“”Know your enema.
|—Probably not Sun Tzu|
A colonic or enema is a preparation or procedure that removes waste products from the colon via purging, often referred to by proponents as doing a "cleanse." While the history of such procedures goes back thousands of years, current colonics are generally sold by non-physicians and make claims that are unproven or rest on bunk science.
Since the beginning of human medicine, healers have induced diarrhea in an attempt to "purge" the body of "ill humors." Before the advent of modern medicine this was a standard treatment. One of the signers of the Declaration of Independence, Dr. Benjamin Rush, was the medical adviser to the Lewis and Clark expedition. He was one of the best known early American physicians, and popularly known for his "Rush's Pills" (a.k.a. "Thunderclaps" or "Rush's Thunderbolt"), which induced a rather violent and complete self-cleansing of the colon. Rush's Pills contained 10 grains (0.648 gm) of jalap (Ipomoea purga) and 10 grams of calomel (mercurous chloride). Incidentally, Rush was big on bloodletting, too, and recommended removing 75% of the person's blood. The rather violent effect of some medicines of the 18th-19th centuries, such as Rush's Pills, actually helped to promote homeopathy, which has no effect beyond placebo because it is water.
Despite the lack of proof that these treatments have any benefit, they are still quite popular, with late-night television and internet advertising offering to separate the consumer from their stool and their money. The hallmark of these products is lack of proven efficacy and safety, and much higher cost than similar ingredients bought at the drug store.
Coffee enemas were in use medically as early as the beginning of the 20th century, and appeared in Merck Manual of the Materia Medica starting in 1901  Coffee enemas stopped appearing in the Merck Manual in 1972.
Coffee enemas are the favored method of the Gerson "therapy", which was developed in the 1930s, a quack alternative medicine treatment for cancer. The Gerson therapy also requires a diet consisting entirely of fruit and vegetable juice, so you probably won't even need the enemas anyway. The purpose of the coffee enemas is supposedly to eliminate "toxins" (never mind that coffee contains toxins such as caffeine which the enema is actually introducing into your body), apparently chemical compounds of some sort that no scientist has ever discovered yet but somehow quacks know about.
Livingston-Wheeler Therapy (or Livingston Therapy) is another quack cancer treatment that includes coffee enemas.
In 2013, a Florida couple claimed to be addicted to coffee enemas and were featured on a reality TV show on TLC. Caffeine has some addictive properties, and withdrawal from caffeine causes some relatively mild symptoms, so it is possible.
Despite what Dr. Axe asserts, coffee enemas are not entirely safe. Coffee enemas have caused a several different medical ailments: acute colitis, polymicrobial enteric septicemia, proctocolitis, sepsis, Salmonella brain abscess, and death.
Several products are on the market under names like "Colon Cleanse", which contain only psyllium fiber (Plantago spp.). Psyllium is also the active ingredient in over the counter laxatives such as Metamucil, and does add fiber to the diet. The psyllium products found in the health food store as "colon cleansing" products are usually more expensive than over the counter laxatives containing the same active ingredient. They may be useful for somebody suffering from constipation, or needing to add fiber to their diet, but there is no evidence for any additional health benefits in occasional use for general "cleansing the colon." Barring a few specific medical conditions, a person should eat a high-fiber diet all the time, rather than going through a "colon cleansing" regimen once or twice a year, as its proponents suggest.
Some products contain bentonite clay. This substance, when combined with psyllium, absorbs colon liquid and expands. This will result in the release of mucoid plaque, claimed to be a build up of natural mucus in the colon, but it is really a substance that only appears if you consume the bentonite clay and psyllium.
These contain a mixture of a variety of herbs purported to "cleanse" toxins from the body, and may contain herbs which do have a laxative effect, plus other herbs purported in natural remedies to "cleanse" the liver or kidneys in addition to the colon. Some of these, depending on the active ingredients, are effective as laxatives, but as with the psyllium products their only genuine usefulness is for somebody suffering from constipation. Some of them are just good tasting herbal teas.
Salt water flush
The "salt water flush" is another purported colon-cleansing regimen. It involves drinking a quart or more of salt water, using sea salt (not table salt), first thing in the morning, then spending the next several hours near the bathroom while your "colon" is "cleansed". This practice is recommended in some alternative medicine regimens such as the Lemonade Diet as an alternative to enemas.
