Month: January 2011

Bad Medicine?
Published in The Sunday Business Post on January 2nd, 2011, by Alex Meehan

Overdone it a bit at Christmas and feel you need to cleanse yourself of toxins? Thinking of going on a detox diet in an effort to mitigate all that extra food and drink you indulged in during December?

You’re not alone. But before you pop along to your local chemist, supermarket or health food store and spend your hard-earned money on books, devices or supplements, consider this: there is almost no scientific basis for the concept of detoxing.

In fact, the term has no medical meaning outside the clinical treatment for drug addiction or poisoning.

Despite this, there is a thriving industry selling a willing public the idea that we live in a toxic world, and that day-to-day life is slowly poisoning us. The solution, claim detox proponents, is to eliminate dangerous toxins from our bodies. But just what are these toxins, and how is the idea of detoxing supposed to work?

The answer is not entirely clear. When the British charitable trust Sense about Science investigated the detox industry and contacted the manufacturers of a number of detox products, they found that no two companies could agree on a definition of what the word ‘detox’ actually meant. In addition, little or no evidence was produced that detox products on sale in pharmacies, supermarkets and health food stores were effective.

In the majority of cases, the producers and retailers contacted were forced to admit that they were effectively renaming the likes of cleaning and brushing products as ‘detox’ products. ‘‘The word ‘detox’ has no real meaning outside of the treatment of drug addiction or poisoning,” says Julia Wilson, communications officer with Sense About Science.

‘‘Yet companies and individuals now use it to promote everything from foot patches to hair straighteners, despite being unable to provide reliable evidence or consistent explanations of what the detox process is supposed to be.

‘‘When we contacted companies making these sorts of claims and asked them, firstly, what they meant by the term detox and, secondly, if they had any evidence to support their claims, none of them could do so and, in fact, no two companies had the same definition of what the term detox meant. Essentially, the term is meaningless.”

According to Wilson, companies which produce detox products are spreading misinformation about how the body works.

‘‘They do it mainly by promoting the idea that toxins build up in the body and you need to aid the removal of them in order to feel good. What concerns us is that this idea plays upon the public’s fears, and is used to sell products that nobody actually needs,” she says.

The appeal of detoxing your body, whether in the form of a crash diet, alternative health treatment or food supplement, is easy to understand. But according to medical experts, behind this industry and its products lies a fundamental misunderstanding of human physiology.

According to Dr Ben Goldacre, journalist and author of the book Bad Science, there is no evidence that making an extra effort to be healthy can undo the damage caused by a period of overindulgence. ‘‘The idea that you can do something useful to your health in five days of abstention is obviously ridiculous,” he says.

‘‘What we know about the impact of someone’s behaviour and decisions is that they impact on their health over the course of a lifetime. It’s important to look after your health for the next 50 years, not the next five days.

‘‘Doing it for the next five days isn’t just useless, it’s worse than that, because it lulls people into a false sense of security and makes them believe that they’ve done something good. But nobody has ever presented any sensible evidence to show that short-term detox diets do anything to offset bad diet or behaviour habits.”

Goldacre says that detox remedies tend to fall into three categories – cleansing products, food supplements and diets – all of which, he says, are ‘‘basically nonsense’’.

‘‘With food supplements, you usually find that they’re crammed full of antioxidants, but there have now been scientific trials in very large numbers – with over 150,000 people participating – where half of the people got antioxidant supplements and half didn’t. It turns out that, not only do antioxidant supplements do nothing, if anything they probably increase your risk of dying,” he says. ‘‘The antioxidant myth is exactly that, and it’s typical of the promises that people make about the ingredients in detox products.”

Goldacre is particularly scathing in his criticism of devices such as detox footbaths and patches. ‘‘You can buy footbaths that you put your feet into, and see the water turn brown. That’s not caused by toxins leaking out of your body, but by a metal electrode being placed in a saltwater bath. When a current is passed through the electrode it rusts. You can do exactly the same thing with a nine-volt battery and a nail in a cup of saltwater at home,” he says.

