Many are the "alternative" medicine therapies that I've examined with a skeptical eye over the years. The vast majority of them rest on concepts that range from pre-scientific to religious to outright pseudoscientific to—let's face it—the utterly ridiculous. Examples abound: Reflexology, reiki, tongue diagnosis, homeopathy, ear candling, cupping, crystal healing, urine drinking, detoxifying foot pads, "detox foot baths," and the like. The list goes on.

Of these, one of the most amazingly silly and ridiculous alternative therapies of them all, if not the most ridiculous—although, to be fair, it's really, really tough to compete with nonsense like homeopathy for that title—is the coffee enema. It's a staple of "detox" therapies the world over, as its entire rationale is that it somehow removes the fantastical unnamed "toxins" on which quacks of all stripes like to blame pretty much all diseases on. It's a particularly prominent component of a cancer therapy known as Gerson therapy, which involves many supplements, vegetable juices, and five coffee enemas a day. It's a treatment that, not surprisingly, doesn't work. People who rely on Gerson therapy (and coffee enemas) to treat cancer do not do well. Unfortunately, that has never stopped Gerson therapy believers and alternative medicine practitioners utilizing it for purposes other than cancer from claiming all sorts of benefits in "detoxifying the liver" and cleaning the layers of backed up feces claimed to be leading to "autointoxication" even though surgeons and gastroenterologists never see such a level of fecal buildup, except in patients with bowel obstruction or a lack of bowel motility that make them acutely sick.

I was reminded of this by this by a recent article, which was unintentionally gut-bustingly funny, on the quack website Health Impact News entitled The Powerful Health Benefits of Coffee Enema Therapy that Big Pharma Does Not Want you to Know by John P. Thomas, who evidently thinks that coffee enemas are such powerful medicine that big pharma is afraid of them:

Why does Big Pharma hate coffee enema therapy? The answer is that coffee enemas are a powerful liver detoxification tool, a pain relieving therapy, and a therapy for cleansing and healing the colon. Retention coffee enemas are a key part of successful alternative cancer treatment protocols, because they rid the body of toxins that cause cancer and eliminate the toxins released by dead and dying cancer cells. Coffee enemas do all this and more without side effects and at minimal cost.

Minimal side effects? I suppose that's true if you count "minimal" as meaning the potential for electrolyte imbalance, sepsis, colon or rectal perforation, and proctocolitis due to the coffee itself, among others, up to and including death. One notes that the proctocolitis is not necessarily due to using fluid that is still hot and appears to have something to do with the chemicals (yes, my quacky friends, there are—gasp!—chemicals in coffee!) in the coffee. Sure, the risk is relatively small, but when you're doing a procedure that has no demonstrated medical benefits, even a small risk is too much to countenance. I like to make an analogy to acupuncture, where the risk of significant injury due to acupuncture needles is indeed small—although, I hasten to add, not nonexistent, as its proponents sometimes imply or outright claim—but not worth it given its nonexistent benefits.

I prefer to partake of my caffeine source as God intended, not as quacks intended.

So what's a quack to do? Compare the adverse events of coffee enemas to real medicine, exaggerating the harms of real medicine, and then say:

However, if an alternative herbal therapy might have contributed to the illness or death of 6 people worldwide, then the quack alarm starts its high pitched quack-quack-quacking. That is the sound that conventional medicine and Big Pharma makes when a successful and unpatentable natural alternative therapy threatens their profit margin.

No, it's because six deaths are too much if there is no benefit to the treatment. A single death is too much if there is no benefit to the treatment.

It is, of course, rather interesting to consider how firing perfectly good coffee up one's bum and holding it there would "detoxify" anything. For example, it's believed somehow to "cleanse" the liver because of something called the portal circulation. Basically, there is a part of the circulation called the portal venous system whose veins drain straight from the GI tract to the liver, with the veins converging on the portal vein, before heading to the heart. To put it (very) simply, the function of the portal venous system is to send substances absorbed from the GI tract first to the liver for processing before they reach the general circulation. It's part of the reason why there is something called a "first pass" metabolism of drugs taken orally that can remove much of the drug from the blood before it reaches the systemic circulation. Truly the liver is an amazing organ, and in healthy (and even not-so-healthy) people a most amazingly effective "detoxification" mechanism.

