Green-smoothie and other cleanses

1. Introduction

Version followed: the green-smoothie cleanse as its best-known consumer programme is described by its publisher (JJ Smith's green-smoothie cleanse book, Simon & Schuster/Simon Element, 2014), set within the wider category of "detoxes and cleanses" as the US National Center for Complementary and Integrative Health (NCCIH) defines it. The psychotherapist's work in section 4 is built from NCCIH, the British Dietetic Association (BDA), NICE guidance as reported by Beat, eating-disorder organisations, published case reports and the APA Ethics Code; where it goes beyond them it is marked [synthesis].

What it is. It is a consumer diet product, not a therapy. A psychotherapist does not run, sell, prescribe or recommend a cleanse. The guide covers what clients are likely to be doing and the therapist's own work alongside it.

The method as promoters publish it. The publisher presents the green-smoothie cleanse as a short, fixed-length plan built around blended drinks made from "leafy greens and fresh fruits", promoted as a "detox and weight loss plan" said to help readers "eliminate toxins", "curb cravings" and "reset your metabolism", with no workouts or calorie counting, followed by a longer-term "lifestyle of detoxing and healthy eating"; it cites "thousands of success stories" and a follow-on title (Green Smoothies for Life). [source: Simon & Schuster Canada book page] NCCIH groups this with juice cleanses, fasting, restrictive eating, detox supplements and teas, colon cleansing (enemas, laxatives, colonic irrigation), and sauna or exposure-reduction practices, all promoted to "remove toxins, lose weight, or improve health". [source: NCCIH]

Core idea of change, as promoters hold it. The body is held to accumulate "toxins" that a period of restricted, plant-heavy liquid intake clears, producing weight loss, energy and a reset of appetite and habits. These are attributed claims. [source: Simon & Schuster; NCCIH]

The therapist's core idea of change [synthesis]: a cleanse usually carries meaning (control, a fresh start, hope, purification, belonging to an online community, distrust of medicine, or a disguised route into restriction). Change comes from the client understanding that meaning, making an informed and values-based choice, staying medically safe, and having any eating-disorder or health-anxiety process recognised and treated.

• Evidence status (one line): NCCIH describes the evidence for detox claims as weak, with few, generally low-quality human studies, no long-term studies, and initial weight loss mainly from low calorie intake that is usually regained. [source: NCCIH]
• Regulatory status (one line): in the US, NCCIH reports that the FDA and FTC have taken action against detox and cleanse sellers for hidden ingredients, false disease-treatment claims and unapproved colon-cleansing devices; smoothies and juices themselves are sold as foods, and untreated juice sold in shops must carry an FDA warning label. [source: NCCIH; FDA juice safety page] UK and other jurisdictions: advertising claims fall to national advertising and food-standards regulators [uncertain: not verified].

2. Framework

How the method runs, as promoters describe it. A defined cleanse period replacing usual meals with smoothies (the publisher's framing), then a maintenance or "lifestyle" phase, supported by books, recipes, success stories and follow-on products. [source: Simon & Schuster] Other cleanses are sold as kits, juice-company programmes, health-centre retreats, or as part of naturopathic treatment. [source: NCCIH] Recipes, quantities, durations and schedules are deliberately not described here.

Who practises or sells it. Self-help authors and publishers, juice and smoothie companies, wellness retreats, some naturopaths, social-media influencers and, in some cases, multi-level-marketing distributors. [source: NCCIH for commercial, health-centre and naturopathic routes; influencer and MLM routes are synthesis]

The psychotherapist's framework [synthesis]. There is no fixed session count; this is work woven into ongoing therapy, with follow-up at later reviews.

