Issue 129 teatoxing an overview

FOOD & DRINK

Alice Fletcher Registered Dietitian, Countess of Chester NHS Foundation Trust Alice has been a Registered Dietitian for almost three years working within NHS Communitybased teams.

She is passionate about evidencebased nutrition and dispelling diet myths. Alice blogs about food and nutrition in her spare time.

NutritionIn Wonderland.com

For full article references please email info@ networkhealth group.co.uk

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‘TEATOXING’: AN OVERVIEW OF AN EVER-GROWING DIET TREND Over the past three years, diets that promise to detox the body and promote rapid slimming effects following regular ingestion of specific tea, have become increasingly popular on social media. The regimen usually consists of two cups of tea per day, with a day and night-time blend, to be taken for 28 days. There are over 710,000 posts hash tagged as ‘teatox’ on Instagram. This craze shows no signs of stopping.

Teatox products also appear in mainstream healthfood shops and have recently been advertised on television. They commonly have celebrity endorsements, mostly lesser known reality television personalities, with more well-known celebrities increasingly jumping on board, including Hilary Duff, Britney Spears, Demi Lovato and Kylie Jenner (and no, I’m not sure why Kylie Jenner is famous either!). Undoubtedly, these well-known women are being paid large sums of money to promote teatox brands, however, they are under no obligation to disclose this - and don’t.

There are around 10 main companies with products available in the UK (click here to see Table 1). The advertising is slick and beautiful, with the majority featuring tall tanned immaculately preened young women holding the products with their heads cocked to one side, smiling at the camera. The marketing is clever and attractive.

It makes you want to look like the models. All you need to do is fork out an extortionate sum for two teabags per day.

The do-the-bare-minimum-and-berewarded mentality is reminiscent of diet pills or supplements such as raspberry ketones or aloe vera gel, only this time the take-home message is marketed behind

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a seemingly innocuous substance. The majority of people in the UK drink tea, it isn’t something you would instantly associate with the possibility of harm (except perhaps if it burns you!).

WHAT ARE THESE PRODUCTS COMMONLY PROMISING?

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Improve fat burning Reduce bloating Cleanse and detox the body Make the consumer feel ‘lighter’ All natural ingredients with no hidden chemicals

Weight loss is always alluded to but not always directly stated. Although the brands often include advice to eat healthy wholesome and nutritional food and exercise regularly, some claim to have the desired effects without the user changing their diet and lifestyle. Five of the six main companies I looked at in detail provided dietary information including meal plans to ‘improve results’. However, two of these were at an added cost (click here for Table 1).

DETOX

I do not need to explain to anybody reading this article that ingestible products promising to ‘detox’ the consumer are unfounded. As we know, there are currently no foods or fluids

available that can ‘detox’, or, in other words, remove (unidentified) toxins from our bodies.

The general public, however, are less aware of this and it is a term we are hearing being used more frequently (particularly in the month of January).

WHO ARE TEATOX PRODUCTS AIMED AT?

From the extensive marketing within social media there is no doubt that teatox products are aimed at young women. From looking at the websites and social media platforms of the 10 companies discussed, six appear to be aimed purely towards women, three appear more gender neutral from their marketing style and products, one of the 10 sells a product specifically aimed at men. Skinny Teatoxes’ latest advertising campaign is titled ‘Back to school blowout’. Skinny Teatox also sell a ‘breast enhancing tea’ named ‘Bounce with me’. You read that right the first time.

COST

The average cost for a 28-day programme of the companies mentioned in Table 1 is £35 (price range = £14-£41). Teatox products are commonly sold to be cheaper the more of them you purchase.

This could be encouraging further usage.

WHAT’S ACTUALLY IN THE PRODUCTS?

All the companies I looked into (Table 1) state the ingredients within their daytime and night-time blends on their websites, but some were easier to find than others. The ingredients are listed in order of volume, as with any food product, but the exact quantities of the ingredients are not stated for any products. Some companies provided me with more specific information upon request, others I did not hear back from. In total, three of the seven companies that I contacted for further information (mainly regarding senna content) did not respond (after 10 working days).

