Purification, or just a purge?

Times Staff Writer

PAST the desert scrub and cacti, at the end of a long drive to nowhere, sits a fenced-in oasis guarded by a big black gate. Press the secret code and you enter an exclusive paradise: a spa where the rich and beautiful flock to purify their bodies of the chemical excesses of 21st century existence.

"Between the stresses of everyday life (deadlines, relationship struggles, traffic) and the impurities found in processed foods, the body is full of toxins and the mind, tension," declares the website for the We Care Spa. "We Care is leading the new movement of detoxing the body and hence, the body and soul."

Guests here go without solid food for anywhere from three to eight days, subsisting on a liquid diet that supposedly helps flush their systems of pollutants and preservatives while still providing vital nutrients.

They gulp down 14 individually formulated drinks daily to boost their energy and loosen up stuck matter in their colons. They imbibe endless cups of fresh vegetable juice, gallons of blood-purifying tea and enough water to grow a tree in the desert.

Then, packed to the gills with fiber and herbal laxatives, they receive colonics, lymphatic massages and Korean skin scrubs to help flush out the toxins.

"The cleansing may be physical, but the results are much more penetrative and profound," proclaims the spa. "In five days, it can change your life."

A spa such as this, with a price tag that can run into the thousands, is definitely for the well-heeled. But its focus on detox is part of a larger alternative health trend that has been briskly growing in the last few years. Celebrities such as Beyonce and Angelina Jolie are said to have done detox regimens. Less wealthy health faddists do it too, often brewing up their cut-price detox concoctions at home (and sometimes blogging of their experiences in intimate detail).

Through scouring out their innards, drinking gallons of liquid and popping pills and powders, these enthusiasts hope to purge themselves of accumulated metabolic waste and man-made poisons -- fighting disease, sharpening minds, increasing stamina and (with all that intestinal flushing) flattening bellies.

A plethora of DIY detox books are available to help them in their quest: "7-Day Detox Miracle," "Purify Your Body," "Detoxification and Healing" and more. And a bevy of detox products exists too, on natural health-store shelves: Liver Detox, Detox Cleanse, First-time Cleanse, bentonite clay and psyllium husks, to name a few.

In fact, cleansing and organ supplements (largely consisting of herbal-based cleanse and detox kits) make up the fastest growing segment within the herbal formulas category, says David Browne of SPINS, a market research and consulting firm for the natural products industry. Last year's growth was twice that of the year before, he says.

Most people who do detox regimens speak of them with the zeal of religious converts. They can't wait to detox again.

But medical professionals urge caution. They say detox diets can be extreme and potentially dangerous. They also say there's no evidence that these diets do any good.

"The idea that foods are poisonous, or that we need detoxification, or a cleansing regimen to improve our health is without scientific merit," says Roger Clemens, a nutritional biochemist at the USC School of Pharmacy. "We have wonderful organs, great enzymes, a great system for eliminating toxins naturally."

Purification's past

Throughout history, people of almost every civilization have undergone periods of deprivation as a path to physical, emotional and spiritual purification. Jesus fasted for 40 days and nights in the desert. Buddha reached enlightenment after breaking his fast.

Even the current trend was seeded years ago. The perennially popular Master Cleanse, or lemonade diet -- in which people survive anywhere from three to 40 days on little more than a brew of lemon juice, cayenne pepper, maple syrup and lots and lots of water -- was created 60 years ago. And We Care has helped guests cleanse their bodies for 20 years.

But today's detox craze is something different, according to those watching the trend.

"What I think is new about it is the commercial component, the increasing economics of detox dieting," says Dr. Peter Pressman, an internist and attending physician at Cedars-Sinai Medical Center, who has written on the subject. "Over the last three years it has become an international industry."

Detoxing is based on the idea that people take in or absorb toxic chemicals such as pesticides, mercury, dioxins, polychlorinated biphenyls (PCBs) and food additives through the food they eat, air they breathe and water they drink. When these chemicals build up to a certain level, the theory further goes, they can overpower the body's natural detoxification system -- causing fatigue, mental sluggishness and various "allergy-like symptoms."

Eliminating most foods and following a regimen to empty the digestive system and flush away these chemicals, advocates say, allow the body to eliminate the buildup and begin to function efficiently once more.

