Doctors weigh in about the lack of benefits—and the very real risks—of starting the year with a caffeinated colon cleanse.
Gwyneth Paltrow’s lifestyle brand Goop is known for its questionable health advice, and for promoting “wellness” products whose claims aren’t back up by science. Its newest promotion is no exception: As part of its 2018 Beauty and Wellness Detox Guide, the website is currently hawking a $135 at-home coffee enema kit called the Implant O'Rama.
The Implant O'Rama is recommended by Alejandro Junger, MD, a Los Angeles-based cardiologist and frequent Goop contributor, “if you wish to use a home system and you know what you are doing.” Other health experts, however, say that pumping any type of liquid into your colon—let alone a liquid that is both caffeinated and acidic—is not something that should be done in the pursuit of beauty or wellness, especially not without a professional’s supervision.
To learn more about colon cleansing and this rather unconventional use of coffee, Health spoke with Ranit Mishori, MD, a professor of family medicine at Georgetown University School of Medicine. In case it’s not obvious, Dr. Mishori is not affiliated with Goop and does not support the website’s marketing of at-home enemas. Here’s why.
First things first: What is an enema, and why do people do them?
According to the U.S. National Library of Medicine, an enema is the “injection of a liquid through the anus into the large bowel,” also known as the large intestine or the colon. Proponents of colon cleansing believe that flushing the gastrointestinal tract removes toxins, promotes weight loss, and improves the body’s absorption of nutrients. But there’s no published evidence that any of those things is true.
“I think people are constantly looking for ways to feel better, and there’s a psychological component to wanting to cleanse yourself and get things out of your system, so to speak,” says Dr. Mishori. “But that’s already being done, very expertly, 24 hours a day, 365 days a week, by the kidneys and the liver; it’s why we have bowel movements.”
The terms colonic and colon irrigation are sometimes used interchangeably with enema, although colonics often refer to procedures performed at spas or wellness clinics, using machines with a pressurized flow of liquid. These “extreme enemas,” says Dr. Mishori, send liquid deeper and more forcefully into the colon than a traditional enema, which only uses gravity. (The Implant O'Rama, for what it’s worth, includes a silicone pump that “allows the liquid to be pushed in with a small amount of force, delivering the liquid to areas higher in the colon.”)
Enemas can occasionally have health benefits
There are a few scenarios in which a doctor might prescribe an enema, says Dr. Mishori, like before a colonoscopy or gastrointestinal surgery. “If we need to visualize or have access to the lower GI tract, it can be helpful to cleanse it beforehand,” she says.
Enemas can also be performed to treat cases of severe constipation, usually in elderly people or those with health conditions that affect their ability to have regular bowel movements. In these cases, though, she’d only recommend enemas done by doctors or licensed health professionals—not by spas or DIY devices.
Most healthy people don’t need them—and there can also be dangers
Dr. Mishori has been speaking out against colon cleanses for years; in fact, she co-authored a 2011 scientific review, published in The Journal of Family Practice, that concluded that doctors “should advise patients that colon cleansing has no proven benefits and many adverse effects.”
After she wrote that review, she says, she began receiving calls from lawyers representing patients who had been injured by colonic procedures or families of people who had died or experienced near-death complications. “They are likely more harmful than we know, because most of these cases don’t make it into the scientific literature.”
Enemas and colonics have the potential to irritate the lining of the GI tract, or to introduce harmful bacteria and cause infection, she says. There’s also a risk that the tube inserted into the rectum can perforate the intestine. Even if there were no health risks, she adds, “I can’t imagine why a healthy person would want to do this.”
Health’s medical editor Roshini Raj, MD, agrees. “If you are constipated, it is a better idea to drink more water, increase your fiber intake, and talk to your doctor if these measures don’t work,” she told Health via email. (Read her full take on colon cleanses here.)
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And what about the coffee part?
Coffee is high in antioxidants, and numerous studies suggest that drinking it regularly can have real health benefits. However, says Dr. Mishori, there is no evidence to suggest that flushing the colon with coffee provides any of the same perks.
“I am a big believer in coffee, but I don’t see any reason to put it in the body from anywhere other than your mouth,” she says. It is true that substances can be absorbed through the GI tract, she adds, but that’s not necessarily a good thing. “It has the potential to upend the very delicate balance of bacteria and electrolytes and could affect the body in unpredictable ways,” she says. Coffee enemas have also been linked to at least two deaths.
Dr. Mishori’s not the only one who feels this way. Ob-gyn and frequent Goop critic Jen Gunter, MD, blogged about coffee enemas on her website last week, calling the concept behind colon irrigation “fake medicine.” And while there is no data to suggest that adding java to the mix has any real health benefits, she writes, “there are plenty of reports of coffee-enema induced rectal burns.”