Do you need to do a detox? (Transcript)

Dr. Jen Gunter:
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George Washington spent December 12, 1799 overseeing his farms. It was an UGLY day -- wind, rain, hail, and snow. He came home wet, with “snow hanging upon his hair.” About a day later, he started feeling sick. His wife Martha observed that he could barely speak and had trouble breathing. He developed horrible throat pain and a fever. So his assistant sent for doctors.

Three doctors arrived and recommended a medical treatment that was common at the time….bloodletting. That’s the process of cutting open a vein to drain blood. At the time, they thought fever was related to a buildup of blood. If you have too much blood, you drain it to get back into balance.

George Washington went through 4 rounds of bloodletting that day. During one of them, a QUART of blood -- that’s a standard milk carton, not the skinny one! -- was removed from his body. Washington got worse and worse and worse…he died that night.

Even at the time, his doctors got some criticism for all the bloodletting and Martha Washington objected to it. But this was an accepted treatment. In fact, for THOUSANDS of years, medicine focused on GETTING THE BAD OUT. By bleeding or recommending medications that might make you vomit or sweat.

As we learned more, we realized bodies don’t need to be “cleansed” like this. So this idea -- of getting the bad out -- has been abandoned by medicine. But it lives on elsewhere, in the world of wellness...through cleanses and detoxes…

Cleanses and detoxes are like bloodletting 2.0! They’re based on the same old ideas. And they’ve added in a new twist -- that your organs need to be “supported” to deal with the “hazards” of everyday life.

These days, there are juice and smoothie cleanses, detoxifying teas, milk thistle supplements...there’s so much stuff like this out there! Social media influencers, celebrities, naturopaths, and even some physicians try to sell us all kinds of products like this. They tell us toxins build up in our bodies (like evil humors!), and we need to cleanse and detox regularly to flush them out! Makes sense...right?

Dr. Kaveh Hoda:
No. The only thing these cleanses and detoxes remove from your body is your money.

Dr. Jen Gunter:
I’m Dr. Jen Gunter. From the TED Audio Collective, this is Body Stuff.

Your body is amazing in so many ways. It protects you from viruses, turns food into fuel, gets rid of things you don’t need, and much, much more.

And your extraordinary body isn’t DIRTY inside!!! So you don’t need to CLEAN or “cleanse” it. In fact, cleaning is a really bad analogy for anything that’s going on inside our bodies.

Instead, think of your body as a finely tuned airplane, with sophisticated autopilot and multiple backup systems that work together to keep the plane in the air. Every organ does its part. And there’s one organ that’s an organizing and processing powerhouse...the liver. Liver doctors, like Dr. Kaveh Hoda, are called hepatologists...

Dr. Kaveh Hoda:
I understand it's not like the sexiest title in medicine. You know, like when we were in medical school and people were like, I'm going to be a pediatric cardiologist, I'm going to be a neurosurgeon. I'm going to be whatever it's like, no one was ever like, I'm going to be a hepatologist!

Dr. Jen Gunter:
The liver might not be considered the sexiest organ. But it’s very, very cool. The ancient Greeks were actually fascinated by the liver.

Dr. Kaveh Hoda:
Did you ever study Greek mythology?

Dr. Jen Gunter:
Oh yeah. Oh, Prometheus. We're all over that.

Dr. Kaveh Hoda:
Right. So the Titan Prometheus brought fire to the humans. And so Zeus chained him to this rock and he had either a vulture or an eagle come and peck out his liver. And every night, his liver would regenerate. Your liver, if it's not pushed too far, can regenerate. If part of it's taken out and put it into another person that part of the liver can expand and grow. So the liver is really cool like that.

Dr. Jen Gunter:
I’ve always thought of the liver as kind of mysterious. You can picture how a heart works because you’ve seen a pump. You can picture how a bladder works because you’ve seen something fill and empty. But the liver is like this mystical black box ...

Dr. Kaveh Hoda:
It's a big organ, weighs about three to four pounds. And it does so much for you. It's this incredible manufacturing, processing, and storage plant. It helps you with everything from glucose homeostasis to making sure your blood is clotting. And it helps you remove things from your body that you don't need or might be harmful.

