A well-designed health plan

PHOTO: A well-designed health plan

In the previous article, we touched on myths surrounding "detox", a concept that suggests some sort of purging of toxic wastes in the body.

Apart from the ocean of websites promoting various detox regimens, volumes of books written by an assortment of individuals on the subject can easily fill a library. Conversely, mainstream peer review scientific journals reporting benefits are scant.

Why, then, do people embark on punitive diets lasting from a few days to weeks? In some segments of society, intermittent fasting is a socio-cultural and religious practice. Others may be seeking a quick fix to lose that bulge in quick time. Celebrities on talk shows can start off a craze, after losing 21 pounds in 21 days! Beyonce Knowles did just that on Oprah.

After every new year, short-lived resolutions lead to a spurt in the sales of yoghurt, health supplements, organic foods, and of course, the various detox regimens in town.

Almost all detox regimens are touted to flush the body of toxins, cleanse the gut, restore the immune system, deflate the bulge and ward off ill health. The marketplace is teeming with trendy fads such as the lemonade cleanse, the liver flush, the juice fast and myriad other potentially hazardous protocols.

The evidence-based guys say that there is no proof of effectiveness, and in many instances, can cause more harm than good.

Before we give marks to either group, let us just revisit simple physiology.

Physiology 101

The intestinal system is a complex highway with many routes leading to digestion, absorption, detoxification and elimination of metabolic discards.

Intestinal health also hinges on adequate digestive enzymes, balanced with a healthy population of good bugs (bacteria). The cells lining the route are also of paramount importance as they decide what to let in.

The "leaky gut syndrome" is thought to be a disorder in the integrity of the lining, leading to malabsorption of incompletely digested fragments, thereby affecting the immune system.

At the risk of oversimplification, optimal health cannot be achieved when the intestines are in a state of "dys-ease". The incessant bloating, belching, heartburn, flatulence, disturbed bowel habits, noisy and restless tummy reflects poor gut health.

Cleaning up the gut with laxatives, enemas and colonic flushes are the requisite preparations for a "good view" during instrumentation (passage of various scopes) and surgery. However, mechanically cleansing the intestines cannot guarantee gut health.

Paradoxically, most detox regimens, in one way or another, involve cleansing or flushing the gut of toxins.

Despite ongoing debate of the purported risks and benefits of the "royal flush", a compromise lies in the realm of common sense.

The science behind detox is weak but that does not mean that there are no benefits. For those who must overhaul their engines, avoid DIY or hearsay detox, but follow a guided and safe programme that should be overseen by a health professional who appreciates nutrition.

A detoxification programme need not be punitive. However, beware the dangers and pitfalls.


Dangers and pitfalls

Almost all detox regimens involve calorie reduction; it is unsafe to dip below 1,500 kcal in men and 1,200 kCal in women over prolonged periods. If intake is restricted to lemons, vegetable juices, teas and "finished off" with laxatives, we run the risk of nutrient insufficiency, and electrolyte and fluid imbalance, not to mention a sore bottom from frequent visits to the loo.

Exercise and nocturnal activities are necessarily tailored down as there is hardly enough energy to sustain normal bodily functions. Harsh regimens should not be practised for extended periods as the body's system is pushed into reserve mode (starvation), where secondary sources of fuel like fats and proteins are broken down, leading to an acidic state known as ketosis.

The duration of restrictive diets (below 1,000kcal per day) should not exceed five days at most. Drastic fasting should be avoided in children, during pregnancy and lactation, the elderly, and those suffering from chronic illnesses like diabetes and heart disease.

A safe plan

A well-designed, physiological and safe calorie reduction programme can kickstart the new year resolution and carry forth a healthy lifestyle change. Such a regimen should not be taken as a crash diet for rapid weight loss, for such programmes almost always fail, invariably putting on more than was lost, in rebound.

A dietary change helps to overcome food addiction, especially cravings for carbohydrates. This ultimately resets the metabolic path.

1. Set the calories at a level sufficient to safely meet basal metabolic rate (minimum level of caloric intake needed to sustain life at rest), hovering not below 1,000kcal/day. The physiological metabolic demands of the human vehicle is 50% to 60% of calories from carbohydrates for primary source of fuel, 15% to 20% from proteins for "spare parts" (e.g. making enzymes, hormones and building muscles) and 20% to 25% from fats (storage for emergency use).

It is prudent not to veer too far from this ratio to ensure smooth running of the machinery. Measuring the exact calories from a balanced diet is a feat that is difficult to execute. An alternative is to scout for a replacement meal or shake that meets the above caloric and nutrient criteria.

2. Avoid prolonged periods of caloric deficits as above, ideally not more than five days.

3. Take at least five to six servings of fruits and vegetables, bearing in mind that each is 50 to 60 calories only.

4. Drink at least 2.5 or more litres of water.

5. A balanced combination of soluble and insoluble fibre (at least 25-30g/day) aids bowel propulsion and elimination of wastes.

6. Supplementation with a broad spectrum of essential vitamins, antioxidants and minerals support the liver's detoxification processes (by enhancing phase 1 and phase 2 enzyme systems) and avoid insufficiency of micronutrients.

7. Adding on specific strains of probiotics replenishes the healthy gut flora, aiding digestion, absorption and overall gut health.

8. Specific foods like garlic, cruciferous greens (e.g. broccoli, sprouts), and green pepper and curcumin (tumeric) also enhances the detoxification pathway.


The detox reaction

There are often reports of vague symptoms ranging from headaches, irritability and fatigue to bloating and diarrhoea during the detox or cleansing process. This reaction is popularly known as a healing crisis.

As a simple analogy, when one is suddenly subjected to unaccustomed intense exercises, the aches and pains come calling the following days. During a detox fast, mobilised toxins purportedly build up and are not eliminated rapidly enough, thereby causing some flu-like symptoms.

A similar reaction known as the "Herx­heimer" phenomenon is noted in the treatment of certain infections like syphilis, where such symptoms follow penicillin injections, as toxins of bacterial breakdown flood the circulation. A detox reaction is usually short-lived but if it persists or progresses, it could mean some other coincidental trouble and the programme may have to be stopped, and professional advice sought.

The results of such a five-day detox can cause weight loss, ranging from minute to an impressive drop, depending on compliance and the level of obesity to start off with. A large proportion is, however, fluid loss rather than real fat loss.

Unfortunately, many return to old habits, nullifying the hard work and efforts of the reset programme.

A minority are able to transform themselves at the next stage with a less stringent follow-up diet plan. Fewer still actually reach the goal (i.e. 10% weight loss, reduced blood pressure, reduced insulin resistance, improved lipid profile), but if they do, there is a good chance that these participants are able to maintain the "new you" in the long term.

The book entitled Healthy For Life (by Dr Ray Strand) promotes such a healthy lifestyle plan that has a side effect ... of permanent weight loss!

Metabolic chaos is often the result of poor traffic control at our oral gateway, surrendering to indulgence. The liver is the most burdened organ in our body. Apart from multitasking over 500 functions, it is also bludgeoned to submission by unreasonable overtime and pervasive job demands.

Detoxification is a cellular process that occurs at any instance and the powerhouse of cleansing is in this vital organ. Instead of sporadic and drastic spring-cleaning, practising a healthy lifestyle aids the body's miraculous natural detox process at any one time.

By being conscious, aware and doing the right things, we can succeed in consistent moderation instead of failing in punitive extremes.

Dr C.S. Foo is a medical practitioner. For more information, e-mail starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice.

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