Detoxification

The autointoxication theory

A historical article on intestinal autointoxication traces the belief that putrefaction of the stools poisons the body to physicians in ancient Egypt, and says the ancient Greeks folded it into humoral theory. According to the same article, nineteenth-century biochemical and bacteriological work lent the idea new credibility through the notion of ptomaine poisoning, and the biologist Metchnikoff proposed that intestinal toxins shortened lifespan.

The same account reports that in the early twentieth century surgeons, among them Sir W. Arbuthnot Lane, removed the colon to treat autointoxication, and that by the 1920s the doctrine had fallen into disrepute as science failed to support it. The authors add that the idea persists in the public mind.

Kellogg and colonic irrigation

A science-communication article from McGill University describes John Harvey Kellogg as head of the Battle Creek Sanitarium for about 62 years, and says he attributed illness to harmful substances produced in the bowels. It lists enemas and yogurt among his treatments and reports that he performed a large number of surgeries.

A 1997 editorial in a gastroenterology journal states that autointoxication was the ruling doctrine of nineteenth-century medicine and led to what it calls colonic quackery. In the author's account, colonic irrigation went into decline once its scientific rationale proved wrong and it appeared potentially dangerous, and the author argues that it was being revived in the 1990s on much the same claims.

The modern detox industry

A 2015 critical review describes the detox industry as booming and defines detox diets as popular dieting strategies that claim to facilitate toxin elimination and weight loss. The sources reviewed for this page do not give a dated, sourced history of how the industry grew from the 1990s to the 2010s, and this page does not reconstruct one.

Two senses of the word

The term detoxification is used in two largely separate senses. In wellness marketing it names diets, regimens and therapies promoted to remove toxins, lose weight or improve health. The US National Center for Complementary and Integrative Health lists fasting, juices, limited foods, supplements, herbs, colon cleansing, reducing environmental exposures and saunas among them, and uses the words detox and cleanse for these approaches.

In medicine, detoxification refers to supervised management of withdrawal from alcohol or other drugs, and the treatment of poisoning, including chelation for heavy-metal poisoning. These are clinical procedures with defined indications. Evidence about one sense should not be carried to the other, and the sources reviewed for the wellness sense do not address the medical sense.

The word toxin used loosely

In a toxicology sense, a toxin is a specific poisonous substance, and the review literature on detox diets observes that commercial programs often leave the targeted substances unspecified. The sources reviewed here do not define the term as marketing uses it, and one critical review notes that the few clinical studies of detox diets are hampered by flawed methods and small samples.

A 2012 systematic review of arsenic, cadmium, lead and mercury in sweat shows what a specific usage looks like: it names the elements it measures and the populations studied. By contrast, the historical autointoxication literature used toxin for putrefactive products of the colon, a usage the historical article says later science did not support.

How wellness uses the idea

Wellness programs described as detox are built around a few recurring elements, according to NCCIH: restricted eating or fasting, juices, supplements or herbs, colon cleansing by enemas, laxatives or colonic irrigation, and sauna use. Related pages on this site include Juice Fasting, Master Cleanse, Water Fasting, Colonic Hydrotherapy, Infrared Sauna, Chelation Therapy, Ear Candling and Dietary Approaches. This page gives no instructions for any of them.

Advocates of sauna-based or sweat-based approaches point to measurements of metals in sweat. The authors of a blood, urine and sweat study of 20 people suggested that induced sweating may be a potential route for eliminating some toxic elements, and a systematic review reached a cautious version of the same view.

How medicine uses the term

In medical settings, alcohol withdrawal ranges from mild to potentially fatal, and moderate-to-severe withdrawal may need hospital treatment with close monitoring, according to the National Library of Medicine's MedlinePlus encyclopedia. This is a supervised clinical service and not a cleanse.

Chelating agents are used in the treatment of lead poisoning to enhance excretion of lead, according to a CDC report, which advises providers unfamiliar with them to consult an expert in the chemotherapy of lead poisoning. The report is specific to diagnosed poisoning and is not evidence about elective use.

Toxin removal and weight loss

Detox diets are marketed with claims that they facilitate toxin elimination and weight loss and thereby promote health and well-being, according to a critical review. NCCIH describes the same approaches as promoted to remove toxins, lose weight or improve health.

Colon cleansing and general vitality

Colon cleansing is described in a systematic review as touted as an adjunct to improve vitality and as a way to minimize symptoms, or prevent the development, of a variety of chronic diseases. A New Zealand prescribing-advice journal lists claimed benefits such as regularity, clearer skin and more energy, and presents them as claims and not as established effects.

