Ask the (Science-Based) Pharmacist: What are the benefits of coffee enemas?

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Question: I see a naturopathic doctor for chronic fatigue and fibromyalgia. She recommended coffee enemas. Scott, I’m a faithful reader of Science-Based Medicine, do you think this is safe?

Answer: No. Coffee enemas are considered unsafe and should be avoided. Rare but serious adverse events like septicemia (bacteria in the bloodstream), rectal perforation, and electrolyte abnormalities have been caused by coffee enemas. Deaths from the administration of coffee enemas have been reported.

Coffee enemas are based on a pre-scientific idea called “autointoxication”, the belief we are being poisoned by toxins because we are not digesting and eliminating waste products from our colons. This concept is not new, and has roots as far back as our records of medicine. Autointoxication as a concept was discarded over time, as the scientific basis for disease was discovered. It’s perhaps not surprising that your naturopath recommends coffee enemas, as naturopathy is an alternative medicine practice that is based on prescientific and unscientific concepts of health and disease, such as autointoxication. “Humoral medicine” emerged from ancient Egyptian and Roman ideas that the body was composed of four liquids: black bile, yellow bile, phlegm, and blood. “Balance’ in the humors was the goal, and an accumulation of waste in the colon was though to lead to humoral imbalances. The remedy was flushing colon through enemas and purgatives. This philosophy, now discarded from science-based medicine, is still embedded in naturopathy practice.

There is no credible evidence to suggest that coffee enemas can help with insomnia and cognitive problems. In fact, caffeine is absorbed by the colon when coffee is administered as an enema, so it is a poor option for insomnia. The idea that you are are contaminated with parasites or candida are just that – ideas. While alternative practitioners believe these conditions are widespread in the population, there is no scientific evidence to suggest this. There is no reason to treat conditions which do not exist.

Coffee enemas have their roots as part of the “Gerson Treatment” for cancer, developed by physician Max Gerson in the 1940’s. His regimen included coffee enemas, supplements, juice, and injections of calves’ liver. The approach has been investigated and been shown to be useless for the treatment of cancer.

Some proponents of coffee enemas believe that the chemical components of coffee stimulate liver and gall bladder function. There is no credible evidence to suggest this occurs, or that it is necessary. Your liver and gallblader don’t need an enema in order to work effectively. There is no evidence to suggest that you need to boost your liver’s production of glutathione with enemas. You may in fact be boosting your glutathione already, if you’re a coffee drinker.

I’m very sorry to hear about your chronic fatigue and fibromyalgia. Science-based medicine lacks a good understanding of this illness, and there is a lack of effective treatments. Unfortunately, that can make patients with these illnesses targets to those that profess certainty and offer dubious and unproven treatments, like coffee enemas. A decision to undergo any treatment needs to consider the risk and benefits. And treatments need to be investigated to determine if the benefits outweigh the risks. With coffee enemas, the evidence is clear. Given the lack of benefit and potential harms, there is no plausible justification to undergo these treatments. You should ignore any medical advice from anyone that recommends coffee enemas to you.

Discussion

Autointoxication is a belief that has persisted for hundreds of years, and survives today as the rationale for an array of alternative medicine practices, including coffee enemas, ear candles, “detox” diets, and “cleansing” kits. (For some, the idea that we are being poisoned internally can become downright pathological. A Florida couple admitted to administering coffee enemas four to ten times per day.) These ideas seem almost a part of human nature: Purification rituals are common features of different cultures worldwide. In modern society, and with today’s alternative medicine providers, detoxification is wrapped with a scientific banner, in an attempt to give the treatments (and their purveyors) a veneer of credibility. Autointoxication beliefs are not only wrong, but they are demonstrably dangerous. Practices like coffee enemas have no plausible benefit and a real risk of harm. More broadly, and perhaps most importantly, the continued promotion of these practices distracts from science-based advice that can support better health decision-making.

Photo from flickr user serraboten used under a CC licence.

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