Detox

New Year's Resolutions Worth Making: Week 1 - Sleep

The decision to embark on a New Year’s Detox is a frothy mix of nonsense and lunacy. I discuss why that is – at length – here. The TL: DR version: It’s not a real thing and will do you actual, quantifiable harm. If you want to make a manageable, sustainable improvement in your physical health this year you would be much better off taking 10,000 steps per day (1-2) and maybe delaying your breakfast by a couple of hours(3). So, for those of you who are sufficiently convinced that a ‘detox’ is a giant waste of time, energy and life I offer an alternative health resolution. I’ve compiled a list of the top five things you can do to improve your brain function and mental wellbeing in 2017 (based on non-frothy science) because there is no health without mental health. The fantastic five are: Sleep, diet/nutrition, rest/meditation, exercise, and learning. I was originally planning on creating a top ten but small, incremental changes are the ones most likely to stick so get these under your belt and you will be well on the way to a happier, healthier 2017.

Sleep

There’s supposed to be something very impressive about getting by with very little sleep. We hear urban legends about highly successful people who require only four or five hours per night. They are described as ‘superhuman’ rather than just ‘different’. Corporate law firms and big banks provide beds in their buildings and newly-qualified and graduate trainees fight it out to demonstrate how productive they can be, how much sleep deprivation they can tolerate.

But there is nothing big or clever about surviving on very little sleep. For people who are not natural short-sleepers (and maybe only 2% of the population are) poor and disturbed sleep is a serious problem. The American Centre for Disease Control and Prevention describes insufficient sleep as an ‘important public health concern’(4). According to a recent YouGov poll only half of people are happy with the amount of sleep that they get(5). Psychologically, we know that poor sleep:

  • Increases risk of depression
  • Impairs decision making, including around risk
  • Makes you more easily distracted
  • Makes you less able to adapt to a situation/adopt new strategies that might be more appropriate to the situation
  • Impairs communication and language skills
  • Makes you less able to control mood/impairs mood stability
  • Impairs insight

It has serious consequences for physical health too and poor sleep is associated with increased risk of obesity and heart disease(6).

For a long time disturbed sleep was seen just as a symptom of depression but more recently researchers have been looking at poor sleep as a causal factor in depressive illness(7-8). This perspective presents us with the opportunity to target sleep disorders as a treatment for depression. So, what can you do?

  • Keep cool – Cooling body temperature is a physiological indicator that it will soon be time to sleep. If your room or bed are very hot this can make it harder to drop off and impair sleep quality (think of those hot summer nights). Use the right tog duvet for the season, and use a quiet fan if you need to. You can also promote this sleep-inducing effect by taking a warm bath about an hour before bed, the cooling of the body once you step out of the bath can help to promote sleep.
  • Step in to the light - We all have a natural sleep-wake cycle that coordinates – based on light-exposure – to the 24hr day/night cycle. This is part of the circadian rhythm. Left to its own devices this cycle can drift slightly; it needs light at the right times of day to stay 'anchored'. Try to get at least 30 minutes of bright daylight in the morning or at lunchtime. A half hour walk after lunch is perfect if you can manage it.
  • Hack your ultradian rhythm - As well as the 24hr rhythm you also have a shorter, 90 min cycle clicking over throughout the day, your ultradian rhythm, and tracking this can help you to identify when is the best time for you to go to bed. The ultradian rhythm is remarkably consistent making it a very useful measure and you can track it by timing your yawns. See the image on this page. At the peak of the wave you are at your most alert and this is a great time to work through your to-do list or focus on a challenging problem. 45 minutes later you are at the trough of the wave, at your most sleepy and most likely to yawn. So, if I yawn at 7pm but it’s too early for me to go to bed, I know that I am likely to be most sleepy again at 8.30pm, 10pm and 11.30pm. I might plan, then to be in bed by 10pm or 11.30pm in order to get to sleep quickly.
  • Put down your phone – Smartphones, tablets and computer screens emit blue light. This is the same wavelength as dawn light, and this is received by the suprachiasmatic nucleus (the brain region responsible for controlling the circadian rhythm) as a message that it is time to wake up, be alert and get active. Try to avoid using these devices for at least 60 minutes before heading to bed, or, if you absolutely must, download an app that can help to filter out the blue light.
  • Make sure the room is as dark and quiet as possible (unless that freaks you out). Think about using eye masks, blackout curtains and ear plugs if you live in or near a noisy environment.
  • Avoid alcohol before bedtime – Although it can promote the initial falling asleep, alcohol disturbs the quality of sleep, preventing your brain from entering the deeper sleep stages.
  • Try not to drink too much before going to bed – I mean just normal drinks here. It seems obvious but a lot of people underestimate how detrimental midnight trips to the loo are to a good night’s sleep. Have a bottle of water by your bedside so you can rehydrate in morning.

