The world of fasting, cleansing, and detoxification is quickly evolving into a more recognized domain. Within this realm exist dietary strategies such as one-meal-a-day (OMAD), time-restricted feedings, intermittent fasting, extended water fasting, and juice cleansing.

Layered into this sandwich of autophagy-focused nutritional paradigms are supplements and alternative therapies designed to support our natural detoxification processes.

To be clear, I’m not arguing for or against any of these strategies.  I ‘m merely reinforcing the growing interest in this field.

The renewed interest in detoxication also brings me to today’s topic: the coffee enema.

Coffee what?

The coffee enema is a relatively unknown and somewhat obscure health procedure used for colon cleansing.

When researching the origins and application of the coffee enema, it isn’t uncommon to encounter an abundance of conflicting information.

In the early 1900s, the coffee enema was considered one of the standard alternative treatments for cancer. Time and time again, this failed to hold up in the research. Secondary to this are numerous case reports of self-injury linked to the misuse of the coffee enema. The coffee enema now bears a tainted reputation due to the lack of evidence to support its efficacy in cancer treatment and from documented injuries involving improper use.

Today the coffee enema exists mostly as a hush-hush protocol between alternative practitioners and members of the populace who anecdotally validate its merits.

This article does not support the use of coffee enemas in cancer treatment or as a therapy to correct diagnosed health conditions.

As the Story Goes

According to historical data, the use of coffee enemas backdates to WW1. The veterans who were frequently treated with morphine also experienced constipation as a side effect of this drug. Water enemas were standard treatment when injured veterans failed to defecate properly. As the story goes, available coffee on hand made it into the veterans’ enemas. These enemas reportedly provided the soldiers with apparent ‘pain relief.’

To better understand the benefits experienced by the veterans, a German-American doctor by the name of Dr. Max Gerson studied the research of rectally administered caffeine in rat models. One published study suggested that bile flow increased.¹

Dr. Max Gerson went on to develop a dietary protocol incorporating the use of coffee enemas. His protocol, named The Gerson Therapy, became known as a proposed means of cancer therapy. Dr. Gerson firmly believed the etiology of cancer occurred as a result of auto-intoxication.

What is auto-intoxication? Is this claim substantiated?

Auto-intoxication is the concept that bodily wastes can pool in the digestive tract and slowly poison the individual, leading to chronic health challenges.

The theories behind auto-intoxication were first suggested in the late 18^th century and early 19^th century by various physicians and researchers.

To this day, the theory that auto-intoxication is a primary factor in cancer development has never been proven (or disproven) in the research.

Onwards

Before dying from pneumonia in 1959, Dr. Gerson produced a detailed handbook of his exploration with his protocol.² Dr. Gerson’s daughter continued to promote The Gerson Therapy and founded The Gerson Institute in 1977.

In 1982 continued research in rat models suggested the possibility that chemical constituents in green coffee beans upregulated Glutathione-S-Transferase.³ Green coffee beans are also known as unroasted coffee beans.

Was The Gerson Therapy effective for cancer treatment?

Since its introduction, several publications and reviews suggest The Gerson Therapy is contraindicated and ineffective for cancer treatment. ^4,5,6

Does this discredit the concept of endotoxemia or the need to support our bodies’ detoxification capacity?

Whether we need to support detoxification is a challenging debate and dives into one of the biggest clashes between the holistic and conventional models.

In the preliminary inquiries into endotoxemia, proponents like Dr. Max Gerson held the sentiment that internal toxicity is the root of all health concerns. Meanwhile, numerous anti-intoxication activists also came forward with compelling arguments and critical reviews to reject this concept.

The debate between believers of auto-intoxication and those who refuted it laid the foundation for years of ongoing research.

A publication released in 2018 provides the most concise overview of this debate by comparing newer research into the microbiome to theories suggested by proponents of autointoxication.⁷

Here are the key takeaways from this article:

• • The connection between mental health, gut bacteria, and mental health took hold most prominently in France in the early 19^th century
  • Several French publications during this time suggested: “auto-intoxication is the key concept that will unlock the potential of psychiatry and enable it to move from conjecture and speculation into the realm of facts and science.”
  • Interest in auto-intoxication simultaneously fell out of favor as quickly as it took hold because it was, “ [conflated] with broader conditions and symptoms; [recruited] by individuals and organizations driven by commercial interests; [misappropriated]….to sell products based on unfounded claims; and exaggerated and overhyped promises.”
  • Reviews of previous research that invalidated auto-intoxication turned out to be neither “rigorous and decisive” as previously thought⁸
  • Current research into the microbiome unearths new data reopening the inquiry into auto-intoxication
  • New research conducted between 2016-2018 indicates “clear links between intestinal microbiota, mood, behavior and cognitive impairment.” ^9,10,11,12

  This article made it clear we are now in the process of gathering data that is overwhelmingly in favor of auto-intoxication.