Dr. Jen Gunter:
The liver performs OVER 500 vital functions for our bodies. It’s incredibly sophisticated and really good at its job. So all those ads for cleanses and detoxes are insulting to the brilliance of the liver!

Dr. Kaveh Hoda:
The challenge we deal with is the marketing of people who are trying to sell these detox or cleansing agents, they're much better at marketing it than us, because it's easier to say you have toxins building up in your blood! You have toxins building up in your colon! You need these cleanses to get them out. It's a lot harder to be like, okay, well here's actually what your liver is doing.

Dr. Jen Gunter:
One of your liver’s biggest jobs is sorting through your blood. The cells that do a lot of this work are called hepatocytes.

The liver gets blood from the arteries and also from the intestines through a vein called the portal vein.

Dr. Kaveh Hoda:
It looks over that stuff that comes through it. And if it finds something that looks like it's either waste or it might be toxic, it works to convert that to something that's safe or inert. And then it sends that substance off to your kidneys to be peed out, or it sends it to your intestines to be pooped out. So it's filtering things, changing things to make it suitable for your body and then finding a place to put it.

Dr. Jen Gunter:
Let’s walk through this with something a lot of people associate with the liver, alcohol. Alcohol is toxic. It can’t just linger in your body. It has to be broken down into something else. When you drink alcohol, it ends up in your blood, and then in your liver.

The liver treats anything that needs to be broken down like it’s a LEGO structure… it splits it up into smaller building blocks, in a few chemical steps.

Dr. Kaveh Hoda:
The first step is the alcohol goes through some oxidization from an enzyme called alcohol dehydrogenase, and it becomes something called acetaldehyde. One thing to note is sometimes in this process, the breakdown of those little pieces, you can have one that's not good for you. So acetaldehyde is one of those pieces that's not good for you. And that gets broken down further by another enzyme, which forms acetate.

Dr. Jen Gunter:
Acetate is then broken down even further into carbon dioxide and water. Which you can breathe and pee out! The liver took something that’s harmful and in a few steps broke it down into something you can safely clear out of your body! And here’s another cool thing about our liver -- we all have different variations of the liver enzymes that break things down. Those variations can affect how we respond to alcohol...

Dr. Kaveh Hoda:
If for example, you don't have enough of one of the enzymes, you get a buildup of the acetaldehyde. That is the thing that gives you those symptoms of being hungover -- the flushing, the headache.

Dr. Jen Gunter:
So what about hangover cures then? Are any of those real?

Dr. Kaveh Hoda:
No, no. Not that I know of. Although I personally think that like, you know, getting a big, greasy breakfast always tastes good the morning after there's no real evidence to prove that it helps you in any way.

Dr. Jen Gunter:
The liver breaks down other things in your blood, too, like medications...

Dr. Kaveh Hoda:
Everything you take goes through your liver and goes through this process that's pretty intense and very efficient at finding anything that might be a problem and changing it to something that is not.

Dr. Jen Gunter:
There ARE things your liver can’t handle. Like excessive alcohol, or poisons like arsenic or lead. In that case, you need a real, medical detoxification.

Dr. Kaveh Hoda:
You might need dialysis. You might need a chelating agent. You might need some other medications to counteract it. You'll definitely need something from a real medical source, not some over the counter pill or something sold by a TV celebrity online. It's going to have to be something in a medical setting to remove it at that point.

Dr. Jen Gunter:
If your mighty liver stops working, there’s no machine that can do its job.

Dr. Kaveh Hoda:
All those things that we talked about it doing all that manufacturing, all that processing, all that stuff it’s doing -- filtering the blood. It's no longer doing that. And then your body will fail. And unfortunately, the really only thing that you can do at that point, if you're having acute liver failure is liver transplant and that's not an easy surgery. It's not an easy ask. It's a big deal.

Dr. Jen Gunter:
The cleanses that celebrities and influencers tell you to try...they don’t do ANYTHING for your liver! Take the so-called “master cleanse” -- which is only having a concoction of lemon juice, maple syrup, cayenne pepper, and water.

