Colon cleansing: At best a loss of $100, at worst a loss of life

I have strong opinions about ‘snake oil salesman’ medicine.  My husband and I have vociferous debates about this.   I think he drinks the kool-aid a little too much, and he thinks I place too much weight on evidence-based medicine.

Colon cleansing, or colonics, are a prime example of a much-touted “medical therapy”, purported to cure a variety of gastrointestinal ailments.  From what I’ve read, outpatient hydrotherapy colonics cost about $100/session.  Do-it-yourself kits and extended “spa stays” run the gamut of expense.   I can’t even watch the commercials put on by colon cleansing salesman because they simply make me too angry, and I am afraid I will punch my TV in frustration (I like my TV.  I don’t get paid enough to replace it every time a medical fallacy comes on TV).

I cannot stand to watch overt consumer manipulation and lying.

Colon cleansing promises to cleanse your body of all of the dangerous toxins that have been building up in your system for years, claiming you have industrial/toxic sludge lining the inside of your intestine.  You didn’t even know that you had toxic sludge in your intestine, did you?  Some of them also promise to provide weight loss, improved energy, and “cures” for constipation.

Like the long-standing habit of douching, which falsely claims to provide similar benefits for the female genital region, this practice simply doesn’t do what it says it does.  Not only is ineffective for many of its claimed therapies, it can be a very dangerous thing to do.

A recent article published in The Journal of Family Practice (Mishori et al. August 2011 · Vol. 60, No. 08: 454-457) is an excellent and short report detailing a history of colonics, the process, and the lack of evidence for benefits.  This is a really good summary, and the authors looked very hard for anything to support colonics and hydrotherapy.

They just didn’t find it.

What they did find however, were patients who are seriously harmed from participating in this type of nonsense.

Today, the wildly popular consumer site Angie’s List also published an article about colon cleansing.  (Where I got the JFP source).  I belong to Angie’s List, and you can bet that my Gastroenterology hackles were up when I saw the title.

I have to applaud Angie’s list, though, for being fair and balanced in their opinion.  They reported individual patient experiences (positive) as well as negative aspects such as lack of regulation of centers, deaths [DEATHS] associated with hydrotherapy and colonics, lawsuits against practitioners, and repeated FDA warnings.  Only one state (Florida) requires a license to provide this therapy.   Luckily my own state (Illinois) requires a doctor’s oversight before getting the hydrotherapy procedure.

Western medicine is our worst enemy when is comes to the popularity of treatments such as these.  We have failed our patients in so many ways, and it is only natural that they seek alternative methods for their common problems we cannot “fix” (i put “fix” in quotes because some of my patient’s problems are ones I consider normal annoyances of being human, particularly over-indulgence, and not pathological problems that need a cure).

Complementary and alternative medicines are widely used by Americans and people around the world.  Native medical traditions, including Ayurveda in India and Sri Lanka and traditional Chinese medicine, have been addressing patient illnesses for thousands of years in ways that have not been embraced (and rarely studied) by the West.

I have no beef with these traditions.  I think they can truly provide relief to patients in need who have not found help from the type of medicine I practice.  I even encourage patients to consider alternative therapies when I don’t think these therapies cause harm and when I feel like they can be adjunctive to other things that I prescribed.

Colon cleansing does not fall into this category.   It is simply not physiologic to claim that a person has toxins built up “for years” inside their system that needed to be cleansed by whatever herbal therapy is being advertised that day.  The intestine clears itself of what we eat in a systematic fashion.  (You want less toxins? EAT LESS CRAP).  The time that it takes individuals to do this this is quite variable, but the majority of people will clear within 24-48 hours.  There are some people with severe constipation and motility disorders, though, who take much longer than this and it is this group of people for whom I am willing to admit that hydrotherapy can be a PART of the treatment process.

I’m talking about straight up water hydrotherapy, and NOT herbal oral or rectal colonics.  Herbal colonics should never be done, EVER.  These treatments can put you in the hospital with dehydration, fluid/electrolyte disturbances, and chemical colitis.  Severe electrolyte problems, particularly potassium problems, can kill you.

Hydrotherapy is like an enema on steroids, and it carries a small risk of perforation.  Infections and electrolyte imbalances can result from this type of therapy, too, given the massive amounts of water instilled with force into the colon and the potential for contaminated equipment.  Some people, though, have REALLY severe constipation and this is better to them than drinking liters of Miralax (an over-the-counter, generally safe laxative) or other oral laxatives and standard enemas.  I have had some patients who find them beneficial.

It is not a cure for constipation.  It will not make your colon squeeze more quickly than its squeezes.  But if you find that traditional laxatives do not provide you enough relief, and you are willing to take the risks of hydrotherapy, then you can talk to your doctor about it.

You should NOT do this without talking to your doctor first, particularly if you have had extensive surgery on your bowels.  You probably should not do this at all if you have an inflammatory bowel problem like Ulcerative Colitis or Crohn’s disease due to the risk of causing a flare or a tear in your intestine.

Please be skeptical of any therapy that promises benefits above and beyond what a reasonable doctor can give you.  There are very few “miracle cures” in life.  Do your research before undertaking any therapy, and accept the risks that come with participating in a non-studied, non-standard, and sometimes dangerous practice.

Also bookmark the fantastic website QuackWatch.  Read his take on colon cleansing here.  This website was created by a psychiatrist, Stephen Barrett, with a long career evaluating medical therapies.  With a healthy dose of skepticism and humor, he evaluates various “alternative” therapies.  Read it and form your own opinions.  (He also lived in Chapel Hill, go HEELS!)