Australasian Science: Australia's authority on science since 1938

Getting to the Bottom of Colon Cleansing

By Joanne Benhamu

Colonic cleansing has persisted as an alternative therapy for centuries despite a lack of evidence.

Sir Arthur Hurst, Founder of the British Society of Gastro­enterology, said in 1935: “No organ in the body is so mis­understood, so slandered and maltreated as the colon”.

Medical history is liberally peppered with claims that the bowel causes all disease, as decomposing waste stagnating in the bowel “poisons” the body. These beliefs originated in Ancient Egypt, where physicians believed that faecal putrefaction released a noxious substance into the blood, producing “heat” and increasing pulse. Bodily decay would follow. The solution was a combination of purgatives and venesection.

The Cnidian School in early Greek medicine drew from these beliefs, adopting the putrefactive principle and the concept of Hippocrates’ four humors. The digestive cycle was believed to last 3 days– anything longer than this would bring fever, disease and imbalance of the humors.

The great Roman physician and philosopher, Galen, expanded these ideas in the 2nd century with the concept of miasmas (airborne particles) given off during putrefaction. Galen hypothesised that this was a plausible model for disease transmission. Humoral imbalance, however, persisted as the overriding theory of illness until the late 19th century.

Johann Kampf’s concept of infarctus – that impacted faeces would cause distension, thickening and slowing of blood and fluids – revived the idea of self-poisoning in the 18th century. Kampf prescribed enemas thrice daily. Meanwhile, King Louis XIV’s personal physician warned of “faeculant blood”, and Swiss physiologist Albrecht Von Haller warned of constipation leading to insanity and fever.

In the 19th century the medical community held that changes in diet and activity accompanying industrialisation were to blame for an epidemic of constipation and associated ailments. The developing fields of bacteriology and biochemistry confirmed the presence of toxin-producing bacteria, adding weight to the idea that putrefaction in the intestines was at the root of human illness. Scientific investigations by Ludwig Brieger demonstrated that intestinal flora broke down faecal protein residues into toxic compounds, which he called ptomaines.

Physician Charles Bouchard coined the term “intestinal autointoxication”, extending the concept to liver and kidney function being overwhelmed in the presence of toxins. Bouchard dramatically referred to the constipated thus:

Man is in this way constantly living under the chance of being poisoned; …he makes continual attempts at suicide by intoxication.

James Whorton, a Professor of Medical History at the University of Washington, suggests that autointoxication gave doctors a diagnosis for patients presenting with non-specific symptoms and no clear organic cause. Doctors embraced these ideas zealously, driving an anxious public into the eager pockets of charlatans and hucksters. Fewer than one bowel movement per day was unacceptable.

The turn of the last century saw the rise of the “health food” era. Russian biologist and Nobel Laureate, Ilya Metchnikoff, recommended yoghurt to prevent premature ageing by altering the gut microbiota. Yeast and bran cereals were similarly promoted. To this day, the belief that dietary fibre will protect against bowel cancer persists despite a lack of evidence.

The era of surgery brought extreme interventions such as Sir William Arbuthnot Lane’s intestinal bypass for constipation. Lane attributed tuberculosis, rheumatoid arthritis and thyroid problems to intestinal stasis and advocated such extreme interventions as total colectomy as a cure. Lane was a competent and respected surgeon but failed to gather evidence to support his theories and the dangerous interventions he prescribed.

Dr John Harvey Kellogg valued empiricism, but his Seventh Day Adventist upbringing strongly informed his advocating better health through exercise, sunshine, vegetarianism and abstinence from tobacco and alcohol. Kellogg’s influence drew visitors to Battle Creek Sanitarium, where an enema machine ran 15 gallons of water into the colon in seconds, followed by a pint of yogurt – half by enema, the other half consumed. The result was a “squeaky clean intestine”.

The era’s obsession with all things colonic was reflected in advertising; a collection of frightening and amusing devices and concoctions such as Vita radium suppositories containing “real” radium to “bombard your body with its health-giving atoms”, or the “Rectorotor, promising results due to its scientific construction”.

The developing science ultimately saw these ideas crumble. Roughly a century ago, Donaldson and Alvarez demonstrated that rectal distension with an inert substance replicated the discomfort of constipation, sounding the death knell for intestinal autointoxication. By the 1930s it had fallen into disrepute.

But the 21st century sees a resurgence of these ideas, and with them a range of “treatments” designed to cure what ails you. A later column will look at these treatments and the risk posed to the public with their increasing popularity under the banner of complementary and alternative medicine.

Joanne Benhamu is a Clinical Research Nurse in Radiation Oncology. She is on the Executive of Friends of Science in Medicine and Australian Skeptics Inc. Follow her on Twitter @JoBenhamu.