Dr. Kaveh Hoda:
Sounds like most of what they're taking is water and of little nutritional value. And it sounds like probably more sugar than you need, probably not the kind of thing that we would recommend. I mean, cayenne pepper can actually irritate the GI tract and potentially even cause diarrhea for some people. So it’s not helping you.

Dr. Jen Gunter:
Then what do you think the liver does with cayenne pepper?

Dr. Kaveh Hoda:
It probably breaks it down the same way it breaks everything else down.

Dr. Jen Gunter:
I imagine these hepatocytes getting this, like cayenne pepper going, “puh! Another attempt. You insult our mastery!”

Dr. Jen Gunter:
Cleanses basically put you on an unbalanced diet, which is not good for your body! Some cleanses can even be dangerous.

Dr. Kaveh Hoda:
When they look at some of these cleanses that are sold and they look at some of these pills, like these detox teas, they actually find ingredients in there that are bad for your liver.

Dr. Jen Gunter:
And some kinds of COLON cleanses can cause really serious damage.

Dr. Kaveh Hoda:
It leads to more problems than it will ever help in cases of cramping, diarrhea, vomiting, really serious outcomes are things like a perforated bowel or infections. And if you have underlying kidney or heart problems, you can get electrolyte imbalances that could be really dangerous. So again, those things are just unnecessary.

Dr. Jen Gunter:
Leave your liver alone! It does not need a cleanse or detox. Your hepatocytes know what they’re doing!

Dr. Kaveh Hoda:
I like this, the character, the hepatocyte character you developed. This is something you should run with.

Dr. Jen Gunter:
Like, I just imagine these hepatocytes being so...

Dr. Kaveh Hoda:
Angry all day?

Dr. Jen Gunter:
Like, do you not think that I can do my job because I can do my job? You know, I can do my job.

Dr. Kaveh Hoda:
I say give it an English accent. What is this rubbish? Get out of here!

Dr. Jen Gunter:
See, the liver is a total badass!

After the break, if cleanses don’t help our bodies, why have they been around for so long? Why is this myth so sticky?

Dr. Alan Levinovitz:
It is a way of helping people feel like they can return to that pure and natural state that was given to us by God, before we interfered with it. And of course you need to do it periodically, because these polluting elements are ever present in the world around us.

<AD BREAK>

Dr. Jen Gunter:
The aesthetic was West Coast spa, California chic...but in a large conference room overlooking New York City’s East River. There were stations of food and people offering something they called toxic-free manicures. There was even a doctor giving injections of vitamin B12 to people who were lined up as if they were taking communion.

Someone was handing out charcoal lemonade as a way to flush out toxins. I tried some and it tasted like what I imagine the swill on the floor of a spa would taste like. This conference was hosted by a popular wellness brand, founded by a celebrity.

I thought of this conference as a research trip -- I wanted to experience the lure of the marketing up close. When the celebrity founder arrived on the stage, she had the air of a preacher at a megachurch. They opened with “healing” music and our inner self was supposed to travel to the center of the world. It felt like an opening hymn at a religious service.

And all the speakers who came after her were like her apostles … We were introduced to a medium and two people who claimed to have come back from the dead -- one was a doctor. They said things like “God has pure healing energy,” “a deep spiritual journey can cure anything,” “spontaneous healing from cancer and infections can happen with love,” “you get sick because your life is not going in the right direction.”

We were told death is not real. And I looked around the room and realized I was essentially at a religious conference. Throughout the day, speakers kept talking about God and nature and spiritual forces to explain rules we should live by to be good, pure, clean, and natural....
I HAD to message my friend, Dr. Alan Levinovitz.

He’s a religious studies scholar, who specializes in classical Chinese thought… and he’s really interested in how religion and health overlap. A little while ago, he was studying Daoist monks.

Dr. Alan Levinovitz:
Some of the Daoist monks that I studied had all these elaborate dietary plans. There was a diet in which you banned the five grains, which are what most people ate. And they had proprietary supplements. And I was looking at these diets and I was thinking to myself, you know, this looks a lot like modern dietary restrictions today. And in the same way they would promise miraculous cures.