‘‘It’s a simple piece of theatre, but you find these baths in spas and beauty salons all over the place. It’s a similar story with the foot patches you see for sale. If you just spray some warm water on a foot pad and then stick it under a cup of tea to keep it nice and warm – like it would be if it was on the sole of your foot overnight – then the stuff in the footpad will go brown and sludgy in exactly the same way. It’s basically a teabag that contains some mashed-up plant material.

‘‘It all plays into this rather theatrical idea that unhealthy lifestyles which are bad for you somehow leave some kind of brown toxic residue inside your body that can be extruded using these magical machines. Non-specific toxic residue, of course – they’ll never tell you the names of any of them. It’s all just marketing guff.”

‘‘I couldn’t agree with Dr Goldacre more,” says Dr Daniel McCartney of the Irish Nutrition and Dietetics Institute.

‘‘These preparations are usually offered at premium prices that are unfortunately more reflective of the marketer’s audacity than of any benefits they might yield. They distract people from the same reliable, well-founded, scientific-based messages like consume your five-a-day, eat wholegrains when possible, don’t smoke, take some exercise and drink only in moderation.”

The problem, according to McCartney, is that it’s relatively hard to sell this message to the public, but comparatively easy to sell a magic pill or potion. ‘‘People are overwhelmed by misinformation in this area – it’s very poorly regulated, and often it’s the sensationalist headlines that get all the attention,” he says.

‘‘Consumer fatigue is a real issue and regulation could do a lot to help this. You hear a lot of baloney about wonder foods and extreme diets, but the truth is that, without regulation, the consumer can’t really have any confidence that what they’re being told is true.”

McCartney, who is also a lecturer in nutrition and dietetics at the Dublin Institute of Technology, says the key problem with detox products is that they promise a lot but don’t deliver.

‘‘There is so much fallacy in this area. People are looking for all sorts of magic solutions to their health problems – they want to feel more youthful or have more energy – and when it comes to how to achieve that, they don’t know what to believe. But in actual fact, when you get away from the hyperbole and misinformation, there’s quite a lot that we know about the science of nutrition,” he says.

‘‘When we look at specific components of diet and specific nutrients, there are reasonably valid reasons for saying that some foods can be better for us than others. Unfortunately, they’re very rarely the same ones that are touted in the product literature or magazine articles that we see most often.”

According to McCartney, at a fundamental level the damage that is caused to human body tissue by the wear and tear of day-to-day living is caused by chemicals called free radicals, and there are three main sources of these.

‘‘First, they are produced by every living cell in the body – in other words, every cell that uses oxygen produces free radicals as a by-product, in much the same way a car produces exhaust fumes as it burns petrol,” he says.

‘‘The second source is in our immune system. When our white blood cells deal with pathogens in the body, such as bacteria, viruses or fungi, they use these damaging free radicals to do the job for them. But when those cells of the immune system be come over-active, and there is an uncoordinated or overactive inflammatory response, the body produces too many free radicals. The excess spills out into the surrounding tissue, and this is what makes your throat feel sore when you have an infection. It’s not necessarily the streptococcus, but the immune response to it.”

The third and final source of free radicals, according to McCartney, is the environment around us and our personal habits. Key factors in the over-production of free radicals in the body are things like inhaling cigarette smoke, not taking enough exercise, gaining weight around the middle of the body and heavy alcohol consumption.

‘‘There are proven things you can do to make yourself healthier, but there’s no quick-fix solution. Going on a so-called ‘detox diet’ after a period of overindulgence doesn’t offset the damage you’ve done. It can actually cause more harm, and in fact some kinds of damage to your liver, brain and gut can never be undone. The best advice from a dietician’s point of view is to have a habitually healthy balanced diet where you’re not overindulging in things like alcohol,” he says.

So if you want to become healthier and take better care of your body, what’s the key?

