Myths and Realities: Colon Cleansing: Healthful or just a load of @$%!

July 16, 2009

colonixChau Che MD

Faculty Peer Reviewed

You’ll have increased energy, radiant skin, reduced joint pain, improved asthma symptoms, and best of all…you will lose weight. These are some of the purported benefits of removing “toxins” (otherwise known as undigested material) from the colon through cleansing. As with fashion, music, and art, what’s old has a way of becoming trendy again…especially when celebrities such as Beyonce talk about it on the Oprah Winfrey show. Colon cleansing has become popular but it is far from a new idea.The concept of disease-causing toxins arising from the bowel is called intestinal autointoxication and dates back to the Egyptians in the 16th century, B.C. who practiced colon cleansing. Physicians at that time believed that feces, absorbed into the circulation, were responsible for producing fever and pus (7,8). The Greeks also believed that incomplete digestion of food resulted in residue ascending to the head and causing disease (1,2,8). The practice of colon cleansing can be traced throughout history although its popularity has waxed and waned. Many well respected physicians in the 1800s and 1900s advocated colonic cleansing to maintain good health. In 1884, this concept regained prominence when Charles Bouchard coined the term intestinal autointoxication, claiming that “[Man] is continually on the threshold of disease. Every moment of his life he runs the risk of being overpowered by poisons generated within his system” (1). Inherent in his theory was that the intestinal tract was responsible for these poisons.

Eli Metchnikoff, a Russian born scientist, who won a Nobel Prize and is considered the Father of Probiotic Research, expanded further on autointoxication, describing the colon as “the reservoir of waste of the digestive processes, [that] stagnates long enough to putrefy. The products of putrefaction are harmful. When fecal matter is allowed to remain in the intestine…certain products are absorbed by the organism and produce poisoning” (2). Acceptance of this “disease entity” resulted in hospital admissions and reached its apex in the early 20th century when a prominent surgeon, Dr. Sir William Arbuthnot Lane, began performing colectomies to “cure intestinal autointoxication.” The practice of colonic cleansing in its various forms fell out of favor by the 1930s when books such as “Nostrums and Quakery” from the AMA press challenged the health benefit claims [Cramp AJ, ed. Nostrums and Quackery, vols. 1 and 2. Chicago: American Medical Association Press, 1911 and 1921].

In today’s society, the popularity of colonic cleansing has been driven largely by the interest in leading a healthy lifestyle. Numerous products on the market today, including Colonix, Oxypowder, Almighty Cleanse, Dual Action Cleanse, as well as high-colonics, have been promoted in the media as effective methods of expelling impurities from your body through cleansing of the colonic lumen. Although popular, is there truth behind the claimed benefits of colon cleansing?

Despite evidence to the contrary, the idea that colon cleansing is therapeutic by removing impurities, lives on. However, these claims largely fail to consider normal physiology. The digestive tract has inherent properties that work to clean our colon. After food ingestion, the small intestine absorbs nutrients and contracts to move indigestible residue into the colon. The colon continues the digestive process by absorbing and secreting electrolytes and fluids while its resident bacteria ferments the undigested food products (4). These are just some of the many mechanisms in which the digestive tract works in order to ensure that the colon does not become encrusted with fecal matter as some products claim. The black, rubbery material passed on a colon cleanse is actually a byproduct from the supplements and fiber in the colon cleansing product as opposed to old fecal material, in which consumers are led to believe (5).

Colon cleansing is at times a necessary medical procedure, for example in preparation for a colonoscopy. Incorrect use and overuse of colonic cleansing may result in harm from deregulation of the colonic environment. The colon contains indigenous probiotic bacteria that play important roles including digestion of nutrients, inhibition of pathogenic enteric bacteria, and maintenance of the colonic epithelial barrier (6). The bacteria also induce intestinal production of anti-inflammatory cytokines and reduce production of proinflammatory cytokines (3,6). Of note, the rising incidence of inflammatory bowel disorder in the United States has been linked to the loss of resident bacteria and thus its various functions (6). Colon cleansing products may disrupt the natural flora in the colon by removing both the pathogenic and indigenous bacteria because the detoxification process does not differentiate between the two entities. Disruption of the resident bacteria may actually lead to increased inflammation or infection (6). Cleansing methods such as “high colonics” which introduce large volumes of fluids into the large intestine, have been associated with perforation, electrolyte imbalances, as well as transmission of pathogens from improperly sterilized equipment.

In 1935 the physician Sir Arthur Hurst stated that “No organ in the body is so misunderstood, so slandered and maltreated as the colon” (2). This statement still resonates in today’s society as the preoccupation of intestinal regularity continues to exist in the public and health practitioners. Conventional physicians and researchers were at the forefront of intestinal autointoxication in the 18th century; however, it is now the unorthodox practitioners who are proponents of the theory. Numerous experiments have shown that in healthy individuals putative toxins are generally not absorbed from the colon, and those that do, are inactivated by the liver (2,8). Although double blind trials do not exist to support or contest claims of colonic cleansing, it is best to allow the colon to continue doing its job instead of offering it unsolicited help from colon cleansing products.

Reviewed by Michael Poles MD and Fritz Francois MD, NYU Division of Gastroenterology

1. Brown, J.H., Sonnenberg, A. The Wax and Wane of Intestinal Autointoxication and Visceroptosis-Historical Trends of Real Versus Apparent New Digestive Diseases. The American Journal of Gastroenterology, 2002; 97(11): 2695-2699.
2. Chen, T.S.N., Chen, P.S.Y. Intestinal Autointoxication: A Medical Leitmotif. Journal of Clinical Gastroenterology, 1989; 11(4): 434-41.
3. Chichlowski, M, Hale, L.P. Bacterial-mucosal interactions in inflammatory bowel disease-an alliance gone bad. American Journal of Physiology: Gastrointestinal and Liver Physiology, 2008; 295: G1139-1149.
4. Hasler, W. Harrison’s Principles of Internal Medicine. Ed. Kasper, D.L., et al. New York: McGraw-Hill, 2005. 1725.
5. Horne, S. Colon Cleansing: A Popular, but Misunderstood Natural Therapy. Journal of Herbal Pharmacotherapy, 2006; 6(2): 93-99.
6. Ismail, A.S., Hooper, L.V. Epithelial Cells and Their Neighbors. IV. Bacterial contributions to intestinal epithelial barrier integrity. American Journal of Physiology: Gastrointestinal and Liver Physiology, 2005; 289: G779-G784
7. Muller-Lissner, S.A., Kamm, M.A., Scarpignato, C., Wald, A. Myths and Misconceptions About Chronic Constipation. American Journal of Gastroenterology, 2005; 100: 232-242.
8. Sullivan-Fowler, M. Doubtful Theories, Drastic Therapies: Autointoxication and Faddism in the Late Nineteenth and Early Twentieth Centuries. The Journal of the History of Medicine and Allied Sciences, 1995; 50: 364-390.

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