Dr. Farrell on Colon Health

The Case Against Colon Cleansing

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Posted By Dr. Farrell

Colon cleansing comprises a significant share of the over-the-counter products promoting colon health. Colon cleansing has gained in popularity over the past decade.

What Is Colon Cleansing?
I would like to provide an overview of this practice known as colon cleansing. Firstly, colon cleansing is not to be confused with taking a cleansing solution as part of a bowel preparation for a colonoscopy. A bowel preparation for colonoscopy is to ensure that all fecal material is evacuated from the colon so that optimal visualization of the colon lining can be achieved so that even the smallest of colon polyps can be identified and removed. Moreover, colon cleansing is not to be confused with taking a laxative or fiber supplement in reasonable dosages to treat constipation and promote bowel regularity. Simply put, colon cleansing represents the practice that tries to evacuate fecal material from the colon in order to promote ‘wellbeing.’ A colon cleanser can be given orally in the form of mega-doses of a laxative or fiber-containing product that induces a catharsis and eliminates fecal matter. A colon cleanser can also be administered rectally either by an enema or by inserting a tube into the rectum and providing irrigation; this practice is often referred to as hydrotherapy. Oral colon cleansers can be purchased in many store pharmacies or on the internet and are commonly promoted on the radio or television usually in the form of an infomercial. Colonic hygienists or colon therapists typically administer colon cleansing enemas or rectal irrigation treatments. I am not aware of any physician who promotes or administers colon cleansing.

The intent and goal of colon cleansing is supposedly to cleanse and ‘detoxify’ the colon in order to promote colon and overall health. Proponents of colon cleansing believe that toxins emanating from the gastrointestinal tract can cause a variety of health problems such as bloating, constipation, fatigue, arthritis, allergies and immunologic disorders including asthma. They believe that colon cleansing improves health by removing accumulated stool and toxins, promoting healthy intestinal bacteria and enhancing your immune system. Colon cleansing is also promoted as a treatment for colon polyps, cancer, and numerous other conditions. None of these claims are valid.

The Scientific Truth
There is no scientific evidence to support the practice of colon cleansing to promote health or treat ANY disease. In an article from 2009, Acosta performed a comprehensive review of the medical literature including the complementary and alternative medical literature from 1966 to 2009 and failed to identify a single credible study to support the use of colon cleansing for general health promotion or wellbeing. Conversely, the review disclosed multiple reports that describe the adverse effects of colonic cleansing including dehydration, electrolyte disturbances, introducing infection, and bowel perforation requiring surgical repair.

Proponents of colon cleansing will state that people feel better after colon cleansing and I believe that this benefit is not from the purging of toxins, but rather from the comfort and ritual of the ‘hands on’ practice similar to acupuncture or massage therapy. Alternative healthcare providers have a reputation for providing this ritual benefit. A study by Taffinder from 2004 found that patients who underwent colonic irrigation often did so because they were not satisfied with conventional medical care.

Physicians and other conventional healthcare providers do not recommend colon cleansing for detoxification because the digestive system naturally eliminates waste material on its own. The natural elimination occurs by the constant shedding and turnover of the intestinal cells and by the muscular contractions of the intestines known as motility.

Why Has Colon Cleansing Been A Marketing Success?
Given what I have described above, two questions are obvious: (1) why would the Food and Drug Administration (FDA) allow this to happen? And (2) why are so many people fooled into believing that colon cleansing is beneficial?

The FDA has allowed this to happen because colon cleansing products are considered dietary supplements, which do not require FDA approval. The FDA, however, does require that colonic irrigation system devices meet certain requirements, but the agency has never approved any system for general non-medical purposes, such as colon cleansing. Why does the practice of colon irrigation persist? Good question. During the past decade the FDA has issued numerous warning letters to manufacturers for the unapproved use of the devices for colon cleansing.