‘‘At a basic level, drop the junk food, sugary foods and sweet fizzy drinks, as well as fatty foods and excessive alcohol. Have at least five servings of fruit and vegetables every day and make sure you eat good amounts of high-fibre starchy foods. Eat plenty of oily fish at least twice a week – mackerel is particularly good. Do some exercise, because if you keep your weight in control, that stops you producing damaging free radicals,” says McCartney.

‘‘Foods like refined sugars, which are found in cakes, biscuits and sweet drinks, all increase our production of free radicals. Likewise, trans-fats found in low-quality processed foods or margarines, and saturated fats that we largely get from red meat, should be avoided as they are associated with an increase in inflammatory markers that indicate higher rates of free radical production.

‘‘The fitter your body is, the better it can cope with threats to your health, particularly things like heart disease, kidney damage and vascular disease. If you’re covering those bases in your diet, then you’re really doing great.”

Ben Goldacre believes that the majority of people who purchase detox remedies know that they aren’t supported by scientific evidence, yet choose to buy them anyway.

The reasons are varied and complex. ‘‘I think people know that there’s something a bit dodgy about them, and I don’t think they’re necessarily being ripped off – they’re giving over their money quite willingly, and they know that these claims aren’t mainstream,” he says.

‘‘People sometimes make these purchases as part of a slightly misguided political stance. They feel they’re standing up to doctors and to mainstream society by spending some money on a magic pill or whatever. And that’s fine, because if people want to waste their money, then that’s their own personal decision.”

A much bigger problem, in Goldacre’s opinion, is the fact that many high-street pharmacists sell products for which there is no scientific evidence alongside proven drugs and medications.

‘‘I’m not surprised when a vitamin pill company or some wacky holistic alternative therapy shop presents the public with misleading claims about their products, and I think anyone who hands over their cash in those situations essentially deserves what they get. It’s a sort of voluntary, self-administered tax on scientific ignorance,” he says.

‘‘However, pharmacists have a very different set of responsibilities, and I think it’s sad to see pharmacists – who should be the scientist on the high street, and upon whom you should be able to rely to give you sensible, evidence-based advice – profiteering from this kind of thing.”

Goldacre believes selling these products devalues the good work that pharmacists do. ‘‘In the long run, I don’t think it does them any good. If pharmacists are selling magic sugar pills and homeopathic remedies and detox stuff, people will start to think that maybe they can’t be trusted when it comes to medical drugs as well,” he says.

‘‘That’s sad, because the public do need someone that they can go to who can give them sensible help and evidence-based advice.”

In a statement responding to Goldacre’s comments, the Irish Pharmacy Union told The Sunday Business Post that each individual pharmacist makes up their own mind on what products they choose to stock.

‘‘This is a decision for individual pharmacists to make. All products making medicinal claims must be authorised and licensed by the Irish Medicines Board,” says Gerard Howlin, head of policy and public affairs with the Irish Pharmacy Union.

However, there is an onus on pharmacists and other retailers to make sure that the products they sell perform as advertised.

‘‘Under Section 8 of our code of standards, which is the section that deals with the health and beauty industries, the basic principle is set forth that there should be substantiation of any claims a product makes,” says Frank Goodman, chairman of the Advertising Standards Authority of Ireland.

‘‘If we ask for substantiation, it should be available. Also, and importantly, none of these products should be offering to cure anything that is in any way serious or which might require the services of a medical practitioner. Detox products that might offer to minimise the effects of drinking too much, for example, cannot be advertised in away that would encourage over-indulgence.”

Goldacre concedes that pharmacists are in a ‘‘slightly difficult’’ situation. ‘‘It’s sad to see them undermining themselves by selling these products, but most of them are small, independent businesspeople. However, we hope that they have a good deal of integrity and that we can rely on them to give us evidence-based advice while, at the same time, making money as small businesses.”

CLAIMS MADE ABOUT DETOXING

Claim 1: toxins build up in the body and need to be flushed/cleansed from it

The terms ‘toxic’ or ‘toxins’ are used to imply that a chemical is causing you harm. In reality, all chemicals can be toxic and it is the dose that is important – for example, one 400mg vitamin A tablet may be beneficial, but taking 20 at once could damage your liver.

