Although they are widely touted on TV, on the Internet, and in newspaper and magazine ads, colon cleansing regimens have:

• No proof that they are effective in promoting general health or well-being.
• Lots of evidence that they are actually harmful, even potentially life-threatening.

Administered either orally as teas, pills, or powders or through the rectum as high-powered enemas or colonic hydrotherapy, colon cleansers promise to "detox" the body and eliminate fatigue, weight gain, and headaches.  Using informercials and celebrities, they say they will "boost the immune system" and promote weight loss.

The problem is that there is not a shred of evidence that colon cleansing does any of these things.

And there is evidence that it can make holes in the colon requiring surgery, cause serious infections, lead to dehydration and heart and kidney damage, and sometimes kill.

In a recent article in the Journal of Family Practice,  Dr.Ranit Mishori reviewed the case for colon hydrotherapy and herbal supplements sold to clean the colon and "detoxify" the body.

Dr. Mishori found little evidence that they were effective and many reasons to avoid them. Some adverse events were mild like cramping and nausea, others life-threatening including bowel perforations, kidney and heart failure, and abdominal abscesses.  Several patients died when unsterile hydrotherapy equipment infected them with amebiasis, an intestinal parasite.

Devices used for colonic therapy and irrigation are Class III medical devices and must be licensed by the FDA and used only for those medical purposes that are approved by the FDA.  Colon hydrotherapy is not one of those purposes, and the FDA has issued a number of warning letters to "colon hydrotherapists" who misuse the devices.

In the Journal of Family Practice, Dr. Mishori urges doctors to raise the issue of colon cleansing with their patients and let them know about lack of evidence and potential risks.  He concludes with 4 things to tell patients about colon cleansing:

• Colon irrigation is not wise—particularly if you have a history of gastrointestinal disease (including diverticulitis, Crohn’s disease, or ulcerative colitis) or a history of colon surgery, severe hemorrhoids, kidney disease, or heart disease. These conditions increase the risk of adverse effects.
• Side effects of colon cleansing include nausea, vomiting, diarrhea, dizziness, dehydration, electrolyte abnormalities, acute kidney insufficiency, pancreatitis, bowel perforation, heart failure, and infection.
• The devices that practitioners use for the procedure are not approved for colon cleansing by the US Food and Drug Administration. Inadequately disinfected or sterilized irrigation machines have been linked to bacterial contamination.
• Colon cleansing practitioners are not licensed by a scientifically based organization. Rather, practitioners have undergone a training process structured by an organization that is attempting to institute its own certification and licensing requirements.

In 2009, gastroenterologists Dr. Ruben D. Acosta and Dr. Brooks Cash searched medical literature and conference abstracts for information related to colon cleansing, scoring studies for quality.  They published their review in the November 2009 issue of the American Journal of Gastroenterology.

Out of 297 abstracts, they found only 16 published manuscripts and 1 letter that met quality standards.  Only 2 were clinical trials.  None described the benefits of either colonic hydrotherapy or oral medicines.  Most were devoted to describing the adverse effects of using colon cleansing to promote general health.

Acosta and Cash found evidence of 36 cases of amebiasis among patients who underwent colonic hydrotherapy in a Colorado clinic. Ten of those patients had to have their colons removed surgically and 6 died.  Testing of the clinic hydrotherapy equipment after routine cleaning found heavy contamination with fecal coliform bacteria.

Other reports include rectal perforation, all in patients for whom there was no medical indication and none of whom were told of the danger that the treatment might make a hole in their colon or rectum.

Some patients have ended up in the emergency room with confusion due to excessive water intoxication.  There have been published reports of deaths after electrolyte imbalances after coffee enemas, and coffee enemas have also caused both blood poisoning and colon infections.

Dr. Acosta and Dr. Cash concluded,

Colonic cleansing as an adjunct to general health has been around for centuries and will likely continue to be used by uninformed and suggestible individuals, often in response to commercial inducements involving questionable claims of health benefit.

Our review of the current mainstream and complementary and alternative medicine literature failed to identify any methodologically rigorous studies to support the use of colonic cleansing administered per os or per rectum for general health promotion or well-being. To date, there have not been any convincing clinical trials or even case series to substantiate any claims of persistent general health benefits from routine or periodic cleansing of the colon. There are, however, numerous reports of serious adverse reactions to colonic cleansing therapy, primarily related to complications caused by colonic hydrotherapy

Both Mishori's and Acosta's reviews cite many additional medical articles with evidence for serious, sometimes life-threatening adverse events and lack of evidence for the effectiveness of colon cleansing for general health and well-being.

The idea that toxins build up in feces and can leak into the body has been around for centuries.  Before modern medicine enemas and purges were often the only remedies that physicians could offer a sick person.  Their use stemmed from the idea of autointoxication, the notion that feces in the intestinal tract were the cause of disease.

In 1997, Dr. Edzard Ernest, the first Professor of Complementary Medicine at the University of Exeter in the United Kingdom, wrote an editorial for the Journal of Clinical Gastroenterology entitled Colonic Irrigation and the Theory of Autointoxication: A Triumph of Ignorance over Science.  In that article he discusses the history of autointoxication theories and their treatment and writes:

Autointoxication is an ancient theory based on the belief that intestinal waste products can poison the body and are a major contributor to many, if not all, diseases. In the 19th century, it was the ruling doctrine of medicine and led "colonic quackery" in various guises. By the turn of the century, it had received some apparent backing from science. When it became clear that the scientific rationale was wrong and colonic irrigation was not merely useless but potentially dangerous, it was exposed as quackery and subsequently went into a decline. Today we are witnessing a resurgence of colonic irrigation based on little less than the old bogus claims and the impressive power of vested interests. Even today's experts on colonic irrigation can only provide theories and anecdotes in its support. It seems, therefore, that ignorance is celebrating a triumph over science.

Bottom Line

There is no evidence that colon cleansing -- whether given as a pill or powder or liquid or administered through the rectum -- has any value whatsoever to promote health or well-being.

There are significant dangers.

Strong laxatives do have limited medical use in preparing for a colonoscopy, but that use should be supervised by a doctor.

In 2008, Edzard Ernst wrote an open letter to the Royal Pharmaceutical Society of Great Britain asking for a crackdown on sales of homeopathic remedies, a different sort of alternative treatment. But it has importance to our discussion of colon cleansing:

My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying.

Sources

Mishori et al., Journal of Family Practice, Volume 60, Number 8: 454-457, August 2011.

Acosta and Cash, American Journal of Gastroenterology, Volume 104: 2830-2836, November 2009.

Ernst, Journal of Clinical Gastroenterology, Volume 24, Issue 4: 196-198, June 1997.

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