Not only is it gross but it is potentially very dangerous. If the salt water ingested is not isotonic (the same salinity as the human body, 9.0 g NaCl per liter of H2O) the hypertonic solution will dehydrate you as the human body ends up expending its own water to dilute the salt enough to prevent overloading the body with sodium. Consuming enough salt at once or depleting the body's water reserves can eventually overwhelm even this protective mechanism, resulting in hypernatremia (salt overload in the blood), which can cause seizures, cardiac arrhythmia, and death. Do not do this.
Familiar to American insomniacs and shilled by a mustashioed Steve Buscemi look-alike, this product purports to "tone and cleanse the colon while eliminating unnecessary toxic build-up." It contains such exotic ingredients as psyllium fiber (Metamucil), guar gum (used in many food products as an emulsifier, but here touted as "regulating glucose levels"), and Lactobacillus (the active culture in yogurt). It also contains Cascara Sagrada (Rhamnus purshiana), a bark-derived laxative first approved by the FDA in 1939, but that "is not generally recognized as safe and effective for OTC [over-the-counter] use… Any available OTC products containing Cascara Sagrada are to be considered misbranded. Many OTC products have already been discontinued by the manufacturers."
The two most likely ingredients in the Dual-Action cleanse to have a laxative effect are the psyllium fiber and the Cascara Sagrada. The least expensive product offered by this company is $60.00, if you order it to be shipped monthly. As a comparison, generic psyllium capsules cost about $6.00 for 100 capsules, depending on the brand and formulation, and generic senna extracts (the closest equivalent to cascara) cost about $8.00 for 200 pills.
These products sell themselves with "testimonials" which tend to be vague. For instance, on their website, Dual-Action lists two separated customers as feeling "healthier and happier, wonderful".
The website does not seem to make the same claims of increased health as the TV infomercial. The spokesman for the product claims that toxins build up in the colon, as do food residues that reduce the caliber of the colon. These "facts" lead to all manner of illnesses. There are no studies showing any efficacy of colon purging. This product is essentially a very high-priced laxative and fiber supplement that perhaps could treat irritable bowel or constipation.
Colon hydrotherapy is the fancy name woo-meisters use for an enema. According to the "International Association for Colon Hydrotherapy, "the colon has been referred to as the sewer system of the body. It is the place where we store the waste material that most of us would rather not think about and most of us don't until our health becomes poor or we feel constipated or have diarrhea. It best benefits the body due to release of this accumulated congestion in the bowel."
Advocates of enemas list many reasons for choosing to have one. According to one website: "parasites are man's deadliest enemy… they kill more people annually than cancers!" It is directly implied that colonics can help remedy this problem. They fail to mention that the parasites that kill so many people are not colonic parasites, but such diseases as malaria.
They also make the argumentum ad populum that many people subscribe to alternative therapies, therefore they must work.
According to the FDA, colonic irrigation systems are Class III devices that cannot be legally marketed except for medically indicated colon cleansing (such as before a radiologic or endoscopic examination). No system has been approved for "routine" colon cleansing to promote the general well being of a patient.
Colon hydrotherapy is essentially unregulated, so practitioners can charge whatever they wish. Insurance does not pay. A typical cost would be about $100 for a session, compared to $2.39 for Fleet's osmotic laxative solution. These therapies are often offered along with other unproven treatments, like "manual lymphatic drainage" and "iridology". In fact, the waste passing through the colon has little to do with systemic disease. Most absorption of nutrients takes place in the small bowel, and what water is absorbed from the colon is essentially sterile.
Enemas have no benefits except for a small number of very specific medical conditions relating to malfunctioning bowels, and can be harmful. Colonic perforation and electrolyte imbalances can occur. Infection from improperly sterilized equipment (Giardia, Clostridium difficle), and severe cramping can all occur. In addition, it may cause symbiotic bacteria in the colon to disappear, resulting in more diarrhea.
As "detox" or general health therapy, enemas are pure bunk.
