Running Head: DIET BOOK CRITIQUE Kozlosky 1

Diet Book Critique

Jessica Kozlosky

ND 581: The Energy Nutrients and Alcohol

28 November 2020
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Caroline Wheater, author of 1993’s ​The Juicing Detox Diet,​ asserts that poor diet, stress,

pollutants, and the sluggishness of one’s organs overwhelm the body’s kidneys, liver, colon,

skin, lungs, and lymph, allowing toxin buildup (Wheater, 1993). She touts fruit and vegetable

juices as “nature’s cleansers”, insisting that engaging in semi to completely exclusive

consumption of them boosts immunity, accelerates metabolism, rests the GI tract, reduces bodily

acidity, compensates for organ dysfunction, and eliminates bodily toxins (Wheater, 1993). Her

book includes one day, two day, one week, and two week diet plans; the prior two consist solely

of consumption of 8 fl oz of fruit juice at meals while the latter feature an 8 fl oz cocktail of fruit

and vegetable juices at each meal alongside solid foods (See Appendices A, B, C, D, and E).

While Wheater occasionally offers sound advice, she bases much of her guidance on

misunderstandings of the anatomy and physiology of multiple body systems and ignorance of the

dangers of restrictive diets. Combined with the fact that the benefits of her plans can be found in

less extreme diets, ​The Juicing Detox Diet​ is at best, a waste of consumers’ time and effort and at

worst, a threat to their health.

Wheater’s claim of boosted immunity is partially correct. Vitamin C, present in vegetable

and fruit juices, encourages proliferation of neutrophils, T-lymphocytes, and B-lymphocytes and

bolsters the phagocytic abilities of neutrophils (Carr & Maggini, 2017). A 2018 study published

in the ​Journal of Immunology Research ​demonstrated the spread of eosinophils and

intraepithelial T-cells throughout intestinal mucosa in association with polyphenols, a class of

compounds found in plants and plant derivatives (Ding et al., 2018). It also reported

polyphenols’ ability to inhibit the formation of IgE antibodies, immunoglobulins responsible for

allergic reactions. Moreover, polyphenols have been shown to increase T-cell mediated immune
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responses to cancer cell death, also known as immunogenic cell death (Ding et al., 2018).

However, Wheater’s one and two day plans omit nutrients vital for immunity such as zinc and

linolenic acid, thus working against this claim. While her longer plans do encourage the

inclusion of linolenic acid and zinc sources such as seaweed and pumpkin seeds respectively,

more popular sources like linolenic acid-rich fatty fish and zinc-rich meat are excluded.

Alongside bolstering immune function, Weather’s diets also have the potential to impact

metabolism. Diets including daily consumption of 300 mL orange juice for 60 days have

decreased blood glucose, insulin resistance, total cholesterol, LDL, and triglycerides in women

(Cesar et al., 2020). Studies utilizing pomegranate juice (PJ) have prompted decreases in LDL

oxidation and free radical activity (Hou et al., 2019). In participants with Type 2 Diabetes

Mellitus (T2DM), intake of 40 mg PJ for 8 weeks resulted in lower levels of triglycerides, LDL,

and LDL/HDL and TC/HDL ratios. Two studies, one using T2DM patients and the other healthy

persons, found PJ to reduce plasma levels of malondialdehyde (MDA), an indicator of oxidative

stress (Hou et al., 2019). In another study, daily 26 gram supplements of beetroot juice increased

urine concentrations of glycocholic and chenodeoxycholic acids and AICAR, implying increased

bodily levels (Kozlowska et al., 2020). The acids are associated with heightened brown adipose

tissue metabolism during exercise while AICAR, a metabolic intermediate, intensifies

translocation of the insulin-dependent transporter GLUT4 to the plasma membrane of striated

muscle cells and improves insulin sensitivity (Kozlowska et al., 2020). Yet, it should be

acknowledged that some of these studies possessed a longer duration than Wheater’s diets and it

is unlikely that all juices produce the same effects as the ones tested.
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Unlike her prior assertions, Wheater’s claim that GI muscles need to be rested in order

for them to function and that juices will provide such reprieve is incorrect and rooted in a

misconception of GI physiology. It ​is​ true that in cases of trauma to or disruption of the function

of the GI tract, such as following major abdominal surgeries like a ​Whipple procedure or

intestinal resectioning resulting in short bowel syndrome, a brief break from GI stimulation

grants time for affected organs to marginally recover from dysfunction (Jiang et al., 2019;

