There are several methods of colon cleansing that are popular with alternative medicine practitioners, which include colonic irrigation, herbal colon cleansing products, and enemas. The concept of colon cleansing is based on the idea that undigested food causes a buildup of toxins and mucus in the colon. This leads to a leaky gut, which then allows undigested food particles, toxins, and bacteria into the bloodstream, which in turn leads to illness. This is partially true. Eating a high-fat diet that includes a lot of animal food and junk food does contribute to poor gastrointestinal health, damage to the gut microbiome, and leaky gut. Taking prescription drugs such as antibiotics contributes to the damage too. But colon cleanses do not resolve these issues and can sometimes make the problems worse or create new ones.
Colon cleanses are advertised as a way to relieve a variety of symptoms ranging from headache and fatigue to weight gain and cancer. As is the case with many treatments, both conventional and alternative, results are exaggerated and risks are minimized.
Colonic irrigation, also known as colon hydrotherapy, involves the patient lying on a table while the therapist uses a low-pressure pump to flush several gallons of water through a tube inserted into the rectum. This water is sometimes infused with enzymes, herbs, or coffee. The patient releases the water, along with waste, into a bucket and the process is repeated.
A review of published research studies concerning various colon cleansing methods showed that there are no rigorous controlled trials that have been conducted on these practices for health improvement, but there are many case reports and case series documenting adverse effects. [1] In the case of colonic irrigation, these include rectal perforation,[2] water intoxication and hyponatremia,[3] aplastic anemia,[4] abscesses,[5] infection,[6] and life-threatening gangrene resulting from rectal perforation. [7] Additional side effects include vomiting, nausea, cramps, dizziness, bowel perforation, partial or total washing away of gut bacteria, and changes in electrolyte balance.
The International Association for Colon Hydrotherapy has established training and certification procedures for colon hydrotherapists. In order to enroll for level one training, which allows an individual to perform hydrotherapy, the candidate must have a high school diploma or equivalent; have completed an anatomy and physiology course at an accredited school, have a CPR card, and received between 1 and 3 colonic procedures. The training itself requires 100 hours of live instruction over a 10-day period of time, or a person can submit proof of having performed 100 colonic hydrotherapy sessions during a one-year period (apparently with no formal training). To complete the process the candidate must pass a written exam and make a 15-minute presentation on colon hydrotherapy to a class. IACH also offers Intermediate Level, Advanced, and Instructor-level certifications, which require more classroom hours and more practical experience. But the basic requirements in order to practice are concerning since colon hydrotherapy is an invasive procedure that involves the risk of side effects, some serious.[8]
Colonic irrigation is not a good idea for anyone, but particularly not for people who have gastrointestinal diseases such as diverticulitis, Crohn’s disease, and ulcerative colitis; or for those with kidney disease or heart disease. People with these conditions have an increased risk of side effects. The FDA has not approved the procedure or the devices used to perform it.[9]
Coffee enemas are another popular form of colon cleansing. Although coffee enemas have been reported since ancient times, Dr. Max Gerson popularized the use of them in the 1930’s for the treatment of cancer in the U.S. His theory was that caffeine from the enema would cause toxins to leave the blood stream through the walls of the colon, and to cause the bile ducts to dilate, which would in turn facilitate removal of toxins from the liver.[10] Max Gerson’s approach to cancer treatment was quite complicated, and it is difficult to determine which of the many parts of the treatment were responsible for the “cures” which he claimed resulted from his plan. It is true that the government, funding agencies and medical institutions had and continue to have no interest in researching the Gerson protocol. But even several decades later, according to Dr. Ralph Moss, the clinic, which is now located in Mexico, has not published credible case reports, or even made patient files available to researchers like Dr. Moss who investigate alternative therapies with an open mind.
While there is little research to support the use of coffee enemas for therapeutic purposes, there is some evidence that they can be harmful. Potential risks include rectal burn,[11] colitis,[12] electrolyte imbalance, and even death. [13]
Another issue is that one of the benefits of coffee is thought to be its caffeine content. The absorption of caffeine from a coffee enema is considerably less than when a subject is given caffeine via suppository or when coffee or caffeine-containing beverages are consumed orally.
Many colon cleansing products and programs contain laxatives, such as cascara, magnesium, cat’s claw, burdock root, and milk thistle. Often fiber products such as inulin are added which expand in the digestive tract and cause bowel movements to become bigger. This gives the appearance that larger amounts of waste are being excreted, leading purchasers to think that the cleanse is “working.” Risks associated with colon cleansing programs include dehydration, cramping, abdominal pain, nausea, vomiting, electrolyte imbalances, kidney failure, and reduction or elimination of gut bacteria. There is no evidence that long-term health outcomes are improved by using these products and kits.
