by Dr Joe Proietto
Sometime during my tenure as president of the Australasian Society for the Study of Obesity, I was rung by a journalist from a Sydney newspaper to give an opinion on the "liver-cleansing diet" in the treatment of obesity. As a devout and enthusiastic Skeptic, I instantly replied "it is a lot of rubbish".
On December 3 l, 1997, as is my habit each year, I reflected on life in general, where I was going and how I could improve myself. An issue that came to mind was my increasing intolerance of "alternative medicine". Just as the clock struck twelve I determined that I would be more tolerant in the future. I needed to be, because in my estimation, well over half of the population believe in all manner of alternative forms of medicine such as homeopathy, iridology, naturopathy, pyramid power, etc. In fact, I would say that Skeptics are very much in the minority in the population. Could it be that we are wrong?
A chance to redeem myself came quickly. Some days into the new year I was in my local chemist shop picking up a roll of film, when my eyes fell upon a book titled The Liver Cleansing Diet by Dr Sandra Cabot and in bold red letters the words Love Your Liver and Live Longer. This was the very liver cleansing diet that I had thoughtlessly described as a lot of rubbish. This was my chance to educate myself. I picked up the book and was inspecting it before purchase, when the friendly attendant came over to assist me. "Is this the book about the famous treatment for obesity?" I asked. Seeing that I was not particularly overweight, she said "Yes, but it is good for all sorts of other things as well" - a fact that I eventually confirmed by reading the book. She went on to point out that an important part of the treatment was the taking of some liver cleansing tablets, the Livatone liver tonic capsules, only $39.95 for 240. I politely declined the tablets preferring to purchase the book.
The book has a preamble written by Dr Cabot. We are told that the liver cleansing diet is not a trendy weight loss diet for the 90s. Many fad diets come and go, but "In contrast, the liver cleansing diet is easy and safe and is really a form of awareness or consciousness which will give you the key to a strong immune system and healthy blood vessels".
It was clear from this preamble that poor Dr Cabot had been given a hard time by a couple of thoughtless people who were, I fear, like I used to be. She quite rightly points out that:
..the most amazing thing of all is that these two critics bag my book without first talking to me about my results or case histories and neither of them had tried the diet on any of their sick patients to see if it really worked. How can anyone know the benefits of a particular diet or therapy without evaluating its effects upon patients first.
This was precisely the scruples I was having on New Year's Eve. However, Dr Cabot is not one to be trodden down by such thoughtless criticism. She comes out fighting. In the third last paragraph, she says "... thankfully we live in a democracy and have freedom of thought and speech although some would wish it otherwise". She goes on to say "let's not suffer from what I called the fossilised brain syndrome, where lateral and original thinking becomes a crime".
I was moved by these words. Dr Cabot deserves to be given a chance to prove the effectiveness of her diet. She had mentioned in the introduction that she had results. I searched two large databases to look for published results of the diet. Sadly I could find none. Certainly there are no references to her own publications in the book. However, what is in the book immediately following Dr Cabot's introduction, are 12 testimonials from grateful patients who have had all manner of serious illnesses corrected by the liver cleansing diet, including acne rosacea, sclerosing cholangitis, hepatitis C and of course obesity.
Each of these unnamed individuals was absolutely convinced that the diet had caused their improvement. One of them, a Mrs K from South Australia, found that the diet was very effective for her weight problem. On the liver cleansing diet she lost 11 kgs. She states that previously she had had a problem losing weight even though she did not eat excessively. Indeed, she says, "the less I ate the more I would put on" which is truly miraculous, reminding one of the parable of the loaves and fishes where the more the faithful ate the more food appeared. Sadly, this first part of the book was a little disappointing, given that it is generally agreed that anecdotal evidence of this quality is no evidence at all. With this preamble over, the book began in earnest.