Nahikian-Nelms et al., 2016). However, in persons without severe GI contraindications, a lack of

food-induced peristalsis has been associated with hypoplasia of intestinal villi (Madnawat et al.,

2020). Furthermore, enterocyte maturation and function requires contact of intestinal mucosa

with digested nutrients and the presence of chyme in the intestinal lumina. Absences of these

factors, such as during total parenteral nutrition, have resulted in decreases in the surface area

and height of villi, depth of crypts, and amounts of epithelial cells and induced atrophy of GI

muscles as quickly as 24 hours after the cessation of GI stimulation (Madnawat et al., 2020).

Ultimately, the most restrictive of Wheater’s diets still provide some stimulation and so will not

result in atrophy, yet her idea of the need to rest the GI tract is nonetheless mistaken.

In a similar vein, Wheater’s position that juices reduce bodily acidity, approximated to

blood pH, ignores the existence of blood pH buffers. The lungs’ carbon dioxide exhalation and

kidneys’ excretion of acids and reabsorption of bicarbonate maintain blood pH in the slightly

alkaline range of 7.35-7.45 in the face of outside forces that act upon the body (Seifter & Chang,

2016). If one shifts focus to GI acidity, organs of the tract also possesses means to regulate pH.

Hydrochloric acid secreted by gastric parietal cells, combined with stomach churning and

activity from enzymes such as pepsin, reduces food boluses in the stomach to acidic chyme
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(MacFarlane, 2018). After entering the small intestine, chyme is neutralized by alkaline

bicarbonate secretions from the pancreas and duodenal Brunner glands (Ma et al., 2020). It

remains neutral to slightly alkaline as it continues digestive and absorptive processes and

ultimately becomes feces (Azzouz & Sharma, 2020). The aforementioned GI secretions easily

alter the pH of food boluses regardless of the foods’ pH. Furthermore, fruit juices are themselves

acidic and thus cannot raise the pH of most other substances (Reddy et al., 2016).

While juices lack notable GI pH altering abilities, some foods present in Wheater’s one

and two week diet plans such as whole grains, fruits, and vegetables do possess this potential.

Food-derived fibers that pass through the small intestine undigested can be fermented by colonic

flora to produce short-chain fatty acids. However, these byproducts lower colonic pH rather than

raise it, further debunking Wheater’s claim (Cheng et al., 2017).

Despite the body’s use of pH regulatory systems, these mechanisms ​can​ be overridden.

Such phenomena, however, are undesirable. In the GI tract, one example is hypochlorhydria,

high gastric pH, and small intestine bacterial overgrowth due to overuse of substances akin to

proton pump inhibitors (Haastrup et al., 2018). This less acidic pH allows pathogens, namely ​H.

pylori,​ ​ t​ o easily reproduce and lead to the development of peptic ulcers and occasionally cancer

(Sharma & Pernitzsch, 2017). Other pathogens that take advantage of altered GI pH

environments and cause infections include ​C. difficile ​and ​C. jejuni (​ Haastrup et al., 2018). A rise

in blood pH outside normal limits, known as alkalosis, can be the consequence of metabolic

events such as excessive vomiting or respiratory conditions like drug-induced hyperventilation; it

is also undesirable (Seifter & Chang, 2016).

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Wheater’s primary claim that fruit and vegetable juices detoxify the body of food

additives, waste, heavy metals, and pollutants has a weak foundation; limited evidence exists for

it and arises from situational circumstances. Daily ingestion of 30 mL of lemon juice and extract

for six weeks has been shown to reduce serum uric acid (Wang et al., 2017). However, given that

Wheater’s diets last a maximum of two weeks and include many juices, they may not provide

enough time or lemon juice to reap benefits. In a study concerning aluminum overload, malic

acid, citric acid, and succinic acid, all found in fruits, increased fecal excretion of aluminum in

mice (Klein & Kiat, 2015). Succinic and citric acid also decreased the amount of aluminum

stored in bones, reducing the metal’s osteomalacic effects. However, the amount of aluminum

administered was 50 mg/kg​-1​, 25 times the WHO-established limit of 2 mg/kg​-1​, and the acids

were administered via intraperitoneal injections (Klein & Kiat, 2015). In humans where

aluminum intake is lower and malic, citric, and succinic acids are obtained via intestinal

absorption, it is unknown if these acids would produce the same effect.

