While orthodox medical detoxification procedures are used in such areas as dialysis, or to stabilize bodies that have become accustomed to high levels of alcohol or drugs, many alternative therapists claim it is necessary to "detoxify" the colon and the liver, organs which do not in fact need detoxing.

As Raso (1993) noted, despite evidence to the contrary, many of those involved with vitalistic alternative therapies, "... regard the colon as a 'toxic waste dump' ." (p. 256) that produces large amounts of poisonous toxins. To remove this dangerous waste they recommend the regular use of some form of colonic cleansing, either by fasting, "…eating natural vegetable fibre to eliminate waste from the body ...," (Gravett, (1993, p.30), the use of purgatives, or by Enemas, or by Colonic Irrigation.

Although both refer to a process in which fluid is introduced into the colon the primary difference is in the amount of liquid used. Enemas, use a small amount of fluid to flush out the lower part of the colon, the rectum and the sigmoid colon; whereas Colonic Irrigation involves filling the entire colon with a large volume of warm fluid, generally 50 litres or more, and then flushing it out, repeatedly.

The function of the colon is to move digested food waste to the rectum by a process of involuntary peristalsis. Because of the very effective operation of the colon orthodox medicine rarely recommends enemas except for severe cases of constipation, colonic inertia, prior to a colonoscopy if the prescribed laxative is not completely effective, or, with Barium to highlight the stomach and intestines prior to an X-ray analysis.

Despite this alternative therapists recommend enemas for a wide range of problems, including, Addictions, Arthritis, Allergies, Eczema, Epstein-Barr virus, Fatigue, Gout, Headaches, High Blood Pressure, Hypoglycaemia, Lupus, Menstrual Disorders, Prostate problems, Psoriasis, even for pimples and skin blemishes. (Rosenfeld, 1996, p.203)

Alternative "detoxification" practices are based upon outdated pseudo-scientific theories which Green (1992) indicated, had their origins in the ancient belief in "corrupt humours" which were believed to spread contagion through a normally healthy body, and were treated with regular enemas, to induce, "…copious bowel movements" (p. 3224). Despite the fact that the theory of humours fell out of favour after the Renaissance, the concept of "corrupt humours" was replaced with the theory of "autointoxication" which claimed that, usually due to poor diet, faeces could build up inside the colon, forming a solid mass that not only obstructed the passage of food but, even worse, produced toxins that could poison the body. During the 19th century this theory provided the main justification for colonic cleansing, even amongst orthodox medical practitioners.

So entrenched was this theory that in 1902 Metchnikoff of the Pasteur Institute declared the colon was a useless, redundant organ, which evolution "…had unfortunately failed to eliminate... an objectionable object which we might do better without because of the absorption of noxious products from the putrefying products which it harbors." (Kellogg, 1917, p. 1957).

He claimed that the "…the most effective method of getting rid of colon germs and poisons would be the removal of the colon itself." (p. 1957). During the late 1800s and early 1900's Colonic irrigations were the preferred form of treatment for "autointoxication", and it was particularly popular as a form of hydrotherapy in many sanatoriums and clinics. At the Battle Creek Sanatorium, John Harvey Kellogg, who had an almost obsessive concern for the bowels of his patients, used a special machine that could deliver a series of enemas. This was followed by the delivery of a pint of yoghurt containing Bacillus bulgaricus and Bacillus bifidus, several ounces of which were administered via an enema, to ensure the protective germs of the yoghurt were directed to the place where they were most needed, and the remainder taken orally. The mechanical administration of enemas remained a popular part of orthodox medicine, and by the 1920s such machines were to be found in most hospitals and medical practices.

However, as Ernst (1991) noted, it was eventually realized that most of the intestinal absorption process occurs in the small intestine, not in the colon, and the physical problems thought to be caused by autointoxication were actually caused by the simple distension.of the gut. Although Autointoxication was seen to be a useless and sometimes dangerous treatment, enemas continued to be used well into the 20th century, the prevailing attitude apparently being that "while they did no harm they might do some good"!

Alternative therapists claim that virtually all disease is due to: "…absorption of bacterial poisons from the intestines." (Hall, 2008, p. 9) Such claims are quite absurd. Others claim stagnant faecal waste remains in the colon for months or even years at a time, and use such sensational claims as justification for regular colonic cleansing. They conveniently fail to mention the fact that it is extremely rare for digested matter to adhere to the self-cleaning walls of the colon; and so colonic irrigation is somewhat redundant!

