoroughly honest tone.

      I wish we heard more of the same generally.

  4. MTDoc says:

    A great website for reliable info on a variety of scams is Steve Lower;s website http://www.chem1.com. Click on “aquascams” and go down to “detoxifying foot baths” to see how these demostrations work. While you are there, read all about “ionized water”,a sure cure for all that ails you,and even invoking a nobel prize laureate. A wealth of useful information for anyone interested in SBM, or just science.

  5. bluedevilRA says:

    Toxin/cleanse quackery is probably my favorite. There is so little effort on the part of the hucksters to present any evidence beyond anecdote (I feel like acupuncture, supplements, etc at least try to play the peer-review game) and yet the products go on to sucker millions. No one can ever identify a specific toxin or a plausible mechanism by which the toxins are “cleansed” from the body. Boosting liver function? Wouldn’t that involve changing the liver’s metabolism? It’s a good thing this is all nonsense. But I could easily imagine a scenario where a patient takes some cleanse that induces the cytochrome p450 system and leads to “boosting” of liver function to the point that the patient metabolizes warfarin, OCPs or seizure medications more rapidly. But then again, since most of these people are the worried well, they may not take any prescription medications.

    And now I want to try these kale chips that everybody keeps talking about.

    1. Andrey Pavlov says:

      Kale chips are awesome and super easy to prepare. I suggest you try them!

      Just get some kale, very lightly oil them, chuck them in a 350 degree oven for a few minutes (just until they get a little crispy), season with salt/pepper/your preference (Tony Cachere works well for some down south spice to it!) and Robert’s your mother’s brother.

      1. William says:

        Good one Andrey! And Charles is your Mother’s sister.

        1. Andrey Pavlov says:

          LOL. Thanks William.

      2. Interrobang says:

        I just can’t get into the idea of kale chips, but I find most brassicas to be darn near inedibly bitter; I can’t even imagine *dehydrating* them.

        1. goodnightirene says:

          You HAVE to try the lacinato (or dinosaur kale, so-called for its bumpy texture) variety–it has a different flavor than the curly kale, which I only use in soup.

  6. DJDenning says:

    My favourite detoxers are the ones who proudly post pictures of their poop as proof of a successful detox. Talk about waaaaay too much free time on their hands!

    The whole detox thing also points to the hypocrisy of sCAM. Those of us who work in health care are supposed to be engaged in a massive conspiracy to enrich ourselves by keeping people sick, suppressing cures for cancer, injecting toxic vaccines, etc. In the meantime, sCAMmers make their money selling products to healthy people who don’t need anything.

    1. windriven says:

      Interesting observation, DJDenning.

      Many of the altie types seem to be fixated on their feces – either phobic, fearing the accretion of nastiness in their colons, weighing them down and incubating countless succubi – or celebrating feces with the pride of a new parent, complete with wallet-sized photos and a beaming smile. I wouldn’t pretend to pick through the underlying psychology. But I do find it interesting.

      1. nancy brownlee says:

        It seems to be a resurgence of the autointoxication theory. I’m rather past middle age- and had a couple of grandmothers who were permanently fixated on “the bowels”. They did firmly (no smirks, please) believe that constipation caused everything from acne to migraine, and that chronic constipation invariably led to cancer.

        1. Sarah says:

          Defecation is the means of the body getting rid of the ingested foodstuff it doesn’t need, the rectum absorbs and puts substances into the circulatory system (think suppositories). If one hasn’t taken a dump in a while one is re absorbing the things that the body doesn’t need leading, potentially, to illnesses.
          There is a time honoured saying in nursing – “you don’t eat, you don’t shit; you don’t shit, you die”.

          1. weing says:

            “If one hasn’t taken a dump in a while one is re absorbing the things that the body doesn’t need leading, potentially, to illnesses.”
            I suggest you check out the book ‘Gulp’ by Mary Roach, you definitely might learn something.

            1. BillyJoe says:

              That should be “definitely will learn something”

              1. weing says:

                “That should be “definitely will learn something””
                That’s what I initially wrote. But then I thought that I was assuming too much about her willingness and ability to learn and changed it.

      2. weing says:

        @windriven,
        Pictures are sometimes useful.
        http://en.wikipedia.org/wiki/Bristol_stool_scale

        1. windriven says:

          Thanks weing! I’m going to set up an altie website and sell full color wall charts of the Bristol scale along with a selection of herbal remedies so that everyone can marvel over their own perfect Type 4′s. Maybe I’ll offer a scratch-n-sniff version to licensed NDs for diagnostic use.

  7. Greg says:

    You’ve just confirmed what I always suspected – detoxes are a huge scam! People who fall for these, just don’t think for themselves or apply any logic. I read somewhere that people can have decaying matter accumulate in the colon and the only way to get rid of it is a colon cleanse. Looking at it logically you realize that unless the colon has been damaged it is not possible because an accumulation of decaying matter defeats it’s purpose. Our biology is more clever than that. Besides, wouldn’t a bout of diarrhea clear it out anyway?

  8. Mark says:

    I find it ironic that there is now a group of people who practice “colon cleanse’s” and then eat or drink bugs for their colon (probiotics)! You can’t help but laugh!!

    Someone explain to me how these bugs, (proteins right) get past the HCl of the stomach and proteases in the gut?

    1. Andrey Pavlov says:

      @mark:

      Actually the real issue is not the passage from the stomach to the gut. Yes, you are right that the vast majority of these bugs will end up in bacteria heaven rather than your colon, but a small percentage do actually survive. And then they can seed and procreate in their colonic paradise. The REAL issue is – which species of bug should we be using? The problem is that we don’t actually have a solid answer on this and the species generally used don’t really make sense to use since they are not part of the natural flora. This is why we treat intractable C. diff colitis with fecal transplants from close relations and it tends to work really well. And this is usually done by putting a tube through the nose and into the stomach. From my understanding it doesn’t matter if you get the tube past the stomach or not – the effect is the same. Which means that the bugs definitely make it through. But probiotics don’t seem to help in C. diff colitis.

      Now to complicate things a bit more, there IS evidence that in some cases – particularly more mild cases and especially so in *preventing* antibiotic associated GI disturbances – probiotics DO seem to help. Not a HUGE effect, but definitely there. Enough that I would probably recommend it to my patients, in particular those who are especially sensitive to antibiotics (primarily because they are cheap and seem to have no particular negative side effects). Now WHY this works is unknown, but it likely is not a direct effect of colonization from lactobacillus but from an environmental shift in the complicated microbiome of the gut resulting in further downstream changes that produce the desired effect. The key will be to try and see if we can figure out more optimal species/combinations of species, though I predict this will be exceedingly difficult.

      1. Denise says:

        Yogurt did seem to help me recover from antibiotics. Prior to that, three expensive bottles of probiotic pills with differing bugs in them were a complete waste. It was lucky for me that I got a hankering to eat some yogurt, because by then I’d completely given up on the idea that probiotics were going to be of any use.

