To Cleanse or Not to Cleanse?
by Diana Price
Chances are you’ve heard the hype: friends raving about a green juice cleanse that leaves them feeling fantastic; someone’s sister who lost 10 pounds on a 30-day detox diet; your local juice bar promoting a springtime liver cleanse. But are these sometimes drastic changes to your diet actually beneficial? Are there risks involved?
While the words cleanse and detox are catchphrases in today’s healthy-living vocabulary, it’s helpful to know what the terms actually mean and what the goal of engaging in these behaviors is for those who choose to do so.
According to Academy of Nutrition and Dietetics spokesperson Robin Foroutan, MS, RDN, HHC, “detoxification is a process that transforms molecules that need to be removed from the body, or ‘toxins.’”1 These toxins are produced internally through our body’s metabolic process (endotoxins) or are introduced to the body from our environment (exotoxins).
“Exotoxins include pollutants, pesticides, mercury in seafood, lead from car exhaust and air pollution, chemicals in tobacco smoke, dioxin in feminine care products, phthalates from plastic, and parabens from lotions and cosmetics,” Foroutan says, as well as medications, whereas endotoxins “include compounds such as lactic acid, urea, and waste products from microbes in the gut.”1
The point of detoxing or cleansing the body of these molecules is to avoid having them build up to unhealthy levels, which might have a negative impact on health. The body generally does this naturally, transforming toxins and excreting them through sweat and waste. Diets that are labeled as cleanses or detox protocols are designed to promote the process of transforming toxins and clearing them from the body.
To understand how stepping into the cleanse craze might—or might not—be a good choice for you, two experts provide insight into the topic: Alicia Romano, MS, RD, LDN, a clinical registered dietitian at the Frances Stern Nutrition Center at Tufts Medical Center in Boston, Massachusetts; and Cynthia Sass, MPH, MA, RD, CSSD, a nutritionist, author, and health educator in private practice in New York City and Los Angeles.
As a nutritionist, how do you define a dietary cleanse?
Alicia Romano (AR): A dietary cleanse can really mean a whole host of things, depending on the context and who is “prescribing” it. A cleanse typically refers to some type of diet plan that either restricts or limits the diet, encourages fasting, and pinpoints specific foods aimed at ridding the body of toxins for a period of time, with or without the addition of dietary supplements. What is tricky is that they have definitely become part of pop culture—a trend we see regularly highlighted in magazines and social media. Unfortunately, like many other fads that don’t have specific scientific backing, many are started by untrained health “experts” and promoted with exaggerated claims.
On the flip side, there are actual detoxification diet protocols using whole foods that are based on existing evidence from integrative and functional medicine registered dietitians; unfortunately, these are not the “cleanses” that are typically glamorized or sought out by consumers.
Cynthia Sass (CS): There are so many versions or definitions of a “cleanse” today. For some people it can mean cutting out processed foods, sugar, alcohol, and caffeine. For others it’s juicing or something formal like a cleanse program, of which there are many.
What do you feel inspires women to seek out cleanses and detox diets, and why arethey so popular?
AR: The motivations can vary but might include cosmetic reasons such as to make skin brighter or a desire to jump-start weight loss, improve gastrointestinal/colon health, aid in digestion, or increase energy and concentration. Additionally, with rising concerns about food additives, pesticides in our foods, and chemicals in our personal care products, cleanses are receiving increased attention.
CS: I think there are a few big drivers behind this trend. Some people use cleanses or detox diets to compensate for unhealthy patterns, like overeating all weekend or during a vacation or holiday; they start a cleanse to “undo the damage.” Others try cleanses to see quick weight-loss results or as a jump-start to a new, healthier eating pattern.
In my experience some people need to see quick results to feel confident and successful and to gain the motivation and momentum they need to move forward with long-term lifestyle changes and avoid getting stuck in unhealthy patterns. While this can be helpful, I don’t like to see people use cleanses as a regular form of purging: that ongoing pattern of overeating followed by a strict cleanse and then a return to overeating can be devastating to both physical and emotional health.
What does clinical research tell us about the benefit, or lack thereof, of cleanses?
AR: We know that nutrition can play a role in the detoxification process: a diet rich in fruits, vegetables, whole grains, and lean proteins and limited in processed foods can aid the body in its ability to function optimally, which includes ridding itself of toxins. Although certain foods and nutrients have been found to aid in the detoxification process, nutrition’s role is still an emerging science, and determining specifics of which foods aid the process is ongoing. At this point there is a lack of evidence-based, peer-reviewed clinical trials evaluating specific dietary detoxification protocols, and debate in the medical community remains about whether the body’s natural detoxification system alone can accommodate the burden of our current lifestyle when accounting for pollution, pesticides, chemicals, additives, and the like.
Given the lack of clinical data, gimmicky cleanses promoted by untrained practitioners should be looked on with caution.
Are there potential serious risks of engaging in cleanses?
