Royal Flush

Colonic therapy is more popular than ever, but do the risks outweigh the benefits?

HOW DO YOU LIKE YOUR COFFEE? Black, with sugar and cream—or right up the old hinder? That’s right: a coffee enema. A cup ’a Joe flush is perhaps the most extreme form of a procedure that goes by such names as “colonic purging,” “colonic irrigation,” “detoxification therapy,” “high colonic,” or “hydrotherapy.” And judging by the number of questions I’ve fielded from patients and friends recently, it’s back.

Most colon therapists use plain old water for colonic irrigation, a procedure that works like this: A machine or gravity-driven pump sends a large volume of warm water (as much as 20 gallons) into the colon via one tube. Then the contents of the colon are flushed out through a second tube. During the procedure, the colon therapist massages the abdomen. The flush is typically repeated several times in an hour.

Relief of constipation is the most obvious benefit of the practice, a kind of enema gone into hyperdrive (a regular enema usually involves a quart of fluid). And though the procedure itself isn’t all that complicated, the science behind it—the theory of “autointoxication”—certainly is. Practitioners of the art of hydrotherapy believe that incomplete digestion of food within the colon produces toxins (“autotoxins”) that are absorbed into the body and cause every manner of disease. One Twin Cities wellness center, for example, lists the following signs of autointoxication: fatigue, constipation, excess weight, stomach bloat, gas, bad breath, coated tongue, body odor, skin problems, lower-back pain, depression, poor memory, weakened immune system, and lethargy.

The idea of autointoxication as the “disease of diseases” is not new; in fact, it may be the most overarching idea in the entire history of medicine. The patriarchs of Western medicine, the Greek Hippocrates and the Roman Galen, thought autointoxication to be a prime factor in spread of disease; and an Egyptian papyrus from the 16th century B.C. offers a basic explanation of how we are poisoned by decomposing waste in our bowels (it sounds more sophisticated in hieroglyphics).

The autointoxication craze hit its peak at the turn of the 19th century, championed by the likes of Charles Tyrell and his “Cascade,” a do-it-yourself colon-cleansing device. Cascade users sat on the five-quart rubberized water bottle, creating their own flushing pressure. In the 1920s, books like The Conquest of Constipation, The Lazy Colon, and Le Colon Homicide topped best-seller lists, warning that the contents of the colon were “a burden, fermenting, decomposing, putrefying, filling the body with poisonous substances.”

The idea was so mainstream, the threat so visceral (pardon the pun), that between 1900 and 1920, the renowned London surgeon Sir William Arbuthnot Lane removed the colons of hundreds of patients.

As crazy an idea as colon-purging might seem, a lot of people find the theory of autointoxication, well, intoxicating, and modern science does support some of the rationale behind the ancient practice. The human colon is crowded with bacteria, and 30 percent of feces is made up of dead organisms. Though colonic bacteria have been difficult to study, DNA techniques have now identified 800 species and 7,000 different strains. At the risk of oversimplifying things, there seems to be good species and bad species, depending on what kind of fermentation products the bacteria emits.

By the time a meal courses its way through the small intestine, most of what’s left is water—the colon absorbs about a liter and a half a day. The small amount of fiber, starch, and protein that could not be broken down by stomach acid and pancreatic enzymes is fodder for colonic bacteria, which are capable of at least partly digesting them. In the process, they release nutrients that are the primary source of energy and nutrition for the cells that line the colon. This is why antibiotics often give patients diarrhea: Colon bacterial counts drop, and the weakened cells are unable to absorb the fluid they normally would. Bacterial action also synthesizes nutrients like vitamin K, vitamin B12, thiamin, and riboflavin, which are then absorbed for body-wide use.

But that’s where science and colonic irrigation seem to part company. Colon-therapy literature leans hard on a description of a toxic sludge that lines the colon wall—it’s where such legends as John Wayne having 40 pounds of undigested red meat in his colon at the time of his death come from. But Robert Ganz, a gastroenterologist with Minnesota Gastroenterology, has looked at hundreds of unirrigated colons, and he’s never seen sludge.

Ganz sees colonic purging as “pointless,” for two reasons. First, flushing out the colon doesn’t sterilize it (which would be disastrous to the inner lining of the colon for reasons noted above). “So you knock down the bacterial counts from a trillion to 100 billion,” Ganz explained. “But then you start eating again, and the next day they’re back up to a trillion. What difference have you made?” Ganz asked.

Second, even if a mythical glue began caulking up the lining of the colon, it wouldn’t last long: the cells lining the colon live for about three days and then fall off.

At an average of $75 per treatment, colonic irrigation might be just an expensive, though more thorough, enema. Money aside, the practice does seem to suffer from mission creep, as it takes what we know of colon microbiology and colon health and promises a panacea. If you’re looking to cure your diabetes, arthritis, or depression by flushing out your colon, know that there’s no scientific evidence to support the notion.

If you feel better doing it—and can afford it—the only other thing to consider is if the practice is dangerous. The large volumes of water used can cause fluid and electrolyte shifts in the body, shifts that people with weak kidneys or congestive heart failure cannot tolerate. (This is true even for some conventional enemas. One of the most popular enemas used to prep patients prior to colonoscopy recently fell out of favor after it became clear that the high amounts of phosphorus it contains were pushing people with weak kidneys into kidney failure.)

The amount of pressure used during instillation is also important. Any perforation of the colon is a dangerous thing, since the bacteria that are a normal part of a healthy colon can raise lethal havoc if released into the abdomen (as is the case with appendicitis).

In the meantime, those considering colonic irrigation should remember the words of the Roman physician Galen: “Res ipsa loquitur.” Translation: “Let the buyer beware.” Or something like that.

Craig Bowron is a Twin Cities internist.

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