Coffee enemas: grounds for healing or harm?
• Healing properties are much less bioavailable when inserted into the colon
Coffee lovers often have a passion for the brown brew bordering on the religious. To most, the notion of injecting coffee up their rear end is nothing short of sacrilegious.
Yet increasing numbers of coffee addicts take their love for java to bold, new heights by having “coffee enemas”.
These enemas involve inserting a mixture of roomtemperature water and brewed, caffeinated coffee into the colon through the rectum. Not just any coffee will do.
Specialists in coffee enemas recommend an organic coffee blend, minimally roasted to preserve antioxidant properties. By all accounts, it is undrinkable when taken in from the other, more “normal” end.
Coffee enemas are part of so-called “alternative” and “complementary” health practices known as colonic irrigation, colonic hydrotherapy, or simply “colonics”.
Colonics are not part of modern, mainstream medicine. That’s mainly due to a dearth of robust or randomised controlled trial evidence, to support the health claims, efficacy and safety of self-administration of colonics.
Randomised controlled trials are the “gold standard” of modern medical scientific evidence.
Claimed benefits for colonics include constipation relief, an immune “boost”, increased energy levels, a mood lift, better cognition and improved gut health and peristalsis. The latter is the medical term for wavelike muscle contractions that propel food and substances through the digestive tract, starting from the oesophagus and ending in the anus.
The risks of colonics are legion. Just reading through reported lists of risks in the scientific literature is enough to put you off colonics altogether. However, when reading the scientific research, it helps to remember that association is not causation.
Still, it’s putting it mildly to say that many, if not most, medical doctors are not fans of colonics. And when they prescribe enemas, it is primarily for relief of chronic constipation, to prepare patients for medical procedures or for medical imaging.
Colon hydrotherapy is relatively new compared with enemas, which are as old as the hills of ancient Greece, India, Egypt and China. Enema practice was prevalent in all these cultures and regions. Some sources say that the first enema mention was in the Egyptian Ebers Papyrus, around 1500 BCE.
The main differences in practice were materials and liquids that ancient folk used for the procedure. Liquids varied from water to unconventional substances, such as pig’s bile and vinegar, cooked donkey’s milk and cabbage juice.
Coffee enemas are relatively junior upstarts in enema history and date back to the mid-1800s. The practice gained popularity in the 1930s through the work of German-American medical doctor Max Gerson. Known as Gerson therapy, it has survived into the 21st century as alternative treatment, including for cancer, through claims of “detoxification”.
Small studies and case reports suggest potential benefits to the Gerson therapy. However, larger reviews found no scientific evidence for efficacy in cancer treatment.
Arguments for coffee enemas are premised on the belief that coffee has healing properties. Coffee does indeed have healing properties, according to research. It is a significant source of antioxidants, such as chlorogenic acid, a major antioxidant compound in coffee beans. However, coffee becomes significantly less bioavailable when inserted into the colon compared with when you drink it.
Colon hydrotherapy clinics offering coffee enemas have sprung up in SA. One idea behind them is to treat “autointoxication”. Autointoxication refers to a largely discredited historical medical theory. According to the theory, your body produces toxic substances internally, particularly within the digestive system, that can “poison” you.
The theory was popular in the 19th century. It fell increasingly out of favour as opportunistic entrepreneurs (also known as “snake oil salesmen”) exploited it to sell dubious therapies based on unfounded claims.
The differences between colonics and enemas revolve mainly around aim, scope of cleansing and volume, and type of fluid.
Colonic irrigation uses a large volume of water, as much as 60l. Not all in one go, of course. That’s more reason, medical experts say, not even to think of trying colonic irrigation on your own at home — or anywhere else. It’s best to seek professional help.
Enemas are easier to do at home as they target the lower part of the large bowel, specifically the rectal area and use smaller amounts of fluid injections into the colon.
The primary aim of coffee enemas, however, is not so much a bowel “cleanse” as to detoxify the liver and support liver function.
