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Licensed Unlicensed Requires Authentication Published by De Gruyter September 17, 2019

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

Laura Davisson EMAIL logo and Sarah Sofka



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.


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.


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.


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).


We acknowledge Rebecca Herod for assistance with subject enrollment, and Rahul Raiker and Jesse Thompson for data analysis and editing.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. The authors do not have any commercial or proprietary interest in any drug, device, or equipment mentioned in this article.


[1] Klein AV, Kiat H. Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet 2015;28:675–86.10.1111/jhn.12286Search in Google Scholar PubMed

[2] Kim MJ, Hwang JH, Ko HJ, Na HB, Kim JH. Lemon detox diet reduced body fat, insulin resistance, and serum hs-CRP level without hematological changes in overweight Korean women. Nutr Res 2015;35:409–20.10.1016/j.nutres.2015.04.001Search in Google Scholar PubMed

[3] MacIntosh A, Ball K. The effects of a short program of detoxification in disease-free individuals. Altern Ther Health Med 2000;6:70–6.Search in Google Scholar

[4] Callahan E. Changes in weight loss and lipid profiles after a dietary purification program: a prospective case series. J Chiropr Med 2013;12:30–8.10.1016/j.jcm.2012.11.004Search in Google Scholar PubMed PubMed Central

[5] Morrison JA, AL I. Symptom relief and weight loss from adherence to a meal replacement-enhanced low calorie detoxification diet. Integr Med 2012;11:42–7.Search in Google Scholar

[6] Bland JS, Barrager E, Reedy RG, Bland K. A medical food-supplemented detoxification program in the management of chronic health problems. Altern Ther Health Med 1995;1:62–71.Search in Google Scholar

[7] United, Bureau SC. American FactFinder. Accessed: 16 Feb 2018.Search in Google Scholar

[8] Chatfield M, Mander A. The Skillings-Mack test (Friedman test when there are missing data). Stata J 2009;9:299–305.10.1177/1536867X0900900208Search in Google Scholar

[9] Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859–7310.1056/NEJMoa0804748Search in Google Scholar PubMed PubMed Central

[10] Calvin AD, Carter RE, Adachi T, Macedo PG, Albuquerque FN, van der Walt C, et al. Effects of experimental sleep restriction on caloric intake and activity energy expenditure. Chest 2013;144:79–8610.1378/chest.12-2829Search in Google Scholar PubMed PubMed Central

[11] Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004;1:e62.10.1371/journal.pmed.0010062Search in Google Scholar PubMed PubMed Central

[12] Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Penev PD. Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med 2010;153:435–41.10.7326/0003-4819-153-7-201010050-00006Search in Google Scholar PubMed PubMed Central

[13] G C. Health Disparities in Appalachia. In: Sheps Center ARC, editor. Washington DC: PDA, Inc, 2017.Search in Google Scholar

Received: 2018-09-14
Accepted: 2019-05-31
Published Online: 2019-09-17

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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