Detox needs to be ingrained in the DNA of a company. Firstly, that means not toxifying your customers more –be conscious about the use of petrochemicals in personal care products, the water [used in pools and for drinking] and the quality of food. It’s already happening in some spas, but not many. There’s only half a dozen luxury spas worldwide, including Chiva-Som, Rancho La Puerta, Kamalaya, Como Shambhala and Gwinganna serving all-organic food: it’s hard to offer consistently and it’s expensive.

The people who are seeking detox are paying a lot for it and are generally highly educated. So, if a spa claims to specialise in detox and offers highly processed or non-organic food and drink then the clients will see right through it.

As the need for more detox spas spreads and more facilities crop up in urban areas, air quality will need to be addressed also. Savvy managers will tailor solutions for local concerns like these by offering havens for clean air and treatments such as oxygen therapy.

There are two main principles spas can stick to when choosing treatments. The first is to prevent toxicity to begin with. The second is ensuring flow and movement of toxins through the body. This involves supporting all the processes of elimination including the function of the liver, kidneys, bowels, lungs and sweat glands. Treatments that increase circulation without increasing the production of metabolic waste products, such as a sauna or hot tub session or lymph drainage massage are fantastic because they help to flush out the body. Exfoliation of dead skin cells is a good thing, as is anything that supports regular bowel movement – whether you go to the extent colonics or just eat a healthy, high fibre diet. Ayurvedic medicine, particularly the five-stage cleansing process panchakarma, is one of the only proven ways of removing fat soluable toxins, with research being performed in a spa rather than a hospital or clinic (see p38).

Detox is not just something you do for an hour, it’s a lifestyle. Ideally a spa would be able to accommodate customers over days or weeks and educate them on how to reproduce the experience at home.

The challenge for the spa industry is to integrate this expert knowledge into a specific service as any area of detox could be a specialist field in its own right. Operators should begin with self-education and making it relevant to their own market. But they should avoid anything that’s out of their range of competency.

Offering serious detox in spas is going to be a learning curve – we still even don’t know the best way to provide low-toxic food and air to a population as the area is so under-researched. The spa industry has a leadership role to play in this and it could serve as a catalyst for the whole global industry to move towards a more sustainable, toxin-free planet.

Cohen is one of Australia’s pioneers of integrative and holistic medicine and has made significant impacts on its education, research, clinical practice and policy in the country. Details: www.rmit.com

My views will probably not endear me to spa operators. But it’s important they consider the other side of the argument.

I’ve been a qualified physician since 1978 and have also received hands-on training in acupuncture, autogenic training, herbalism, homeopathy, massage therapy and spinal manipulation. During the last 20 years, my research has focused on the critical evaluation of all aspects of medicine, but I do not aim to promote any therapy – my goal is to provide objective evidence and reliable information.

Alternative detox comprises a range of treatments that claim to reduce toxins from the body. Ayurveda, colonics, lymph drainage massage, exfoliation, saunas, hot tubs, organic food, filtered water, good quality air – to the best of my knowledge there is no ‘good evidence’ that any of them eliminate toxins. By good evidence, I mean scientific studies like randomised controlled trials, as these minimise as many sources of bias as possible.

Some may say no evidence exists because alternative detox is a field that’s under-researched, but if the claim is not biologically plausible then why test it? If the treatments don’t work, people may be wasting money or could face harmful side-effects: sauna may result in heart problems in predisposed individuals and ayurvedic remedies are often contaminated with heavy metals, for instance. Spas that are making claims that are not supported by evidence are, in my view, dishonest, arguably illegal and unethical.

The onus should be on those who make the claim to demonstrate that it’s valid. Spas could conduct their own studies – this would include defining the toxin they claim is eliminated in a treatment and measuring it in a proper trial (as described). They would need to hire a scientist to conduct the study but it’s not necessarily a lengthy or expensive process. A meaningful study could be done in two to three months. It might cost around £20,000 (US$14,700, €12,150) but if it’s of sufficient quality, backing could come from official funding bodies such as the Medical Research Council in the UK. Having provable results is an essential precondition to making therapeutic claims.

Ernst has written a number of books critically evaluating alternative and complementary medicine. Details: www.edzardernst.com

On a physical level, detox is about removing toxins from the body. On a psychophysiological level, it’s about removing imbalances – tension or abnormalities anywhere in the body or mind – to restore proper function. The mind, body and emotions all need to be detoxed. Emotional stress, for example, stimulates the production of stress hormones such as adrenalin and cortisol which can cause damage the heart and blood vessels.

I’m not familiar with all spas, but many I’ve seen are superficial. Yet they have the potential to tackle detox at a deeper level which could fill a major gap in healthcare today. Two of the most powerful therapies in detox which also have well-documented scientific research behind them, are meditation and ayurveda.

Along with my role at The Raj, I’m professor and director of the Institute for Natural Medicine and Prevention at the Maharishi University of Management (MUM) in Iowa. The institute receives federal funding to scientifically investigate natural approaches to healthcare. We’ve conducted randomised, controlled blind trials which show that detoxing of the mind via the transcendental meditation technique helps to prevent and treat hypertension, cardiovascular disease and other stress related disorders.

I’d recommend meditation as part of a mind-body detox programme, but it should be done every day. It’s something people could learn and take home with them rather than a one-off annual thing.

