Colonics, Laxatives, and More
Stephen Barrett, M.D.
The importance of "regularity" to overall health has
been greatly overestimated for thousands of years. Ancient Egyptians associated
feces with decay and used enemas and laxatives liberally. In more recent times,
this concern has been embodied in the concept of "autointoxication" and has been
promoted by warnings against "irregularity." 
The theory of "autointoxication" states that stagnation of the large
intestine (colon) causes toxins to form that are absorbed and poison the body.
Some proponents depict the large intestine as a "sewage system" that becomes a
"cesspool" if neglected. Other proponents state that constipation causes
hardened feces to accumulate for months (or even years) on the walls of the
large intestine and block it from absorbing or eliminating properly. This, they
say, causes food to remain undigested and wastes from the blood to be reabsorbed
by the body .
Around the turn of the twentieth century many physicians accepted the concept
of autointoxication, but it was abandoned after scientific observations proved
it wrong. In 1919 and 1922, it was clearly demonstrated that symptoms of
headache, fatigue, and loss of appetite that accompanied fecal impaction were
caused by mechanical distension of the colon rather than by production or
absorption of toxins [3,4]. Moreover, direct observation of the colon during
surgical procedures or autopsies found no evidence that hardened feces
accumulate on the intestinal walls.
Today we know that most of the digestive process takes place in the small
intestine, from which nutrients are absorbed into the body. The remaining
mixture of food and undigested particles then enters the large intestine, which
can be compared to a 40-inch-long hollow tube. Its principal functions are to
transport food wastes from the small intestine to the rectum for elimination and
to absorb minerals and water. Careful observations have shown that the bowel
habits of healthy individuals can vary greatly. Although most people have a
movement daily, some have several movements each day, while others can go
several days or even longer with no adverse effects.
The popular diet book Fit for Life (1986) is based on the notion that
when certain foods are eaten together, they "rot," poison the system, and make
the person fat. To avoid this, the authors recommend that fats, carbohydrates
and protein foods be eaten at separate meals, emphasizing fruits and vegetables
because foods high in water content can "wash the toxic waste from the inside of
the body" instead of "clogging" the body. These ideas are utter nonsense .
Some chiropractors, naturopaths, and assorted food faddists claim that "death
begins in the colon" and that "90 percent of all diseases are caused by
improperly working bowels." The practices they recommend include fasting,
periodic "cleansing" of the intestines, and colonic irrigation. Fasting is said
to "purify" the body. "Cleansing" can be accomplished with a variety of
"natural" laxative products. Colonic irrigation is performed by passing a rubber
tube through the rectum. Some propoponents have advocated that the tube be
inserted as much as 30 inches. Warm water -- often 20 gallons or more -- is
pumped in and out through the tube, a few pints at a time, to wash out the
contents of the large intestine. (An ordinary enema uses about a quart of
fluid.) Some practitioners add herbs, coffee, enzymes, wheat or grass extract,
or other substances to the enema solution. The
Total Health Connection
and Canadian Natural Health and Healing Center
Web sites provide more details of proponents' claims. The latter states that
"there is only one cause of disease -- toxemia" and offers "the most
comprehensive in-depth colon therapy on the continent." The course costs $985
for 5 days of in-clinic training or $295 by correspondence.
Some "alternative" practitioners make bogus diagnoses of "parasites," for
which they recommend "intestinal cleansers," plant enzymes, homeopathic
remedies. Health-food stores sell products of this type with claims that they
can "rejuvenate" the body and kill the alleged invaders.
The danger of these practices depends upon how much they are used and whether
they are substituted for necessary medical care. Whereas a 1-day fast is likely
to be harmless (though useless), prolonged fasting can be fatal. "Cleansing"
with products composed of herbs and dietary fiber is unlikely to be physically
harmful, but the products involved can be expensive. Some people have reported
expelling large amounts of what they claim to be feces that have accumulated on
he intestinal wall. However, experts believe these are simply "casts" formed by
the fiber contained in the "cleansing" products.
