"Cleanse" detoxification diet program in Appalachia: Participant characteristics and perceived health effects

Introduction Numerous detoxification or "detox" diets purport to eliminate toxins from the body, help with weight loss, and improve health. Despite the claims of proponents, few of these programs have evidence of effectiveness. They often have significant associated costs and may have potential for harm, but they seem to be quite popular. Members of a community in Appalachia were invited to participate as a group in one such diet (called a "cleanse"). We conducted a study to explore characteristics of people who chose to complete the program, including their motivations and their perceptions of the health effects related to participation. Methods Those who volunteered to participate were educated on this program's definition of a "clean" diet through an information session and were given written guidelines. The diet was to last 21 days, and instructions were outlined as to which foods were allowed and which were to be eliminated. This study evaluated participants in two cohorts (June 2014 and January 2015). Individuals who registered for the study were asked to complete three anonymous surveys: one pretest before beginning the program (PRE), one roughly 1 week after completion (1wPOST), and one follow-up 8 weeks after the end of the diet period (8wPOST). Descriptive statistics, Skillings-Mack test, and Wilcoxon signed rank test were used to analyze results. Results Thirty-four individuals completed the PRE surveys, 15 individuals completed the 1wPOST surveys (44% of those completing the PRE surveys), and 8 individuals completed the 8wPOST surveys (24% of those completing the PRE surveys). Comparing results from the PRE, 1wPOST, and 8wPOST surveys, there were significant overall differences seen in the following health characteristics: cravings for sweet/salty foods (p=0.03), "giving in" to cravings (p=0.04), energy levels (p=0.001), and sleep quality (p=0.0001). These differences seen were between the PRE and 1wPOST surveys. Weight satisfaction and overall health did not show any overall significant differences. Conclusions While participants in Appalachia could benefit from a program that could improve health, this program's participants did not share socioeconomic characteristics reflective of most people from that area. Most were college-educated females with a reported family income and level of education that were higher than the average population. Self-reported health characteristics related to cravings, energy levels, and sleep quality demonstrated overall significant improvements from the PRE to the 1wPOST surveys. This exploratory study provides insight into the popularity of such programs. While measurement rather than self-report of clinical outcomes would be needed to more definitively determine the effects of this program, it would be worthwhile to explore further in an experimental study the outcomes identified in this study as being affected (cravings, energy, sleep, and weight).