Beyond juices’ detoxifying properties, Wheater’s concept of “sluggish” detox organs

lacks a scientific definition. Wheater does not provide a concrete definition for “sluggishness”,

but implies that it is a sudden, self-resolving, and periodic decline in function. However, abrupt

declines in bodily function usually signal damage or disease. For example, one metric used to

assess kidney function is glomerular filtration rate (GFR), which indicates the volume of blood

the kidneys filter per minute (Levey & Inker, 2017). GFR naturally declines with age, but

sudden, large drops are abnormal (Levey & Inker 2017; Pottel et al., 2017). If one takes the

liberty of assuming that sluggish kidneys are ones in which GFR suddenly drops below the

normal threshold of 90 ml/min/1.72 m​2​, such a circumstance would be indicative of a condition

DIET BOOK CRITIQUE Kozlosky 7

like an acute kidney injury (AKI). While it is true that dietary changes such as increases in

kilocalorie and protein intakes can help alleviate the catabolism that often occurs alongside an

AKI, these changes cannot restore kidney function; resolving an AKI involves treating its

underlying cause. (Nahikian-Nelms et al., 2016). Additionally, because neither fruits,

vegetables, nor their juices are particularly viable sources of protein, they are not even first

choice foods when the aforementioned dietary changes are pursued (Doyle & Forni, 2016;

Flores-Mireles et al., 2015).

Similarly, an approximation of sluggish lymph is lymphedema, or swelling caused by

impaired drainage of lymphatic fluid related to trauma, parasites, or improper lymphatic vessel

development (Goss & Greene, 2018). Lymphedema is not a natural, periodic occurrence in

healthy persons nor is it a temporary condition; it is a chronic, multi-stage disease that often

requires surgical interventions to manage (Granzow, 2018).

In addition to touting false claims, Wheater’s diets, namely her one and two day cleanses,

are harmful. The 24 ounces of juice consumed per day in these cleanses provide approximately

77 grams of carbohydrate, 1.5 grams of fat, 5.2 grams of protein, and 335 kilocalories per day,

falling far below the macronutrient and kilocalorie requirements for healthy adults (Orange

Juice, Fresh). Wheater does warn that this restriction is not safe for children, the elderly, or

people with diabetes, hypoglycemia, candidiasis, or seriousness illnesses, however, such intakes

are not safe for anyone and lead to unwanted catabolism of glycogen, adipose, and proteins

(Rolfes et al., 2017). Continuing to the topic of inadequate advisories, despite the absence of

animal products from her one and two day plans and relative lack of them in her one and two

week diets, Weather does not inform readers about potential vitamin B​12​ deficiencies. She also
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fails to warn readers that grapefruit juice, one of the many juices she promotes, interacts with a

variety of medications and may be dangerous for some participants to consume (Bailey 2016).

Amidst the drawbacks of Wheater’s diets, her one and two week plans, while flawed, lay

a foundation that can be improved to develop an adequate eating pattern. Wheater’s

recommendations to supplement juice intake consist mainly of produce, some grains, and beans

and yogurt; the latter two are exclusive to the two week plan. By expanding beans and yogurt to

the one week plan and adding fish, poultry, non-tropical plant oils, milk and nuts, and additional

whole grains, a diet rich in macro and micronutrients and low in saturated fat and added sugars

can be created. Of course, it is very possible that participants in these diets will not make any

additions and instead follow guidelines as they are listed, resulting in suboptimal eating patterns.

In conclusion, the diets proposed in ​The Juicing Detox Diet f​ ail to deliver on many of

their claimed benefits- they will not reduce bodily acidity, compensate for organ dysfunction, nor

rest the digestive system and are unlikely to assist in toxin elimination. Although they do have

the potential to bolster immunity and improve metabolism, such benefits can be found in any diet

featuring fruit and vegetable juices. Furthermore, the hypocaloric nature of Wheater’s one and

two day cleanses presents unnecessary risk to participants while her one and two weeks plans,

although more sufficient, still require independent addition of foods to be nutritionally adequate.