      2. Greg says:

        “The REAL issue is – which species of bug should we be using?” Perhaps a wide spectrum would be best. As you have observed, most probiotics use dairy based bacterium which is what is found in yogurt. Plant-based probiotics are available (in Canada) – I haven’t tried them, however a number of years ago, when I was a gym-rat, I used kefir instead of yogurt in the protein shakes I would down before I hit the gym in the morning. Kefir tastes like sour milk, but the fermentation is from grains and is reputed to be beneficial to our health – http://www.ufrb.edu.br/kefirdoreconcavo/images/artigos/artigo06.pdf‎

        1. Andrey Pavlov says:

          @greg:

          Perhaps a wide spectrum would be best

          Which wide spectrum? Based on what information do we decide how wide and which specific bacteria to include? And, mechanistically important, does the ratio actually matter? If so, how do we ensure that ratio survives the stomach to get to the gut? If it doesn’t matter how do we determine if one or more components of the cocktail are actually making it to the colon? What if the effect is primarily just that of perturbing the colonic microenvironment to instigate a change towards homeostasis and NONE of the bugs in the cocktail actually last? And all of this in the context of a condition that is highly variable by nature and with a large subjective component (so even taste and personal preference on taste and delivery method could influence outcomes). And those are just the confounders I could think of off the top of my head.

          The point is that we simply can’t say with any confidence anything beyond “it seems to help in some cases and has little or no side effects.” The danger would be in thinking that these findings in prophylactic use of yogurt mean that increasing the dosage (e.g. pills of live culture) or broadening the number of species involved will mean a greater or otherwise better effect. The deeper issue is that any testing of any probiotic is simply a stab in the dark. There is nothing to inform a rational approach to probiotic use and the interplay of numerous species in the probiotic plus the stomach and the gut and the existing flora is horrendously complex.

          Kefir tastes like sour milk, but the fermentation is from grains and is reputed to be beneficial to our health

          For some reason I can’t access the link you attached – it gives me a 404 error.

          I actually like Kefir myself. I basically grew up with stuff like that as a kid. But beyond an overall good option for nutritive value I am hard pressed to think of any specific effect Kefir may have.

          The bottom line is that this sort of stuff is very, very difficult to study. Personally, I wouldn’t be in the field of clinical study on this. I just don’t think we know enough to inform any studies and the vast majority will either be completely fruitless or just tell us again what we already know – that it seems to have some small to moderate helpful effect with little downside. Until we have a better understanding of the microbiome and can rationally model interactions to at least have some sort of rational approach to testing, it will be a field of arguing how many angels can dance on the head of a pin. Unless, of course, someone gets insanely lucky and stumbles upon a specific decoction with very obvious and large effect sizes. In which case said person should immediately buy a lottery ticket*.

          *No, not really. I know they are independent events and chance doesn’t work that way. It was a rhetorical tactic, in case that wasn’t clear.

          1. Greg says:

            Those darn confounders! I see your point(s). The link is to a pdf file I found on a search of “kefir a complex probiotic”. I found another site which seems to allow you to download the same PDF – hopefully this one works – it is blocked at my place of employment – http://ebookbrowsee.net/kefir-a-complex-probiotic-pdf-d239329120

            1. Andrey Pavlov says:

              Yes, kefir is indeed a “complex probiotic.” But this is trivially true – it has lots of bugs, yeasts, and their metabolic products. The paper goes into how there is some preliminary and bench science/in vitro and animal data to suggest some effects. It even specifically mentions that there is essentially no human data.

              All of this is interesting as a hypothesis generator but the reality is that there is nothing specifically unique to kefir that would really make it particularly more likely to have specific effects. Isolating certain compounds may prove fruiftul but this is no different than any sort of standard science based pharmaceutical sciences investigation of naturally occurring compounds for pharmacological activity. And we know how the vast, vast majority of these investigations fail to show results. Such is the nature of the game and why high throughput testing was developed.

              Additionally the “grains” of kefir are not cereal grains – they are just the term used for the bacterial culture used to produce kefir from milk products.

              Once again this falls perfectly within what I have written above – if my patient likes Kefir and finds it helpful when I prescribe antibiotics, then by all means drink it. I personally find it delightful in flavor and texture and would not hesitate to recommend it to my patient. It would be a more general recommendation to take something like yogurt or a yogurt based drink with live cultures and see if it helps. If it doesn’t, trying something different is reasonable (like a Danon probiotic drink or even just plain old yogurt which is what I grew up eating myself. I love just plain yogurt with no flavors or mix ins).

              And of course all the confounders that I listed above (and then some!) still apply.

              1. Greg says:

                Ok, thanks for indulging my ignorance. I realized that kefir grains are not like cereal grains, but wasn’t sure exactly what was meant by the term in reference to kefir.

  9. milwaukeeguy says:

    I go to my local health food store and buy several bunches of organic parsley each week. I’ve been doing this as a cleanse of sorts for a few weeks. I have about a half a bunch each morning. I found the comment about people showing their poop funny. When I chew the parsley, I sometimes dribble some juice into my hand; seeing how green the liquid gives me a good feeling about eating this. It’s not particularly tasty, but I’m at least getting a serving of veggies this way (and realistically, just that – no special extra cleansing with this routine).

    1. Nashira says:

      So you eat tabbouleh for breakfast?

      1. milwaukeeguy says:

        Nope, just straight parsley. I’m actually getting accustomed to the taste, and it provides good fiber.

        One of the worst detox experiences I had was having a juicer and doing internet searches on cleansing juices. One extolled the virtues of onions. The suggested combination of onion and apples, etc. was written to assure people that the onion taste would not be overpowering. I tried the detox and should have realized something was not right when there was a strong onion/burning sensation in my mouth. I decided to tough it out and down the whole disgusting smoothie. After finishing, I doubled over on the floor. Did not throw up, but had to lay there on the floor and not move for about 15 minutes. That experience caused me to throw away my juicer. In this context, the parsley is way more rational (even though it does not have any special detox powers).

        1. Nashira says:

          I was hoping you were cracking a joke, not being serious like detoxing is a thing that people should be doing. Did you actually read the post at all, or just jump straight to the comments for story time?

        2. Chris says:

          “I go to my local health food store and buy several bunches of organic parsley each week.”

          To bad you live in Wisconsin. If you moved west until you hit salt water you could grow your own (like to this Milwaukie). It grows like a weed around here. It is biennial, so it goes to seed in its second year where it readily grow back. I started with one Italian parsley plant, and now I always at least a dozen year round to pick from.

          You might be able to grow your own in a cold frame or a very bright window. Perhaps with some other very healthy herbs like thyme, oregano, sage and rosemary. Or some actual leafy veg like chard, kale and arugula.

          By the way, I started growing herbs in the window of my apartment during college. Most of them (basil, rosemary, thyme) are too aromatic to be bothered by aphids, fungus gnats and spider mites. So if you decide to grow parsley indoors, make sure you have some aromatic herbs next to it. If you do get those pests, paint some popsicle sticks (available in craft stores), yellow and cover them with “tangle foot” (available in garden stores), and be willing to give your plants a shower every so often.

          1. goodnightirene says:

            I grow parsley almost year round in MilwaukEE–though I admit it is easier to do so in MilwaukIE. When the snow starts to bury it, I drag it (in its pot) inside and put it in a sunny window where it thrives until it goes back outside in early spring.

            Hey, parsley guy! Why not just make some lovely tabbouleh instead of munching on plain parsley? It will have a lot more fiber AND a lot more flavor–won’t dribble down your chin either!

            1. NoCanDo says:

              Ummm, sorry, but too much parsley is poisonous. In the old times it was used to cause spontanious abortions. Whenever you find a place called “parsley street” in Europe, that’s usually where the prostitutes where doing their thing…

              Parsley also contains a lot of oxalic acid which in large quantity can harm your kidneys. It also contains some kind of drug-like substance that (in large quantities) can cause euphoria, dizziness and other things (I forgot the name, something starting with M).. A simple internet research will show you loads of articles about that.