The idea is that while the liver’s natural and main function is detoxification, modern lifestyles place excessive stress on the organ to keep up with detoxification demands. Proponents of coffee enemas say that these allow the body to absorb caffeine into the bloodstream via the rectal veins and pass it directly to the liver via the portal vein.
For this reason, some specialists describe the procedure as a “coffee implant” and a “retention enema”. Retaining the coffee mixture in the colon for up to 15 minutes then dilates bile ducts, bypasses the digestive process and stimulates the production and flow of bile.
One claim for coffee enemas is an increase in the production of glutathione. This is a molecule that enjoys a reputation as the liver’s “master antioxidant”. Glutathione is crucial for detoxification. However, glutathione itself also decreases inflammation and oxidative stress in the liver. There is no scientific evidence that coffee enemas are beneficial in this regard. Evidence for or against ends up anecdotal.
Johannesburg gastroenterologist Dr Ian Berkowitz is relatively restrained about colon hydrotherapy, saying only that he views it with “reserve” and home enema use with “extreme caution”.
Berkowitz is in private practice at the Milpark Hospital, covering a wide range of gastrointestinal problems. He performs endoscopic procedures, including gastroscopies, colonoscopies and endo-ultrasound.
He says that risks of colonics include large bowel perforation, uncontrolled diarrhoea, alteration of bowel microbiota and infections, such as infective colitis and septicaemia. Among his patients who had colon hydrotherapy, he has “seen electrolyte abnormalities as a result”.
Other risks include thermal burns from heated solutions, strictures (intestinal narrowing), bowel perforation, rectal burns, nausea, vomiting, cramping, bloating, dehydration and infections.
Adverse effects associated with coffee enemas include colitis (colon inflammation), proctitis (rectal inflammation), rectal burns, tenesmus (muscle spasms causing frequent urges to defecate), electrolyte imbalances and diarrhoea.
Coffee enemas may also cause heart palpitations, tachycardia, shakiness and agitation, Berkowitz says.
In other research, in a worstcase scenario in the literature, scientists reported at least three deaths that appear to be related to coffee enemas.
Despite all this, coffee enema kits for home use are a trend. Actor Gwyneth Paltrow’s lifestyle website, Goop, boosted it some years ago by promoting an at-home coffee enema kit, Implant O’Rama priced at $135. (It seems to have disappeared from the site after vigorous criticism about misleading advertising and unscientific claims.)
In SA, a clinic website offers home-enema coffee kits for R1,300 and “detox coffee enema blends” for R200. Another website offers a reusable enema bag kit for the “current price” of R562.
Before patients embark on home remedies or self-treatments, Berkowitz advises ensuring that they have “no underlining gastrointestinal issues”.
British, Australia-based epidemiologist Dr Gideon Meyerowitz-Kahn is more jaundiced about coffee enemas. In his writings, he calls them the “strangest health fads of the last century”.
Coffee is a “delicious nectar”, and one of the “best things humans have created”, Meyerowitz-Katz writes. “Squirting it up your butt is just a bizarre and unusual thing for humans to come up with”.
He clearly sees no need to ever put coffee in your anus. He writes that coffee enemas are “at best completely worthless for your health and can be actively dangerous.
“Best to put the coffee in your mouth.”
Former Springbok rugby player Kobus Wiese’s stellar sporting career is now matched only by his passion for coffee. Wiese is founder of Wiesenhof Coffee Roastery, a brand that has become synonymous with conventional, quality coffee experiences.
The unconventional idea of taking in the brew via any route other than the mouth is a mystery to him. He is not aware of any medical benefit of coffee enemas or which variety of coffee would work best.
“But if a cappuccino or cortado could work as well for an enema as it tastes, there just might be merit to the procedure,” Wiese says.
CLINICS OFFERING COFFEE ENEMAS HAVE SPRUNG UP IN SA ... TO TREAT AUTOINTOXICATION, A DISCREDITED MEDICAL THEORY
DR IAN BERKOWITZ IS RELATIVELY RESTRAINED ... SAYING HE VIEWS IT WITH RESERVE AND HOME ENEMA USE WITH EXTREME CAUTION