The environment today is very different from the environment of our ancestors. Over the last 200 years a host of chemicals have been introduced to our food, air, and water. Many of these chemicals have not been tested for safety or are assumed to be safe in low concentrations, without taking into account that the simultaneous presence of many low-concentration pollutants may have negative effects on our health. Some chemicals, such as the endocrine disruptors dichlorodiphenyltrichloroethane (DDT) and polychlorinated biphenyls (PCBs), have been banned in the United States for years, but persist in the environment and food chains. Since these chemicals have been associated with a variety of illnesses, a number of “detoxification” procedures have been developed that are thought to help eliminate these substances from the body.
My colleague, Dr. Nicholas Gonzalez, and I routinely recommend such procedures to patients under our care as they embark on our program of intensive nutritional supplementation. On our treatment, patients may develop “flu-like” symptoms that we believe result from the body’s repair mechanisms leading to the release of stored toxins and large amounts of biologically active waste materials. Procedures such as coffee enemas and liver-gallbladder flushes may help stimulate the liver to rid the body of these waste materials and pollutants.
Enemas have been used for centuries to relieve constipation and improve general health and well-being, appearing in medical writings as far back as ancient Egypt. More recently, directions for administration of various types of enemas, including coffee enemas, were included in medical and nursing textbooks. (1) Coffee enemas were mentioned in the Merck Manual of Diagnosis and Therapy, a compendium of orthodox medical treatment, through the Twelfth Edition, published in 1972. (2-4) In a letter to my colleague Dr. Gonzalez, an editor of the Manual commented that they were removed primarily because of space considerations.
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.
Dr. Gonzalez and I believe that coffee enemas stimulate the liver and gallbladder to increase the flow of bile, aiding the liver in its detoxification efforts. In support of this, coffee when drunk has been shown to cause gallbladder contraction and elevate levels of cholecystokinin, a hormone that stimulates bile flow. (10) Enemas can also stimulate the liver and gallbladder; in a 1929 paper in the Archives of Internal Medicine, investigators at Lenox Hill Hospital in New York reported that rectal installations of several different liquids caused an increase of bile flow from the liver. (11)
Some physicians claim that coffee enemas are dangerous, based on case reports of patients who reportedly developed electrolyte imbalances or infections after coffee enemas. (12;13) Close review of these cases shows that the patients in question were seriously, even terminally ill, and that the infections or electrolyte disturbances blamed on the coffee enemas could have come about simply because of the patients’ underlying disease. Only a few such cases have been reported; to put this in perspective, every year in the United States, thousands of people die from the side effects of medications such as aspirin and ibuprofen, all available without a prescription. Dr. Gonzalez and I have instructed thousands of patients to perform coffee enemas and none have had any significant problems from them. However, we would also recommend that coffee enemas only be done after consultation with a qualified medical professional.
The liver is the primary detoxification organ in the body, and many of the wastes it processes are eliminated in bile, which travels from the liver through the bile duct to the small intestine. In addition, bile contains bile salts, necessary for the digestion of fat. Bile is stored in the gallbladder, an organ connected to the bile duct in between the liver and the small intestine; when a fatty meal is eaten, the stomach and intestine send a signal to the gallbladder to contract, expelling bile into the intestinal tract to aid in digestion.
Stones or sludge can form within the gallbladder, which may then block the opening through which bile flows. This can cause nausea and abdominal pain after eating a fatty meal, as the gallbladder tries unsuccessfully to squeeze out its contents. Gallstones can also travel into the bile duct and become stuck, leading to infection, or migrate into the pancreatic duct (which connects to the bile duct) and cause acute pancreatitis. Either of these conditions can be life-threatening. The most common treatment for gallstones is removal of the gallbladder; 750,000 Americans undergo this operation each year.
The liver-gallbladder flush is an old technique to help stimulate and cleanse the bile ducts and gallbladder, and relieve the nausea and abdominal pain experienced by patients with symptomatic gallstones. There are several variations, but all include drinking oil, usually olive oil, which induces vigorous contraction of the gallbladder. Typically, round green objects pass in the stool the next day, traditionally believed to be passed gallstones. (14) However, in a letter to the journal Lancet, doctors in New Zealand reported that chemical examination of such objects brought in by a patient after a liver-gallbladder flush revealed that the “stones” were most likely created from the olive oil that she drank to do the procedure. (15) The authors claim that this proves the procedure does not work, but identifying the green objects that passed in this individual patient as olive oil derivatives does not answer the question of whether the procedure can be successful in stimulating stones or sludge to pass or in relieving symptoms from gallstones.