Phase C runs immediately if any red flag appears in Phase A (fainting, rapid weight loss, purging or laxative misuse, pregnancy, a child on the regime, diabetes or kidney disease). [synthesis]

3. Guiding principles

• Never perform, sell, prescribe or recommend. You do not suggest a cleanse, endorse a brand, supply recipes or advise how to do one more safely. You talk about the client, not the regimen. [synthesis; APA 3.06, 5.01]
• Curiosity before information. Ask what it means before giving any facts; facts offered first are heard as judgement. [synthesis]
• Attribute claims; neither endorse nor ridicule. Say "the programme says it removes toxins" rather than stating or dismissing it. [synthesis]
• Point to neutral, authoritative information. Where a client wants information, signpost NCCIH or the BDA fact sheet rather than your own nutritional advice. [source: NCCIH; BDA] Practical meaning: you are not a dietitian.
• Stay within competence. Medical, nutritional and medication questions go to the doctor, pharmacist or dietitian. [source: APA 2.01] Practical meaning: never advise on medicines or on starting, stopping or changing anything that is prescribed.
• Respect autonomy and self-determination. Adults may choose a cleanse; your role is informed choice, not compliance. [source: APA Principle E]
• Keep eating disorders in view. Cleansing and "clean eating" can mask or trigger restriction; do not rely on weight or BMI to judge severity. [source: NICE guidance as reported by Beat; National Alliance for Eating Disorders]
• Know the medical risk groups. Kidney-stone tendency, gastric bypass or fat malabsorption, kidney or heart disease, gastrointestinal disease, diabetes, pregnancy, children, older adults and the immunocompromised. [source: NCCIH; AJKD case; FDA]
• Consent governs liaison. Share information with the doctor only with consent, unless law or serious risk requires otherwise, and share the minimum necessary. [source: APA 4.05]
• No commercial entanglement. Do not sell or distribute wellness products to clients or take referral fees. [source: APA 3.06; synthesis]
• Children are safeguarded. A child on a restrictive regime is assessed against safeguarding thresholds, not treated as a lifestyle choice. [synthesis]
• Document. Record what the client uses, what was discussed, risks identified and actions taken. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside a client's cleanse. None involves running, adapting or recommending a cleanse. NCCIH advises people to tell their health care providers about detoxes and cleanses so decisions can be made together; the procedures below are the therapist's way of making that conversation possible. [source: NCCIH; procedures are synthesis unless otherwise tagged]

4.1 Routine, non-judgemental inquiry and recording

• Purpose / when: At intake and periodic reviews, and whenever a client mentions "detoxing", "resetting", "clean eating", juicing or a new diet programme. Makes disclosure normal rather than confessional. [synthesis]
• Steps:
  1. Include complementary practices, diets and cleanses in your standard intake list, alongside medicines and supplements.
  2. Ask open, neutral questions: what it is (product, book, juice company, retreat, practitioner), when it started, how they heard of it, who else is doing it, what it costs.
  3. Ask whether their doctor, pharmacist or dietitian knows.
  4. Ask about effects so far: energy, mood, sleep, concentration, dizziness or fainting, bowel changes, thoughts about food.
  5. Record in the notes: the named programme or product, source, start date, cost, medical awareness, red flags, and what you discussed.
• Example language (illustrative): "Lots of people I see use diets, cleanses or supplements alongside everything else. Is anything like that part of your life at the moment?" / "What made you choose this one, and how is it going so far?"
• Watch for: Defensiveness or embarrassment (slow down, normalise); disclosure of laxatives, detox teas or colonic cleansing, which carry added risks of dehydration and electrolyte problems [source: NCCIH; BDA]; secrecy from family or doctor; cleanses repeated in cycles. Working when: the client mentions diet changes spontaneously in later sessions.

