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The previous chapter discussed dietary supplements, including how they are marketed. That chapter stressed that much of this marketing is based on delivering false and misleading information to potential customers. This present chapter continues the subject of how the problem of false and misleading information is widespread across many areas of nutrition. This problem has a long history across many areas of the medical sciences. In Victorian times a common belief was that masturbation was a major cause of blindness and insanity. In the 1970s, a great many people believed that if they were always feeling irritable and lacking in energy, this was a sure sign of low blood sugar. This epidemic mysteriously disappeared only to be replaced by newer epidemics such as an allergy to gluten, an overload of toxins, and a yeast infection (Candida). The scope of the problem of false and misleading information is enormous and is continuously changing. It is clearly impossible, therefore, to cover all aspects of this problem. This chapter is intended only to present some illustrative examples of the problem. Physicians and other healthcare professionals need to be cognizant of this problem. This is because out of any random group of a dozen patients several will believe some of the false ideas that are being continually disseminated.
A Plague of False and Misleading Information
Norman J. Temple, PhD
False and misleading information is widespread across many areas of
This chapter briefly examines some examples including Dr Oz and his TV show,
unscientific weight-loss treatments, diet and exercise programs that are based on their
blood type, and detoxification.
The chapter also looks at training programs for nutritionists that lack scientific credibility
Problems of conflict of interest in research are discussed.
Key Words: blood groups, conflict of interest, detoxification, Dr Oz, false information,
misleading information, nutritionist training program
The previous chapter discussed dietary supplements, including how they are marketed. That
chapter stressed that much of this marketing is based on delivering false and misleading
information to potential customers. This present chapter continues the subject of how the
problem of false and misleading information is widespread across many areas of nutrition. This
problem has a long history across many areas of the medical sciences. In Victorian times a
common belief was that masturbation was a major cause of blindness and insanity. In the 1970s a
great many people believed that if they were always feeling irritable and lacking in energy, this
was a sure sign of low blood sugar. This epidemic mysteriously disappeared only to be replaced
by newer epidemics such as an allergy to gluten, an overload of toxins, and a yeast infection
(Candida). The scope of the problem of false and misleading information is enormous and is
continuously changing. It is clearly impossible, therefore, to cover all aspects of this problem.
This chapter is intended only to present some illustrative examples of the problem.
Physicians and other healthcare professionals need to be cognizant of this problem. This is
because out of any random group of a dozen patients several will believe some of the false ideas
that are being continually disseminated.
Dr Mehmet Oz is a highly accomplished heart surgeon whose TV show is watched by millions of
people across North America. He dispenses advice on many topics in the general area of health.
Researchers from the University of Alberta in Edmonton, Canada, recently made a careful
analysis of the accuracy of his claims (1). They estimated that 39% of his advice was in the area
of diet. The researchers were able to find evidence in support of 46% of the recommendations
while 15% were contradicted by the evidence. That left 39% of the recommendations where no
supporting evidence could be found. In other words, at least half of the recommendations made
by Dr Oz lacked supporting scientific evidence.
One of his claims landed him in hot water. Dr Oz was called before Congress to testify at a
Senate hearing about deceptive advertising for over-the-counter diet supplements after he sang
the praises of green coffee bean extract as a "miracle" weight loss pill (2). Sen. Claire McCaskill,
who chairs the Senate's Consumer Protection panel, blasted him for making such claims on his
show when "you know it's not true."
If diet books worked, then the obesity epidemic would have been vanquished years ago. But for
the past two decades, the diet book industry has been growing at the same rate as American
waistlines. A search at Amazon shows that thousands of books are published each year on the
subject. A perusal of the titles reveals obvious indicators that false and misleading information is
a common ingredient. For example, 140 books were published in 2014 that included the words
quick and easy weight loss" in the title (or a slight variation of these words). Similarly, the
words “belly fat” appeared in the titles of 256 books.
This problem extends to magazines. Woman’s World is a supermarket tabloid sold across North
America. It regularly features the latest “lose a pound per day” diet on its front cover.