Dr. Jen Gunter:
After Dr. Levinovitz first noticed this, he started to see echoes of religious practices in other “wellness” trends.

For a long time, MEDICINE and religion were deeply intertwined. Powerful religious institutions like the Vatican funded hospitals. Illness was viewed as a sign of sin or evil.

Dr. Alan Levinovitz:
Part of what I want people to realize is that even though now we see the categories of religion and science or religion and medicine as very separate and institutionally they're very separate, for individuals that overlap never disappeared.

Dr. Jen Gunter:
I see this all the time…the wellness world is full of language with religious connotations. Take, for instance, the idea of a health “guru.”

Dr. Alan Levinovitz:
People that follow these gurus treat them the way you would treat someone who is infallible in a religious sense. And I think that's one of the things that I'm really interested in exploring. Why do we have that tendency and how can we stop ourselves from doing that? Because it can cause us to make terrible mistakes with our choices about medicine and health.

Dr. Jen Gunter:
So why do you think people do that?

Dr. Alan Levinovitz:
Well, my basic answer is that as human beings, we need simple rules, ways to sort the world that save us time and energy thinking.

Dr. Jen Gunter:
For example, when we go to the grocery store, we don’t want to examine every product we buy to figure out if it’s healthy or not. We want some simple rules: This is always healthy. This is always bad.

Dr. Alan Levinovitz:
And once we have those rules in place, we’ve freed up a bunch of cognitive space to think about other things. And, that makes a lot of sense. We can't just constantly be analyzing and reanalyzing and reanalyzing, but it also means that we're going to end up making mistakes.

Dr. Jen Gunter:
That’s because the world isn’t simple! But Dr. Levinovitz says if you’re looking for a guiding principle, try this one…be suspicious of miracle cures!

Dr. Alan Levinovitz:
If something is a panacea, if it's good for everything, perhaps it is not as good for those things, as you might think. And you see this frequently in alternative medicine -- the interventions that they have are not specific. They apply to virtually every illness, short of a broken leg.

Dr. Jen Gunter:
Dr. Levinovitz has noticed that one simple rule is particularly captivating to us -- NATURAL is always good. He has literally written an entire book, Natural, about the power of this one word.

Dr. Alan Levinovitz:
It wasn't just in the places you would expect it to crop up, natural medicine or natural food. I found people using the same word to reinforce the status quo in economic theory. For example, the idea that a natural market is the best market. And so if you interfere with the markets, artificially manipulating them, things will be bad.

Dr. Jen Gunter:
People are selective about how they use the word natural and what that means to them. Some people may want a “natural” remedy for a cold but not a “natural” dental filling or tooth extraction! This really shows the problem with the word -- it’s a chameleon. You can make many things sound natural or unnatural depending on how you frame them.

The word natural has a lot of power. And it’s had power for centuries, across many cultures … including in classical Chinese thought...

Dr. Alan Levinovitz:
The word that's typically translated as natural is ziran, which would mean self so or the way it is of itself. And I actually really like that word for illustrating why natural has been important across cultures. There's an idea that natural means uninterfered with, things that are so of themselves they were created by forces beyond and before humans. And of course the forces that come before humans are often divinized. And so naturalness has a kind of inherent divine purity associated with it because human artificiality, our art, our technology hasn't messed up the natural thing yet.

Dr. Jen Gunter:
Cleanses draw on other powerful religious concepts too. Like purification and hidden knowledge.

Dr. Alan Levinovitz:
Ayurvedic medicine, traditional Indian medicine. There are practices in which you sweat out toxins. And if you think about, Native American rituals and the sweat lodges, this was also thought of as a way of purifying yourself and it's not that these rituals are bad or wrong. It's that these wellness influencers try to yank the rituals out of their original religious slash philosophical context and say, “Oh no, no, no, no. These are just, this is actually a purifier. It's a medical ritual.” No, this is in essence, a religious ritual. And if you want to practice it as that, I think that's absolutely fine. What you can't do is pluck it out of its original context, rebrand it as natural medicine and, and sell it to your Instagram followers as "the cure that they don't want you to know."