Laxative ingredients Sennosides within senna leaf and pod extract acts as a stimulant laxative. This type of anthroquinone stimulant laxative acts by irritating the lining of the gastrointestinal tract, resulting in increased peristalsis, therefore, elimination of intestinal contents. The onset of action is between six to 12 hours following ingestion. Senna is effective in

the treatment of diagnosed constipation and for bowel evacuation prior to medical procedures.1-3 The advice within the British National Formulary states that the recommended dosage of senna for adults is 7.5-15mg daily (max per dose 30mg daily); the dose is usually taken at bedtime; the initial dose should be low then gradually increased; higher doses may be prescribed under medical supervision. It should not be taken consecutively for more than a week unless advised so by a doctor.3,4 Commonly, teatox products contain senna in their night-time blends. Of the 10 companies discussed in this article: • six presently sell products containing senna; • two have sold products containing senna in the past, but have now removed it; • two companies sell only products that do not presently and never have contained senna.

How much laxative?

Unlike liquid or tablet form medications containing senna leaf/pod extract that state the milligrams of senna contained within the product, it is very tricky to work this out for teatox products.

When I asked Flat Tummy Tea for the amount of senna in milligrams contained within their tea, they stated that it contains 1g per teabag. I emailed the company for clarification regarding how that compares to over-the-counter senna tablets, but they could not provide any further help. Flat Tummy Tea do state the following on their website regarding their night-time tea: ‘Weaken or strengthen the effects by infusing it for less or more time.’

Could this trend be normalising the repeated regular use of laxatives?

Taking stimulant laxatives such as senna for four weeks without a break, without clinical indication (for constipation or to prepare for a colonoscopy) could lead to: • serum electrolyte imbalances (mainly low sodium and potassium); • disruption to flora in the bowel; • long-term senna usage (in this case repeating the teatox regimen several times per year over a number of years) may lead to a lazy bowel and reliance on laxative agents for regular bowel movements; www.NHDmag.com November 2017 - Issue 129

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FOOD & DRINK • reduction in absorption of vitamins and minerals from the large intestine, resulting in nutritional deficiencies (particularly alongside a restrictive diet).5-7 Senna is not appropriate for those with a diagnosis of inflammatory bowel disease, this is not specifically advised on any of the 10 companies’ websites.3 Notably, senna is not recommended in conjunction with liquorice root preparations or diuretics.3 Liquorice root As stated above, liquorice root preparations are not recommended in conjunction with senna.3 Of the 10 companies discussed, two available in the UK contain both senna and liquorice root in one teabag. (Teatu, Flat Tummy Tea). Not all of the ingredients in Skinny Teatox are stated. Bootea used to contain liquorice root and senna prior to February 2017.

I was unable to find any studies related to liquorice in tea form aside from one case report from the British Medical Journal where a 45-year-old woman presented to her general practitioner with hypertension and mild hypokalaemia. The patient had been drinking up to six cups of liquorice tea per day as a substitute for caffeinated tea and fruit-based infusions. When she stopped consuming the drink within two weeks her symptoms, hypertension and hypokalaemia had entirely resolved.8 Ingredients with diuretic properties Other herbal ingredients very commonly listed (click here for Table 1) include hawthorn, fennel, dandelion and nettle. These have all been found to act as herbal diuretics (increasing the excretion of urine from the body as well as the amount of sodium in urine) with variable potency.

EATING DISORDERS AND LAXATIVE USE

Laxatives can lead to temporary weight loss by causing dehydration, especially if used alongside diuretics. Because of the quick and efficacious activity, stimulant laxatives such as senna, are most frequently abused to promote weight loss by increasing gastrointestinal transit time.5-7 40

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Surveys conducted by Beat (the UK’s leading eating disorders charity) has found that the use of laxatives as a weight loss aid is a significant problem, and that the use of them seems to be growing. Beat are campaigning for laxative products to be regulated and have age restrictions.9 IMPACTS UPON MEDICATIONS

There have been media reports of women not realising that these teatoxes may affect the efficacy of the contraceptive pill, with unplanned pregnancies resulting from this.10 Some companies have improved the visibility of any warnings about effectiveness of the contraceptive pill in response to this media coverage.11,12 From reviewing company websites, I found that of the six products that contain senna mentioned in Table 1, three (Flat Tummy Tea, Skinny Teatox and Skinny Me) state that possible reduced efficiency of the contraceptive pill may occur and recommend using extra protection. In contrast, Lyfe Tea and Teami do not state this; Teatu states, ‘We highly recommend that you consult with your doctor on this matter, as it is on a case-by-case basis’. This company also recommends the use of their product for at least three months.

