Written by
Dr. Tanis Fenton RD, PhD - Dietitian, Epidemiologist and PEN® Evidence Analyst
University of Calgary and PEN® Canada
Responding to Misleading Nutrition Info in a Lay Publication via a Letter to the Editor, a case study:
Reading a health column in Reader’s Digest (Canada), a popular health and lifestyle magazine sold in grocery stores, I saw recommendations for cleansing. They suggested reducing food intake to a minimum, and relying on juices only for up to 8 days, to gain the benefits of reduced “exposure to toxins and allow certain organs, such as the liver, to rejuvenate” (April 2013). There were 3 authors to the article, a yoga instructor whom provided quite reasonable advice, a medical doctor, and a Nutritionist, the latter two whose responses were concerning.
The statements that concerned me included these by Zotlan Rona MD: “A cleanse or an elimination diet … both can reduce exposure to toxins and allow certain organs, such as the liver, to rejuvenate. Some doctors recommend cleanses to boost energy while elimination diets are used to diagnose allergies and bring down inflammation. Other benefits include improved vision, hearing and taste; better sleep; and anti-aging effects. I like a one-day or, if you have some time off, an eight-day juice fast using most mostly vegetable juices. Detoxifying is safe and effective for most healthy people”
Also concerning me was the statement from the Nutritionist, Julie Daniluk: “Cleanses can flush toxic chemicals, such as pesticides and insecticides found in foods, from your system….” She made some statements that I could agree with: “I prefer to avoid extreme programs that suggest low-calorie fasting (such as the Master Cleanse) or strict juice fasts that only fruits, vegetables, and low-fat soups: these can slow your metabolism and cause fatigue.” But then she went on to say: “A much safer approach is a balanced elimination diet that avoids common allergens and toxins to reduce inflammation and boost vitality. Giving your digestive and immune systems a rest – I recommend eight weeks –from gluten, dyes, preservatives, dairy, potatoes, peanuts and refined sugar helps heal inflammatory conditions such as arthritis, asthma, and skin and bowel conditions, and can help energy levels to soar”.
Wondering if there was new science that I was not aware of, I went off to do some more reading on cleanses. I found that there is no good evidence in MedLine to support any of these claims. Of concern, some of their suggestions are potentially health damaging. I have had personal experience with the downsides of cleanses as a relative of mine had a seizure during a cleanse, due to hyponatremia. She was in intensive care on a ventilator for 3 days. A very similar case in England ended up with brain damage after being advised to follow a detoxifying diet by a “nutritionist” (1). I decided to write to the Reader’s Digest Editor to clarify the information presented to the reader.
While going for a walk, I thought of some wording I would use to approach this. I discussed it with first one colleague (my daughter, a Medical student) and she suggested some more wording ideas. Then I sent my draft to a respected colleague, who further encouraged me. The letter was ready to submit.
My letter was published in the July 2013 issue of the magazine:
“Cleansing is: celebrity endorsed, heavily promoted, and is becoming big business.
There is no need to give your digestive system a rest, since your body eliminates best when given enough fibre from wholegrains, vegetables, and fruit daily. The foods listed as causing inflammation do not cause problems unless someone has a specific allergy or intolerance to the food.
There is no evidence that anything can help remove pesticides from our bodies. Your Nutritionist was correct that low calorie fasting or juice cleansing can slow metabolism and cause fatigue.”
Three parts that were not published from my submitted letter included:
- “Cleansing is not evidence-based: no studies document any benefits from cleansing.
- Your body needs about 0.8 grams of protein per kilogram each day, which for an average woman would be around 45 grams of protein per day. If her daily protein intake is below her daily requirement, her body will meet that need by breaking down muscle.
- The only licensed nutrition professionals in Canada are designated as Registered Dietitians or Registered Nutritionists. “
The magazine’s Editor responded beside my published letter:
As you correctly point out, the benefits of cleansing are based on anecdotal claims, not evidence from controlled peer-reviewed studies. Even so, most experts agree that avoiding highly processed foods and common allergens over a short period of time is not a bad idea. (It may also help one to discover previously unconfirmed food allergies.) The more extreme versions of cleansing diets can have adverse effects, though, so you’re right to remind us to continue consuming sufficient calories and nutrients to meet our needs.
Basically the Editor, in consultation with his or her “experts” agreed with most of our points. I was glad that I had not worded my letter too strongly, had not attacked their “experts”, and that I pointed out an aspect of the Nutritionist’s letter that I could agree to. These factors may have helped the Editor to decide to publish my letter and to agree with most of our points. Overall, I feel that I achieved what I hoped to do: provide Reader’s Digest readers with the point that “cleansing” is not a necessary or healthy thing to do.
Dietitians should not be afraid to challenge published information when it is misleading, but critical to your response is to be factual, provide the evidence or indicate the lack of, and be professional in your approach.
Dietitians need to meet people where they are at. The word “cleanse” can mean very different things to people, ranging from decreasing processed and refined foods, to eliminating all foods except juices, to fasting, to using the various “cleansing” products sold in drug and health food stores. When a client you encounter is interested in a cleanse, perhaps a way to start is to congratulate them for taking an interest in their health. Clients may answer with anecdotal claims of improvement, and if they had been eating a diet rich in processed foods, one would expect feeling better when improving their diets by focusing on vegetables, whole grains, fruit, lean protein, etc. Even though we don’t recommend “cleanses”, many people do believe in them. So, let us be the bridge back to healthy eating.
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