4.2 Exploring meaning, hopes, expectations and explanatory model

• Purpose / when: After disclosure, to understand what draws the client: control, a fresh start, punishment after a binge or holiday, hope of feeling clean, belonging to an online group, a wellness identity, or distrust of medicine. [synthesis]
• Steps:
  1. Ask what they hope the cleanse will do, physically and emotionally.
  2. Elicit their explanatory model: what "toxins" mean to them, where they think their symptoms come from, what they believe the cleanse changes.
  3. Ask what it would mean if it did not deliver; and what it means to stop early.
  4. Explore the emotional sequence around it: what happened just before they started (stress, a comment about their body, a medical scare, grief).
  5. Reflect themes back without correcting the model.
• Example language (illustrative): "When you picture the end of the cleanse, what's different for you?" / "You said it feels like 'getting clean'. Clean of what, for you?" / "What would it say about you if you stopped halfway?"
• Watch for: Moral language about food ("good", "bad", "poison", "cheating"); guilt and compensation cycles; the cleanse functioning as self-punishment; fear of contamination or illness pointing to health anxiety (4.9). Working when: the client can name the need the cleanse is meeting and consider other ways of meeting it.

4.3 Attributed-claims and information conversation

• Purpose / when: When the client asks your view or wants information, or when decisions depend on beliefs about how cleanses work. You present what authoritative sources say, attributed, without lecturing. [synthesis]
• Steps:
  1. Ask permission before offering information.
  2. Summarise attributed positions: the programme claims it removes toxins and resets metabolism [source: Simon & Schuster]; NCCIH describes the evidence as weak and early weight loss as mainly from low calorie intake and usually regained [source: NCCIH]; the BDA explains that the skin, gut, liver and kidneys remove waste continuously and that there is no evidence products do this better [source: BDA].
  3. Offer the NCCIH and BDA pages for the client to read themselves.
  4. Ask what they make of it and what fits or does not fit their experience.
  5. Return to their goals and values (4.5).
• Example language (illustrative): "Would it help to hear what some health bodies say about cleanses? You can weigh it up yourself." / "The programme says one thing, the dietitians' association says another. What do you make of the difference?"
• Watch for: Shifting from informing to persuading; the client hearing criticism of their community as criticism of them; you giving nutritional advice (refer to a dietitian instead). Working when: the client engages with the information rather than defending against it.

4.4 Eating-disorder awareness and screening

• Purpose / when: With every client using a cleanse, detox or restrictive plan; especially adolescents, young adults, athletes, people with a history of an eating disorder, people who cleanse repeatedly or after eating episodes, and anyone with rapid weight change. [synthesis]
• Steps:
  1. Ask directly about patterns that clinical and eating-disorder organisations describe as warning signs: fixation on the quality or purity of ingredients, cutting out whole food groups, dread of eating out, and distress when eating rules are broken [source: National Alliance for Eating Disorders, citing Eating Recovery Center]; also bingeing, vomiting, laxative or diuretic misuse, compulsive exercise and preoccupation with weight or shape [synthesis].
  2. Use your service's validated eating-disorder screening questionnaire, administered as licensed [synthesis; specific instruments not reproduced here].
  3. Do not use weight or BMI alone to judge whether an eating disorder is present or serious; NICE guidance advises against single measures such as BMI or duration of illness in deciding whether to offer treatment. [source: Beat reporting NICE guideline NG69]
  4. If an eating disorder is suspected, refer to a community-based, age-appropriate eating-disorder service as NICE recommends, and involve the GP for physical assessment. [source: Beat reporting NICE NG69]
  5. Record screening outcome and actions.
• Example language (illustrative): "Sometimes cleanses become a way of keeping control over food that's hard to let go of. Has anything like that happened for you?" / "How do you feel if you eat something that isn't on the plan?" / "Has food or your body been taking up more of your thinking lately?"
• Watch for: Orthorexic patterns presented as health virtue; cleansing after binges (compensatory behaviour); a client who looks well but reports dizziness or fainting; concealment. Medical emergencies in eating disorders are covered by the Royal College of Psychiatrists' MEED guidance, which stresses early identification and responsibilities across professions [source: BSG page hosting RCPsych MEED]; refeeding syndrome and electrolyte risks in a person who has been severely restricting are assessed by medical teams, not by the therapist [uncertain: refeeding detail not verified]. Working when: risk is documented and, where needed, the client has been seen by the GP or an eating-disorder service.