Dr. Jen Gunter:
This is cultural appropriation, which makes this marketing even more troubling. And just like “natural” and “secret” are great marketing ploys…so is selling something as “ancient.”

AD CLIP:
“This ALL NATURAL Reishi mushroom cleanse was used by ancient Chinese civilizations for thousands of years…”

Dr. Jen Gunter:
There’s this idea that if something has been around for awhile, it must be good.

AD CLIPS:
“Purify yourself now with the power of a turmeric cleanse, used by Eastern cultures for millennia.”

“Detox with this ancient Aztec purity ritual… “

“Follow the ancient wisdom of Tibetan herdsmen with this juice cleanse…taken straight from the Himalayan Highlands.”

Dr. Alan Levinovitz:
There's the sense that as history moves forward, you're playing a game of telephone and the original message gets corrupted. And so that ancient fallacy is related to the desire to want to have the pure original version of something.

Dr. Jen Gunter:
When you think about all these powerful concepts that cleanses draw upon, it makes sense that this myth has stuck around for so long -- even after medicine moved away from using bloodletting and purging to get rid of “toxins.”

It makes sense that so many of us find cleanses and detoxes appealing. What I want you to remember, though, is that MARKETING buzzwords like naturalness and purity, are not scientific or medical. Even if they claim to be ...

Dr. Jen Gunter:
So [Dr. Alan Levinovitz], what would you tell someone who wants to embark on a cleanse or a detox or thinking of doing one? Would you have any thoughts you would want them to run through?

Dr. Alan Levinovitz:
I would want them to reflect on why they're doing it, the authority on which they're doing it and, and what they expect to get from it. If these rituals reinforce some kind of ideal of purity, I want people to really reflect on how that in the long term might end up making them less happy. There's no such thing as purity and wanting to be pure is ever and always going to be a frustrating goal.

Dr. Jen Gunter:
I think it’s really important to point out that people are lured down these rabbit holes of misinformation. Medical problems are really complex and often doctors don’t do a good job of explaining them...Or people don’t have access to the kind of treatment they need...And sometimes not every medical condition has a treatment.

So there ARE gaps in medicine, and people will take advantage of that to sell us scams.

My two boys were born prematurely and they had a lot of health problems as babies. One son had a serious heart defect, and the other had cerebral palsy. And these were things that could be made better with treatment but not cured. I’m a doctor, but after my sons were born, I was really just a parent with two struggling kids. And I did what a lot of parents do in that situation...I scoured the Internet for answers.

I found a clinic that offered stem cell transplants as a cure for both heart conditions and cerebral palsy, two completely different conditions that are in no way treated the same. That should have been my red flag! But I wanted to help my sons. I was desperate.

Instead of emptying my bank account, I used my medical knowledge and connections to track down an expert. He said it was still an UNPROVEN therapy. The way he said it made me realize what I was seeing online was stem cell tourism with tempting anecdotes, bold claims, and a slick website.

I just needed someone to hear my pain and suffering, acknowledge it, and then explain the truth in a way that I could hear. But most people don’t have the connections I have to find an expert health concierge. So they’re left grappling with these complex health problems -- and people selling products capitalize on that.

They know it’s hard to explain how our liver works...so it’s easy for them to say that toxins are building up in your body and you need to try the cleanse they’re promoting. And they know they can draw on all these powerful concepts from religion and history to entice us.

CLEANSES aren’t going to help your liver, and they might even hurt it. But there are things you can do to keep your liver healthy. Here’s our hepatologist, Dr. Hoda again....

Dr. Kaveh Hoda:
It's the boring stuff: eat well, eat a diet that's high in fiber and low in sugars and low in processed foods. If you do that and you get your recommended amount of exercise, you're going to put your liver in the best shape it could possibly be to do everything that it needs to do for you for the rest of your life.

Dr. Jen Gunter:
No scammy products! Just taking care of yourself! Dr. Hoda says keeping your diet low in added sugar is especially important for your liver.