              So, I would recommend eating a little less of it…

              1. NoCanDo says:

                **were* instead of *where*, sorry (it’s early where I am…)

  10. Peter Browne says:

    I would like to know his thoughts on l-cysteine

    1. Andrey Pavlov says:

      @peter browne:

      what about l-cysteine? It is an amino acid that our body synthesizes de novo. It is used in building various proteins, notably in keratin. What else would you like to know?

      1. Peter Browne says:

        It’s also used for acetaminophen poisoning right and I think mercury also.
        It also comes in the form of NAC.
        Everything I’ve read about it seems to point in that direction,and seems to have some medical research back up.
        I’m sceptical of most of the milk thistle and echinacea theories people and usually research something to the death before buying it.
        But there must be some good things to take when are bodies are full of acetaminophen from being on the piss the night before,like B complex and electrolytes that can have some benefit right?
        I started using L-cysteine for hangovers a couple of yrs ago ,and half my psoriasis cleared up after yrs of zero improvement.
        It also seemed to reduce the duration of a hangover significantly,
        go figure…

        1. Andrey Pavlov says:

          Yes, it certainly can be used in the acetylated form for certain conditions (not just tylenol poisoning). However, I doubt you are getting this since there is currently a nationwide shortage in the US and it is by prescription only (though I suppose some supplement company could be selling it as part of a supplement or something). But it doesn’t really have an effect beyond that. So of course there is a lot of medical research on using NAC for those purposes – I’ve prescribed it myself for exactly those reasons.

          Milk thistle and echinacea have no evidence supporting their use and plenty against it.

          If your body is “full of acetaminophen” then the best thing to do is stop taking acetaminophen. In any event, unless you actually overwhelm your liver’s ability to process it, taking NAC (which, once again is different than l-cysteine and is not typically available OTC) will do nothing to help you. The mechanisms by which it works is restoring stores of glutathione to allow for the neutralization of free radical generated not by acetaminophen but by it’s metabolite (NAQI). If you haven’t burnt out your glutathione (which you will not have unless you overdose in which case you will have acute issues) then the NAC won’t do anything. It doesn’t work by increasing the rate of processing – it works by making sure you have enough anti-oxidant capacity to deal with the byproducts of the liver metabolism.

          As for drinking… B vitamins and other vitamin deficiencies are a chronic issue of alcoholism, not an acute one from a night of overindulgence. Alcohol does decrease the ability to absorb B12 in particular, but the primary way in which alcoholics end up with clinical hypovitaminosis is be chronic malnourishment from drinking booze rather than eating a good diet. In any event, your B vitamin stores are enough to last you months to years, so supplementing before or after a night of drinking really doesn’t make any physiological sense.

          In regards to hangovers, also no real mechanism for effect beyond placebo. I’m sure if you believe a hangover cure works it will make you feel better (which is more accurately said as it will help you ignore your hangover more successfully). But the hangover itself comes – once again – from the metabolites of ethanol. L-cysteine does not have a role in ethanol metabolism and, even if it did, that would actually serve to worsen your hangover if it did anything at all. The hangover is primarily induced by acetaldehyde produced as a product of ethanol metabolism and secondarily by impurities (known as congeners) in the alcohol (which is why darkly colored alcohols like scotch tend to give worse hangovers than lightly colored ones like vodka). So if you increase the metabolism of ethanol you will also increase the production of acetaldehyde which will increase its concentration and thus worsen your hangover. It is for precisely this reason that the one well known hangover “cure” and preventative actually works – drinking a lot of water (or infusing saline through an IV). It lowers the concentration of acetaldehyde by helping you maintain volume status and allow for easier renal elimination of ethanol’s metabolites. Ethanol also acts as a diuretic both directly and indirectly so one tends to become dehydrated when drinking.

          As for your psoriasis… no idea. To my knowledge there is no data to show that cysteine or NAC would be helpful nor any basic science to provide a mechanism of action. However, it may well have helped you specifically for some reason. But we have no way of knowing since it could have simply been regression to the mean of a disease known to be highly variable. At the end of the day this is more likely than any actual effect, but we have no direct way of completely ruling out an effect.

          1. Peter Browne says:

            Thanks for the in-depth reply.
            As I’m aware NAC is currently available in most vitamin shops.
            I have a bunch of them in my press.
            What I did mean to say was acetaldehyde poisoning also.
            I do think it played a part in the clearing of my psoriasis even if temporarily,and I have read some material ,although not a lot relating it to psoriasis.It seems that it possibly may only benefit a small portion of people.

            Thanks again,

            PB

          2. Seppo says:

            I can’t say about psoriasis, but there is evidence to show acne is related to oxidative stress. Last year a study came out that showed about 50% reduction in acne after supplementation with NAC or sillymarin. Though that’s the only study of the kind and doesn’t actually qualify as rock-solid evidence, but it does suggests a possible treatment option in acne. Perhaps the same mechanism could also work in psoriasis?

            http://www.omicsonline.org/2155-9554/2155-9554-3-163.php?aid=10078

            1. Andrey Pavlov says:

              @seppo:

              I am not terribly impressed with the study. If you look at it in detail it has some significant flaws. The first is that while the total n seems impressive it is much less so when you realize that they actually split them into 4 sub-groups and then did not do any correction for multiple comparisons. This is further compounded by the fact that they added a 5th group of “healthy individuals” to compare baseline levels to – they declare that there is a significant difference, which is true, but when you look at the actual distribution of the values across all groups you find a LOT of overlap meaning that while mathematically there is a “significant difference” the reality is that they are merging groups of people with highly variable baseline values into different groups than their baseline serum levels would otherwise dictate. In other words, statistical significance with relatively poor correlation between clinical and serological groups.

              Next, we find that only some of the groups showed significant difference from the placebo group and that the serological signficances did not fully jibe with the clinical changes.

              Lastly we find that in all cases there were confounders in that everyone was advised to wash their face, put on lotion, and the placebo group only took 1 pill per day instead of 3 or more.

              I would also say that I would find more plausibility in this preventing new pimple formation rather than curing existing formation, have difficulty understanding why global serum levels of glutathione would be so significantly depressed in a skin condition, and take issue with authors segregating results into “significant” and “highly significant.” This last part is because the idea of something being “very significant” makes no sense from a statistical standpoint. Coupled with their lack of correction for multiple comparisons and zero mention of the high level of heterogeneity in their paper makes me suspect of their analysis.

              But beyond that, this data would not apply to psoriasis. I had to double check this to be sure, but the immunology of acne and psoriasis is vastly different and more specifically the decrease in IL-8 noted by the researchers of this paper has essentially no bearing on psoriasis. It is a completely different subset of immune cells and cell signaling molecules that mediate the two conditions.

              1. Seppo says:

                Thanks for the detailed comment, Andrew.

                Your criticism of the study is valid and I do agree it’s not methodologically very strong. If this were the only study to show such findings I would be more inclined to agree with you, but the findings fit into a pattern seen in several other studies. Jotting from the top of my head (I don’t have the references at hand now, and this is off topic, but if you want I can send something over for you):

                - Several studies have shown lover levels of antioxidant vitamins and enzymes in acne patients than in healthy controls, this has been shown both in serum and in skin scrapings. If I recall correctly, studies on psoriasis have shown similar findings.
                - Studies on skin scrapings have shown oxidative stress even in the very earliest stages of a pimple, even before bacterial colonize the skin follicle.
                - So far at least 3 double-blinded RCTs have shown sodium ascorbyl phosphate cream to be either equally or more effective than benzoyl peroxide or antibiotic creams.