Although the actual origins of the use of enemas are unknown, they were mentioned in Babylonian and Assyrian cuneiform inscriptions as early as 600 BCE (p. 215), and were popular amongst the ancient Egyptians who administered concoctions that often contained "disgusting" ingredients such as ox-bile. The ancient Greek physicians simplified the ingredients to water, with or without salt, and honey and oils.

In earliest times enemas were delivered via a tube with a funnel end; later, a manually compressed animal bladder was added to the tube, this was known as a clyster purse. Avicenna, (980-1036) the famed Persian physician and Albucasis of Cordoba, (936?-1013) both developed an actual syringe and during the Renaissance this was improved and adapted for self-use. Only in the 17th century with the introduction of a flexible tube, did the process become extremely popular, in many instances, daily events.

It may not be entirely coincidental that colonic irrigation is so favoured by those with alternative health views. Many who follow alternative life-styles tend to have an exaggerated perception of their health and often adopt rather severe diets, sometimes with unfortunate results. Extreme vegetarianism is one such example, for while certain vegetarian diets can be beneficial, extreme forms can often be detrimental; as Jarvis (1997), a former Seventh Day Adventist who himself had followed a strict vegetarian diet, observed, "... digestive distress is legendary among SDAs."

There are certain inherent dangers for patients associated with the administration of enemas, especially when performed by those who lack proper medical knowledge. As Rosenfeld (1996) mentioned, repeated use of enemas can stretch the bowel to such an extent it loses its peristaltic elasticity; once that occurs it is unable to properly push waste through the colon resulting in severe constipation. (p. 204). Much more serious is the potential for infection. Istrre at a/ (1982) reported 36 incidents of amebiasis (an infection of the intestines by a species of pathogenic amoeba) between June 1978 to December 1980 amongst patients who had received colonic-irrigation therapy at a chiropractic clinic in western Colorado. The cause of the contamination was traced to faecal coliform bacterial infection in the colonic-irrigation machine. As a result of the infection ten patients required a colonoscopy (surgical removal of part of the bowel) and of these, six died.

Similarly Handley, Rieger and Rodda (2004) reported three instances of perforation of the rectum apparently caused by direct injury by the irrigation device used to administer, "... colonic irrigation to relieve chronic constipation, to "cleanse" or clear out stale faeces" (p. 575), or by the generation of high pressure, "…within the lumen of the bowel." (p. 575)

While observing that, "...colonic irrigation is of dubious benefit, especially when delivered to remove so-called "toxic waste" when bowel function is satisfactory." (p. 575-6), they noted not only that there is real potential for physical harm to patients undergoing such procedures but that patients were not warned of any potential dangers. In addition, lacking the medical skills the alternative therapists involved failed to note the injuries at the time and failed to provide any follow-up which might have led to an earlier discovery of the problem.

Most of the claims promoting colonic irrigation are fallacious and sensationalized. Promoters of these products often use outright deception in advertising, e.g. Blessed Herbs (2008) feature on their web-sites pictures of the faecal discharges of a number of customers who have used their product. However, what they fail to mention is that these discharges are actually "casts" – referred to as mucoid plaques by some alternative therapists, and that these are (a) formed by the high level of fibre contained in the colonic cleansing products. (Barrett, 2008), and (b) are only found in those who use these types of bowel cleaning products.

One claim on the Internet is that after movie actor John Wayne died, an autopsy found 40 pounds (18.14 kilograms) of impacted faecal matter in his cancerous colon, (the implication apparently being that [a] eating meat was dangerous and [b] this had caused his cancer). As Snopes (2005) reveals, no autopsy was ever carried out on Wayne and it would have been impossible to amass such a large amount of material in the colon.

Nevertheless, similar bizarre theories continue to be promoted by advocates of colonic cleansing, some even claiming it can be used for curing cancer. For instance Gerson therapy which relies heavily on coffee enemas, and a diet low in sodium and high in potassium rich, to treat cancer is, as Green (1992) points out, based on obsolete concepts that although popular in Germany over a century ago, have absolutely no valid scientific basis, and as Rosenfeld (1996) noted, "...are primitive by today's standards" (p. 206). Rosenfeld (1996) also commented that the use of coffee enemas serve no useful purpose, the claims that the coffee can "...activate a liver enzyme that destroys free radicals" (p. 205) remains unproven, while the claim they reduce the pain associated with cancer is suspect. Reports of such positive benefits are rare, and the reported pain relief extremely minimal and, as Rosenfeld observed, most patients would prefer the speedy convenience of an injection rather than endure the pain and inconvenience of an enema.