Weather also fails to inform readers of the risk of nutrient deficiencies and drug-nutrient

interactions posed by her diets, therefore jeopardizing the health of participants. Ultimately, the

false claims present in ​The Juicing Detox Diet​, dangers posed by its one and two day cleanses,

and availability of its benefits in less restrictive diets make the book unworthy of reading or

consideration by potential dieters.

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References

Azzouz, L. L., & Sharma, S. (2020, July 27). Physiology, Large Intestine.

https://www.ncbi.nlm.nih.gov/books/NBK507857/.

Bailey, D. G. (2016). Predicting Clinical Relevance of Grapefruit-Drug Interactions: A

Complicated Process. ​Journal of Clinical Pharmacy and Therapeutics,​ ​42(​ 2), 125–127.

https://doi.org/10.1111/jcpt.12463

Carr, A., & Maggini, S. (2017). Vitamin C and Immune Function. ​Nutrients,​ ​9(​ 11), 1211.

https://doi.org/10.3390/nu9111211

Cesar, T., Fidelix, M., Sivieri, K., & Millenkovic, D. (2020). Daily Consumption of Orange

Juice Modulated Intestinal Microbiota and Improved Glucose and Lipids Metabolism in

Women. ​Proceedings of the Nutrition Society,​ ​79(​ OCE2).

https://doi.org/10.1017/s0029665120005832

Cheng, W., Lu, J., Li, B., Lin, W., Zhang, Z., Wei, X., … Yuan, J. (2017). Effect of

Functional Oligosaccharides and Ordinary Dietary Fiber on Intestinal Microbiota

Diversity. ​Frontiers in Microbiology,​ ​8.​ https://doi.org/10.3389/fmicb.2017.01750

Ding, S., Jiang, H., & Fang, J. (2018). Regulation of Immune Function by Polyphenols.

Journal of Immunology Research,​ ​2018,​ 1–8. https://doi.org/10.1155/2018/1264074

Doyle, J. F., & Forni, L. G. (2016). Acute Kidney Injury: Short-term and Long-term

Effects. ​Critical Care​, ​20​(1). https://doi.org/10.1186/s13054-016-1353-y

Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary Tract

Infections: Epidemiology, Mechanisms of Infection and Treatment Options. ​Nature

Reviews Microbiology​, ​13​(5), 269–284. https://doi.org/10.1038/nrmicro3432

DIET BOOK CRITIQUE Kozlosky 10

Goss, J., & Greene, A. (2018). Diagnosis and Staging of Lymphedema. ​Seminars in Plastic

Surgery,​ ​32(​ 01), 012–016. https://doi.org/10.1055/s-0038-1635117

Granzow, J. W. (2018). Lymphedema Surgery: The Current State of the Art. ​Clinical &

Experimental Metastasis​, ​35​(5-6), 553–558. https://doi.org/10.1007/s10585-018-9897-7

Haastrup, P. F., Thompson, W., Søndergaard, J., & Jarbøl, D. E. (2018). Side Effects of

Long-Term Proton Pump Inhibitor Use: A Review. Basic & Clinical Pharmacology

& Toxicology, 123(2), 114–121. https://doi.org/10.1111/bcpt.13023

Hou, C., Zhang, W., Li, J., Du, L., Lv, O., Zhao, S., & Li, J. (2019). Beneficial Effects of

Pomegranate on Lipid Metabolism in Metabolic Disorders. ​Molecular Nutrition & Food

Research,​ ​63(​ 16). https://doi.org/10.1002/mnfr.201800773

Jargin, S. (2017). Grapefruit: Perspectives in Nutrition and Pharmacology. ​Journal of

Intercultural Ethnopharmacology,​ ​6(​ 3), 1. https://doi.org/10.5455/jice.20170511061624

Jiang, Z., Wen, C., Wang, C., Zhao, Z., Bo, L., Wan, X., & Deng, X. (2019). Plasma