Dr. Kaveh Hoda:
Once you reach certain levels of sugar, then your liver starts to store those things. It starts to say, okay, we need to store this in case we ever need it in the future. And it stores it as fat in your liver. We don't have great treatments for fatty liver yet. And we're seeing more cases of severe scarring or cirrhosis caused because of fatty liver disease.

Dr. Jen Gunter:
Something else you should watch out for -- and this one’s probably not a surprise to you -- drinking a lot of alcohol...

Dr. Kaveh Hoda:
There's the acute effect, you can develop inflammation or hepatitis of the liver and that's called alcoholic hepatitis, and that can be dangerous and that can make people very sick. And then chronic use leads to chronic inflammation. Chronic inflammation leads to scarring. Scarring can happen over so much time that it can become cirrhotic. Completely scarred. And when that happens like we mentioned before it can’t regenerate, it can't fix itself even if you stop drinking. And then you might need a transplant as well.

Dr. Jen Gunter:
You might be surprised to learn that supplements can be really dangerous for your liver too. They cause TWENTY PERCENT of medication-related livery injury in the United States. Dr. Hoda has seen many patients who’ve come in with liver problems caused by supplements.

Dr. Kaveh Hoda:
Oftentimes it was just supplements that people took that were billed as healthy like some sort of tea, herbal extract, something they got from a herbalist. Sometimes it was some sort of powder supplement that people took to help them work out more, to get them more protein and more bulk. All of them shared the same basic principle, which is some untested health product that people took to improve their lives in some way.

Dr. Jen Gunter:
If you’re taking supplements, tell your doctor! And one last proactive way to actually help your liver out...get the vaccine for Hepatitis B, a virus that can damage your liver.

The liver is an incredibly complex organ. But as with other parts of your body -- your skin, your bones, your immune system -- even understanding the basics is empowering. It gives us the information we need to navigate a world where so much of the health information we get comes from people selling us stuff.

Remember, your body is an evolutionary marvel. Healthy organs don’t need help. And if something feels off or you have symptoms, talk to a medical professional! Don’t turn to “wellness gurus,” celebrities, or marketers.

If you’re looking for a couple of simple rules for staying healthy, they’re -- exercise, a balanced diet with lots of fiber, sleep, getting vaccinated, and avoiding smoking and excessive drinking. I know this may make you roll your eyes. I get it! But these things provide huge benefits for your body! And it all adds up! (Remember, a beach is made from grains of sand.)

Your body, from your kidneys to your colon to your brain to your liver, is intricate, wonderful, and awe-inspiring. It doesn’t need a boost or a super food or a cleanse. But maybe your body does need a splashy marketing campaign, so … Spread the word to the people in your life. Spread the power of real medical information.

Body Stuff is a member of the TED Audio Collective. It’s hosted by me, Dr. Jen Gunter, and brought to you by TED and Transmitter Media. This episode was produced by Camille Petersen and edited by Sara Nics and Lacy Roberts. The rest of the team includes Alice Wilder, Gretta Cohn, Michelle Quint, Banban Cheng, Roxanne Hai Lash, Ama Adi-Dako, Valentina Bojanini, Sammy Case, Micah Eames, Nicole Edine, Will Hennessy, Jen Michalski, Anna Phelan, Alex Segell, Emma Taubner, Peter Zweifel, Mike Femia, Casey Walter, and Sarah Jane Souther. Alex Overington is our sound designer and mix engineer. Krystian Aparta and Neeraja Aravindan are our fact checkers.

And special thanks to Meade Bernard, Katie Green, and Max Savage Levenson.

Dr. Kaveh Hoda:
My new cartoon I'm producing for kids...it's about the liver.

Dr. Jen Gunter:
[laughs] What's it going to be about, uh, Lucy the Liver or…?

Dr. Kaveh Hoda:
Oh God. Lucy the Liver and her sidekick, Gary the Gallbladder. And they're going to go off on these little adventures and then Gary the Gallbladder is always going to be forming these gallstones that he's not supposed to be doing with the bile that Lucy the liver gives him and hijinks will ensue. It'll be hilarious.

Dr. Jen Gunter:
I like it. And then he'll like, he can throw the gallstones at people if people are bad to him.

Dr. Kaveh Hoda:
Oh, there you go.