In 1991 James D'Adamo published a book with the title “The Blood Type Diet: Your
Personalized Diet and Exercise Program”. The theme of this book is that a person should select
their diet and exercise program based on their ABO blood type. Over the years several other
authors jumped on the publishing bandwagon with books making similar claims. These books
claim that a person’s blood type is the basis for treating an assortment of health problems
including cancer, heart disease, diabetes, arthritis, and overweight.
How much evidence is there to justify the many claims made in these books? There is, in fact,
surprisingly strong evidence that blood groups do affect health. Folks who have blood group O
have a significantly reduced risk of cardiovascular disease, some types of cancer, as well as of
all-cause mortality (3). This suggests that the antigens that are the basis of blood groups have
complex effects on disease etiology. Perhaps one day this information will be translated into
practical advice on reducing risks to health if your parents bequeathed you a bad blood group.
But there is no evidence to support the claims of those promoting particular diets based on a
person’s blood group. A systematic review on this subject was published in the American
Journal of Clinical Nutrition (4). The researchers concluded that: “No evidence currently exists
to validate the purported health benefits of blood type diets.”
Detoxification was discussed in the previous chapter where it was pointed out that many dietary
supplements, mainly herbal ones, are sold with the claim that they enhance health by speeding
detoxification. This claim is devoid of supporting evidence. However, the claims made in the
area of detoxification go well beyond supplements.
The American chapter of the story started a century ago. Benedict Lust emigrated to the USA
from Germany late in the nineteenth century. In 1918 he wrote the following: “The natural
system for curing disease is based on….the employment of various forces to eliminate the
poisonous products in the system…” (5) Lust later became one of the founding fathers of
naturopathy in the USA.
The concept of detoxification is based on the general claim that the accumulation of toxins in the
body is involved in much sickness and that disease can be cured using treatments to eliminate
these toxins. This concept is still the basis for various naturopathic therapies today. Indeed, a
survey of naturopaths in the USA reported that 92% reported using detoxification therapies (6).
Detoxification is often advocated to enhance weight loss. The treatment at the center of
detoxification is fasting, often accompanied with juices. As noted above and in the previous
chapter the supplement industry has also jumped on the bandwagon and promotes many products
as aids to detoxification. In recent years the concept has gained much popularity in nutritional
and health circles that clearly lie well outside the mainstream. There has also been an explosion
of books on the subject in recent years.
A variation of this approach is autotoxicity where the focus is on removing toxins from the
colon, often with the aid of an enema. A more extreme variation is colonic irrigation, a procedure
that is potentially harmful as it can hyper-extend the colon (7, 8). The irony of this treatment is
that the same effect can be achieved by a few teaspoons of wheat bran at far less risk, far less
discomfort, and far less cost!
There is very little credible evidence that detoxification treatments, such as dietary changes,
consumption of herbs and supplements, fasting, or colonic irrigation, can remove toxins from the
body (9). Moreover, there is no evidence that these treatments improve health.
The USA has a very large number of people who are highly active in promoting the distorted
nutrition science referred to above. Sometimes they come together. Here is an example. In May
2016, a free online conference took place called the “Vitamin Summit”. In their promotion of
this conference the organizers claim that the speakers are: “The most distinguished and diverse
group of vitamin experts ever assembled for one event!” Let’s take a closer look. Here are some
of the illustrious speakers:
Andrew Saul. This person advocates megadoses of vitamins, including vitamin C. This
idea was popularized in the 1970s but has largely been abandoned by conventional
physicians and nutritionists as clinical studies rarely provide supporting evidence.
Dr Joseph Mercola. According to an article on him in Wikipedia he dismisses medical
concerns over avian influenza pandemics. He asserts that the government, big business,
and the mainstream media have conspired to promote the threat of avian flu in order to
accrue money and power. Furthermore, he has been highly critical of vaccines and
vaccination policy, and questions whether HIV is the cause of AIDS (10).
Ty Bollinger. This person promotes heavily distorted and grossly unscientific information
about medicine and cancer.