Sweating is also presented as a way to clear stored metals. The authors of a systematic review note that sweating has long been regarded as cleansing and as low risk, and they frame their own work as asking whether it deserves consideration for toxic element detoxification. Those authors do not endorse commercial sauna programs.

Detox diets

A 2015 critical review in the Journal of Human Nutrition and Dietetics examined whether detox diets are necessary, what they involve, whether they are effective and whether they are dangerous. It concluded that there is very little clinical evidence supporting them. A handful of small studies with flawed methods reported effects on liver detoxification or on persistent organic pollutants, and the authors found no randomized controlled trials of commercial detox diets in humans.

NCCIH reports that few human studies of detoxes exist, that most are of low quality because of design problems, small samples or absence of peer review, and that no long-term studies exist. It adds that a 2015 review found no compelling research that detox diets aid weight management or remove toxins, and that initial weight loss on such diets is usually regained.

Colon cleansing

A 2009 systematic review in the American Journal of Gastroenterology searched the conventional and complementary literature for colonic cleansing used for general health. It found no methodologically rigorous controlled trials supporting the practice, found multiple case reports and case series describing adverse effects, and concluded that the practice was not supported in the published literature and could not be recommended at that time.

Sweat and metal excretion

A 2012 systematic review identified 122 records and included 24. It reported that in people with higher exposure or body burden, sweat concentrations of some elements generally exceeded plasma or urine concentrations, and that one case report described mercury levels normalizing with repeated sauna sessions. The authors concluded that sweating deserves consideration and that appropriately sized trials are needed.

The 2010 blood, urine and sweat study of 20 people, 10 healthy and 10 with health problems, found many toxic elements preferentially in sweat. These are measurements of excretion, not trials of health outcomes, and the sources reviewed do not show that sauna use improves health or reduces illness.

What was not found

The searches run for this page covered PubMed for detox diets, colon cleansing, sweat and metals, autointoxication and cleanse-related kidney injury, plus the NCCIH, CDC and MedlinePlus sites. An independent Sense About Science report on detox products and a BMJ or Lancet commentary could not be opened and were dropped. No studies of ear candling were reviewed, and the sources reviewed do not describe the liver, kidney, lung and skin processes in detail.

Documented harms of cleanses

NCCIH reports that multi-day fasting with large amounts of water or herbal tea can cause dangerous electrolyte imbalances, that fasting can cause headaches, fainting, weakness and dehydration, and that laxatives can cause diarrhea leading to dehydration and poor nutrient absorption. It also states that colon cleansing side effects can be serious, and that some detox or cleansing programs can be unsafe and falsely advertised.

A case report in the American Journal of Kidney Diseases describes a 65-year-old woman who developed acute oxalate nephropathy after a green smoothie juice cleanse and progressed to end-stage renal disease. She had a history of gastric bypass and recent prolonged antibiotic treatment, and the authors state that such cleanses increase oxalate absorption in people with risk factors. It is a single case, and it does not give a frequency.

A New Zealand prescribing-advice journal reports that the main risk of colonic irrigation is colon perforation, citing three Australian cases that needed surgery, and describes electrolyte depletion with large volumes of water and infections from poor equipment sterilization. It states that short fasts and laxative use are likely harmless, a statement that sits alongside the NCCIH warnings above.

Chelation outside poisoning

A CDC Morbidity and Mortality Weekly Report describes three deaths from hypocalcemia during chelation therapy between 2003 and 2005. They included a 2-year-old girl in a hospital, where the wrong edetate product was administered through a look-alike, sound-alike drug-name error, and a 5-year-old boy with autism who died during intravenous chelation in a physician's office. The third was a 53-year-old woman treated at a naturopathic clinic.

The report states that disodium edetate is not recommended for children, advises reporting cases of cardiac arrest or hypocalcemia during chelation, and notes that off-label chelation for autism and coronary artery disease is not supported by accepted scientific evidence. It supports a harm finding for these cases and does not describe how often harm occurs.

Medical detox and the care boundary

MedlinePlus states that alcohol withdrawal may quickly become life-threatening, that delirium tremens involves confusion, hallucinations, fever and seizures and can be fatal, and that seizures, fever, severe confusion, hallucinations or irregular heartbeats call for emergency care. Medical detox for alcohol or drug withdrawal is a real hospital or facility treatment that needs clinical supervision, and a home cleanse is not a substitute for it.

The sources reviewed do not report documented rates of eating disorders or of delayed care connected with detox programs, so this page makes no claim on either. As NCCIH advises, people with diabetes or other medical conditions should consult their care team before restrictive regimens, and detox programs should not delay or replace necessary medical care.