Also, remember that here is no magic number. The right amount of sleep is the amount that is enough for you, for you not to feel excessively sleepy during the day. That might be seven hours, that might be nine, we all have different sleep needs. So, work out what is right for you and try to achieve that more often than not.

Next week, the effect of nutrition on brain function. Until then, wishing you a very restful night.

Kx

 

References

  1. Yuenyongchaiyat, K. (2016). Effects of 10,000 steps a day on physical and mental health in overweight participants in a community setting: A preliminary study. Brazilian Journal of Physical Therapy.
  2. Castres, I., Tourny, C., Lemaitre, F. & Coquart., J. (2016). Impact of a walking program of 10,000 steps per day and dietary counseling on health-related quality of life, energy expenditure and anthropometric parameters in obese subjects. Journl of Endocrinological Investgation, DOI: 10.1007/s40618-016-0530-9.
  3. Horne, BD., Muhlestein, J. B. & Anderson, J. L. (2015). Health effects on intermittent fasting: hormesis or harm? A systematic review. American Journal of Clinical Nutrition, 102, 464-470.
  4. https://www.cdc.gov/features/dssleep/
  5. http://cdn.yougov.com/cumulus_uploads/document/bt915di765/YG-Archive-140520-Sleep.pdf
  6. Kecklund, G. & Axelsson, J. (2016). Health consequences of shift work and poor sleep. British Journal of Medicine, 355, i5210.
  7. Chen, Y., Keller, J. K., Kang, J., Hsieh, H. & Lin, H. (2013). Obstructive sleep apnea and subsequent risk of depressive disorder: A population-based follow up study. Journal of Clinical Sleep Medicine, 15, 417-423.
  8. Roberts, R. E. & Duong, H. T. (2014). The prospective association between sleep deprivation and depression in adolescents. Sleep, 37, 239-244. 

What’s wrong with the New Year Detox? Well, pretty much everything.

 

First published 31 Dec 2015

It’s coming to the end of the Dead Zone, those few structureless days between Christmas and New Year’s where there are no rules. Nobody knows what day it is or what to do (is it still okay to eat mince pies?) We’re off work but there’s nowhere to go because we’re all broke from festive fiscal excess. And that’s not the only extravagance we are left to contemplate. Three solid weeks of unabashed eating, drinking and being merry have left most of us with a little more abdominal insulation than seems fair – we were having such a good time. Now we have a few long days to rub our bellies in forlorn resignation, lamenting our gustatory largesse and making heartfelt, if vague, promises to put it right on the first Monday in January. So, it’s less of a ‘Dead Zone’ and more a kind of alimentary purgatory where the already devoured sins are weighed up against the promises to repent.

Repentance comes in the most puritanical of forms, the January Detox, a month of mass mania and ritual self-flagellation. Bodies are pounded on pavements and vile-tasting shots of medicinal herbs are downed in order for the body to be cleansed. This annual penance for the sins of December results in maybe a few pounds temporarily lost but comes at the cost of a month of your life spent in constant self-loathing, misery and deprivation. This is clearly no way to live but it has become a Hunger Game that we play with ourselves, goaded on by the innumerable media outlets and self-styled gurus looking to cash in on this most harmful annual custom. And it certainly is harmful, both physically and psychologically, and it’s about time that we stopped.

There are so many fundamental problems with the January Detox that, like a chocolate orange, it is better to break it down into chunks.