4.5 Supporting an informed, values-based decision

• Purpose / when: When the client is deciding whether to start, continue, repeat or stop a cleanse, or is spending significant money on one. The aim is a choice that is informed, consistent with their values and free of pressure, including pressure from you. [synthesis; APA Principle E, 3.10] No published decision aid specific to cleanses is used here.
• Steps:
  1. Clarify the decision and who is making it (the client, a partner, a group, a seller).
  2. Ask what matters most: health, appearance, energy, control, belonging, money, time with family, enjoying food.
  3. Lay out options the client names, including doing nothing, and for each ask about likely benefits, costs and risks in their own view, adding attributed information from 4.3 if they want it.
  4. Ask what information they would want from their doctor or a dietitian before deciding, and offer to support that contact (4.6).
  5. Summarise their reasoning back and let them decide; record the discussion.
• Example language (illustrative): "It's your decision. My job is to help you make it with everything you'd want to know." / "If you imagine looking back on this in a year, which choice fits the person you want to be?"
• Watch for: Your own bias leaking in; the client deferring to you ("just tell me"); coercion from a group or seller; a decision being driven by an eating-disorder voice rather than values (return to 4.4). Working when: the client can explain the reasons for their choice and feels it is their own.

4.6 Coordinating with the doctor, pharmacist or dietitian (with consent)

• Purpose / when: Whenever a medical risk group applies (4.7), the client takes regular medicines, or symptoms appear. NCCIH advises people with diabetes to follow their care team's eating plan and consult providers before major dietary changes. [source: NCCIH]
• Steps:
  1. Explain why contact would help and ask for explicit consent; agree what will be shared.
  2. Prefer the client making the contact themselves with your support; otherwise write a brief factual note: the programme or product used, symptoms reported, your concerns, and that you are not advising on diet or medicines.
  3. Share only the minimum necessary. [source: APA 4.05]
  4. Route every question about medicines (including whether a cleanse affects them) to the prescriber or pharmacist; never advise starting, stopping or changing a medicine.
  5. Suggest a referral to a registered dietitian for nutrition questions.
  6. Record consent, what was shared and the response.
• Example language (illustrative): "Because you take medication for your blood sugar, your GP or pharmacist really needs to know about the cleanse. Would you call them, or would you like me to write a short note?"
• Watch for: The client fearing the doctor will scold them (rehearse the conversation); doctor dismissiveness that pushes the client further from medicine (help the client prepare questions); refusal of consent (respect it unless risk overrides; see 4.7). Working when: a medical professional is aware and the client feels able to discuss diet with them.