INCH LOSS, NOT WEIGHT LOSS

The companies discussed often appear to avoid stating that customers will ‘lose weight’ by taking their products, focusing more on having a flatter stomach and reduction in bloating when it comes to written communications. The copious before and after photos, however, are clearly insinuating that users are smaller following completion of the teatox programmes. The most alarming thing about the before and after photographs commonly used is that the women pictured are very rarely overweight to begin with.

Many testimonials allude to feeling lighter after following the programmes. Any weight loss that is felt is likely to be secondary to fluid losses from a mixture of diuretic and laxative ingredients (if laxatives included). No fat mass will be lost unless there has been a significant calorific deficit.

The teatoxing companies are not marketing their products as a short-term one-off fix. They are encouraging customers to become part of the ‘journey’ or ‘movement’ SHOW ME THE EVIDENCE: CLINICAL TRIALS

I contacted six of the companies listed in detail within Table 1 for any clinical trials related to claims made regarding teatox products that they sell. Unfortunately, none of the companies directed me to a clinical trial of any of their products.

RETURN CUSTOM

The teatoxing companies are not marketing their products as a short-term one-off fix. They are encouraging customers to become part of the ‘journey’ or ‘movement’ (no pun intended). For the 10 companies discussed, the advice around frequency and duration of the teatox programmes varies, for example, Teatu (containing senna) recommends use of their product each day for at least three months for best results. Other teatox programmes are recommended to last for generally 14 to 28 days. Consumers may find that they feel increasingly ‘sluggish’ or constipated when not using the products and, therefore, go back for more.

STANDING UP AGAINST LAXATIVE MISUSE:

It took almost 29,000 signatures on a petition developed by Dr Lauretta Ihonor to remove senna root and leaf from some teatox products on the UK market.11,12 Bootea, Skinny Mint and Slendertoxtea have produced laxative-free versions for sale in the UK. Holland and Barrett held talks with Bootea and reached a decision to change the labelling on the packaging of original formula Bootea teatoxes to make the risks clearer and also outline that people under the age of 18 should not take it. Slendertoxtea, one of the UK’s popular teatox brands, was inspired by the petition and as a result decided to stop using senna in their teatoxes altogether.

FINAL THOUGHTS

• Teatoxing, if laxative agents are not included within the ingredients, is unlikely to be highly

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damaging to users, however, the benefits of such a regimen are also not evidenced by any clinical trials, only positive customer testimonials.

It may well be that people feel as though they can stick to a healthy balanced diet more easily if they have purchased a ‘teatox plan’, but there is not any clinical evidence to support this for the products discussed.

It is difficult to calculate amounts of active ingredients consumed due to the nature of brewing tea.

Repeated use of herbal tea containing unclear amounts of senna may cause harm, particularly alongside liquorice root preparations.3 The teatox trend may be normalising the repeated regular use of laxatives as a weight loss aid amongst young women.

It must be noted that senna in tablet and liquid form can be purchased over the counter in many high street shops without a prescription, something Beat are campaigning against.9 The marketing of teatox products containing laxatives and diuretics towards young women who are a healthy weight is potentially dangerous.

All of the above information regarding the named teatox companies was accurate at the time of submitting this article (13/9/17) Teatox company websites: Bootea: www.bootea.com Flat Tummy Tea: https://flattummyco.com Lyfe Tea: https://lyfetea.com Skinny Me: www.skinnymetea.com.au Skinnymint: www.skinnymint.com Skinny Tea Co: https://skinnytea.co.uk Skinny Teatox: https://skinny-teatox.com Slendertoxtea: www.slendertoxtea.co.uk Teami: https://www.teamiblends.co.uk Teatu: www.teatuteatox.com

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