The Science Problem

The first of many problems with the January Detox is the one that is the easiest to expose: it has absolutely no scientific basis. Unless you are addicted to heroin or have been licking lead pipes and require medical intervention detoxing is not a thing. Year after year doctors and science writers valiantly debunk the myth that your body needs the assistance of juices, gels, patches, enemas, or celebrity endorsed magic water to eliminate waste products. They say things like this:

“Let’s be clear,” says Edzard Ernst, emeritus professor of complementary medicine at Exeter University, “there are two types of detox: one is respectable and the other isn’t.” The respectable one, he says, is the medical treatment of people with life-threatening drug addictions. “The other is the word being hijacked by entrepreneurs, quacks and charlatans to sell a bogus treatment that allegedly detoxifies your body of toxins you’re supposed to have accumulated.”– The Guardian, December 2014 (1)

They present reviews of the available literature and conclude: “To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans.” (2) That is to say that there is no good quality evidence that any of this stuff works. Or just ‘no evidence’.

We are reminded that no two manufacturers of detox products or purveyors of detox diets can agree on what a toxin is but we blithely trundle on in the pursuit of purity presumably because the idea of a ‘detox’ performs a wholly different function to the reality of it. I’ll get to that in a bit.

As with many other illusions that we like to keep hold of in the face of objective scrutiny (and we all do at times) the wealth of contradictory evidence is casually dismissed in favour of specious subjective experience. During the annual purge detoxers report experiencing symptoms such as bodily aches, brain fog, cravings, acne, poor sleep and digestive problems all of which are referenced on health and weight loss websites as being signs that you are detoxifying (hoorah!). All of which can be more credibly attributed to inadequate caloric intake and a sudden change in diet (oh, wait…).

But, no big deal, right? So maybe it doesn’t technically do anything, there’s no harm done and maybe it will kick-start some healthy changes, yeah? Um..no.

The Sustainability Problem

This is where it gets a bit technical (*dusts off A-level biology textbook*). The reason that diets of this kind are indicated for short periods of time is because they are inherently unsustainable. When you drastically reduce your caloric intake below basal metabolic rate (the amount needed to keep the organ systems ticking over) it doesn’t take long for the body to glean that there is something drastically wrong. After about 2-3 days the body’s glycogen (sugar) stores are depleted and metabolism switches to using fat as fuel and the production of ketones that the brain can use for energy. There is still, though, a small sugar requirement. In the absence of dietary carbohydrates these missing sugars are synthesised from the body’s own proteins. The body will begin to break down lean tissue (muscle and organs) because ‘the first priority of metabolism in starvation is to provide sufficient glucose to the brain…Initial sources of protein are those that turn over rapidly, such as proteins of the intestinal epithelium. (3) It is worth knowing then that the cells that line the intestine create a barrier between the contents of the gut (including pathogens) and the rest of the body. Damage to this lining impairs the immune system and exacerbates digestive disorders such as IBS and Ulcerative Colitis (4). In the long term very low calorie diets can cause serious damage to the organs and this is the reason that Anorexia Nervosa is the most deadly psychiatric condition, with death often caused by heart or kidney failure.

Of course I’m not talking here about chronic psychiatric conditions. A detox is only a month, maybe six weeks so the risks of long term damage are low. Except they’re not. A study published in 2011 (5) looked at the long-term effects of short term ‘very-low-energy’ (500-550 calories per day) diets. A year after completing the 8 week diet:

  • Levels of leptin, the hormone responsible for feelings of satiety, were significantly lower than at the start of the study

  • Levels of ghrelin, the ‘hunger hormone’ were significantly higher

  • Peptide YY, an appetite suppressor, was lower

  • Self-reported ratings of hunger, desire for food and urge to eat were higher as were preoccupations with food thoughts

  • Participants expended less energy and felt less full.

So brief exposure to a very low calorie diet resulted in long-term hormonal changes that left the dieters hungrier and more obsessed with food than they had been at the start, increased the likelihood of subsequent weight gain and made it harder to lose the next time. The particular cruelty of this situation is that dieters who regain weight (and 90% of all dieters do) will believe – or worse, be told – that it was their lack of control or the failure of their willpower that is to blame, not the powerful biological adaptations to starvation that were set in motion by the diet/detox in the first place. It is a pernicious lie and it makes me angry. Throw the sense of total failure in to the pot with the misery of feeling hungry and deprived the whole time and the fact that this is no long-term solution becomes self-evident.