Metabolomics of Early Parenteral Nutrition Followed with Enteral Nutrition in Pancreatic

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Klein, A. V., & Kiat, H. (2015). Detox Diets for Toxin Elimination and Weight

Management: A Critical Review of the evidence. ​Journal of Human Nutrition and

Dietetics,​ ​28(​ 6), 675–686. https://doi.org/10.1111/jhn.12286

Kozlowska, L., Mizera, O., & Mroz, A. (2020). An Untargeted Metabolomics Approach to

Investigate the Metabolic Effect of Beetroot Juice Supplementation in Fencers—A

Preliminary Study. ​Metabolites,​ ​10(​ 3), 100. https://doi.org/10.3390/metabo10030100

Levey, A., & Inker, L. (2017). Assessment of Glomerular Filtration Rate in Health and
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Disease: A State of the Art Review. ​Clinical Pharmacology & Therapeutics​, ​102​(3),

405–419. https://doi.org/10.1002/cpt.729

Ma, Z. F., & Lee, Y. Y. (2020). Small Intestine Anatomy and Physiology. In ​Clinical and Basic

Neurogastroenterology and Motility​ (pp. 101–111). Elsevier.

MacFarlane, N. G. (2018). Digestion and Absorption. ​Anesthesia and Intensive Care

Medicine​, ​19​(3), 125–127. https://doi.org/https://doi.org/10.1016/j.mpaic.2018.01.001

Madnawat, H., Welu, A. L., Gilbert, E. J., Taylor, D. B., Jain, S., Manithody, C., … Jain, A.

K. (2020). Mechanisms of Parenteral Nutrition–Associated Liver and Gut Injury.

Nutrition in Clinical Practice​, ​35​(1), 63–71.

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Nahikian-Nelms, M., Sucher, K. P., & Lacey, K. (2016). Diseases of the Lower

Gastrointestinal Tract. In ​Nutrition Therapy and Pathophysiology​ (Vol. 3, p. 427).

Cengage.

Orange Juice, Fresh​. CalorieKing.

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orange-juice-fresh/EPSrLWPETdqgFkAAY2mPlw.

Pottel, H., Delanaye, P., Weekers, L., Selistre, L., Goffin, K., Gheysens, O., & Dubourg, L.

(2017). Age-dependent Reference Intervals for Estimated and Measured Glomerular

Filtration Rate. ​Clinical Kidney Journal​, ​10​(4), 545–551.

https://doi.org/10.1093/ckj/sfx026

Reddy, A., Norris, D. F., Momeni, S. S., Waldo, B., & Ruby, J. D. (2016). The pH of
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Beverages in the United States. ​The Journal of the American Dental Association​, ​147​(4),

255–263. https://doi.org/10.1016/j.adaj.2015.10.019

Rolfes, S. R., Whitney, E. N., & Pinna, K. (2017). Metabolism: Transformations and

Interactions. In ​Understanding Normal and Clinical Nutrition​ (11th ed., p. 215),

Brooks/Cole.

Seifter, J. L., & Chang, H.-Y. (2016). Disorders of Acid-Base Balance: New Perspectives.

Kidney Diseases​, ​2​(4), 170–186. https://doi.org/10.1159/000453028

Sharma, C. M., & Pernitzsch, S. (2017). Multiple Acid Sensors Control Helicobacter pylori

Colonization of the Stomach. ​PLOS Pathogens.​ http://doi.org/10.1371/journal.ppat.10061

18

Wang, H., Cheng, L., Lin, D., Ma, Z., & Deng, X. (2017). Lemon Fruits Lower the Blood

Uric Acid Levels in Humans and mice. ​Scientia Horticulturae,​ ​220,​ 4–10.

https://doi.org/10.1016/j.scienta.2017.03.023

Wheater, C. (1993). ​The Juicing Detox Diet.​ Thorsons.