4.7 Recognising and responding to medical and other risk

• Purpose / when: Continuously while a cleanse is in progress. The therapist does not diagnose but must recognise when medical attention is needed. [synthesis]
• Steps:
  1. Know the risk groups and risks as sources state them:
     • Juices or smoothies from high-oxalate foods such as leafy greens and beets can pose risks for people prone to kidney stones. [source: NCCIH]
     • A published case described acute oxalate nephropathy (kidney injury from calcium-oxalate crystals) in an older woman with a previous Roux-en-Y gastric bypass after a green-smoothie cleanse; risk factors named were gastric bypass or fat malabsorption, antibiotic use and high oxalate intake. [source: AJKD Blog on Makkapati, D'Agati and Balsam]
     • A second case described an older man with previously adequate kidney function who developed acute oxalate nephropathy after sustained heavy spinach-based juicing together with volume depletion and remained on dialysis a year later. [source: Case Reports in Nephrology 2022, DOAJ record]
     • Laxatives and detox teas can cause diarrhoea, dehydration and impaired absorption; consuming only water or herbal tea without food can cause dangerous electrolyte imbalance; fasting can cause headaches, fainting, weakness and dehydration. [source: NCCIH; BDA]
     • Colon cleansing carries higher risk for people with gastrointestinal disease, previous colon surgery, severe haemorrhoids, kidney disease or heart disease. [source: NCCIH]
     • Severe restriction can cause tiredness, dizziness, irritability and poor concentration and may lead to nutrient shortfalls. [source: BDA]
     • Untreated (unpasteurised) juice can cause serious foodborne illness; children, older adults, pregnant women and people with weakened immune systems (including people with cancer, diabetes or HIV, and transplant recipients) are at greatest risk. [source: FDA; NCCIH]
  2. Ask about warning symptoms at each session during a cleanse: fainting or near-fainting, marked weakness, confusion, palpitations, reduced urine, vomiting or persistent diarrhoea, new pain.
  3. Respond proportionately: urge same-day medical contact for warning symptoms; advise emergency services for collapse, confusion or chest pain [synthesis]; for known kidney disease, kidney stones, gastric bypass, diabetes or heart disease, ensure the doctor knows before or during the cleanse (4.6).
  4. Watch for delayed medical care: if the client is using a cleanse instead of seeking investigation or treatment for symptoms or a diagnosed illness, name this gently and support medical contact. No cleanse is a treatment for any physical disease.
  5. Document risks identified and advice given.
• Example language (illustrative): "You mentioned feeling faint on the stairs. That's something a doctor should hear about today. Can we work out how you'll do that?" / "Has anyone medical checked your kidneys since the bypass? I'd like your GP to know about the smoothies."
• Watch for: Minimisation ("it's just the toxins coming out"); symptoms reframed by the programme as signs of detoxing [synthesis]; clients with gastric bypass, kidney-stone history or antibiotic courses. Working when: the client reports symptoms promptly and seeks medical review.

4.8 Children, adolescents and pregnancy

• Purpose / when: When a pregnant client is cleansing, when a parent puts a child on a cleanse or restrictive regime, or when an adolescent client is cleansing. [synthesis]
• Steps:
  1. Pregnancy: ask whether the midwife or obstetric team knows; support the client to tell them; note that pregnant women are among those at greatest risk from untreated juice [source: FDA]; do not give dietary advice.
  2. Adolescent clients: screen for eating disorders (4.4); involve parents or carers according to your service's confidentiality policy and the young person's competence; obtain the young person's assent and, where required, parental consent for liaison.
  3. A child placed on a regime by a parent: explore the parent's reasons with respect; ask whether the child's doctor knows; consider growth, weight loss, missed meals, symptoms, missed medical care and the child's distress.
  4. Where a child is deprived of adequate nutrition or necessary medical care, or is harmed by products or procedures, consult your safeguarding lead and follow local child-protection procedures. [synthesis]
  5. Document reasoning and actions; never name the child outside the record and required reports.
• Example language (illustrative): "I can see you want the best for her health. Can we think together about what her doctor would need to know?" / to an adolescent: "Who else knows you're doing this? Would it help to have someone on your side when you talk to your parents or GP?"
• Watch for: A parent's own eating disorder or health anxiety shaping the child's diet; adolescents copying influencers; secrecy; signs of faltering growth reported by others. Working when: the child's or pregnant client's medical team is involved and safeguarding concerns are either ruled out or acted on.