The usual training program in North America for a person who wishes to be recognized as a
nutritionist is a 4-year degree in nutrition. To become a dietitian also requires an internship. But
do a Google search using the term “nutritionist training program” and many programs pop up,
most of which are seriously lacking in scientific credibility. Here is one example.
The American School of Natural Health ( offers
a training course to become a “nutrition consultant”. According to the website: “[the] course
stresses the use of whole and organic foods – an integral concept in many indigenous societies.
Today we see that a return to chemical free foods along with other dietary measures is an
effective answer to many health complaints and common conditions. The course also focuses on
the importance of Detoxification & Cleansing, as only fully functioning organs are able to absorb
and utilize nutrients optimally.”
Programs of this type typically take about one or two years to complete which is considerably
less than conventional nutrition programs. But many people are in a rush to become a qualified
nutritionist. The American Fitness Professionals & Associates (
certification-programs) caters to those people. They will train a person to become a “Certified
Nutrition & Wellness Consultant” in only 100 h.
Some schools offer a more in-depth program. The International College of Natural Health and
Traditional Chinese Medicine (, based in Ontario,
Canada, has a 24-mo program called the “Orthomolecular Nutrition Diploma Program”. Some
indications of what students will learn during the program are indicated by a description of books
from the approved reading list:
(i) “The 4-Week Ultimate Body Detox Plan shows you how to get rid of toxins using a
simple and effective step-by-step approach.”
(ii) “Control the level of acid in your body and reclaim your health with this simple, step-by-
step program Beginning a healthier lifestyle can be as easy as starting your day sipping a
glass of water with a squeeze of lemon juice. Drinking this simple drink is only one of the
many ways, all outlined in The Ultimate pH Solution, that you can change your body's pH
and ward off disease.”
(iii) “The only Self-Help Guide to make alterative cancer therapies work for YOU. A bold
revelation of what this century's early naturopaths learned about not only the causes
of cancer, but also effective treatments and what you CAN DO NOW to save your life
with this vital knowledge.”
Commercial organizations have a long history of meddling in the scientific process so as to
distort the outcomes of research in ways that are favorable to the particular industry. The tobacco
industry and Big Pharma have been playing this game for decades. Here we look at how this
takes place in the area of food and nutrition.
There is an enormous amount of money tied up in the results of research studies in the area of
nutrition science. Reports have appeared that suggest that conflict of interest exists and is
distorting the findings of some research studies. An analysis was made of studies conducted
between 1999 and 2003 on soft drinks, juice, and milk (11). The findings of each study were
classified as being favorable or unfavorable to the industry that sponsored the study. For
interventional studies none of the studies with industry financing reported a finding that was
unfavorable whereas 37% of studies with no industry funding did so. For all types of study,
including observational studies and reviews, those with industry financing were 7.6 times more
likely to report a finding favorable to industry than studies with no industry financing. Much the
same has been reported concerning research on olestra, a fat substitute (12). By contrast, an
analysis of papers in the area of obesity or nutrition saw no evidence of a relationship between
the source of funding and the results (13); however, that study focused only on studies published
in four of the leading medical journals. Those journals may have higher standards and may
therefore routinely reject papers where the results may not be kosher.
These findings, taken as a whole, do not necessarily indicate that actual fraud has taken place.
Rather, they raise suspicion that the research process has been corrupted. This can occur in
various ways such as by designing randomized trials in such a way that the results desired by the
funders are more likely to be observed, by analyzing the data so as to make the conclusions as
close as possible to what the paymasters wants to hear (“if you torture the data long enough, it
will eventually confess”), and by only allowing the findings of studies to be published if they
report the “right” results.
Journals are well aware of this problem, especially in the area of drug research. As a result most
journals now insist that all authors of papers state whether there is any potential conflict of
interest. But that is only a partial solution to the problem as the following example illustrates. A
paper was recently published in a nutrition journal that reviewed the value of vitamin
supplements (14). The paper strongly argued the case that such supplements are of much value. A
note at the end of the paper stated that funding for the work came from Pfizer but failed to
mention that Pfizer is the manufacturer of Centrum multivitamins, which is the leading brand of
multivitamins sold in North America.