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Appendix A: Cleanse Guidelines

One Day Juice Plan:

Frequency: Once per week or every two weeks

After Waking: Lemon water

Breakfast: 8 fl oz fruit juice of choice

Lunch: 8 fl oz fruit juice of choice

Supper: 8 fl oz fruit juice of choice

Between Meals: Approved beverages

Before Bed: Lemon water

Weekend Clean-up Plan:

Frequency: Once per month or every two months

After Waking: Lemon water

Breakfast: 8 fl oz fruit juice of choice

Lunch: 8 fl oz fruit juice of choice

Supper: 8 fl oz fruit juice of choice

Between Meals: Approved beverages

Before Bed: Lemon water

One Week Vitality Plan:

Frequency: Four times per year

After Waking: Lemon water

Breakfast: 8 fl oz scheduled juice cocktail, approved breakfast and anytime foods

Lunch: 8 fl oz scheduled juice cocktail, approved lunch and anytime foods

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Supper: 8 fl oz scheduled juice cocktail, approved supper and anytime foods

Between Meals: Approved beverages and anytime foods

Before Bed: Lemon water

Juice Cocktail Schedule

Breakfast Lunch Dinner

Day 1 7 fl oz orange, 4 fl oz apple, 4 fl oz carrot,

1 fl oz lemon 4 fl oz strawberry 2 fl oz watercress,

2 fl oz celery

Day 2 5 fl oz pineapple, 5 fl oz apple, 6 fl oz carrot,

3 fl oz papaya 3 fl oz grape 2 fl oz beetroot

Day 3 5 fl oz grapefruit, 5 fl oz peach, 4 fl oz apple,

3 fl oz orange 2 fl oz strawberry, 4 fl oz carrot

1 fl oz papaya

Day 4 5 fl oz pineapple, 4 fl oz pear, 4 fl oz celery,

3 fl oz mango 4 fl oz peach 2 fl oz spinach,

2 fl oz apple

Day 5 4 fl oz orange, 4 fl oz pineapple, 3 fl oz cucumber,

4 fl oz mango 2 fl oz papaya, 3 fl oz celery,

2 fl oz peach 3 fl oz watercress
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Day 6 4 fl oz strawberry, 5 fl oz orange, 6 fl oz apple,

4 fl oz mango 3 fl oz carrot 2 fl oz beetroot

Day 7 5 fl oz grape, 3 fl oz apple, 4 fl oz carrot,

3 fl oz pear 3 fl oz carrot, 2 fl oz spinach,

2 fl oz pineapple 2 fl oz celery

Two Week Vitality Plan:

Frequency: Twice per year

After Waking: Lemon water

Breakfast: 8 fl oz scheduled juice cocktail, approved breakfast and anytime foods

Lunch: 8 fl oz scheduled juice cocktail, approved lunch and anytime foods

Supper: 8 fl oz scheduled juice cocktail, approved supper and anytime foods

Between Meals: Approved beverages and anytime foods

Before Bed: Lemon water

Repeat cocktail schedule from 1 week vitality plan

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Appendix B: Suggested Juices

Fruit Juices:​ Apple, grape, grapefruit, lemon, mango, melon, orange, papaya, peach, pear,

pineapple, strawberry, watermelon

Vegetables Juices:​ Carrot, beetroot, cucumber, celery, spinach, watercress

Note: Wheater encourages the addition of juices not listed here.

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Appendix C: Approved Foods for One Week and Two Week Vitality Plans

Breakfast:​ Fresh fruit, porridge

Lunch:​ Mixed salad (lettuce, red cabbage, white cabbage, beansprouts, cucumber, alfalfa,

sprouting seeds, chickpeas, watercress, carrot, fennel, radish, celery, tomato, green and red

pepper), steamed or stir-fried vegetables, any fresh fruit from juice list, brown rice, millet, barley

Dinner:​ Steamed, stewed, raw, or stir-fried vegetables, mixed salad (same as lunch), any fresh

fruit from juice list, brown rice, millet, barley

Anytime:​ Kombu, wakame, and dulse seaweeds, oat and rice cakes, hummus, tahini, prunes,

cranberries, raisins, sultanas, pumpkin and sunflower seeds, carrot, cucumber, and red pepper

sticks, cauliflower florets

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Appendix D: Additional Approved Foods for Two Week Vitality Plan

Anytime:​ Goat and sheep yogurt, beans, pulses, tofu, cous-cous, rye bread, stewed dried fruit,

home-made vegetable soup

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Appendix E: Approved Beverages (All Plans)

Anytime:​ Water, lime water, herbal tea