4.9 Health anxiety, somatic symptoms and "toxin" fears

• Purpose / when: When repeated cleansing is driven by fear of contamination, unexplained symptoms attributed to "toxins", or beliefs about environmental sensitivity. Cross-refer to Domain II for full protocols for health anxiety and somatic symptom presentations. [synthesis]
• Steps:
  1. Map the cycle: trigger (symptom, article, social-media post), interpretation ("toxins are building up"), emotion, safety behaviour (cleanse, checking, reassurance-seeking), short-term relief, return of doubt.
  2. Agree a shared formulation in the client's language, without debating whether toxins exist.
  3. Offer the established psychological approach for the presentation (for example CBT for health anxiety or somatic symptom disorder) as set out in Domain II.
  4. Coordinate with the GP so appropriate medical assessment happens once and is not repeated indefinitely.
  5. Treat cleansing as one safety behaviour among others, to be understood and reduced collaboratively rather than banned.
• Example language (illustrative): "It sounds like each cleanse brings relief for a while, and then the worry comes back. Shall we map out what happens?"
• Watch for: Escalating restriction to manage anxiety; overlap with orthorexic patterns (4.4); medical symptoms wrongly attributed to anxiety (keep the GP involved). Working when: the client tolerates uncertainty about their body with less need to cleanse.

4.10 Commerce, online communities, multi-level marketing and conflicts of interest

• Purpose / when: When the client is buying expensive programmes, distributing products, recruiting others, or belongs to a group where leaving or eating normally is discouraged. Also governs the therapist's own conduct. [synthesis]
• Steps:
  1. Ask about money: what they have spent, whether they are selling or recruiting, whether income is promised, whether there are tiers or upgrades.
  2. Ask about the group: what happens if someone stops, questions results or eats off-plan; whether testimonials or "success stories" are expected of them.
  3. Explore the pull of belonging, identity and hope separately from the product.
  4. Where debt or financial exploitation appears, signpost to debt advice and consumer-protection bodies.
  5. Your own conduct: do not sell, distribute or endorse wellness products, cleanses or courses to clients; do not take referral fees; declare and manage any conflict of interest. The APA Ethics Code requires psychologists to refrain from roles where personal or financial interests could impair objectivity or risk exploitation (3.06), and covers multiple relationships (3.05) and false or deceptive statements, including those promoting products (5.01, 5.02). [source: APA Ethics Code]
• Example language (illustrative): "What does the group say when someone decides it isn't for them?" / "How much has this cost so far, and how do you feel about that?"
• Watch for: Recruitment of the therapist or other clients; shame about money spent; high-control group dynamics (cutting off doubters, pressure to post results). Working when: the client can weigh the group's value and costs openly.

4.11 Reporting routes

• Purpose / when: When a client has been harmed by a product, misled by health claims, or a child is at risk. [synthesis]
• Steps:
  1. Adverse health effects: encourage the client and their doctor to report harm from a food, supplement or product to the national food or product regulator (in the US the FDA; in the UK the relevant food and medicines regulators) [uncertain: specific reporting portals not verified].
  2. Misleading advertising or disease-treatment claims: consumer and advertising regulators (in the US the FTC, which NCCIH reports has acted against detox sellers alongside the FDA [source: NCCIH]; in the UK the advertising standards regulator [uncertain: not verified]).
  3. A registered practitioner (for example a regulated health professional selling or supervising cleanses with false claims): the relevant professional board.
  4. Children: local safeguarding or child-protection services through your safeguarding lead.
  5. Record what was reported, by whom and when; support the client to make reports themselves where possible, respecting confidentiality (APA 4.05).
• Example language (illustrative): "What happened to you is something the regulator collects reports about. Would you like help working out how to tell them?"
• Watch for: Clients' shame or fear of the seller; your own duty to report under local law where a child is at risk. Working when: reports are made where warranted and the client feels supported rather than exposed.

5. Handling problems

Sources on cleanses do not address psychotherapy problems directly; all responses below are [synthesis] unless tagged.