  While Dr. Max Gerson may have been well ahead of his time, we still don’t have all of the research to validate his claims thoroughly. Thus,  ongoing research is still needed to fully understand how we can address, support, or modulate our microbiome for health outcomes.

  Without a clear verdict on the efficacy of detoxification protocols, are these protocols still being used today, and what are their outcomes?

  In a 2010 survey of 196 naturopathic doctors, 92% claimed to use detoxification protocols in their practice.¹³ However, the majority of these respondents claimed they did not use objective measures for treatment efficacy. In this study, the primary means between N.D.’s to determine treatment outcome was in a self-rating system provided to patients after protocol completion. This paper also outlined the results of a ten-year review of patients who underwent detoxifications protocol. The results indicated 83% felt “good” or “great” afterward.

  What Can We Gather So Far?

  1. New research into the microbiome is favoring the concept of auto-intoxication
  2. There are links between mental function and wellness and bacteria in the gut
  3. Most participants who engage in detoxification protocols report feeling better post-treatment

  Let us go ahead and revisit the coffee enema….

  What are the claims surrounding the use of the coffee enema?

  In the original Gerson Therapy protocol coffee enemas are combined with:

  • 13 x 8-ounce glasses of vegetable/fruit juice per day
  • A mostly vegetarian diet with some meat, fish, eggs
  • A supplement routine incorporating potassium salts, pancreatic enzymes, bee pollen, and vitamin c among other derivatives

  Here are the reported benefits of the coffee enema when used as a stand-alone treatment:

  1. Dilute the portal vein releasing bile and clearing toxicity from the liver
  2. Decrease inflammation of the intestine
  3. Release toxins from blood serum
  4. Promote peristalsis of the colon
  5. Allows caffeine to pass through the liver every 3 minutes via enterohepatic circulation

  What does the research say about these claims?

  1 – Dilutes the portal vein releasing bile and clearing toxicity from the liver

  Bile release and upregulation of antioxidant status are validated primarily in animal models.^1,3 While animal research can be useful and can predict effects seen in humans, they are far from conclusive. Although animal models are considered weaker models of evidence, they may be suggestive of improved experimental design in human trials.

  A human trial using 17 patients prepping for a medical intervention called video capsule endoscopy (VCE) used coffee enemas to prepare for their procedure. The coffee enema group revealed better bowel preparation in the mid and distal segments of the small intestine compared to the control group.¹⁴ This study was not able to validate the mechanisms by which coffee enemas affect bile excretion in humans.

  2 – Decrease inflammation of the intestine

  I cannot find any research that validates this or invalidates this.

  I can, however, speculate that moving coffee through the colon may generate a change in the commensal bacteria within the colon. Moving coffee through the bowel will also mobilize waste matter. It is a far stretch to say whether we can wash away toxins or change the organization of bacteria enough to modulate inflammation.

  A more significant aspect of managing intestinal inflammation is supported by eliminating triggering foods, additives, drugs, or chemicals which negatively impact our gut health.

  3-Release toxins from blood serum

  I cannot find any research that validates this or invalidates this.

  4- Promote peristalsis of the colon

  I cannot find any research that validates or invalidates this.

  While coffee enemas promote the expulsion of the contents of the colon, we cannot attribute this to the action of peristalsis.

  5- Allows caffeine to pass through the liver every 3 minutes via enterohepatic circulation.

  In a human trial conducted in 2013, researchers measured the differences in plasma caffeine levels after coffee enemas and oral caffeine consumption. Researchers measured serum caffeine was 3.5x lower in the coffee enema group while having a statistically faster time to reach max concentration.¹⁵ The results of this study confirm that caffeine absorbs through both routes. This study did not indicate whether caffeine in serum is supportive in any way.

  In a human trial using Thai men, researchers measured serum levels of glutathione (GSH), malondialdehyde (MDA), and trolox equivalent antioxidant capacity (TEAC) following oral and enema consumption of coffee. According to the study, there were statistically insignificant shifts in GSH and MDA (a marker of oxidative stress). There was a slight drop in TEAC at 6 and 12 days after oral consumption and 12 days after the coffee enema. According to these results, coffee consumption in oral and enema forms of delivery does not promote beneficial changes in glutathione status, antioxidant capacity, or markers of oxidative stress.

  From this, we can infer that while caffeine absorbs through the liver during oral consumption and enema delivery; however, it might not bear much impact on liver function.

  Is the coffee enema dangerous?

  From rectal perforation to sepsis, cases of undesirable outcomes using the coffee enema are not challenging to find.