Chapter 1 is titled Introduction to the Liver-Cleansing Diet. In the second paragraph of the first page, Dr Cabot says:
I must admit it took me more than twenty years of medical practice before the solution dawned on me! The liver, the supreme organ of metabolism had to be the missing key. It seemed so simple and yet so incredible; why hadn't someone thought of this before?
Why indeed? After all, we all know that the liver is the largest organ in the body. How could we have missed it. However, the key issue, and the most important lesson for those of us interested in obesity comes in the following paragraph, where she says "Excessive weight is a symptom of liver dysfunction and not solely due to the number of calories you eat". There you have it. Obesity is due to a disorder of the liver. I was stunned. Here we had a novel new theory, obviously come to us by what appears to have been divine inspiration, which I must admit was not yet supported by any publications. Pitted against it, was over 30 years of research with thousands of publications suggesting that, just possibly, the hypothalamus might be responsible for regulation of body weight.
What could I do? I desperately wanted to be fair to Dr Cabot, but the lack of published evidence worried me. Maybe I was missing something. Perhaps the evidence that the liver caused obesity would come soon. I was not reassured when Dr Cabot admitted that her vast knowledge of the liver was not learnt at medical school but rather as we learn on page 9:
As a medical student I spent many hours sitting in with leading naturopathic doctors as I was intrigued by their natural healing techniques ... It was with such naturopaths that I first learnt of the tremendous importance of the largest organ in the body – the LIVER ... In all their patients naturopathic doctors examine the state of the liver through various techniques such as iridology, acupuncture, pulse techniques and from the patient's history.
But at least the treatment was simple. Dr Cabot says on page 11:
When you follow the Liver-Cleansing Diet you eat delicious liver-cleansing and liver-friendly foods and your liver will then give a big sigh of relief and merrily get on with its job of regulating metabolism and burning fat.
However, although the diet is simple, you do need some help and this is given in the very last line of Chapter 1, which says;
To enhance this programme I have included natural therapies for liver-cleansing and healing on pages 66 to 71.
These natural therapies are none other than those tablets that the friendly pharmacist assistant was trying to sell me at $39.95 for 240.
Chapter 2 asks the question "Who Can Benefit from the Liver-Cleansing Diet?" I was very pleased to read that it is useful for just about all illnesses that beset humanity, including obesity, all manner of liver disease, gall bladder disease, high blood pressure, general digestive problems, irritable bowel syndrome, imbalance in the immune system, auto-immune diseases, chronic fatigue syndrome, arthritis, allergies, headaches and migraines. It's even a cure for old age. The diet will increase longevity. As Dr Cabot says, "older persons will find the liver cleansing diet a great tool for increasing longevity and vitality and staving off the degenerative diseases that unfortunately have become so common in our ageing population". At last, something that had scientific evidence. Although Dr Cabot does not quote them, studies have indeed shown that if rats are food restricted, they live longer. Maybe there was something in this after all. I read on.
Chapter 3 is titled "What are the Symptoms of an Unhappy Liver?" These are multiple and include a coated tongue, circles under the eyes, a bloated feeling, poor digestion, nausea, weight gain, constipation, irritable bowel, unpleasant mood changes, depression and foggy brain, allergic conditions, headaches, high blood pressure, fluid retention, hypoglycaemia or unstable blood sugar levels, an inability to tolerate fatty foods, gall bladder disease and gallstones, chronic fatigue syndrome, excessive body heat and others.
In this chapter we are also told that support for the theory even comes from Chinese medicine.
The Chinese have a liver remedy with the delightful name of 'the free and easy wanderer' that they use for depression and it contains the Chinese herb Xiao Yan Wan. We can all become free and easy wanderers, and slim and beautiful wanderers as well, if only we will take care of our livers: the Liver-Cleansing Diet will enable you to do this. A good liver tonic (see page 71) will also help to bring back the free and easy old you.
Chapter 4 delves into "Liver Physiology and Function". This chapter clearly illustrates that Dr Cabot did not entirely waste her time in medical school. The function of the liver is explained and among other things we are told that it regulates protein metabolism. The liver manufactures many proteins. I got very excited when I read that "it makes sex hormone binding globulin which is the protein that binds the steroid sex hormones". This much I already I knew, but what came after was a revelation.