                Here’s one systemic review that goes over many of the above mentioned points: http://www.ncbi.nlm.nih.gov/pubmed/22648222

                So there is quite a bit of data to show oxidative stress to be a factor in acne, and thus treatment with antioxidant supplements is at least plausible and that’s why I’m inclined to give this paper more merit than it scientifically deserves.

                As to why glutathione or antioxidant levels would be depressed in people with skin disease. The hypothesis in acne goes something like this. Exposure to oxidative stress, such as UV, air pollution, etc, degrades squalene into squalene peroxide, a substance shown to be highly comedogenic. Squalene peroxide can trigger hyperkeratosis in keratinocytes and thus kick off the comedone formation process. Acne patients not only produce more sebum but the fatty acid composition of sebum from acne patients is somewhat different to sebum from people with healthy skin, namely acne patients show higher ratio of squalene.

                The hypothesis goes that this creates excessive demand of antioxidants that the antioxidant system cannot meet. Thus we see depressed levels of antioxidants and higher levels of markers of oxidative stress in acne patients.

                That’s my reading of the studies, but lacking proper background education in medicine, I realize my interpretation can be subject to embarrassing mistakes :)

            2. Andrey Pavlov says:

              Once again the threading is not working properly for me so I can’t reply under your last comment.

              I also apologize since I simply cannot seem to get the full article from the link you referenced so I can’t properly comment on it.

              However, you are making no embarrassing mistakes – in fact you are making very good points along the way. You are missing some context, but surprisingly little for not being a medico yourself.

              Several studies have shown lover levels of antioxidant vitamins and enzymes in acne patients than in healthy controls, this has been shown both in serum and in skin scrapings. If I recall correctly, studies on psoriasis have shown similar findings.

              This seems quite reasonable to me. The significance of it and the direction of causality I cannot comment on though. A priori it is possible but not exceedingly likely. Also, the fact that the two processes both show decrease antioxidants levels does not itself mean that they would both be amenable to antioxidant therapy.

              We know (and on a different thread Angora Rabbit discussed this briefly) that cellular regulation of metabolic products is pretty tight, with multiple levels of control and feedback. It is a system with buffers in place (not chemical buffers, but systemic) such that it become difficult to perturb the system. The best way to do so is to perturb the components of the system. But to try and add products often does not work very well at all. That could be part of why the antioxidant theory of aging just didn’t pan out. So I am skeptical that adding antioxidants will be able to have that much of an effect. Remember that this is not background level of antioxidants – this is an active signal for immune cells to produce antioxidants. That signal is constant as long as the instigating stimulus is active and the AO supplements aren’t changing that. So the only premise by which it would work is if you essentially overwhelm your immune system to the level that it is incapable of producing free radicals and oxidative damage. And that, I would imagine, is not a good thing to happen.

              Now that doesn’t mean that it absolutely couldn’t be helpful in some way. It just makes me feel that it probably isn’t and if it is, it probably isn’t a huge or robust effect.

              The latter – lack of robustness – is to do with the fact that we know that antibiotics have a rather significant and robust effect on severe acne. That means the offending instigator is a bacteria – and we know which one – Propionibacterium acnes. So once again here, I would not expect AO’s to help because they do nothing to remove the P. acnes.

              We also know that Vitamin A (retinoic acid) works quite well also. Which points to a mechanism of mechanical blockage as being a significant part of comedogenesis. The VitA matures keratinocytes rapidly so that the epidermis exfoliates faster, removing blockages from pores.

              So at best we are only able to address a small subset of the acne population – those that have severe acne that is refractory to antibiotics and retinoic acid. Even then, it could be useful to add to the armamentarium. I don’t know the literature, so I can’t really be too sure what it actually says, but I am skeptical that it would even be worth that. And, sadly, even if it were if it is relegated to the small population it will be more difficult and more expensive to ascertain since you will have to have trial participants fail antibiotic and VitA treatments and then aggregate enough numbers to detect an effect.

              So there is quite a bit of data to show oxidative stress to be a factor in acne, and thus treatment with antioxidant supplements is at least plausible and that’s why I’m inclined to give this paper more merit than it scientifically deserves.

              Maybe. It could be the 3rd significant cause. But still less common than bacteria and/or mechanical blockage.

              As for the psoriasis link. It is not unreasonable to think that since they both demonstrate increased oxidative stress that an AO treatment for one could work with the other. The problem is that the mechanisms and reason for immune mediated oxidative stress is different enough that most immunomodulatory effects of AO’s would be unlikely to influence the immune response in psoriasis (acne is mostly neutrophils and macrophages, psoriasis is mostly T cells and they use fairly different cell signaling molecules and pathways). Yet they are fundamentally the same in that the stimulus generating the oxidative stress is not addressed by the AO’s. In the case of psoriasis it is thought that it is actually a response to an antigen – foreign DNA – rather than an actual autoimmune mechanism. So I suppose if it is at a very low-level inflammatory stage AO’s could potentially help a bit. Perhaps decrease the frequency (and maybe severity) of flare ups. But it would be unlikely to do much in significant flare ups/severe chronic psoriasis. And the acne paper does not, in my opinion, really offer much, if any, information useful to inform the use of AO’s in psoriasis. Perhaps there is separate data to address this, but I haven’t looked for it. I would still have the same skepticism though, for the above reasons.

              1. Seppo says:

                Thanks for the reply. You make a lot of valid points, but I do think that you also have a false premise. As far as I can tell, you presume that bacterial colonization of the skin follicle and mechanical blockage are separate from oxidative injury. As far as I understand this, they are all part of the same chain of events that starts with oxidative damage to sebum. It goes something like this:

                - Oxidative damage to squalene degrades it to squalene peroxide.
                - Squalene peroxide ‘stimulates’ keratinocytes to produce more keratin, leading to hyperkeratosis that contributes to mechanical blockage of the skin follicle.
                - This part goes a bit over my head, but here’s how I understood it. Within the blocked skin follicle squalene peroxide depletes oxygen levels and creates an ideal environment for P. Acnes bacteria to flourish. Microcomedones are formed before the bacteria colonized the skin follicle, thus the bacteria doesn’t cause acne per se.
                - Bacterial metabolites irritate the cells in the blocked skin follicle and exponentially increase inflammation in the area. This creates the visible pimples.

                If this chain of events is correct, and I believe it is based on all the papers I’ve seen, then it’s perfectly plausible that antibiotics, retinoids and antioxidants would be helpful in acne. They all work on the different parts of the chain of events that leads to acne.

                Possible support for this hypothesis comes from studies showing vitamin C derivative sodium ascorbyl phosphate topically applied shows good efficacy in acne. You can see the studies here:

                http://www.ncbi.nlm.nih.gov/pubmed/?term=sodium+ascorbyl+phosphate+acne

                Of course this hypothesis is far from proven, but it does show promise.

                If you want, I can email you the PDF from my earlier comment, acneeinstein [at] gmail dot com.

              2. Andrey Pavlov says:

                @seppo:

                Once again, threading.