The irony is that not only does the body resist restriction but the brain does too. In a paper published in 1975(6) restrained eaters - people who tried to rigidly control what they ate and avoided unhealthy foods – tended to overeat when their guard was down. Unrestrained/relaxed eaters ate to their appetites; they stopped when they were full. Making a food forbidden makes us much more likely to overeat when the opportunity arises.

The Psychological Problems

Perhaps longer lasting than the physical effects are those on the mind and these are the ones that I encounter most frequently, in my consulting room. They are multitudinous but I’ll just hit up the main ones.

The social norms around detoxing - its associations with health, celebrity and ‘instaglamour’ - help to cement the denial and perpetuate the essential illusion: that you are doing something healthy for benevolent reasons. In truth you are not ‘detoxing’ you are ‘crash dieting’. It is not because you want to feel good but because you feel guilty and angry with yourself for overindulging during the festive season. It is a kind of open conspiracy; we all know that ‘detox’ is a code word for ‘crash diet’ but we all nod in silent permissiveness of what could more honestly be called ‘elective starvation’. Somehow the word ‘detox’ seems to soften the edges of extreme dieting. If at any other time of the year (except perhaps before a summer holiday) a friend told you that they were restricting themselves to 450 calories per day you’d worry, think these were desperate measures, tell them it was a bad idea, but in January it’s all good, you wish them well and make a date for drinks in a month’s time. In many ways I would be happier for people to call it what it really is, at least that would be honest. It would be real. And we could address it. As it is ‘detoxing’, ‘cleansing’ and elimination diets are a too often a socially sanctioned cover for disordered eating and eating disorders as is attested by the number of high-profile healthy food bloggers who have admitted to having serious eating disorders (7) and those who haven’t…

Also problematic is that this cycle of binging in December and purging in January (sounding disordered yet?) promotes polarised thinking and behaviour. In CBT this is referred to as ‘all or nothing’ or ‘black and white’ thinking, in psychoanalytic theory it’s known as splitting; the setting up of dichotomous states of mind with no room for moderation or shades of grey. It’s absolute triumph vs total worthlessness, virtue vs sin. It’s the two biscuits that ‘ruin everything’ or the additional pound on the scales that means it is going to be a ‘bad day’. Whilst different therapies use different terms for this phenomenon all are agreed that these kinds of extremes are unhealthy. These harsh attitudes make it impossible to experience self-compassion, a trait that is associated with positive mental health outcomes. People who are self-compassionate are happier, more optimistic and emotionally resilient and less likely to be depressed or anxious (8). Self-compassion isn’t about self-pity or lack of discipline and, interestingly, it can support attempts to eat healthily. A recent study suggests that rigid diets tend to result in overeating and that self-compassion can reduce this tendency.(9)

Another facet of this particular brand of splitting is that detoxes tend to be based on the consumption of foods that either don’t taste good (I’m looking at you, wheatgrass) or don’t taste of anything (two words: Rice. Cakes) strengthening the association between ‘pain and piety’ and pleasure as ‘sin’. Coming so soon after the dietary abandon of December the implication is that eating for pleasure is a bad thing and that one should suffer for health. This is both utterly wrong and incredibly unhelpful, particularly when trying to encourage individuals to eat more healthfully in our currently failing attempts to stem the tsunami of obesity.

Rather than helping dieters to understand their personal relationships with food – including the attitudes to food, weight and body shape in their families, schools, society etc. – the January Detox reinforces the two-headed dietary monster of the ‘one-size-fits-all’ and the ‘quick fix’. It should be common sense that genetically (including the gut microbiome) unique individuals with different food histories would benefit from personalised dietary approaches, and that your relationship with your own body is a life-long partnership requiring ongoing investment. But it’s not, and that’s because the diet industry, media outlets and some lifestyle bloggers (a few well-intentioned, others not so much (10)) continue to perpetuate the myth that if you just try hard enough with this short-term intervention everything will be perfect. This is oversimplification to the point of ridiculousness and aspiration to the point of sadism.