Panchakarma, an holistic, ayurvedic system, is especially effective in eliminating accumulated toxins and psychophysiological imbalances. It consists of five purification therapies with special herbs, massages, heating treatments, oil applications and gastrointestinal elimination to balance the brain, nervous system and the whole body. Notably Dr Robert Herron and Dr John Fagan [scientists at MUM] found that panchakarma reduced chemicals know as fat soluable toxins in the blood by 50 per cent. Their findings were published in the journal of Alternative Therapies in Health and Medicine.

Any spa that wants to avoid ineffective detox treatments should employ methods with scientific evidence or at least methods of long tradition of use and preferably ancient. If something’s persisted for millenniums that itself suggests that it’s useful and helpful.

Spas often have an eclectic mix of therapies and clients don’t know what’s best for them. Ideally, a panel of experts would advise what individual combination would be most effective. This might not sound practical, but if a spa really wants to resolve people’s problems, it needs to work at a deeper level. At the very least, programmes should be put together with a panel of interdisciplinary experts.

Schneider’s work at The Raj and MUM comprises teaching, research and clinical practice in integrative preventative healthcare. Details: www.theraj.com or www.mum.edu

Sadly, there’s no research to date which shows that detoxification reduces cellular toxicity. But there are forms of detoxification that we know can assist the organs of elimination – namely the liver, kidneys, colon, lymph system, skin and lungs – to function better to improve health. All of our detox programmes at Gwinganna focus on aiding those organs and removing the big five saboteurs in our toxic world: alcohol, caffeine, sugar, persistent organic pollutants (including smoking) and xenoestrogens (chemical compounds used widely in plastics), plus certain proteins such as gluten and casein.

Supporting and improving the function of these organs is key to developing any detox programme or treatment in a spa. And juicing and fasting aren’t the only options.

There are different styles of massage which can stimulate the lymph system, while chi ne tsang improves blood flow to internal organs. Herbs and supplements from traditional healing systems and naturopathy can support organs – there’s strong evidence that milk thistle supports the liver, for example.

The skin is the largest organ of the body and therefore plays a huge role in the body’s natural detoxification process also.

Treatments such as brushing, salt scrubs, saunas and steamrooms assist elimination along with specific exercise.

However, I’m not convinced every business that uses the word detox understands the implications of it and has the integrity to follow through with consistency. A business that puts a guest into a chemically-ridden whirlpool, or uses skincare or massage oil with chemical ingredients during or after detox treatments isn’t looking at the bigger picture.

The ideal environment to provide a detox is non-toxic and that means a huge commitment. The bonus is, by abiding by these principals you will automatically green your business. At Gwinganna, we grow and use organic food and only have organic skincare. We use no chemicals on the property – the rooms are cleaned using natural products such as eucalyptus. We provide 100 per cent filtered rainwater to drink, bath and shower in and non-chemical swimming pools [silver copper ionisation]. We choose natural materials to build and use non-toxic paint. Our on-site store is also a reflection of what to purchase, offering natural sunscreens and non-chemical insect repellents.

For any spa offering detox, education is key too, as lifestyle changes are challenging and understanding consequences empowers people to make informed decisions. We offer daily educational seminars where guests learn in detail how to assist their body in self-regulating and come back to allostasis. We also counsel them using qualified staff to choose treatments that serve both their belief system and their body’s needs.

The spa industry in general is in a perfect position to differentiate itself from the resort industry and claim wellness. There’s an opportunity to be authentic and really make a difference to human health. But it has to be delivered consistently.

Research which proves that detox treatments are efficacious, will offer credibility to our industry and hopefully persuade governments to change policies on improving human health. Until there is research, however, our focus should be on helping ourselves and other people to learn about the everyday choices that either support or sabotage the body’s ability to detoxify itself because there’s so much toxicity elsewhere in the world that we aren’t able to control.

Kolkka has 34 year’s experience in health and wellbeing. She’s been at Gwinganna for 10 years and set up all of its treatment programmes. Details: www.gwinganna.com

An obstacle spas face in offering detox is the lack of evidence that it works. Marc Cohen, professor of complementary medicine at RMIT University in Australia is tackling this head on by co-ordinating more than 20 studies at lifestyle retreats such as Gwinganna in Queensland. The studies focus on how eating organic food can help to reduce toxins.

In Iowa, USA, The Raj spa (see p38) is used as a testbed for federal-funded research looking at how meditation and ayurveda helps to detox the mind and body and prevent a number of diseases. Details of studies are on its website: www.theraj.com/rajresults/

Moving forwards, Cohen “would love to see global standards for recording data in spas” to enable them to carry out their own credible investigations. Some tests researchers are using may soon be accessible to spa consumers. Innovative online assessments, such as those provided by cogstate.com, can measure the role of toxins in dulling cognitive function. Meanwhile, tests by ubiome.com can analyse bacteria in the gut and determine your ‘enterotype’– via a stool sample – for as little as US$90 (€66, £54). Cohen says this is significant as “we’re only just discovering that the bacteria lining in your gut is an important factor in the absorption of many toxins.”

What’s really going to open up the possibilities to spas, however, is customer recorded data thanks to the increasing number of sophisticated biometric measuring devices that can record a range of data from heart rate and blood pressure to oxygen consumption and environmental pollution levels.

Cohen concludes: “If spas can demonstrate that their services can educate people and positively impact on such measures, then they could be viewed as offering an essential health service rather than merely a pampering, luxury experience.­­”