                In any event – your description of the pathogenesis of acne is overall correct, but to my knowledge the arrow of causality is not quite right. At least not in all (or even most) cases.

                The pore is not then colonized with P. acnes. That bacterium is always on our skin and inhabits the pores because it is microaerophilic. Meaning it likes a low oxygen tension but is not anaerobic.

                So yes, squalene to squalene peroxide does happen and does indeed contribute to the maturation of acne. However, from what I learned in medical school (and we actually had an entire week on this for some reason that is still unknown to me, LOL) that is not the triggering event in isolation. Meaning that there is not some globally higher level of oxidative stress that then takes an otherwise normal pore, clogs it up, and then P. acnes colonizes and makes things worse. Certainly that could happen, but it strikes me as an uncommon cause.

                Typically what happens is that a normal pore already contains P. acnes and that during times of puberty or other hormonal shifts that induce very increased sebum production, the bacteria find themselves in a microaerophilic environment with ample food supplies (they eat the sebum) and begin to multiply. This then triggers an immune response which leads to squalene peroxide and further clogging of the pore (it was also somewhat functionally clogged by the increased sebum production and, in many cases, can become completely clogged by thickened sebum in the pore tract itself; this is why we have both “open” and “closed” comedones).

                So in most cases, based on the pathogenesis that I am aware of, AO’s would not prevent acne formation because it wasn’t oxidative stress that caused the problem in the first place. And for the reasons I mentioned before it also wouldn’t be particularly helpful in treatment. However, it could be helpful as an adjunct treatment to help antibiotics, VItA, or topicals like benzoyl peroxide work faster and perhaps have a better cosmesis in severe cases. That seems reasonable to me, but as of yet unproven.

                As for the VitC derivative topically applied – I see a lot of room for confounding. Essentially the way that any topical works (except VitA) is that it acts as a desiccant and abrasive to dry out and break up the surface of the comedone, opening the blocked pore to allow the sebum/bacteria mix out. It is perfectly reasonable to think that one or both actions could be happening with ascorbyl phosphate and thus any actual effect be chalked up to that. It would be rather difficult to control for this, but I do not find it to be compelling evidence that topical AO is the mechanism of action – if there even is a robust effect. There is more reason for that as well, including the poor track record of AO’s doing anything physiologically.

                I also finally clicked on your name and saw your blog. It seems like you have a vested interest in this topic. However, your posts seems fairly reasonable overall. I personally would just eschew the nomenclature of “alternative medicine” simply because I don’t think it exists as a valid category. It is either demonstrated to work and is medicine or is not. But aside from that, from the brief skim of articles, I’d say you seem to have a pretty reasonable blog.

              3. Seppo says:

                @Andrew, treading, hope this shows up at the right spot. This should come after your comment regarding the arrow of causality in acne formation process.

                There’s quite a bit of research done in the past decade that calls into question the chain of causality taught in medical school. This of course doesn’t mean that the new research would be correct. It raises no obvious red flags for me, many of the clinical trials are randomized, blinded and controlled, experimental research comes from many research groups and is published in in seemingly reputable journals. I usually understand the papers, but without proper background knowledge it’s hard to tease out confounders and other things you pointed. We’ll have to wait for later research to sort this out.

                Yes, I have a vested interest in the topic. Being that I had to deal with acne myself for almost 20 years. Fortunately I can now keep it under control with everything I’ve learned from reading the studies.

                I understand your point about alternative medicine not being a valid category. But at this point I have to take off the skeptic hat and put on the marketing/copywriting hat. For many, acne is a ‘gateway drug’ to the dark side of alternative medicine – I know it was for me.

                The site is primarily aimed at acne patients who have given up on dermatologists and are scouring the net for ‘alternative and natural solutions’. I try to show them that we can use science, reason and logic to find out treatments that are plausible and can work. That it’s possible to ‘go natural’ without abandoning science and reason.

                So far it has been fairly successful. I get good feedback from readers who like the more rational approach, and I’ve managed to convert a few people out of the alt med world. Call it my little contribution to skepticism.

                Of course a lot of what I write is somewhat and far from ‘proven’, but it kinda goes with the territory. In most cases there’s just not enough research to draw from. But people are going to try these things anyway, so why not arm them with the data we have available.

              4. Andrey Pavlov says:

                @seppo:

                And yet again, threading bites me in the rear.

                Anyways, I understand your points and I think they are overall pretty valid. I’d consider you to be someone doing good work in good stead and laud you for it. I also am not an expert on acne and honestly I do not have the desire to vest the time on the matter to really address the issue as deeply as you want to take it. I think that regardless of new research most of my criticisms stand and that the role of AO’s in the treatment or management of acne (particularly in severe cases) will be limited at best and unlikely to be a viable as a standalone treatment option.

                I think your blog overall looks very good and you do good work. I especially like your use of QualiaSoup – he is an excellent source for critical thinking. I highly recommend all his videos. C0nc0rdance is also an excellent source, if you are not yet familiar.

                In any event, I don’t know that there is much more that I can add to the conversation. I am not expert enough to come down definitively and staunchly say a conclusion one way or another. I do know enough as a scientist, skeptic, and critical thinker that my skepticism still stands. Hopefully I have provided you with enough background information and thoughts on the pitfalls of these types of studies and data to be of use to you in your future endeavors.

                Best of luck!

              5. Seppo says:

                Thanks for the conversation, Andrew. It was nice to get some feedback from skeptical doctors. At least to show I’m not totally off track. I do share your skepticism with regard to antioxidants and their role in acne. I tend to give more credit to later research, mainly because there’s quite a bit of it and I haven’t noticed any significant flaws in them. Anyway, have to wait for further research to sort it out.

                Thanks for your insights!

              6. Andrey Pavlov says:

                @seppo:

                Same to you and I am glad you found our exchange useful. No, you certainly are not off track and do know your material quite well for someone not in the field. You go a little further than I would, but maintain a good amount of appropriate skepticism. Keep it up!

      2. Peter Browne says:

        here’s one of many articles

        http://www.ncbi.nlm.nih.gov/pubmed/3656363

        and just for the record I agree with everything you said in the initial article

  11. Lauren Hale says:

    It is really fucking disgusting about detox scams.

    That being said, a prominent doctor is up in PsychToday making claims about toxins. I guess we all need a bubble. Oh and a brick wall, so I can ram my head into it.

    LH

    1. MadisonMD says:

      Hope you are OK, LH.

      1. Lauren Hale says:

        That is oddly comforting. Thanks.

    2. JoshP says:

      “Oh and a brick wall, so I can ram my head into it.”

      If you do, I hear that coffee enema is very good for headaches.

  12. Chris Hickie says:

    If article/ad contains “toxin” OR “detox” OR “cleanse”—>skip article/ad,
    hen label promoter of article/ad as a QUACK.

    The only toxins I worry about are when a parent calls me out of concern for a child being misdosed on a medicine or eating/drinking something that was not intended for human consumption (or consumption while still a child).