Much of what has been written in this chapter will doubtless be out of date within a few years.
But creative minds will dream up many new forms of false and misleading information. Some
will do it because they are deluded, some because they love the publicity, and others because of
greed. There is little that can be done to stop these people. A society that values free speech
allows people to say that HIV does not cause AIDS and that megadoses of vitamin C cure cancer.
The public generally has no formal training and no ability to discriminate between nutritional
facts, fancies, and fantasies. This places the onus is on health professionals to be aware of this
never-ending problem. They also have a responsibility to explain the problem to their clients and
to provide sound information.
Food and Drug Administration. Health fraud scams.
MedlinePlus. Health fraud.
Nestle M. Corporate Funding of Food and Nutrition Research: Science or Marketing?
JAMA Intern Med 2016;176:13-4.
1. Korownyk C, Kolber MR, McCormack J, et al. Televised medical talk shows—what they
recommend and the evidence to support their recommendations: a prospective
observational study. BMJ 2014;349:g7346.
2. Firger J. CBS News, June 17, 2015. Dr. Oz defends weight-loss advice at Senate hearing
on diet scams.
senate-hearing-on-diet-scams. Accessed March 28, 2016.
3. Franchini M, Lippi G. The intriguing relationship between the ABO blood group,
cardiovascular disease, and cancer. BMC Med. 2015;13:7.
4. Cusack L, De Buck E, Compernolle V, Vandekerckhove P. Blood type diets lack
supporting evidence: a systematic review. Am J Clin Nutr. 2013;98:99-104.
5. Lust B. Principles of health. Butler, NJ: Lust Publications, 1918. Cited by Pizzorno JE,
Snider P, Katzinger J. Naturopathic medicine. In: Micozzi M, ed. Fundamentals of
complementary and alternative medicine. St Louis, MO: Saunders; 2011. p. 292-321.
6. Allen J, Montalto M, Lovejoy J, Weber W. Detoxification in naturopathic medicine: a
survey. J Altern Complement Med 2011;17:1175-80.
7. Acosta RD, Cash BD. Clinical effects of colonic cleansing for general health promotion:
a systematic review. Am J Gastroenterol 2009;104:2830-6.
8. Mishori R, Otubu A, Jones AA. The dangers of colon cleansing. J Fam Pract
9. Klein AV, Kiat H. Detox diets for toxin elimination and weight management: a critical
review of the evidence. J Hum Nutr Diet. 2015;28:675-86.
10. Wikipedia. Joseph Mercola. Accessed
March 26, 2016.
11. Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS. Relationship between
funding source and conclusion among nutrition-related scientific articles. PLoS Med
12. Levine J, Gussow JD, Hastings D, Eccher A. Authors' financial relationships with the
food and beverage industry and their published positions on the fat substitute olestra. Am
J Public Health 2003;93:664-9.
13. Kaiser KA, Cofield SS, Fontaine KR, et al. Is funding source related to study reporting
quality in obesity or nutrition randomized control trials in top-tier medical journals? Int J
Obes (Lond). 2012;36:977-81.
14. Ward E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutr J.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Other than being present at the surface of red blood cells, the antigens of the ABO blood group system are efficiently expressed by a variety of human cells and tissues. Several studies recently described the involvement of the ABO blood group in the pathogenesis of many human disorders, including cardiovascular disease and cancer, so that its clinical significance extends now beyond the traditional boundaries of transfusion medicine. In a large cohort study recently published in BMC Medicine and including over 50,000 subjects, Etemadi and colleagues reported that nearly 6% of total deaths and as many as 9% of cardiovascular deaths could be attributed to having non-O blood groups, a condition that was also found to be associated with increased risk of gastric cancer. In this commentary, the clinical implications of ABO blood groups are critically discussed and a possible common pathogenic mechanism involving the von Willebrand factor is described.