In any case, there is an old concept mentioned before known as autointoxication. It's an ancient concept, dating back to ancient Egypt, that posits that our fecal wastes are poisoning us. Now, back then they had no idea of the portal circulation, but the idea was that the "unclean" stuff from the feces could back up and slowly poison the body. A more sophisticated version of the concept of autointoxication rose to prominence in the 19th century and persisted even in mainstream medicine until even the 1920s. The idea was little different, namely that putrefactive products of digestion remained in the colon, there to leech into the bloodstream and sicken patients. There were even surgeons—and prominent ones!—who advocated total colectomy for the autointoxication that was thought to cause diseases ranging from epilepsy to "lassitude." Indeed, I was reminded by this last season on The Knick, the Cinemax TV show about a surgeon from turn of the century (as in 1900) New York City, there was a storyline involving a woman with severe psychiatric problems who was treated by removal of her teeth and her colon. Although autointoxication was not explicitly mentioned, it was the rationale for such barbaric treatments unrelated to the actual pathophysiology. In the show, the doctor who subjected the woman to colectomy for her psychiatric issues came to be viewed as a quack, but there were others out there who advocated surgery who were not so considered. What's particularly amazing about this whole "autointoxication" concept was that, in the time before antibiotics, colon surgery, even relatively straightforward colon surgery, had a high mortality due to infection. It was pretty risky surgery.

By the 1920s or so, science had shown that the various symptoms observed in patients with chronic constipation were largely due to distension of the bowel and were not due to autointoxication. As is its wont, scientific medicine moved on from a failed hypothesis. Alternative medicine practitioners, as is their wont, never did, hence the continued popularity of coffee enemas, which are supposed to correct autointoxication both through their physical action removing fecal matter and "stimulating" the liver to produce bile through the absorption of the various substances in the coffee, such as palmitic acids, straight into the portal circulation. Of course, one of those substances, one of the main reasons people drink coffee, is caffeine; so symptoms of caffeine overdose are another set of potential adverse events due to this exceedingly silly alternative treatment. Amazingly, in contrast, Thompson claims that actually drinking coffee instead of doing enemas with it "impairs" liver activity. The evidence for that? The same as for the rest of the article: None.

All of this is not surprising that a "holistic" quack named Linda Isaacs, who worked with Nicholas Gonzalez, whose treatment protocol for pancreatic cancer also involved "detoxification" with coffee enemas as a prominent part, cites 19th century literature as a justification for coffee enemas:

Coffee enemas have long been in use. In a case report in the Pacific Medical and Surgical Journal in December 1866, M.A. Cachot, MD, described successful use of a coffee enema to treat a child dying from an accidental poisoning. (5) Articles from the late 1800s reported that coffee enemas were helpful in post-operative care; (6) at a medical meeting in 1896, Dr. W.J. Mayo, one of the founders of the Mayo Clinic, mentioned coffee enemas as a routine part of care for patients after abdominal surgery. (7) Coffee enemas were listed as a stimulant and as a treatment for shock in medical and nursing textbooks in the early 1900s. (1;8) In an extensive 1941 article in Uruguayan Medical, Surgical and Specialization Archives, Dr. Carlos Stajano described immediate improvement in near-terminal patients after coffee enemas, including a patient with cocaine intoxication and a patient with post-operative shock. (9) He elaborated on his extensive experience with coffee enemas in post-operative management and made a plea for their continued use.

Even if all of this is true, it's irrelevant. Many medical practices of the 19th century were abandoned because they were later found not to be useful. Yes, it's true that enemas were used in colon surgery. They're still used sometimes to this day, although better ways of cleaning the feces out of the colon in preparation for surgery and colonoscopy have supplanted them, such as the ever-dreaded GoLytely and similar solutions that patients drink to flush themselves out.