In a small study presented at the 1997 meeting of the North American Primary Care Research Group and subsequently described in American Family Physician, Richard L. Garrison, MD, studied the effect of a “traditional home remedy for inducing gallstone expulsion using lemon juice, olive oil, cascara sagrada and garlic/castile enemas” in 6 patients with symptomatic gallstones which had been confirmed by ultrasound. (16) An ultrasound after the procedure assessed clearing of stones. Alter completing the liver flush, five of six patients were asymptomatic for periods ranging from two to 27 months. At least one woman cleared all her stones, but she proceeded with surgery anyway at the advice of her surgeon. The investigators concluded that the procedure could potentially eliminate the need for surgery in many patients.
Our patients report that they feel better as a result of doing these detoxification procedures, and so do I – I have been doing coffee enemas and liver flushes as part of my health maintenance program for years. But have they been documented to get rid of environmental toxins stored in the body?
Few studies have addressed this question. However, a study published in Alternative Therapies in Health and Medicine looked at the efficacy of Ayurvedic cleansing procedures for removal of fat-soluble toxins such as PCBs. (17) In study participants who performed the cleansing procedures (which included ingestion of oil and herbal enemas), blood levels of PCBs showed a substantial decrease.
We believe the coffee enema and the liver-gallbladder flush, two procedures that have stood the test of time, are valuable aids to the liver in its job of detoxifying the body. However, anyone interested in pursuing these techniques should consult with a knowledgeable medical professional for direction.
1. McClain ME. The patient's needs: Enemas. Scientific Principles in Nursing. St. Louis, MO: The C.V. Mosby Company; 1950:168.
2. Bedside procedures. The Merck Manual of Diagnosis and Therapy. 9th ed. Rahway, NJ: Merck & Co, Inc; 1956:1747-1748.
3. Bedside procedures. In: Lyght CE, Gibson A, Keefer CS, Richards DW, Sebrell WH, Daughenbaugh PJ, eds. The Merck Manual of Diagnosis and Therapy. 10th ed. Rahway, NJ: Merck Sharp & Dohme Research Laboratories; 1961:1754-1755.
4. Bedside procedures. In: Lyght CE, Keefer CS, Lukens FDW, Richards DW, Sebrell WH, Trapnell JM, eds. The Merck Manual of Diagnosis and Therapy. 11th ed. Rahway, NJ: Merck Sharp & Dohme Research Laboratories; 1966:1682-1683.
5. Cachot MA. Case of Poisoning by Aconite; Enema of Coffee in the Treatment. Pac Med Surg J. 1866;9:239-240. Available at http://google.com/books?id=BkAgAQAAIAAJ
6. Allison CC. Operative Technique in Appendicitis, with Cases. West Med Review. 1896;1:152-154. Available at http://google.com/books?id=tOVXAAAAMAAJ.
7. Mississippi Valley Medical Association Society Proceedings. West Med Review. 1896;1:189-194. Available at http://google.com/books?id=tOVXAAAAMAAJ.
8. A General Practitioner. The Illustrated Family Doctor. Dunstable: Waterlow and Sons; 1934.
9. Stajano C. The concentrated coffee enema in the therapeutics of shock. Uruguayan Med Surg Special Arch. 1941;29:1-27.
10. Douglas BR, Jansen JB, Tham RT, Lamers CB. Coffee stimulation of cholecystokinin release and gallbladder contraction in humans. Am J Clin Nutr. 1990;52:553-556.
11. Garbat AL, Jacobi HG. Secretion of bile in response to rectal installations. Arch Intern Med. 1929;44:455-462.
12. Eisele JW, Reay DT. Deaths related to coffee enemas. J Am Med Assoc. 1980;244:1608-1609.
13. Margolin KA, Green MR. Polymicrobial enteric septicemia from coffee enemas. West J Med. 1984;140:460.
14. Dekkers R. Apple juice and the chemical-contact softening of gallstones. Lancet. 1999;354:2171.
15. Sies CW, Brooker J. Could these be gallstones? Lancet. 2005;365:1388.
16. Garrison RL. Home Remedy May Help Prevent Surgery in Some Patients with Gallstones. In: Rose VL. Conference Highlights. Am Fam Physician. 1998;57:785-786. Available at http://www.aafp.org/afp/1998/0215/p785.html.
17. Herron RE, Fagan JB. Lipophil-mediated reduction of toxicants in humans: an evaluation of an ayurvedic detoxification procedure. Altern Ther Health Med. 2002;8:40-51.