AR: There absolutely are risks associated with cleanses, especially those that recommend fasting or severe dietary restrictions or elimination. Prolonged periods of cleansing can leave us nutrient depleted and may be more harmful than helpful. I cannot stress enough that gimmicky or fad cleanses and fasts should be avoided or discussed directly with your physician; cleanses or detox programs that use dietary supplements should also be discussed with your physician, especially to assess for any interactions with current medications.
Additional concerns should be exercised among pregnant and breastfeeding women, who should avoid all vigorous detox programs due to the potential for toxins to be released to the fetus or through breast milk. Caution also applies to young children, as well as those taking medication due to interference with drug metabolism. If you are looking to discuss a safe detoxification protocol for your specific goals, I recommend meeting with a trained functional and integrative medicine registered dietitian; these experts are well trained in providing medical nutrition therapy through detoxification protocols in a safe manner.
CS: Safety concerns really depend on the type and length of the cleanse and how it suits a person’s needs and lifestyle. For example, a cleanse that severely restricts overall calorie intake and doesn’t allow solid food, including vegetables, lean protein, and healthy fat, is basically a form of starvation. Combining that with a high level of physical activity, whether exercise or a physically demanding job, can be dangerous, especially if prolonged.
A too-strict cleanse deprives the body of both fuel and the raw materials needed for the maintenance, repair, and healing of tissues, which is a continuous process. Cleanses that are too strict can lead to burning fewer calories to conserve energy, as well as the loss of muscle and a weakened immune system. And detoxes can backfire if the goal is cosmetic: when you’re not getting enough nutrition and your body is stressed, your skin and hair can look dull and dry, and you may be more prone to breakouts and cold sores. Also, for some people even a short-term restriction can lead to intense cravings, rebound binge eating, and weight gain.
How do you advise women interested in “cleansing” to approach this trend?
CS: I think the first place to start is to know your personality. If in the past trying a strict or limited eating plan has led to feeling miserable, giving up, and binge eating, don’t go down that road again. Maybe you thrive on simplicity and repetition and you need that to help end a chaotic eating pattern.
If you do think a cleanse would be a good fit for your personality, I recommend making sure that it meets the following criteria.
- Don’t go below 1,000 calories per day. If you were to lie in bed all day and do nothing, you’d still need at least 1,000 calories just to keep your heart pumping, your circulation going, and your lungs, nervous system, and brain functioning.
- Include clean, nutrient-rich whole foods, and be sure to include vegetables, lean protein, and healthy fat. Your body needs these nutrients to function optimally. In my experience clients who have the best results cut out processed foods, white flour, sugar, artificial sweeteners, and alcohol but still include plenty of veggies; protein from seafood, organic poultry or eggs, or vegan pulses (beans, lentils, and peas); whole plant-based fats like avocado, nuts, and seeds; fresh herbs and spices; and plenty of water or water and organic green tea.
- If you have a medical condition like diabetes or hypoglycemia, check with your doctor and/or dietitian before starting any kind of cleanse and seek their advice.
- If you are pregnant or breastfeeding, a cleanse is definitely a no-no.
- Listen to your body. A cleanse should make you feel lighter but also energized and nourished. If you feel weak, tired, irritable, or constantly hungry, you’re probably not eating enough. That said, some people do experience withdrawal-like symptoms if they have been eating a lot of sugar and processed food, so try to tune in to what feels like an adjustment versus an actual lack of nourishment.
- If you feel like you need a stimulant to keep you pumped up, your cleanse is probably too strict. Rely on the power of real, healthy food to reboot your body.
- Don’t rely on laxatives, diuretics, or stimulants. Laxatives and diuretics are often popular during detoxes because they trigger additional weight loss—but it’s not fat loss. Laxatives cause the loss of waste that hasn’t yet been eliminated from the digestive system, along with fluid; diuretics simply cause you to lose water weight. Both can be risky, even in young, healthy people, primarily because electrolytes (which regulate heart function and fluid balance) are also lost.
Are there alternative approaches to nutrition that might have the same benefit of a cleanse for women who want to “reset” or “cleanse” without adhering to a strict regimen like those popular today?
AR: You can absolutely support your body’s natural detox by trying a few things:
- Stay hydrated! Drink adequate amounts of fresh water daily.
- Limit highly processed, packaged foods; focus on eating foods from whole sources.
- Minimize known dietary irritants or foods your body may not tolerate.
- Eat your fruits and vegetables—five to nine servings per day. Try to include cruciferous vegetables, berries, artichokes, garlic, and onions, along with other high-antioxidant fruits and vegetables.
- Choose organic foods and produce when possible to limit pesticides and other toxins.
- Work up a sweat regularly!
- Incorporate a variety of spices in the diet.
- Choose green tea as a beverage.
- Consume adequate, not excessive, portions of lean, unprocessed protein to maintain optimum levels of glutathione.
- Incorporate naturally fermented foods like kefir, yogurt, kimchi, and sauerkraut in your diet. These contain beneficial probiotics, which promote a healthy gut.
- Consume adequate fiber daily through vegetables, nuts, seeds, whole grains, and fruits; fiber helps maintain bowel regularity.
1 Foroutan R. What’s the Deal with Detox Diets? Academy of Nutrition and Dietetics website. April 26, 2016. Available at: .