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.
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.
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.
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 18th century and early 19th 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.
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.
Since its introduction, several publications and reviews suggest The Gerson Therapy is contraindicated and ineffective for cancer treatment. 4,5,6
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:
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.
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.
Let us go ahead and revisit the coffee enema….
In the original Gerson Therapy protocol coffee enemas are combined with:
Here are the reported benefits of the coffee enema when used as a stand-alone treatment:
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.
From rectal perforation to sepsis, cases of undesirable outcomes using the coffee enema are not challenging to find.
Let’s review each one…
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.
As far as safety is concerned, these represent the majority of instances where coffee enema usage is of poor choice:
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:
Here are some reasons a person MIGHT want to undergo a detoxification protocol:
Repeat one enema procedure no more than three consecutive days on a quarterly or biannual basis.
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.
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.
Contributed by Naomi Sachs, B.Sc., A.C.H.N., PFT
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.