Although the prescriptions vary greatly, most detox diets involve consuming large volumes of water, huge quantities of crushed raw vegetables and daily doses of digestion-aiding, colon-scouring supplements such as fiber and herbal laxatives -- accompanied by colonic irrigation or enemas.

Claims vary depending on the diet, but testimonials generally suggest that these regimens will boost energy, increase mental clarity and make skin glow.

Such diets seem to resonate with an often-affluent urban psyche that seeks to cure all through health and nutrition, and to fit neatly into this age of instant gratification and pervasive fears about environmental pollution.

"What appeals to people about these detox regimens is you are doing it all at once," says Susan Bowerman, assistant director of the UCLA Center for Human Nutrition. "It's like getting your oil changed."

Janet Canterbury, 60, of Los Angeles recently completed a weeklong Hawaiian cleanse that she learned from her son's girlfriend. "I don't know why I never did one before this, but it was fantastic," she says. Her detox cleanse was simple, she says: For one week she ate plenty of fresh vegetables but no processed food, no meat and no alcohol. Each morning, she had psyllium husks in juice and a teaspoon of "intestinal cleanser" she bought at the health-food store.

"After a couple of days I was cleaned out," she says. Her skin was soft. Her energy was up. Her normally brittle hair felt silky. "I loved the feeling of not having the craving in my stomach for food," she says. "My body was very happy with whatever I was doing to it."

David Oyster, a disc jockey in Colorado, also recently completed a detox diet -- but his regimen lasted five weeks. He'd tried detox cleansing before, he says, including the Master Cleanse. That left him so depleted he could barely function.

But four months ago, he turned again to a detox regimen because he was feeling sluggish. Under the supervision of a nutritionist, he took pills and powders with names such as Toxinout (with L-methionine and L-cysteine, to detoxify the liver, kidneys and blood), ParaDetox (to flush the system) and Oxy-Powder (to oxygenate the colon and remove toxins). And he loaded up on fiber like never before -- for breakfast, smoothies loaded with ColonAid (its main ingredient is psyllium husks); for lunch, salads; for snacks, apples and almond butter; and for dinner, salad, a sweet potato or a beet.

At night, he took yet more pills, including a probiotic supplement to repopulate his intestinal flora. "I felt more energetic, more able to do brain work, more mentally alert and refreshed," he says. "I sleep better, my senses are more acute -- hearing, smell taste.

"I made science documentaries for years. I was kind of skeptical about this. But I decided to try it, and it was a miracle!"

All detox is not equal

A variety of alternative medicine practitioners embrace some form of detox cleansing as a health-promoting practice and a powerful incentive to change a chronically unhealthy lifestyle. They generally caution that such diets should be reasonable, done under medical supervision and not attempted by those who are weak, pregnant or nursing.

Naturopathic doctors -- known as NDs -- are trained, among other things, to help people with detoxification. They believe that this can help prevent the onset of disease and aid a person who is already sick. California naturopathic doctor Carl Hangee-Bauer explains that the goal is to improve the function of the organs involved in processing and eliminating toxic chemicals -- such as the kidneys, bowels and skin.

A detox regimen, Hangee-Bauer adds, could be as simple as drinking more water and avoiding junk food. It could include working up a sweat through exercise, sitting in a sauna or taking substances that, he says, help the liver to do its job better, such as milk thistle, dandelion greens or artichokes.

He says he condemns the excessive use of laxatives and colonics and is wary of patients who appear in his office wanting to do a detox diet to lose weight. He believes mainstream doctors condemn all types of detoxing because they see only the "nutty" side -- people who've overdone it and had to seek medical care.

"What gets their attention is the people who are at the extremes," he says. "Their attitude gets framed by that."

Practitioners of ayurveda -- a traditional medicine founded thousands of years ago in India -- also recommend a process, called panchakarma, which is aimed at ridding the body of toxic chemicals. Lasting from a day to a week, it uses herbs, special oils, massages, steam saunas and enemas to purify the body.

Dr. Nancy Lonsdorf, an internist and former director of the Maharishi Ayurveda Medical Center in Washington, D.C., says the body is designed to get rid of toxins naturally -- but in today's world, that might not be enough.

"If you are feeding someone Big Macs, French fries, and making them work hard, having them breathe toxic air, [drink] toxic water, then yes, the body is getting rid of toxins, but it is taking in more than the body was designed to handle," she says.