Full-text available
To determine the quality of health recommendations and claims made on popular medical talk shows. Prospective observational study. Mainstream television media. Internationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors). Investigators randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show. Percentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made. We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations. Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.Additional details of methods used and changes made to study protocol. © Korownyk et al 2014.
Full-text available
A balanced and varied diet is the best source of essential vitamins and minerals; however, nutrient deficiencies occur, including in populations with bountiful food supplies and the means to procure nutrient-rich foods. For example, the typical American diet bears little resemblance to what experts recommend for fruit, vegetables, and whole grains, which serve as important sources of an array of vitamins and minerals. With time, deficiencies in one or more micronutrients may lead to serious health issues. A common reason people take multivitamin and mineral (MVM) supplements is to maintain or improve health, but research examining the effectiveness of MVMs in the prevention of certain chronic conditions is ongoing. In addition to the utility of MVMs for filling in relatively small but critical nutritional gaps, which may help prevent conditions such as anemia, neural tube defects, and osteoporosis, some evidence supports possible benefits of MVM supplementation with regard to cancer prevention (particularly in men) and prevention or delay of cataract, as well as some aspects of cognitive performance. Unlike some single-vitamin supplements, MVM supplements are generally well tolerated and do not appear to increase the risk of mortality, cerebrovascular disease, or heart failure. The potential benefits of MVM supplements likely outweigh any risk in the general population and may be particularly beneficial for older people.
Full-text available
This study sought to assess the use of clinical detoxification therapies used by licensed naturopathic doctors (NDs) in the United States. This was a qualitative, descriptive, online survey of a convenience sample of NDs. An online survey was conducted of NDs who were licensed in the United States. Responses were analyzed descriptively regarding the use of clinical detoxification therapies. Respondents were recruited from a membership list provided by the American Association of Naturopathic Physicians, and from alumni e-mail lists of Council of Naturopathic Medical Education accredited naturopathic medical schools. Surveys were sent out to 1442 e-mail addresses (261 were returned to sender); a total of 196 respondents completed the survey (16.6%). Ninety-two percent (92%) of respondents reported using clinical detoxification therapies. Over 75% of respondents utilized detoxification therapies primarily to treat patients for environmental exposures, general cleansing/preventive medicine, gastrointestinal disorders, and autoimmune disease. Regarding methods used, >75% reported using dietary measures, reducing environmental exposures, and using botanicals as detoxification therapies. Eighty-three percent (83%) of NDs surveyed reported using follow-up measurements to determine efficacy of detoxification therapies. The most common were patient symptom questionnaires (66%), patient medical histories (54%), and urinary provocative challenge testing (53%). The majority of NDs responding to this survey reported routine use of clinical detoxification therapies to treat a range of medical conditions utilizing multiple therapeutic approaches. Although the majority of NDs reported using some follow-up measurements after detoxification therapy, few of these are an objective means to determine treatment efficacy. Further research is needed in the field of complementary and alternative medicine clinical detoxification to determine the safety and efficacy of these approaches.
Full-text available
Faithful and complete reporting of trial results is essential to the validity of the scientific literature. An earlier systematic study of randomized controlled trials (RCTs) found that industry-funded RCTs appeared to be reported with greater quality than non-industry-funded RCTs. The aim of this study was to examine the association between systematic differences in reporting quality and funding status (that is, industry funding vs non-industry funding) among recent obesity and nutrition RCTs published in top-tier medical journals. Thirty-eight obesity or nutrition intervention RCT articles were selected from high-profile, general medical journals (The Lancet, Annals of Internal Medicine, JAMA and the British Medical Journal) published between 2000 and 2007. Paired papers were selected from the same journal published in the same year, one with and the other without industry funding. The following identifying information was redacted: journal, title, authors, funding source and institution(s). Then three raters independently and blindly rated each paper according to the Chalmers method, and total reporting quality scores were calculated. The inter-rater reliability (Cronbach's alpha) was 0.82 (95% confidence interval = 0.80-0.84). The total mean (M) and s.d. of Chalmers Index quality score (out of a possible 100) for industry-funded studies were M = 84.5, s.d. = 7.04 and for non-industry-funded studies they were M = 79.4, s.d. = 13.00. A Wilcoxon matched-pairs signed-ranks test indicates no significant rank difference in the distributions of total quality scores between funding sources, Z = -0.966, P = 0.334 (two tailed). Recently published RCTs on nutrition and obesity that appear in top-tier journals seem to be equivalent in quality of reporting, regardless of funding source. This may be a result of recent reporting of quality statements and efforts of journal editors to raise all papers to a common standard.