Coffee enemas are nothing more than a variation on the theme of autointoxication in which Gerson (1977) claimed that "poisons" in processed food create a situation whereby the normally aerobic metabolic process in the liver and intestines is transformed into an abnormal toxic producing anaerobic fermentative process that can produce a variety of health disorders, including cancer. Gerson (1977) claims that only by eliminating these toxins from the body, using his "detoxification" process, can the disease be overcome.

However, despite these grandiose claims, "…not a single such 'toxin' has ever been identified." (Rosenfeld, 1996, p. 205)

Furthermore, as Green (1992) indicated, while the proponents of such forms of treatment conveniently overlook the possibilities of any dangers associated with these colonic irrigation regimes, there are risks associated with their use. Jonas and Levin (1999) reported there have been at least two deaths related to "voluminous coffee enemas" (p. 116). It appears these were caused by disturbances to the electrolyte balance rather than a toxic reaction. As Eisele and Reay (1980) noted this could have been the result of excessive use of coffee enemas which tend to, "... produce sodium and chloride depletion and fluid overload on the basis of osmotic and concentration gradients across the colonic mucosa." (p. 1609).

Given the fact that the administration of enemas and other forms of colonic cleansing when used for alternative therapeutic purposes serve no real purpose, and can cause problems, their use is not recommended!

REFERENCES

Barrett, S. (2008) Gastrointestinal Quackery: Colonies, Laxatives and More. www.quackwatch.org/01QuackeryRelatedTopies/gastro.html

Blessed Herbs (2008). It's Gross and It's Minel Entries from our recent "Poo Contest" showing photos and testimonials of real results from the Colon Cleansing Kit by Blessed Herbs.
www.blessedherbs.com/bhl/node/1874?s_cid=colon%20cleansing%20products_780_ 46_001&

Eisele, J.W. and Reay, D.T. (1980). Deaths related to coffee enemas. Journal of American Medical Association, 244, 1608-1609.

Ernst, E. (1991) Colonic irrigation and the theory of autointoxication: a triumph of ignorance over science. Journal of Clinical Gastroenterology, 24(4), 196-8.
 
Gerson, M. (1977). A Cancer Therapy: results of Fifty Cases. Del Mar, California: Totality Books, 3rd edition.

Green, SA (1992). A critique of the rationale for cancer treatment with coffee enemas and diet. Journal of American Medical Association, 268, 3224-3227.
 
Hall, H. (2008). Detox Quackery: from Footbaths to Fetishism. Skeptic, 14:1, 8-9.

Handley, DV., Rieger, N.A. and Rodda, D.J. (2004). Rectal perforation from colonic irrigation administered by alternative practitioners. Medical Journal of Australia, 181 (10), 575-576.

Istre, G.R., Kreiss, K., Hopkins, R.S., Healy, G.R., Benziger, M., Canfield, T.M.
Dickinson, P., Englert, T.R., Compton, R.C., Matthews, H.M. and Simmons, R.A. (1982). An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. New England Journal of Medicine, August 5; 307(6) 339-342.

Jarvis, W.T. (1997). Why I am Not a Vegetarian. American Council on Science and Health. www.acsh.org/healthissues/newsID.760/healthissue_detail. asp

Jonas, W.B. and Levin, J. (1999). Essentials of Complimentary and Alternative Medicine. Philadelphia: Lippincott Williams and Wilkins.

Kellogg, J.H. (1917). Should the colon be sacrificed or may it be reformed? Journal of the American Medical Association, 68:26, 1957-1959.

Raso, J. (1993). Mystical Diets: Paranormal, Spiritual, and Occult Nutritional Practices. Buffalo, New York: Prometheus Books.

Rosenfeld, I. (1996). Dr. Rosenfeld's Guide to Alternative Medicine New York: Random House, Inc.

Snopes (2005). Meat Your Maker. www.snopes.com/horrors/gruesome/ fecalcolon.asp