Psychologically speaking health lies elsewhere. Somewhere between nutritionism (just nutrients on a plate) and hedonism (I think I ate the plate) is a place where food choices are a result of self-respect, self-awareness and self-compassion. Not aggression, external rules or desperation. For many of us it is not an easy place to get to; there are many outlets competing over the right to tell you what to eat and how you should feel about yourself and it’s been happening for a long time. I sit with patients who were put on diets in infancy because their mothers didn’t want a ‘fat baby’ or whose fathers mocked their adolescent body shape. These children then went in to competitive school environments where the aesthetic was king. Somewhere in the midst of these interpersonal challenges the media intervenes to let us know what the standard is and just how far short of it we are all falling. It can be an enormous task to clear through the layers of extraneous commandments and the years of social training to get back to a place of trust in one’s own body. Anyone who has fed a young child will have a sense of this. A spoonful of food can be mid-flight to the mouth when the child stops. No, I’m done. There might be pathetic half of a fish finger on the plate and, unless they are encouraged to ‘clear the plate’, it will remain abandoned because s/he knows that they don’t need it and what the body doesn’t need it doesn’t want. Children trust their bodies because they haven’t yet been taught not to. Sadly this state doesn’t last long and for many adults the external noise is so powerfully intrusive that the assistance of a therapist is essential in helping to create the quiet and the confidence to hear themselves again.

For a lot of those embarking on it the January Detox has nothing to do with food. Instead it symbolises a different kind of panic; not about the waistline but about the timeline. The closing of another year and the start of a new one inevitably evokes reflection on how the time was spent and, unconsciously for some, how much we might have left. If in this retrospection we feel we have not done enough, not succeeded enough, we can feel a need for a quick win. We cannot change our careers/improve our relationships/get out of debt in a month but we can lose a stone! Drastically changing the body becomes a substitute for feeling powerless to change other areas of our lives. But whilst our energy is focused on just making it through this juice fast the real challenges remain unchanged and neglected. It’s that reality issue again.

Being aware of what we are eating and, crucially, why is the key to regaining a compassionate relationship with the body and a non-anxious attitude to food and eating. Being mindful of what we are really hungry for (food, comfort, sleep, affection) enables us to make more honest food and life choices. If we ate mindfully throughout the year, including allowing room for the occasional overeating, we would negate the need for radical ‘cleansing’ in January.

The January Detox encapsulates everything that is wrong with the way we think about our bodies, food and eating. It is no way to live and no way to treat someone as important as you.

Kx

 

  1. http://www.theguardian.com/lifeandstyle/2014/dec/05/detox-myth-health-diet-science-ignorance

  2. Klein A. V. & Kiat, H. (2015). Detox diets for toxin elimination and weight management: a critical review of the evidence. Journal of Human Nutrition and Dietetics, 28, 675-686. http://onlinelibrary.wiley.com/doi/10.1111/jhn.12286/abstract

  3. Berg JM, Tymoczko JL, & Stryer L. (2002) Biochemistry. 5th edition. New York: W H Freeman.

  4. Coskun, M. (2014). Intestinal Epithelium in Inflammatory Bowel Disease. Frontiers in Medicine, 1, 24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292184/

  5. Sumithran, P., Predergast, L., Delbridge, E., Purcell, K. Shulkes, A., Kriketos, A., & Proietto, J. (2011). Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine, 365, 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816#t=articleMethods

  6. Herman, C. P., & Mack, D. (1975). Restrained and unrestrained eating. Journal of Personality, 43, 647–660.

  7. Refinery 29 – My Life with Orthorexia. http://www.refinery29.com/jordan-younger-vegan-orthorexia

  8. Neff, K. D., Rude, S. S. & Kirkpatrick, K. L. (2007). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41, 908-916.

  9. Adams, C. E. & Leary, M. R. (2007). Promoting self-compassionate attitudes towards eating among restrictive and guilty eaters. Journal of Social and Clinical Psychology, 26, 1120-1144. http://self-compassion.org/wp-content/uploads/publications/AdamsLearyeating_attitudes.pdf

  10. Jezebel – Belle Gibson, blogger who lied about having cancer, just keeps lying. http://jezebel.com/belle-gibson-blogger-who-lied-about-having-cancer-jus-1715566234