In my experience, many people who have colonic irrigation, use enemas, or purchase colon cleansing kits and programs do so because they are constipated. These strategies relieve the constipation, which makes them feel better temporarily but it does not address the cause of the constipation, and in fact can make it worse. Instead of relying on laxatives, the individual instead relies on enemas, herbs, or colonic irrigation in order to feel “cleaned out.” This is not a good idea.
Another rationale for colon cleanses is for periodic “detoxification.” Many people have told me that they like to use colon cleansing and other detoxification programs to clean the body out once or twice per year. Many of these people are overweight and do not practice healthy habits, yet think that irrigation, or taking some herbs or enemas once in a while will compensate for not taking optimal care of themselves on a daily basis. This is also not a good idea.
The better and much safer option is to adopt a high-fiber, low-fat plant-centered diet and to drink enough water every day. This strategy is the way nature intended for the body to be cleaned out on a daily basis. Taking high-quality pharmaceutical-grade probiotics is needed in order to restore the gut microbiome, which is sometimes made worse by colon cleansing programs. The bottom line is that “cleansing” is not something to be done with herbal products and mechanical intervention, and to be undertaken a few times per year; but rather something the body takes care of naturally when one practices good habits.
[1] Acosta R, Cash B. “Clinical effects of colonic cleansing for general health promotion: a systematic review.” Am J Gastroenterol 2009 Nov;104(11):2830-2836
[2] Handley D, Rieger N, Rodda D. “Rectal perforation from colonic irrigation administered by alternative practitioners.” Med J Aust 2004 Nov;181(10):575-576
[3] Norlela S, Izham C, Khalid B. “Colonic irrigation-induced hyponatremia.” Malay J Pathol 2004 Dec;26(2):117-118
[4] Smereck J. Aplastic anemia: a possible toxic effect of an herbal “colon cleansing” preparation.” J Emerg Med 2009 Feb;36(2):191-193
[5] Ratnaraja N, Raymond N. “Extensive abscesses following colonic hydrotherapy.” Lancet Infect Dis 2005 Aug;5(8):527
[6] Chen W, Tsao Y. “Fatal aeroportia with systemic embolism after colon hydrotherapy.” J Trauma 2010 Jan;68(1):247
[7] Tan M, Cheong D. “Life-threatening perineal gangrene from rectal perforation following colonic hydrotherapy: a case report.” Ann Acad Med Singapore 1999 Jul;28(4):583-585
[8] http://www.i-act.org/training.html
[9] Mishori R, Otubu A, Jones A. “Colon cleansing – a dangerous practice returns.” J Fam Pract 2001 Aug;60(8):454-457
[10] Gerson M. “The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation.” Physiol Chem and Phys. 1978;10(5):449–464
[11] Sashiyama H, Hamahata Y, Matsuo K, et al. “Rectal burn caused by hot-water coffee enema.” Gastrointest Endosc. 2008 Nov;68(5):1008–1009
[12] Keum B, Jeen YT, Park SC, et al. “Proctocolitis caused by coffee enemas.” Am J Gastroenterol. 2010;105(1):229
[13] Eisele JW, Reay DT. “Deaths related to coffee enemas.” JAMA 1980;244(14):1608–1609
Dr. Pam Popper, Wellness Forum Health
Your Wellness Lifestyle Starts Here
According to the promoters of Paleo and other bad diets, people should avoid eating grains because they increase inflammation and cause disease.
“Whole grains” includes foods like whole wheat, oats, brown, basmati, and jasmine rice, rye, barley, buckwheat, bulgur, quinoa, corn, farro, kamut, millet, and spelt. Whole grains do not include bagels, pastry, cookies, white flour pasta, croissants, pretzels, and cereals like Lucky Charms. While this seems simple – whole natural foods vs highly processed junk foods, there is considerable misunderstanding about this issue. “Grain bashers” like William Davis (author of Wheat Belly) claim that their patients are sick because they eat grain-based products like Wonder Bread, Trix, Fruit Loops, HoHo’s, Oreos, Vienna Fingers and Fettuccini Alfredo. They apparently do not understand the difference between eating highly processed products and foods like wheat berries and millet loaf.
Those who advise against eating grains claim, among other things, that eating grains increases inflammation levels. While this might be true when consuming highly processed foods like cookies, the opposite appears to be the case for whole grain foods, which have been shown to reduce inflammation.