The reason that so many people have been fooled is that the entrepreneurial proponents of colon cleansing have been very effective in selling their misinformation–a modern day snake oil salesman. The colon cleansing industry is not regulated and there is no standardization of the industry. Information about this industry including financial information is virtually impossible to obtain. I believe it is safe to conclude that this industry generates $50-100 million annually in sales.

An examination of the advertisements of companies promoting colonic cleansing therapies gives some insight into the exploitation of concerns of the general public as well as the general lack of understanding regarding the function of the gastrointestinal tract. These promotions most often are in the form of television infomercials, radio spots, and print advertisements. Television advertisements are particularly evocative, using visuals of toxic waste water being discharged from drainage pipes into rivers or pictures of very large stool ‘casts’ purportedly evacuated in response to the cleansing action of the product being advertised. You have probably seen these photos that show 20 pounds of fecal matter being eliminated by colon cleansing. These photos are essentially a hoax and are actually photos of very rare conditions such as Hirschsprung’s disease or megacolon where there can be a functional obstruction of the colon and lead to fecal retention. These conditions are exceedingly rare. I have not seen such a case in 20 years of practice in gastroenterology.

Analogies are also made between the colon lining and sewage pipes that accumulate debris on the lining surface of the pipes—such an analogy could not be further from the truth as the natural elimination occurs by the constant shedding and turnover of the intestinal cells and by the muscular contractions of the intestines known as motility as I mentioned above. Claims regarding ‘feeling lighter’ and having ‘radiant hair and skin’ developing as a result of being freed from the ‘impacted old fecal matter from within your colon’ play directly to the emotions of lay people who may be unaware that such claims are without scientific merit and have not been evaluated by the FDA. Too often, the infomercials show a ‘doctor’ in a white lab coat who is pretending to be an M.D.

Additionally, the evidence to support the claims of companies selling colon cleansing products is often given by testimonials or citing pseudo-scientific articles. In science and medicine, anecdotes or testimonials are considered the absolute weakest of evidence as anyone can concoct a story to support a claim. If a scientific claim is made about a colon cleansing product, I would encourage you to do some research about the claim. A little online research can usually lead you to a conclusion about a claim. Beware of claims or references by ‘Institutes’ or ‘Centers.’ If there is legitimate scientific backing to a claim, a reference from a peer-reviewed article should be provided. A peer-reviewed article has had its methodology, data, results, and conclusions confirmed by other scientists that typically include expert physicians. If such an article cannot be cited, then do not trust the information.

As a physician, and as a gastroenterologist, I feel that it is our duty in medicine to educate the public about what is helpful and what might be harmful. To date, I think that the medical establishment has been woefully inadequate in confronting the colon cleansing industry.

The Correct Path To Colon Health
As a physician and a gastroenterologist, I would propose that the proper way to colon health includes a variety of approaches:

  • Eat a healthy balanced diet. Try to minimize red meats and limit your total caloric intake (approximately 2400 calories per day). I encourage you to read nutrition labels, which help you to calculate the number of calories.
  • Consume 20-35 grams of fiber per day. Check out our Fiber Guide for more info.
  • Exercise regularly. Studies show that exercise helps to maintain ideal body weight and helps to prevent colon diseases as well as many other diseases including stroke and cardiovascular diseases. Learn about your Body Mass Index (BMI) so you can gauge the ‘wellness’ of your weight. See my prior blog post on exercise and colon cancer.
  • Do not smoke. Smoking tobacco raises the risk of virtually every disease in the body.
  • If you are 50 years of age or older, you should have a screening colonoscopy to check for colon cancer and colon polyps. Colon polyps and colon cancer are curable if detected early. For African Americans, the age for recommending a screening colonoscopy is 45. Learn more about colon health here.
  • If you have a disease of the colon, see a gastroenterologist and establish a relationship.

Here’s to your colon health!

Signature of Dr. Farrell

Frank Farrell, MD, MPH, AGAF

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