Lonsdorf thinks that time will show that toxins are not only in our bodies but also a threat to our health. She notes that the Centers for Disease Control and Prevention has begun taking blood from thousands of people, testing for pesticides and toxic compounds and following them over time, as part of a program aimed at measuring Americans' chemical exposure. In a 2005 report from that project, the CDC screened for 148 toxic compounds in the blood samples and found measurable amounts of more than 100 of them present.

Some of the chemicals, such as phthalates, are metabolized fairly quickly. Others, such as PCBs, flame-retardants called PDBEs, methylmercury and dioxins can accumulate in sites in the body such as bone, muscle, lungs, liver and, perhaps most frequently, fat.

"Toxins do build up," Lonsdorf says. "Doctors have to face it. It is not the case that we can get rid of whatever garbage is going in."

Animal studies, and in some cases human studies, have shown that exposure to most of these compounds -- at high levels -- can affect the brain, hormones or immune system. PCBs, for example, can impair liver function, raise blood lipids and cause cancers and reproductive damage in animals.

Bisphenol A, found in plastics, can also cause reproductive abnormality in animals. Phthalates disrupt reproductive development in mice and have been shown to affect genital development of baby boys.

But the significance of this to the general population is unclear because humans are generally exposed to these chemicals not in large amounts but at much lower levels over a long period of time, says A. Jay Gandolfi, a toxicologist and associate dean for research in the college of pharmacy at the University of Arizona.

"Here is our problem," Gandolfi said. "The animal studies we do, we tend to look at higher levels of exposure so we can see the effects.... but there are fewer studies -- even in animals -- at low levels, over long periods of time."

Despite the unknowns, a detox regimen may seem to make sense as a precautionary measure: I put a lot of junk in my body, so now I want to get it out. But can detox really do that?

There are not a lot of studies. One, conducted by Robert Herron, a scientist then at the Maharishi University of Management in Fairfield, Iowa, investigated panchakarma, which Indians traditionally used to get rid of what they call ama, or poisonous waste material produced by the body. In two papers published in 2002 in the journal Alternative Therapies, Herron examined whether the process, as practiced at an Iowa ayurvedic medicine spa, could remove man-made toxic chemicals.

For the first study, Herron took blood samples from two groups of people -- 48 of whom had done a five-day panchakarma procedure an average of 18 times in their life, and 40 of whom had never done it. The blood was sent to a lab recommended by the CDC and analyzed for more than a dozen chemicals, including PCBs. He found PCB levels in the panchakarma group were lower.

In the second study, Herron compared levels of the same dozen chemicals in 15 subjects, before and after the five-day detox procedure. On average, levels of PCBs decreased by nearly 50% in those who did panchakarma.

These studies are small and imperfect (in the case of the first study, the panchakarma group differed in other ways than the comparison group -- more of them were vegetarians, for example). They also address just a few chemicals and are unlikely to be repeated.

Based on what they know about human physiology, toxicologists say some of the common detox techniques might help remove accumulated chemicals, but it's hard to see how others would.

All that liquid consumption, for example. In the case of chemicals that are water-soluble (arsenic, for example, exists mostly in the body as water-soluble salts) drinking lots of water could help, Gandolfi says.

Fiber consumption, which is aimed at catching toxic chemicals inside the intestine in order to eliminate them, might work if the chemicals you're trying to get rid of are in the liver, says Linda Birnbaum, director of the experimental toxicology division of the Environmental Protection Agency. The liver ejects chemicals into the gut in the form of bile salts. They're normally reabsorbed -- unless, that is, they're removed before that can happen.

But this won't work for chemicals that aren't in the liver. Several studies in the 1980s examined whether consumption of oat and rice bran could help reduce levels of fat-soluble compounds such as PCBs and dioxins, Birnbaum says, and concluded the bran had only a small effect.

Raw vegetables, meanwhile, don't have any special detoxifying properties, experts say, except they bulk up stools with more fiber, helping with elimination. And some toxicologists express caution about intestinal cleansing. "Do you want to slough off the insides of your intestines by purging your colon?" Gandolfi asks. "I'd be scared."