  13. Will Gorman says:

    The probiotic comments above should be tied in with comments on prebiotics, fibers that resist digestion in the stomach and pass on intact to the large intestine where they are fed on by the beneficial bacteria. Aiding the proliferation of the good bacteria helps reduce the development of detrimental species e.g. e-coli.
    This is a fascinating and real field of study and more technical than that provided by my brief outline above.
    Do a search on resistant starch and/or dextrins – or simply eat a lot of cold pasta and potatoes that are loaded with the chrystaline forms of natural starches.
    Hope this helps. Will

    1. Andrey Pavlov says:

      E. coli is part of our natural flora. A small part despite what people think (it seems to be big because it is aerobic and therefore the most likely to survive outside the body and be transmitted to cause disease). There are disease causing strains, but the idea of removing ALL strains from our flora does not make sense and we have no way of predicting what the effects of actually doing that would be.

      There is also no specific rationale as to why your aforementioned starches would be preferentially fed on by “good bacteria.” All bacteria are there and a food source is a food source. In any otherwise healthy individual there is no particular reason to suspect that the starches would somehow create a beneficial shift in the gut microbiome nor can we even begin to define what “beneficial shift” actually is. In an ill individual there is no mechanism by which the pathogenic bacteria wouldn’t also be able to utilize the food source and worsen the condition of the patient. There is, however, every reason to believe it will give susceptible people copious amounts of bowel gas production and flatus.

      Yes, it is an interesting field but I have outlined elsewhere the significant and very real difficulties of it. Advice like eating cold pasta and potatoes with “crystalline forms of natural starches” is simply evidence free. And the idea of “crystalline” forms simply doesn’t make any sense – yes, they exist, but so what? Crystalline just means that the component molecules stack up in a neat, ordered, and repeating fashion. Said crystals are broken up before anything happens with them so it simply doesn’t matter what form you ingest them in. And then one is still left with the remaining fact that the very premise still has yet to be well validated.

      1. Will says:

        Mr. or Dr. Pavlov; My modest familiarity with the RS concepts derives from a stint with Starch Australasia, an Australian company that pioneered work in this field. Just a marketing guy, but I became very interested in the technology. Below is a “paste” from and article I searched and I would also refer you to “RESISTANT STARCH: A promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer”
        Janine Higgins and Ian Brown. No axe to grind here since this old dude is retired – just interested in good science. Again hope this helps. Will G.

        “The term “resistant starch” refers to starch that doesn’t get fully digested in the small intestine, which is where refined carbohydrates, such as white bread and pasta, get broken down into glucose.
        Because resistant starch, like fiber, avoids digestion in the small intestine, it travels on to the large intestine, where it feeds the bacteria that reside in the lower gut.

        Like fiber, resistant starch also increases stool bulk and has a laxative effect. In fact, because it acts so much like fiber, food scientists classify it as such, says Jennifer Slavin, professor of food science and nutrition at the University of Minnesota in St. Paul.

        Studies of human populations have shown that people whose diets are rich in fiber tend to eat less and also tend to weigh less, Slavin says. Still, it’s not clear that resistant starch is better than other types of fiber, she adds.

        In part, that’s because the term resistant starch refers to a large category of carbohydrates with different activity in the body. Some pass through the intestines entirely undigested, whereas others get partially digested in the small intestine and partially broken down in the large intestine.

        The purported benefits of resistant starch derive in part from their resistance to digestion, as well as their partial digestion in the lower gut, says Michael Keenan, a professor of human nutrition and food at Louisiana State University and the Louisiana State University Agricultural Center in Baton Rouge. Keenan has studied the effects of resistant starch on lab animals.

        When lab rodents were fed a diet that consisted of as much as 25% of a type of resistant starch called RS2, they ended up with less body fat than rodents eating the same number of calories but no resistant starch, Keenan says. In addition to burning more fat, the rodents consuming the starch developed a different set of microflora, or bacteria, in their large intestine.

        Keenan says this proliferation of bacteria in the gut could be a predictor of improved long-term health prospects: Human studies have indicated that obese people and people with Crohn’s disease or ulcerative colitis have a different set of microflora than lean, healthy people. Still, the precise implications of the rodent experiment for humans remains unknown.

        While it’s clear that lab rats burn more fat when they eat resistant starch, there’s no definitive evidence that humans who consume the starch will weigh less than humans who don’t, says Janine Higgins, nutrition research director of the Clinical Translation Research Center at the University of Colorado, Denver.

        There are four types of resistant starch. Two are fairly easy to find: One occurs naturally in whole grains and another forms in starchy foods such as white rice, pasta and potatoes after they are cooked and then cooled.

  14. Frederick says:

    Detox, those always make me lauch, as if you body was not able to eliminate waste.. it is call urine and poo. if evolution will have built a organism unable to eliminate waste, not sure that organism will have survive for long.

    Anyway those DETOX are everywhere, I remember 3 week ago i want with my wife to diner a couple friend appartement, he is a from Chili and he cook really good veggies food inspire by traditional food for Chili. From drink they offer me Kamboucha ( they did not make it them self) you know that a kind of fermented team. that think taste really good and his kind of bubbly. So my friend, she told me, “it is also good for health”. of course as much as tea/juice are good for you health, I read on the bottle “Detox and Clean”. I said nothing buy i was “yeah right” in my head.
    it seem today everything natural food store sale can “detox”, i think water also can “detox” since when you drink it, you pee a lot ( in my case, i do lol )

  15. Ekko says:

    There is evidence that numerous synthetic chemicals and heavy metals are accumulating in us.
    These include:
    • PBDEs (polybrominated diphenyl ethers),
    • PFCs (perfluorinated chemicals),
    • PCBs (polychlorinated biphenyls),
    • PAHs (polycyclic aromatic hydrocarbons),
    • OPIMs (organophosphate insecticide metabolites),
    • OCPs (organochlorine pesticides), and
    • metals such as lead and mercury.
    Many of these are potential or known carcinogens, hormone disruptors, respiratory toxins, neurotoxins, or reproductive toxins. Some, like bisphenol A and the brominated flame retardants used in furniture are being phased out in some instances because we’ve learned more about their potential for harm.

    The dose makes the poison of course, and acute toxicity with these is not generally the issue – moreso the long term unknowns surrounding life time exposure and accumulation. I understand the liver and kidneys are amazing detoxification organs but nonetheless we are still seeing accumulation of these chemicals. I agree there is no clear evidence that cleanses and detoxes can remove any of these specific chemicals (and it would be great to see some cleanses put to the test) but I also don’t think concerns over what we are accumulating are unwarranted either. The country and region of the world also is a factor for how much people are exposed to these things (variances in industry and regulations and public health measures).

    http://www.epa.gov/oia/toxics/pop.html
    http://environmentaldefence.ca/reports/toxic-nation-report-pollution-canadians
    http://www.ncbi.nlm.nih.gov/pubmed/?term=14757707

    1. Rahul Malhotra says:

      How do we know toxins are accumulating? Are there biopsies or autopsy data?

      1. Ekko says:

        In the example study linked above on Canadians, the results were from blood and urine samples. Urine samples obviously being what is excreted. Fat tissue samples are so much more invasive it would be challenging to find volunteers. The report is mostly concerned with the lack of research in this area, lack of safety data, possible ill health effects, and insufficient regulations – not with “cleansing” or “detox”. I don’t think we really have much idea of how well or how poorly we are able to metabolize and remove many of these novel chemicals from our system or what various combinations are like.

      2. Greg says:

        In a recent report the cord blood of three babies born in the Greater Toronto Area was analyzed for 310 chemicals – a total of 137 were found – http://environmentaldefence.ca/sites/default/files/report_files/CordBloodReport_EnglishWEB.pdf

        1. WilliamLawrenceUtridge says:

          Part of the ability to detect chemicals is related to the ability to detect smaller and smaller amounts. The ability to detect chemicals in parts per billion or trillion levels in no way implies harm in those levels existing in the blood.