The healthy liver is essential for a good sex drive (libido) and if your liver is producing excessive amounts of the protein sex hormone binding globulin your libido may be poor. Many people who have followed the liver-cleansing diet have told me that it has improved their libido.
For that alone I think this diet is worth trying.
Chapter 5 lists the 12 vital principles to improve liver function which include listening to your body, drinking 8-12 glasses of filtered water daily, avoid eating large amounts of sugar, not becoming obsessed with measuring calories, avoiding foods you are allergic to, etc. Some of the advice is quite sensible. I cannot argue with anyone who advises eating fruit and vegetables. So far however it is not clear how this diet differs from others which involve reducing caloric intake.
Chapter 6 lists a variety of different natural remedies for the liver. The interesting thing about this chapter is that it is the only one that contains references. However, the references refer largely to the Australian Journal of Herbalism. Surprisingly, no names of authors are mentioned, nor are page numbers, which makes it difficult to chase up the articles. I did however find that this journal is kept in the library of the Victoria University of Technology in Melbourne. Sadly, Vol 3, issue no:4 and Vol 4 issue no: 1, the issues quoted in the book, were missing from their collection. It is peculiar that these particular references were quoted since I took the trouble of doing a Medline search on the various agents that are mentioned in Chapter 5. There is literature in the mainstream scientific journals in which these substances have been tested, with mixed results. Some do report positive effects on liver function, others do not. However, even in those that work, the effects could hardly be called a "life-saving breakthrough".
The second half of the book is a description of the diet and proposes various recipes. I did not read this in great detail. No doubt, the diet is good because it involves low-fat and more vegetables and more fruit. None of us would argue with that. The problem I have is the claims made for this diet are based on no scientific evidence and the simplistic blaming of the liver for a multitude of different ailments. I will quote again Dr Cabot's own words – "How can anyone know the benefits of a particular diet or therapy without evaluating its effects upon patients first". On this we agree. What we clearly don't agree on is what constitutes proper evaluation. There is overwhelming acceptance in the medical and scientific community that any new therapy or any new claim for an old therapy must be tested in a controlled trial, preferably in a double blind fashion. The words "controlled trial" do not appear anywhere in the book.
I looked up Dr Sandra Cabot on the Internet (http://www.whas.com.au). She has a very professional Home Page which includes information about the Women's Health Advisory Service and how you could join for a mere $55.00 per year. This will entitle you to receive a membership card, a newsletter, naturopathic table, a free bottle of Evening Primrose Oil and one free copy of Sandra Cabot's Handbag Health Guide. I found this internet site just at the right time, since there was a special announcement stating that if I joined the network now, for $55.00 I would receive a massive 20% discount on the new powders Femmphase containing phytoestrogens and Livatone, the liver tonic. I am not sure that the Femmphase would really be for me. There was a large table of various products that could be brought from Dr Cabot. Everything from books, Acidophilus tablets ($18.10 for 90), all the way to Vaginol Tea Tree Cream for vaginal application ($15.40 for 100gms).
Clearly displayed there is a disclaimer stating that Dr Cabot's information
.. should not be used as a substitute for consulting your doctor or matters pertaining to your physical health should be supervised by your health care professional. Women's Health Advisory Service and Dr Sandra Cabot and her associates cannot and will not assume responsibility for your health. It is important that you visit your own doctor regularly for a physical examination and check-ups.
Dr Cabot has clearly consulted her lawyers.
I must conclude, sadly, that this book single-handedly destroyed my resolve to be sympathetic to alternative medicine. Ultimately, however, Dr Cabot may have the last laugh, for while I drive around in a small, slightly tarnished 7 year old Ford Laser, on the internet site there is a picture of a glamorous looking Dr Cabot standing next to what I assume may be her private plane. How should we measure success? – perhaps I will ponder this next December 31.