In fact, most scientists say there is no evidence to support the notion that these often extreme cleansing methods do anything except perhaps dehydrate you and throw off your electrolyte balance. When people do the regimens to excess, they can get muscle cramps or pass out, sometimes even push their kidneys to begin to shut down. "It is fraud," Cedar-Sinai's Pressman says. "It is a distortion and misapplication of science and medicine. Kidneys and livers don't need rest. They don't need water in huge quantities. What they need is to be used. Our body's own capacity to detoxify itself is beyond anything we can design."

Pressman says he's seen a number of people end up in emergency rooms after collapsing from the excesses of detox regimens. One of these was a 97-year-old woman with an underlying heart condition. She'd read about a detox diet in a magazine and decided to try it because of its promise of more energy -- but ended up in an emergency room with life-threatening arrythmia after drinking massive amounts of water, and several enemas.

Doctors said these regimens can be especially risky for adolescents, the elderly, pregnant or breast-feeding women or anyone who has any disease or chronic condition.

Proof is in the process

Susana Belen, the 68-year-old founder of We Care Spa, is not swayed by the lack of science. "Just because it hasn't been scientifically certified does not mean benefits do not exist. It means no one took the time to prove all of this," she says.

Look at her: She has no pain, takes no medication and has the same pulse she had when she was 28. This -- and the fact that 80% of her guests return to the spa -- is evidence enough that it works, she says.

On one recent morning, about 15 We Care guests -- about five men and 10 women -- gather in the spa's main villa for a cooking class called "Healthy Digestion." It is super-hot. No one seems to have much energy.

Lounging on sofas, the guests quietly talk -- of psyllium, stomachs, digestion and hunger. "You should have seen what came out of me!" exclaims one woman, referring to the black goo that emerged from her intestines during a colonic irrigation.

As they sip tea packed with parsley and cilantro for liver and kidney health, and stir individualized baggies of aloe vera, acidopholus and enzymes into cups before gulping them down as prescribed, Belen imparts some longer-term healthy-eating lessons: the uses of nut milk, the benefits of bread made of hemp and sprouted grains.

She encourages guests to drink a little asparagus water every day and tells them artichokes are the best food for the liver.

"If you do detox, and you don't go home and do changes, this is all totally useless," she says.

The smell of quinoa, brown rice and red lentils wafts through the air, and hungry guests file in for a dental-cupful of the grains and pulses, served with a driblet of parsley-cilantro-garlic sauce -- their first food in days.

Afterward, they drift languidly past the sculptures, labyrinths and pyramids that dot the We Care compound. One woman bounces on a tiny trampoline in the shade. She's preparing for her colonic: five minutes of jumping to loosen things up.

"I think the body stores toxins up in the body. It gets clogged," says 45-year-old Jenny Despras of Indian Wells, resting inside between treatments. "And here, you can get that out."

The old-fashioned way

The best way to get rid of man-made poisons is not to go through a detox but to stop exposure, toxicologists say. "The body is set up to reverse the process," Gandolfi says. "We have a system set up to secrete them out. It just takes time."

Of course, this may not be possible in the case of substances in food, which is where many of these chemicals come from. For example, many of the chemicals of concern lodge in animal fats and then lodge in fat in our own bodies. The best way to get rid of those chemicals is not to detox -- but lose weight.

"More slender people get rid of toxins faster than fat people," the EPA's Birnbaum says. "If you have more body fat, it's like you have a larger sink. There are more places for the chemicals to go."

If someone is committed to a detox, they should be sensible, says Dr. Mary Hardy, director of integrative medicine at the Ted Mann Family Resource Center at UCLA. Taking a break from processed foods could be helpful. Starving oneself for 40 days -- not so. She supports one-, two-, and three-day cleanses, but not if a patient is diabetic, hypertensive or has a history of anorexia.

And although many scientists and doctors doubt that a week or so of beets and husks and pills does much, they do see the potential for something bigger and better emerging from the exercise. The greatest gain from the current craze could be that people going through detoxes may stop and examine their lives and the way that they eat and live -- and make changes.

"When people come to me, part of it is to break bad habits," says Hangee-Bauer. "Maybe they are not getting enough water. Maybe they are constipated, feeling lousy, or eating the wrong kinds of foods. They want to do a detox diet to break their bad habits and get on a cleaner path."

Says Hardy: "If this is the beginning of a no-Twinkies, no junk food, whole food diet with lots of fruits and vegetables -- then great."

health@latimes.com

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