          Humans consume large amounts of recognized toxic substances, actively carcinogenic and hepatotoxic, from food. And I’m not talking about herbicides or pesticides, I’m talking about the main and distinctive flavour molecules found in cinnamon, mint, coffee, etc. These are produced by the plants as chemical defences against being eaten – and in sufficient quantities they will kill you.

          Enjoy your mint tea.

        2. MadisonMD says:

          These studies that count the number of chemicals are annoying and misleading. There is nothing in the report that quantifies the amount of the chemicals. Was it 1 part per billion? 1 part per trillion? 1 molecule? How were the measurements done and what is the rate of error? What were the controls that ruled out that miniscule quantities of any did not come from a diluent or laboratory equipment? Really, now. This is not science.

          The only relevant part of the report is this:

          The chemicals found in the samples tested in this study were detected at low levels. While this study shows low levels of exposure for many chemicals, the results cannot be used to predict how exposure to a chemical will affect the fetus, and the individual later in life. The issue is that the results, especially when compared to similar studies conducted in the U.S., indicate that at no point in our lives are human beings free of exposure to toxic chemicals.

          Nevermind that the quality and quantity of life in Canada has never been higher than it is today.

          There may be some real things of concern here. But I cannot tell from this report. A quantification of number of unique chemical molecules without concentrations or controls is misleading and useless. It is clear that this study by “Environmental Defence” is pushing an agenda with data that is designed to play maximally on public emotion by using cord blood and riddling the report with photos of newborns and pregnant women.

          As WLU points out plant-derived toxins are in everything we eat, but we don’t count them up the same way. As he indicates, the naturalistic fallacy is implicit in the report: human-derived chemicals are bad, and natural chemicals are good.

          From the report:

          The dust on your floor, the mattress that you sleep on, the couch in your living room, and the chemicals they contain, are part of your everyday environment. Canadians spend an average of 90 per cent of their time inside. This means we spend most of our daily lives exposed to chemicals found in common household items and dust.

          Well, yes. But if the time was spent out of doors, then Canadians would be exposed to many out-door chemicals, natural and synthetic. A lot of them, considering the biodiversity. Plus this time of year they’d either get frostbite or be exposed to the bad man-made chemicals in their winter parkas.

  16. Thanks for the evidence on milk thistle. I’ve been of the belief that it was incredibly powerful, but I guess that was a delusion from media outlets (more sinister / convincing ones than Dr. Oz!)

  17. Decreased testosterone occurs naturally from aging. Most of the people don’t know that their website have numbers of poor
    quality irrelevant back links. So that first common carp meant
    so much, particularly as it was not a balanced crust and paste bait that tempted that fish as in walker.

  18. I”m starting a juice fast in a few days…judge me.

    1. Harriet Hall says:

      I can’t judge you until you explain why you are starting a juice fast. Please tell us why you chose to use a juice fast and what you hope to gain from it.

  19. Joseph says:

    Have any of you doctors ever watched the documentary Fat Sick and Nearly Dead? What is your take on it?

    1. Andrey Pavlov says:

      @Joseph:

      I have not seen it but I did just do a quick investigation and found a few interesting and salient details.

      So first I watched the trailer. At first I thought it was pretty straightforward – something like “super size me” – but then I saw that they were going pretty hard on the juice fast kick. Now, a juice fast (or other drastic diet) is a good way to kick start weight loss, but not a good way to actually keep it off. There has to be a follow up of some kind and usually, since people are fat because they don’t have good habits to begin with, they can’t keep up with the juice fasting and don’t have the means to do anything else and so they gain the weight back. It can also be dangerous to lose a lot of weight very quickly which is what will likely happen to a morbidly obese person just on a juice fast.

      Anyways, those are the thoughts going through my head as I am watching this and I am feeling rather ambivalent about it but some little nagging red flag is going off in the back of my head. So I read the Wikipedia article on the documentary. It says that it was done under the direction of one Dr. Joel Fuhrman. I don’t recall his name specifically so I look at his page. His bio immediately sets off more red flags and then I look at the list of books he has written. They so don’t judge a book by its cover, but the title can be very informative. And with multiple titles that include concepts like “disease proofing” yourself and “boosting your immune system” I am very, very skeptical.

      So then for S’s and G’s and look up Fuhrman’s name here on SBM and wouldn’t you know it, Dr. Hall wrote about him back in 2010. Her take matched what my suspicions were as I was investigating it.

      So at this point, for myself, I would consider my work done. I don’t feel I need to see the documentary because it is either one of two things: at best, a cheesy documentary with a feel good bit and nothing of any particular substance and at worst a venue for some juice-fast and otherwise diet quackery à la Fuhrman. I just don’t see much room for learning anything particularly useful – not enough to justify the time spent watching it.

      But, I am curious, is there something specific about it that you were wanting a physician’s (specifically a science-based physician’s) opinion on?

      1. WilliamLawrenceUtridge says:

        Now, a juice fast (or other drastic diet) is a good way to kick start weight loss, but not a good way to actually keep it off.

        Not to mention, a juice fast involves drinking a lot of juice. This means stripping the food of significant amounts of fiber, which slows the emptying of the stomach. Which in turn means massive amounts of sugar water (essentially indistinguishable from pop, bar the inclusion of micronutrients – so basically it’s vitamin water complete with the 25 tablespoons of sucrose) gets emptied essentially right into the veins of the obese person. Who might already have issues with blood sugar control.

        A juice fast really seems like a great way to kickstart diabetic neuropathy, unless I’m missing something.

        1. Andrey Pavlov says:

          Yes, in principle you are right WLU, but in practice I don’t think it ends up working that way. You don’t get diabetes or have sustained high blood sugars just by swapping your caloric intake to sugars. You aren’t going to induce pancreatic insulin production failure by eating a lot of sugars/carbs. So you are either going to get Type 1 diabetes anyways or you will end up with Type 2 (yes, we can skip the nuanced discussion of why those types don’t fully accurately describe what is going on). You won’t get Type 2 just from sugar. That is a metabolic process and typically requires some other intrinsic factor, typically becoming obese.

          In general these diets allow you to lose weight because despite being sugar/carb rich and calorie dense by volume, they are self limiting in that people simply can’t ingest enough calories (by a combination of physical satiety and a lack of desire for more freakin’ juice) to maintain their weight. Which means, by definition, they are cutting calories. And if they actually have T2DM and are obese, it could actually reverse the DM. In the short term, it could produce significantly higher blood sugars in an obese person already with T2DM. But if they actually lose weight on the diet (which they almost certainly will if they stick to it) it is likely to be reversed. And the damage from high blood sugar – including neuropathy – is a chronic issue. Having a higher blood sugar for a few months – while not healthy! – won’t suddenly land you with neuropathy or irreversible kidney damage or retinopathy. That takes years to happen.

          So like I said, it can kick start weight loss. But only because it is a drastic diet that does nothing unique except provide yet one more way to ingest fewer calories. But it cannot be sustained, for reasons that will catch up to you before diabetic neuropathy.

          Now, in someone with a tenuous health status this could tip them over the edge and precipitate an acute decompensation of some sort. But that can be said for any drastic diet change in such a person and is entirely dependent on whether they are tenuous enough to begin with and not anything intrinsic with juice fast per se.