• Client won't disclose or minimises ("it's just a smoothie"). Normalise by asking about everyone's diet and supplements routinely (4.1); revisit later; avoid interrogating. Illustrative: "No judgement either way. I ask everyone, because it sometimes affects how people feel."
• Client asks you to approve or recommend a cleanse. Decline the role clearly but warmly; offer to help them think it through and to point to neutral information (4.3, 4.5). Illustrative: "I'm not the right person to recommend a diet, but I can help you work out what you want from it and who could advise you."
• Client asks you how to do it more safely, or about quantities or schedules. Do not give dietary or medication advice; refer to the GP, pharmacist or a registered dietitian (4.6).
• Resistance after information ("you sound like my doctor"). Return to meaning and values (4.2, 4.5); acknowledge the rupture; separate respect for the person from views on the product. Illustrative: "I may have come across as taking sides. I'm more interested in what this means for you."
• Rupture over an eating-disorder concern. Name your concern as care rather than accusation; stay curious; repair before pressing for referral unless medical risk is high, in which case act on risk and repair afterwards. Do not rely on normal weight as reassurance. [source for weight point: Beat reporting NICE NG69]
• Repeated cleansing cycles (cleanse, rebound eating, guilt, cleanse). Formulate as a restriction-compensation cycle; screen for binge eating and bulimic patterns (4.4); consider eating-disorder referral. NCCIH notes initial weight loss is usually regained after normal eating resumes, which can feed the cycle. [source: NCCIH]
• Overwhelm or shame about money spent or results not achieved. Validate the hope that led to the purchase; explore self-criticism; address finances practically (4.10).
• Client distressed by physical symptoms but reluctant to see a doctor. Explore the barrier (fear of judgement, past dismissal, distrust); rehearse the conversation; offer to write a note with consent (4.6). If warning symptoms are present, be direct about urgency (4.7).
• Programme reframes symptoms as "detox reactions". Do not argue the theory; ask what would make them seek medical review, agree that threshold in advance, and keep it in the record. [synthesis; promoters' framing of detox reactions uncertain: not verified]
• Client distrusts medicine entirely. Explore the history behind it; honour autonomy; look for any health professional they do trust; keep the door open; never present the cleanse as a substitute for medical care of a physical disease.
• Group or family pressure. Explore the cost of disagreeing; help the client find words for limits; watch for high-control group features (4.10).
• A parent refuses to involve the child's doctor. Consult your safeguarding lead; record; follow local procedures (4.8).
• The therapist's own reactions (irritation, rescuing, or enthusiasm for wellness trends). Use supervision; check for conflicts of interest and bias (APA 3.06). [source: APA Ethics Code]
• Non-adherence to agreed safety steps (e.g. not contacting the GP). Ask what got in the way; reduce the step to something smaller; reassess risk; escalate if warning symptoms or a child are involved.

Sources

Web sources:

• "Detoxes" and "Cleanses": What You Need To Know (NCCIH)
• 10-Day Green Smoothie Cleanse (Simon & Schuster Canada book page)
• "Green Smoothie" Oxalate Nephropathy (AJKD Blog, January 2018)
• Acute Oxalate Nephropathy Caused by Excessive Vegetable Juicing and Concomitant Volume Depletion (Case Reports in Nephrology, January 2022; DOAJ record)
• Detox diets: Food Fact Sheet (British Dietetic Association, August 2025)
• What You Need to Know About Juice Safety (US FDA)
• What are the 5 Warning Signs of Orthorexia? (National Alliance for Eating Disorders)
• NICE new guideline on eating disorders (Beat news)
• RCPsych Guidance: Medical emergencies in eating disorders (MEED) (British Society of Gastroenterology page)
• Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, amended 2016, effective 2017)

Articles and books cited:

• Makkapati S, D'Agati VD, Balsam L. "Green Smoothie Cleanse" Causing Acute Oxalate Nephropathy. American Journal of Kidney Diseases. DOI 10.1053/j.ajkd.2017.08.002. [uncertain: year, volume and pages not verified]
• Smith JJ (2014). 10-Day Green Smoothie Cleanse. Simon & Schuster / Simon Element.
• National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69). [uncertain: guideline text itself not verified; content as reported by Beat]
• Royal College of Psychiatrists. Medical emergencies in eating disorders (MEED): guidance on recognition and management (College Report CR233). [uncertain: full report and date not verified]