Most chemicals do not accumulate in the body: they are removed by the liver and kidneys. Many detox products which claim to flush the body of chemicals contain diuretics, which increase the amount you urinate. This just removes water and some salt.

In extreme cases, diuretics can cause your salt levels to become depleted, causing cramping or, in the worst cases, a coma. You may achieve temporary weight loss by dehydration, as with a sauna, but this is only short term, as you will regain weight while you rehydrate.

Claim 2: your ‘eliminatory organs’ should be detoxified

The term ‘eliminatory organs’ as used by detox products refers to the liver, kidney and digestive system. These organs don’t need to be cleansed unless you have consumed a dangerous dose of a substance to the extent that they are overwhelmed, such as a drug overdose. In these cases, medical intervention is needed via stomach-pumping, blood transfusion or dialysis.

Claim 3: the product will help ‘neutralise nasty free-radicals’

Detox tonics and supplements often claim to contain high level of antioxidants to help neutralise free radicals in your body. Free radicals are made in the body and can cause cell and DNA damage, but they also play an important role in our immune system, protecting against bacteria and viruses. The body makes its own antioxidants, using the food in our normal diet. Additional antioxidants are removed by the kidneys.

Source: Sense About Science

THINGS TO KNOW ABOUT DETOX PRODUCTS

Shampoos, cleansers and moisturisers

These products bind to substances such as make-up on the skin’s surface, but will come off when you wash. They can’t help your body remove excess substances and are no better than other shampoos, cleansers or moisturisers – and may be more expensive.

Detox patches

Putting a detox patch on your skin may make the covered area sweat more. While very, very small levels of chemicals may be excreted in the sweat, it won’t have any discernible effect on the amount of chemicals in your body.

Detox tonics/supplements

Detox tonics can’t improve your liver or kidney function. Some of the herbs in them may be metabolised more quickly – for example, St John’s Wort – but this is because your body recognises them as a poison and attacks them. If you have too high a dose of some of these supplements, it can cause illness and even death. There is also a risk that they will affect how other substances are processed, such as the contraceptive pill or other medicines, so they don’t work as effectively.

Detox diets

Detox diets are often recommended after periods of excess, but the best diet you can have at any time is a normal, balanced one.

Source: Sense About Science

HOW VITAMIN PILLS COULD BE BAD FOR YOUR HEALTH

A course of vitamin supplements is one of the first ports of call for people feeling rundown and suffering from fatigue, but consumers should be sceptical about the claims made for these products, according to independent British consumer watchdog Which?.

It recently conducted research into the claims made for many health supplements and found that many don’t stand up to scrutiny. At the same time, while visiting supermarkets, chemists and smaller health shops, the consumer body found high-strength products on sale containing vitamin B6 and betacarotene without recommended warnings that taking too much could be harmful.

An additional survey carried out by Which? of more than 1,200 people found that around a third of them didn’t realise that taking too much of some supplements could damage their health.

‘‘We’re concerned that people are being taken for a ride, needlessly paying a premium for many products on the basis of health claims that haven’t been backed up by scientific evidence,” says Peter Vicary-Smith, chief executive of Which?.

‘‘We want to see the European Commission release a list of accepted and rejected claims as soon as possible, so that consumers won’t continue to be bamboozled by health claims they can’t trust.

‘‘With many supplements also failing to carry voluntary warnings about high levels of vitamins and minerals you can overdose on, it’s also necessary that safe levels are agreed as soon as possible.”

Supplements claiming to aid in the maintenance of healthy bones and joints were singled out for criticism by Which?, with many based on ingredients like glucoasmine which have had the evidence to back them up rejected by the European Food Safety Authority (EFSA).

The EFSA is the body responsible for analysing the scientific evidence behind health claims on all foods, including supplements. In around 80 per cent of the cases it has studied so far, it couldn’t identify a cause and effect relationship between the ingredient submitted and the purported health claim.