          1. WilliamLawrenceUtridge says:

            Ah, so I was missing something :)

            I would guess this only works for pure juice diets (which would in turn present problems in terms of lacking fats and proteins, over the short and medium term – and lacking proteins will indeed induce weight loss, because of muscle wasting if nothing else), ’cause IIRC there was research indicating that liquid calories didn’t contribute to satiety the same way soild foods did.

            Unless it’s more complicated than that (he said, egging Andrey on)…

            1. Andrey Pavlov says:

              Oh WLU… such an egger-onner you are. Which works really well when I am procrastinating on working on my article….

              Yes, there will be issues with lack of proteins, fats, etc from the diet. However, typically, those won’t become really manifest in the super-short term (barring those very tenuously unhealthy folks I mentioned before). While a couple/few months of it won’t be “good” for you in the sense that there are better ways to lose weight, the benefits of actually losing the weight would (likely) outweigh the negatives of a month or two of juice dieting*. It can only be said that the juice dieting is “worse” in the sense that just doing better portion control, exercising, and slowly losing weight will be less likely to cause serious or irreversible problems.

              The harms that you are (all things being equal, as posited before) likeliest to incur from such a diet are also likely to be temporary.

              I’m not entirely sure about the liquid vs solid calorie satiety issue, but it seems reasonable to me. Now, of course, if you do go on a juice diet and manage to consume enough calories to maintain your weight then yes, that is unequivocally a bad thing. But so would being on an all BBQ ribs diet with the same parameters. In practice, I think most people do end up consuming fewer calories. I also know of at least one anecdote of a morbidly obese man losing significant weight just from adding sugar-free energy drinks to his diet. He just increased his metabolism from drugs, which is probably the worst way to go about it, but effective to some degree (so were tapeworms and thyroid hormone).

              *Obviously everyone is different, different physiological states can precipitate different problems at different times. So I can’t put specific time frames on specific hypothetical cases. Nor is this advice to actually do this, merely an observation that it is, in practice, effective for a number of reasons, none of which are particularly sustainable which is what leads to the ultimate failure most commonly experienced by any drastic diet, including a juice fast diet. There are myriad variations as well, with each having its own pros and cons.

      2. Harriet Hall says:

        I didn’t write the article you linked to, but I agree about Fuhrman. He is definitely not a reliable source of scientific information.

        1. Andrey Pavlov says:

          Derp! I don’t know how I managed to confuse the names. My apologies. Dr. Lipson is also an excellent reference for me to cite.

      3. Joseph Stechschulte says:

        In the documentary the juice diet cured two cases of chronic urticaria and allowed the patients to stop taking all of their many medications. Regarding the sugar intake, most of the juice was made from vegetables which contain very little sugar. They drank the juice simply to provide a source of micronutrients during the fast.

        I was really wondering if you had an explanation as to how the juice fast cured both cases of chronic hives.

        1. weing says:

          “I was really wondering if you had an explanation as to how the juice fast cured both cases of chronic hives.”
          My 2 cents worth. I don’t think it cured it. I have done this in a while, but in the past I would put patients on toast and tea diets for chronic urticaria. After a few days they would introduce a new food every 3 days and see if the urticaria came back and we then knew the cause or causes. By sheer luck, the juice did not contain whatever was causing the urticaria.

        2. Andrey Pavlov says:

          Obviously only speculation can be had as to why chronic urticaria remitted through the course of the diet.

          Weing already pointed out one – it may well have been that there was some foodstuff they were mildly allergic to that was then eliminated from the diet (and potentially never re-introduced if they kept the weight off since that would indicate that they changed their diet significantly for the long term).

          It could also be a form of traction urticaria – being fat lends to folds that rub and cause mechanical irritation and thus chronic urticaria. Losing weight would obviously ameliorate that.

          In the same vein it could be a lack of cleanliness. When you are morbidly obese it becomes difficult to clean your skin adequately.

          There is also the possibility of new antigenic challenge. There is robust research demonstrating that introduction of a parasitic worm to people with chronic auto-immune diseases can indeed ameliorate or entirely cure the symptoms. The not very accurate but good enough nutshell is that the immune system can get “bored” from a lack of antigenic challenge, leading to auto-immune inflammation, and when these folks became more active, traveled, got outdoors, exercised, they were exposed to more antigens (analogous to the worms used in the studies) and thus relieved the “boredom” of the immune system.

          It could also be complete coincidence. A waxing and waning urticaria that waned significantly at the right time. Yes, two individuals makes this less likely but not at all impossible.

          It could be some combination of any or all of these. It could be something else I haven’t thought of.

          As for why they were able to stop taking their meds… simple. They lost weight. Something that any physician would encourage since they know that is the best way to get off the meds. They were on meds for diabetes, high blood pressure, etc and their problems were all a result of (or exacerbated by) their obesity. As a physician I advise my patients that unequivocally the best way to be healthier, get off their meds, and have better outcomes is to lose weight and exercise moderately. In the meantime, we need to protect them from the long-term damage that occurs from uncontrolled hypertension and diabetes since once that happens it is irreversible. Hence the meds, until the weight is lost. The same thing happened to me. I used to be very obese and had very high blood pressure. Doctors tried to get me to lose weight and I was stubborn. In the meantime they said I should go on meds. I was still stubborn. Finally I matured and learned a bit more and agreed. I was on anti-hypertensives for 5 years. I lost a significant amount of weight, became healthy, and my blood pressure normalized. Now I don’t take meds anymore. But, because I left it uncontrolled for a few years, I now have documented left atrial enlargement with an ectopic atrial focus that occasionally leads to supraventricular tachycardia. About once or twice a year (one year it was 3 times) I get this tachyarrhythmia. One time it happened while driving and I had about 30 seconds to pull over before I became extremely faint. Which is why I advise my own patients that the meds are intended to be a stop-gap measure to prevent permanent damage until such time as they optimize their physical health.

          And yes, veg contains less sugar but not no sugar. It is probably better overall, but still juice concentrates the sugars and makes for a higher caloric density than you would get from just eating the veg in the first place.

        3. WilliamLawrenceUtridge says:

          most of the juice was made from vegetables which contain very little sugar

          Carrots? Potatoes? Yams? And if the juices contain very few macronutrients, that creates its own set of problems – notably hypoglycemia. And, of course, being essentially impossible to maintain as a long-term diet.

          Not to mention – gross.

          And of course, how many people tried the juice fast and didn’t cure their rashes?

  20. Zergo says:

    So, when people do liver cleanses, what are the gall-stone like things in their stool?

    A naturopath or herbologist would say they’re liver stones that were in your liver. I’ve read that they could be congealed fat, but how does fat congeal in the body?

    The naturopath/herbologist/other “professional”‘s response is that fat is liquid at body temperature, therefore these have to be real stones. Maybe they’re not understanding something about how fat congeals in the body?

    1. WilliamLawrenceUtridge says:

      Have you ever picked up or examined the “gall stones”? Chances are they are just poop. Sometimes they are the bloated, undigestible fiber that you consume during the “cleanse” (most herbs are mostly fiber, they’re leaves, bark and root, low in macronutrients but high in cellulose).

      An actual gall stone would sink to the bottom of the toilet, probably quite quickly. Quackwatch and Pete Moran (sigh) have more information here:

      http://www.quackwatch.com/01QuackeryRelatedTopics/flushes.html

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