There's a lot of information about the detailed mechanics of actually doing a coffee enema, none of which I want to dwell on. It's an enema, after all. Yes, it's a good idea, if you subscribe to the madness that makes one think that shooting coffee up one's posterior is in any way a good idea, to make sure the coffee's cooled down to a temperature that isn't going to cause internal burns. I was, however, amused by some of the advice on selecting the actual coffee to be used:

Only use organic coffee. Conventionally grown coffee contains pesticides, which will defeat the whole purpose of the enema. The organic coffee must contain caffeine. The caffeine is necessary to stimulate the cleansing of the liver. Do not use instant coffee or decaffeinated coffee.

Good to know! No decaf for my colon, just as I refuse to drink decaf coffee. It defeats the purpose of the coffee. And, of course, avoid those nasty pesticides. Oh, and use light or medium roast and avoid the mold, too:

Some people believe in using raw coffee beans. Some use extra light roast coffee. Some prefer light roast, medium roast, and even dark roast. There are rather intense points of view about this. In general, raw and very lightly roasted coffee will be highest in caffeine content, but may contain a naturally occurring toxin. These coffees will provide the strongest stimulation for the liver and the least level of discomfort during the enema. Light roast, medium roast, and dark roast will have less caffeine. The Gerson cancer clinic recommends either light or medium roast drip grind coffee. [15] Some people have an adverse reaction to the coffee if it contains mold. Many sources of coffee are not screened for mold content. If you are concerned, then seek organic enema coffee that has been tested to be mold free. Yes, there are coffees that are intended for enemas and not for drinking. Otherwise, a high quality organic coffee will work well for most people.

One wonders what coffee growers think about people making coffees specifically for the purpose of wasting it and sticking it up their butts. They probably don't care, as long as they get paid. But beware! You're not done yet. You must use very specific equipment for your coffee butt experience! You can ruin the whole "detox" experience just by using the wrong equipment. Really, you can:

The purpose of doing a coffee enema is primarily detoxification. You are trying to get the liver to release accumulated toxins such as heavy metals, plasticizing chemicals, and other toxic chemicals. This means you should not make the coffee in aluminum, stainless steel, or plastic containers or in equipment that has parts made of these materials. The best way to make coffee for an enema is to boil the coffee in a glass or porcelain lined pot. Once it has boiled for the needed time, then it can be strained with a very fine strainer or simply decanted by pouring off the liquid from the coffee grounds after they have settled to the bottom of the pot. Do not use paper filters, because they contain chlorine and other toxic chemicals. Do not use chlorinated tap water especially if it contains fluoride. Once again, these are the kinds of chemicals that you want to detox from your body. Some people discourage the use of spring water that is purchased in plastic and others discourage the use of reverse osmosis (RO) water. There are many pros and cons to water selection, and they are worth investigating.

Oh, dear. Apparently this means you can't actually use the easiest means of all, a drip coffee maker. Too much metal tubing in the heating element and you have to use a paper filter (disposable) or a metal mesh filter if you're one of those people who have a permanent filter. Of course, inquiring minds want to know whether other forms of coffee will work. What about French press, for instance? Then there's the water. Of course, I figured before I ever read this that tap water would never do. That's just far too...ordinary. I suppose you need to use only the purest rain water collected in a glass or porcelain collector from the deepest, purest depths of the Brazilian rain forest or from deep in the Himalayans. Or maybe you have to find a pristine, crystal spring deep in the heart of the mountains, fed only by snow melting off the unspoiled mountain peaks. Whatever.

I've always viewed this fascination with enemas and "detoxification" as religious in nature, associated with concepts common in many religions involving how human beings are "unclean" and need to ritually purify themselves. Certainly there is no scientific justification for such treatments. The only things they're good for are enriching quacks, lightening the wallets of the gullible, and providing amusing grist for bloggers like myself.