Things claimed to be caused by a dirty colon
Things claimed to be caused by a dirty colon include
- Constipation, which is
ironic since the diet itself probably causes itdefinitely true
- Bladder and kidney infections
which have nothing to do with the colon
- Vaginal Yeast infections (wtf how does that work?)
- Bad breath and body odor
probably caused by eating clay.
Pregnancy (even in males)Abdominal cramps
- Toe and fingernail fungus (wait, what?)
lack ofabundance of anatomical knowledge
- Spontaneous appearance of goat within your immediate vicinity.
"Side effects of colon cleansing include nausea, vomiting, diarrhea, dizziness, dehydration, electrolyte abnormalities, acute kidney insufficiency, pancreatitis, bowel perforation, heart failure, and infection." Colonics are particularly dangerous for some pre-existing conditions: gastrointestinal disease, prior colon surgery, severe hemorrhoids, kidney disease, or heart disease.
- Quackwatch on colonics.
- Mayo Clinic on colon cleansing.
- Scientific American podcast reports on how colon cleansing is a terrible idea.
- My Addiction: Coffee Enemas, a preview from "My Strange Addiction" (TLC)
- "Natural Colon Cleansing: Is It Necessary?" WebMD.
- Benjamin Rush, MD: assassin or beloved healer? by Robert L. North, Proc. (Baylor Univ. Med. Cent.) 2000 Jan; 13(1): 45–49.
- Fads and Quackery in Healing: An Analysis of the Foibles of the Healing Cults, with Essays on Various Other Peculiar Notions in the Health Field by Morris Fishbein (1932) Blue Ribbon Books, 382 pp.
- Merck's 1901 Manual of the Materia Medica: A Ready-Reference Pocket Book for the Physician and Surgeon, page 264.
- Coffee: The Royal Flush by Ralph W. Moss (1990). The Cancer Chronicles nos. 6 & 7.
- Livingston-Wheeler Therapy Memorial Sloan Kettering Cancer Center.
- Now Charles backs coffee cure for cancer: Angry doctors warn of dangers as Prince of Wales lends support to controversial alternative treatment by Jo Revill (26 June 2004 20.07 EDT) The Guardian.
- Coffee Enemas: Even Prince Charles endorses them by Elaine Hollingsworth (2013) Doctors are Dangerous
- Fight Cancer & Detoxify with a Coffee Enema Dr. Axe
- Some Notes on Michael Gerber, M.D. by Stephen Barrett (revised on July 15, 2012) Quackwatch.
- Couple Addicted to Coffee Enemas, Up to Four Times a Day by Susan Donaldson James (Feb. 8, 2013) ABC News.
- Caffeine Myths and Facts. Caffeine Myth No. 1: Caffeine Is Addictive by Melinda Ratini (April 30, 2017) WebMD.
- [Coffee enema induced acute colitis] by C. J. Lee et al. Korean J. Gastroenterol. 2008 Oct;52(4):251-4. In Korean.
- Polymicrobial enteric septicemia from coffee enemas by K. A. Margolin & M. R. Green (1984). West. J. Med. 140(3):460.
- Letter to the Editor: Proctocolitis Caused by Coffee Enemas by Bora Keum et al. (2010). Am. J. Gastroenterol. 105:229–230; doi:10.1038/ajg.2009.505.
- Campylobacter sepsis associated with "nutritional therapy" — California MMWR Morb. Mortal. Wkly. Rep. 1981 Jun 26;30(24):294-5.
- Medical complications of "alternative" cancer therapy by M. Markman (1985). N. Engl. J. Med. 312(25):1640-1.
- Deaths related to coffee enemas by J. W. Eisele & D. T. Reay (1980). JAMA 244(14):1608-9.
- Mayo Clinic: Healthy Lifestyle, Nutrition and healthy eating
- "What would happen to you if you drank seawater?" The Straight Dope. 2003 November 11.
- , His name is Klee Irwin.
- Gastrointestinal Quackery: Colonics, Laxatives, and More by Stephen Barrett
- http://www.alive.com/articles/view/17406/the_best_colon-cleansing_diet This site is ridiculous
- The dangers of colon cleansing by Ranit Mishori et al. J. Fam. Pract. 2011 August;60(8):454-457.