Although laxative ads warn against "irregularity," constipation should be
defined not by the frequency of movements but by the hardness of the stool.
Ordinary constipation usually can be remedied by increasing the fiber content of
the diet, drinking adequate amounts of water, and engaging in regular exercise.
If the bowel is basically normal, dietary fiber increases the bulk of the stool,
softens it, and speeds transit time. Defecating soon after the urge is felt also
can be helpful because if urges are ignored, the rectum may eventually stop
signaling when defecation is needed. Stimulant laxatives (such as cascara or
castor oil) can damage the nerve cells in the colon wall, decreasing the force
of contractions and increasing the tendency toward constipation. Thus, people
who take strong laxatives whenever they "miss a movement" may wind up unable to
move their bowels without them.Frequent enemas can also lead to dependence .
A doctor should be consulted if constipation persists or represents a
significant change in bowel pattern.
Colonic irrigation, which also can be expensive, has considerable potential
for harm. The process can be very uncomfortable, since the presence of the tube
can induce severe cramps and pain. If the equipment is not adequately sterilized
between treatments, disease germs from one person's large intestine can be
transmitted to others. Several outbreaks of serious infections have been
reported, including one in which contaminated equipment caused amebiasis in 36
people, 6 of whom died following bowel perforation [7-9]. Cases of heart failure
(from excessive fluid absorption into the bloodstream) and electrolyte imbalance
have also been reported . Yet no license or training is required to operate
a colonic-irrigation device. In 1985, a California judge ruled that colonic
irrigation is an invasive medical procedure that may not be performed by
chiropractors and the California Health Department's Infectious Disease Branch
stated: "The practice of colonic irrigation by chiropractors, physical
therapists, or physicians should cease. Colonic irrigation can do no good, only
harm." The National Council Against Health Fraud agrees .
The FDA classifies colonic irrigation systems as Class III devices that
cannot be legally marketed except for medically indicated colon cleansing (such
as before a radiologic endocopic examination). No system has been approved for
"routine" colon cleansing to promote the general well being of a patient. Since
1997, the agency has issued at least seven warning letters related to colon
- In 1997, Colon
Therapeutics, of Groves, Texas, and its owner Jimmy John Girouard were
warned about safety and quality control violations of the Jimmy John colon
hydrotherapy unit and related devices .
- In 1997, Tiller Mind & Body, of San Antonio, Texas and its owner Jeri C.
Tiller, were ordered to stop claiming that their Libbe colonic irrigation
device was effective against acne, allergies, asthma and low-grade chronic
infections and improved liver function and capillary and lymphatic
- In 1997, Colon Hygiene Services, of Austin, Texas and its owner Rocky
Bruno was notified that their colonic irrigation system could not be
laegally marketed without FDA approval .
- In 1999, Dotolo Research Corporation, of Pinellas Park, Florida, and its
chief executive officer Raymond Dotolo were warned about quality conrol
violations and lack of FDA approval for marketing ts Toxygen BSC-UV colonic
irrigation system .
- In 2001, Clearwater Colon Hydrotherapy, of Ocala, Florida, and its vice
presdient Stuart K. Baker were warned about quality control violations and
lack of FDA approval for marketing their colonic irrigators .
- In 2003. the International Colon Hydrotherapy Association, of San
Antonio, Texas and its executive director Augustine R. Hoenninger, III, PhD,
ND, were notified that it lacked FDA approval to sponsor "research" that had
been proposed or actually begun on the devices of five companies[ 16].
- In 2003, Girourd and Colon Therapeutics were notified that his devices
require professional supervision and cannot be legally marketed directly to
consumers. The letter noted that he had obtained marketing clearance only
for use in medically indicated colon cleansing, such as before radiologic or
sigmoidoscopic examinations .
- In 2003, the Wood Hygienic Institute of Kissimmee, Florida, and its
owner Helen Wood were warned about quality control violations and the use of
unapproved theraputic claims in marketing their devices .