Full-text available
Patients may look to colon cleansing as a way to "enhance their well-being," but in reality they may be doing themselves harm.
This Viewpoint emphasizes that nutrition researchers and professional societies need to recognize the influence of food-industry sponsorship, take steps to control its effects, and ensure that sponsored studies promote public health. The longstanding influence of food industry funding on nutrition research, researchers, and professional societies1 threatens the credibility of nutrition science. So much research is sponsored by industry that health professionals and the public may lose confidence in basic dietary advice. Although most journals now require authors to disclose who pays for their work, disclosure—even done diligently—is not sufficient to alert readers to the extent to which industry funding influences research results and professional opinion. As is well established from experimental and observational research, drug company gifts and grants can have substantial effects. To recipients, however, these effects are almost always unconscious, unintentional, and unrecognized, making them especially difficult to prevent.2
Detox diets are popular dieting strategies that claim to facilitate toxin elimination and weight loss, thereby promoting health and well-being. The present review examines whether detox diets are necessary, what they involve, whether they are effective and whether they present any dangers. Although the detox industry is booming, there is very little clinical evidence to support the use of these diets. A handful of clinical studies have shown that commercial detox diets enhance liver detoxification and eliminate persistent organic pollutants from the body, although these studies are hampered by flawed methodologies and small sample sizes. There is preliminary evidence to suggest that certain foods such as coriander, nori and olestra have detoxification properties, although the majority of these studies have been performed in animals. To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans. This is an area that deserves attention so that consumers can be informed of the potential benefits and risks of detox programmes. © 2014 The British Dietetic Association Ltd.
Diets that are based on the ABO blood group system have been promoted over the past decade and claim to improve health and decrease risk of disease. To our knowledge, the evidence to support the effectiveness of blood type diets has not previously been assessed in the scientific literature. Objective: In this current systematic review, published studies that presented data related to blood type diets were identified and critically appraised by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Design: A systematic search was performed to answer the following question: In humans grouped according to blood type, does adherence to a specific diet improve health and/or decrease risk of disease compared with nonadherence to the diet? The Cochrane Library, MEDLINE, and Embase were systematically searched by using sensitive search strategies. Results: Sixteen articles were identified from a total of 1415 screened references, with only one article that was considered eligible according to the selection criteria. The identified article studied the variation between LDL-cholesterol responses of different MNS blood types to a low-fat diet. However, the study did not directly answer the current question. No studies that showed the health effects of ABO blood type diets were identified. Conclusions: No evidence currently exists to validate the purported health benefits of blood type diets. To validate these claims, studies are required that compare the health outcomes between participants adhering to a particular blood type diet (experimental group) and participants continuing a standard diet (control group) within a particular blood type population.
The practice of colonic cleansing to promote general health and well-being continues to generate interest among the lay population. These practices are widely touted as adjuncts to improve vitality and as therapeutic modalities to minimize the symptoms, or prevent the actual development, of a variety of chronic disease states. The data supporting colonic cleansing and body "detoxification" have not been studied well in a systematic manner. This report describes a systematic review of the published literature of both the traditional and complementary and alternative medicine arenas that was performed in an attempt to qualify and quantify the value of colonic cleansing. The investigators concluded that there are no methodologically rigorous controlled trials of colonic cleansing to support the practice for general health promotion. Conversely, there are multiple case reports and case series that describe the adverse effects of colonic cleansing. The practice of colonic cleansing to improve or promote general health is not supported in the published literature and cannot be recommended at this time.