A very well-designed study involving 81 participants showed clearly both the benefits of consuming whole grains and the difference between diets based on refined vs whole grain products. For the first two weeks, subjects maintained their typical Western-style and weight-maintaining diet. For the next 6 weeks, 40 subjects stayed on this diet, while the other 41 were switched to a diet which included whole grain foods. Both diets were similar in calories, fat, the number of servings of fruit and vegetables, and the percentage of protein. The meals were prepared by trained staff and designed to make sure that the participants would not lose weight. These strategies were implemented to isolate the effects of whole grain consumption since factors like eating more fruits and vegetables and weight loss have also been shown to lower inflammation levels.
Those subjects eating whole grains had favorable changes in their gut microbiomes including a decrease in pro-inflammatory bacteria. They also showed small but statistically significant and favorable changes in plasma markers for inflammation and improvement in immune function. [1]
In another study, Iranian researchers looked at the impact of grain consumption for 44 overweight or obese girls between the ages of 8 and 15. The girls were randomized to two groups, one that consumed whole grains and a control group. Girls in the whole grain group were give a list of whole grains and asked to make sure that half of their grain intake was from whole grains daily for 6 weeks, while the girls in the control group were given the same list and told to avoid whole grain foods.
Whole grain girls then entered a 4-week washout period after which they crossed over to the other arm for an additional 6 weeks.
Eating whole grains did not affect weight or BMI, but the girls eating whole grains did experience positive changes in inflammatory markers during the 6-week intervention period. These included a 22% decrease C-reactive protein, and a 28% reduction in soluble intercellular adhesion molecule-1. The girls in the control group had increases of 12% and 6% respectively during the same period.[ii]
Overweight people have higher levels of inflammation, but these overweight girls still showed lower levels of inflammatory markers even though their weight did not change. The girls did not convert to a program of dietary excellence; in fact, they were permitted to continue to consume half of their grains in refined and processed form. And the rapidity of effect – only 6 weeks – was notable.
A more recent study included 60 Danish adults who were considered high-risk for developing metabolic syndrome. In a randomized crossover trial, subjects were assigned to two 8-week dietary intervention periods during which they consumed either a whole grain diet or a refined grain diet. The first 8 weeks were followed by a 6-week washout period, after which the subjects switched diets.
Not surprisingly, the whole grain diet resulted in fewer calories consumed and more weight loss than the refined grain diet. But in addition, the whole grain diet reduced markers of inflammation such as interleukin-6 and c-reactive protein.[iii]
Other studies have shown not only that whole grain intake lowers inflammation, but that it also improves glucose metabolism and increases weight loss.[iv] Higher whole grain intake is also associated with decreased risk of developing type 2 diabetes, insulin resistance, cardiovascular disease, and obesity; and decreased fasting glucose.[v] [vi]
It’s important to be clear about the objective of this article. It is not to promote the idea that eating whole grains is the solution to our epidemic of disease. In fact, we have advised for many years that there are no magical foods and nutrients, and it is important to focus on adopting a health-promoting dietary pattern. People who eat whole grains as part of an optimal, low-fat, high-fiber plant-centered diet experience much better results than those shown in these studies. But even when the only variable is whole grain intake, the results are better. People who advise against whole grain consumption are giving incorrect advice which is not supported by evidence.
[i] Vanegas SM, Meydani M, Barnett JB et al. “Substituting whole grains for refined grains in a 6-wk randomized trial has a modest effect on gut microbiota and immune and inflammatory markers of healthy adults.” Am J Clin Nutr 2017 Feb;105(3):635-650
[ii] Hajihashemi P, Azadbakht L, Hashemipor M, Kelishadi R, Esmaillzadeh A. “Whole grain intake favorably affects markers of systemic inflammation in obese children: A randomized controlled crossover clinical trial.” Mol Nutr Food Res. 2014 Jun;58(6):1301-8.
[iii] Roager HM, Vogt JK, Kristensen M et al. “Whole grain-rich diet reduces body weight and systemic low-grade inflammation without inducing major changes in the gut microbiome: a randomized cross-over trial.” Gut Published Online First: 01 November 2017. doi: 10.1136/gutjnl-2017-314786
[iv] Montonen J, Boeing H, Fritsche A et al. “Consumption of red meat and whole grain bread in relation to biomarkers of obesity, inflammation, glucose metabolism, and oxidative stress.” Eur J Nutr 2013 Feb;52(1):337-345
[v] Tang G, Wang D, Long J, Yang F, Si L. “Meta-analysis of the association between whole grain intake and coronary heart disease risk.” Am J Cardiol 2015 Mar;115(5):625-629
[vi] Lutsey PL, Jacobs DR Jr, Kori S et al. “whole grain intake and its cross-sectional association with obesity, insulin resistance, inflammation, diabetes, and subclinical CVD: The MESA Study.” Br. J Nutr 2007 Aug;98(2):397-405
Pam Popper, Wellness Forum Health