Girouard, Colon Therapeutics, Tiller Mind & Body, operators of the
Years to Your Life Health Centers,
companies that manufactured several components of Girouard's colonic irrigation
systems, and organizations that trained operators of the devices are being sued
in connection with the death of a 72-year-old woman who perforated her large
intestine while administering colonic irrigation. The suit alleges that the
woman was unsupervised when she administered the "colonic," perforated her colon
early in the procedure, required surgery the same day, and remained seriously
ill for several months before she died from liver failure. The complaint also
alleges that Years to Your Life Health Center falsely advertised colonic
irrigations as "painless" procedures which provided health benefits including an
improved immune system and increased energy, as well as relief from indigestion,
diarrhea, constipation, weight loss, body odor, candida, acne, mucus colitis,
gas, food cravings, fatigue, obesity, diverticulosis, bad breath, parasitic
infections, and premenstrual syndrome . In response to the woman's death and
reports of serious injuries to four other patients, the Texas Attorney General
has filed separate lawsuits against:
- Girouard and Colon Therapeutics
- Eternal Health Inc., dba Years to Your Life and Cynthia Pitre
- Jennifer Jackson, dba Body Cleanse Spa
- Tiller Mind Body Inc., dba Mind Body Naturopathic Institute and Jerri
- International Association for Colon Hydrotherapy, Class 3 Study Group
and Augustine R. Hoenninger III
- Linda Gonzalez, dba El Paso Health Center.
The suits charge that all of the defendants have engaged in the promotion,
sale or unauthorized use of prescription devices for colonic hydrotherapy
treatments without physician involvement. The state is seeking (a) temporary and
permanent injunctions, (b) civil penalties of up to $25,000 per day per
violation of the state's Health and Safety Code, (c) civil penalties of up to
$20,000 per violation of the state's Deceptive Trade Practices Act, (d)
investigative costs, and (e) attorneys' fees .
For Additional Information
- Chen TS, Chen PS.
Intestinal autointoxication: A gastrointestinal leitmotive. Journal
Clinical Gastroenterology 11:343-441, 1989.
- Ernst E.
Colonic irrigation and the theory of autointoxication: A triumph of
ignorance over science. Journal of Clinical Gastroenterology 24:196-198,
- Alvarez WC. Origin of the so-called auto-intoxication symptoms. JAMA
- Donaldson AN. Relation of constipation to intestinal intoxication. JAMA
- Kenney JJ. Fit
For Life: Some notes on the book and Its roots. Nutrition Forum, March
- Use of enemas is limited. FDA Consumer 18(6):33, 1984.
- Amebiasis associated with colonic irrigation - Colorado. Morbidity and
Mortality Weekly Report 30:101-102, 1981.
- Istre GR and others. An outbreak of amebiasis spread by colonic
irrigation at a chiropractic clinic. New England Journal of Medicine
- Benjamin R and others. The case against colonic irrigation. California
Morbidity, Sept 27, 1985.
- Eisele JW, Reay DT. Deaths related to coffee enemas. JAMA 244:1608-1609,
- Jarvis WT.
Colonic Irrigation. National Council Against Health Fraud, 1995.
- Baca JR.
Warning letter to Colon Therapeutics, April 27, 1997.
- Baca, JR.Warning
letter to Tiller Mind & Body, June 2, 1997.
- Baca JR.
Warning letter to Colon Hygiene Services, June 20, 1997.
- Tolen DD.
Warning letter to Dotolo Research Corporation, July 21, 1999.
- Singleton E.
Warning letter to Clearwater Colon Hydrotherapy, Sept 13, 2001.
- Marcarelli MM.
to International Colon Hydrotherapy Association, March 21, 2003.
- Chappel MA.
Warning letter to Colon Therapeutics, Oct 23, 2003.
- Ormond E.
Warning letter to Wood Hygienic Institute, Oct 23, 2003.
- Barrett S.
Colonic promoters facing legal actions. Quackwatch, Nov 11, 2003.
General Abbott sues ' colonic hydrotherapy ' providers for abuse of medical
devices; one death reported: Suits allege unsafe use of devices without
physician oversight is a public health issue. Texas Attorney General
news release, Dec 1, 2003.