  1. In three instances, women of various ages encountered burns or strictures after using hot coffee enemas. ^16,17,18
  2. In another report, a woman with a history of mixed-type irritable bowel syndrome and biliary colic (and with a family history of Crohn’s and ulcerative colitis) developed proctocolitis after coffee enema treatment.¹⁹
  3. In an older case, a woman with advanced-stage breast cancer developed infections of Salmonella enteritidis and Campylobacter fetus after multiple rounds of coffee enemas. She was also provided with liver juice during this treatment.²⁰

  Let’s review each one…

  1. What is interesting is that these case reports fail to mention that the enema should never be administered hot and the injury occurred as a result of ignoring standard safety protocol. Pouring hot liquid into the colon is a dangerous practice and considered unsafe conduct regardless of the contents of the solution being administered. A water enema which is administered hot would likely have the same outcome. As data that rejected the concepts of auto-intoxication became favored over the years, I am skeptical whether these articles are entirely unbiased, especially when they fail to mention that the injury was a result of temperature rather than a chemical reaction.
  2. In reference to the woman who developed proctocolitis, coffee enema use is contraindicated due to her personal history with irritable bowel syndrome and familial history (Crohn’s, ulcerative colitis). This individual is clearly at high risk for adverse outcomes and should avoid therapies such as these.
  3. In the third example, we see a case where ‘correlation may not indicate causation.’ Liver juice therapy stopped in 1989 due to bacterial and parasitic contamination issues. It may not have been the coffee enema that led to her sepsis and untimely death.

  At first glance, these reports create a framework of mixed feelings around the use of coffee enemas. However, upon reviewing these cases, we can detect the nuances which suggest there is more than meets the eye with these reports.

  Who should avoid the coffee enema?

  As far as safety is concerned, these represent the majority of instances where coffee enema usage is of poor choice:

  • • Colorectal cancer
    • Recent bowel surgery
    • Colostomy
    • Gut obstruction
    • Hemorrhoids
    • Diverticulitis
    • Crohn’s disease
    • Ulcerative colitis
    • Irritable bowel syndrome
    • Failure to follow safety protocol, i.e., sterilization of equipment, temperature regulation, questionable supplements, etc.

    Ok, but I keep reading about and hearing about how great people feel after coffee enemas? I want to try it. What do I need to know?

    All too frequently, I observe the general populace engaging in detoxification protocols or ‘cleanses’ for the wrong reasons.

    Here are some reasons someone SHOULD NOT undergo a detoxification protocol:

    • to FIX a disorder, condition or a diagnosis – cleanses are rarely if ever corrective
    • WEIGHT LOSS– the weight loss is only temporary
    • to FIX years of bad dietary habits – this can lead to binge cycle behavior
    • if sick, UNWELL, bed-ridden, hospital ridden – this can lead to dangerous or scary outcomes
    • if using pharmaceutical MEDICATION – supplements or protocols which may affect the liver may also affect the metabolism of pharmaceutical drugs

    Here are some reasons a person MIGHT want to undergo a detoxification protocol:

    • When an individual is at the peak of health
    • As a means to reinforce a sense of wellness
    • After working or living in a toxic environment (smoke inhalation, fumes, industrial toxins, etc.)

    How can I safely incorporate coffee enemas into my health routine?

    1. Fix the diet first- quality proteins, water type, and cruciferous vegetables, squash, berries, nuts and seeds, mushrooms, etc.
       Remove illicit drugs and alcohol
       Remove foods which negatively affect the gut
    2. Perform a standard colon cleanse using a gentle laxative and a high fiber plant-based diet for seven days
    3. Reintroduce meat and add in a liver support formula for seven days following instructions on the package.
    4. After completing step 3 following these instructions to perform your enema:
       • Boil 3 Tbsp. of Sa Wilsons Blonde Coffee in 24-32 oz of water for 15 minutes
       • Pour coffee into sterilized coffee enema bucket with the hose attached and safety valve clamped
       • Allow the solution to cool to slightly above body temp. You should be able to swirl your finger in the liquid and not feel excessive heat. NOTE: the surface cools faster, so stirring is necessary when temperature testing
       • Apply coconut oil to the end of the speculum.
       • Place bucket onto the washroom counter or location~ 1m off the ground. Lie on the floor in a comfortable position and insert the speculum into the rectum. Release safety valve.
       • Allow the coffee to drain into the colon via gravity—close safety valve.
       • Lie on left side or back for 15 minutes while retaining the liquid. Deep breathing helps.
       • Release contents of the bowels into the toilet. A few more releases will likely occur after the first one.
       • Sterilize your enema bucket, speculum, and hose with bleach or 35% pharmaceutical grade hydrogen peroxide
       • Rinse hose and bucket out thoroughly with water

       Repeat one enema procedure no more than three consecutive days on a quarterly or biannual basis.

    Closing Remarks

    Although the data is not overwhelmingly in favor of the coffee enema, new insights in the microbiome might change the way we look at this therapy over time. I do not believe there to be grave risks associated with the coffee enema when safely administered to healthy subjects. For most individuals, it certainly won’t change the game, but it may consolidate a sense of wellness for those who choose to add it to an involved health routine.

    ^{1 Garbat, Abraham Leon et al. “Secretion of Bile in Response to Rectal Instillations.” Arch Intern Med (Chic), 44(3),1929, 455-462.}

    ^{2 Gerson M.D., Max. “A Cancer Therapy: Results of 50 Cases” The Gerson Institute; 6th edition, 1958, 1-448.}

    ^{3 Luke, K. et al. “Isolation and Identification of Kahweol Palmitate and Cafestol Palmitate as Active Constituents of Green Coffee Beans That Enhance Glutathione S-Transferase Activity in the Mouse” Cancer Research, 42(1) 1982, 1193-1198.}

    ^{4 Journal of Haehwa Medicine. “Overview for clinical use of coffee enema using literatures.” Research Institute of Korean Medicine, 22(2), 2014, pg. 37-45.}

    ^{5 Cassileth B. “Gerson regimen.” Oncology (Williston Park), 24(2), 2010 Feb, 201.}

    ^{6 Ernst, E., M.D. “Colonic Irrigation and the Theory of Auto-intoxication: A Triumph of Ignorance over Science.” Journal of Clinical Gastroenterology, 24(4), June 1997, 196-198.}

    ^{7 Mathias, Manon. “Auto-intoxication and historical precursors of the microbiome-gut-brain-axis.” Microbial Ecology in Health and Disease, Vol 20, 2018, 1-11.}

    ^{8 Bested A, Logan AC, Selhub EM. Intestinal microbiota, probiotics, and mental health: from Metchnikoff to modern advances: part I – auto-intoxication revisited. Gut Pathog. 2013;5(5): 1–16. (4; 11; 10–11; 3).}

    ^{9  Rogers GB, Keating DJ, Young RL, et al. From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol Psychiatry. 2016 June;21(6):738–748.}

    ^{10, Macqueen G, Surette M, Moayyedi P The gut microbiota and psychiatric illness. J Psychiatry Neurosci. 2017 March;42(2):75–77.}

    ^{11 Dinan TG, Cryan JF. Microbes, immunity, and behavior: psychoneuroimmunology meets the microbiome. Neuropsychopharmacology. 2017;42:178–192}

    ^{12 Liang S, Wu X, Hu X, et al. Recognizing depression from the microbiota-gut-brain axis. Int J Mol Sci. 2018 May;19(5):1592.}

    ^{13 A. Jason, DN, MPH. “Detoxification in Naturopathic Medicine: A Survey” J Altern Complement Med. 2001 Dec, 17(12), 1175-1180.}

    ^{14 ES Kim et al. “Coffee enema for preparation for small bowel video capsule endoscopy: a pilot study.” Clin Nutr Res, 2014 Jul, 3(2), 134-41.}

    ^{15 Teeklachumhatean, S et al. “Pharmacokinetics of Caffeine following a single administration of coffee enema versus oral coffee consumption in Healthy Male Subjects.” ISRM Pharmacol, 2013, Vol 2013, 7 Pages.}

    ^{16 Kim, S et al. “Rectal perforation due to benign stricture caused by rectal burns associated with hot coffee enemas.” Endoscopy, 2012, 44(2), 32-33.}

    ^{17 Jones, L. E. et al. “Rectal burn induced by hot coffee enema.” Endoscopy, 2010, 43, 26.}

    ^{18 Kye, Bong-Hyeon. “Intractable rectal stricture caused by hot water enema.” J Korean Surg Soc, 2011, 81(5), 350-354.}

    ^{19 Lee, Anna H. BS. et al. “Proctocolitis from Coffee Enema.” ACG Case Reports Journal, Jan 2020, 7(1), 292.}

    ^{20 Margolin, K. M.D. “Polymicrobial Enteric Septicemia From Coffee Enemas”. The Western Journal of Medicine, 460.}

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    Contributed by Naomi Sachs, B.Sc., A.C.H.N., PFT
    www.naomisachs.com

    Fully-certified since 2015, Naomi has been successfully coaching clients throughout North America and facilitating their self-growth in the nutrition and fitness realm. If you are feeling overwhelmed by the myriad of health strategies available, her services aim to introduce clarity and self-motivation.