E is for Enema

It seems I am the Coffee Enema King. Out of 7,500 websites on the topic at the Google search engine, my essay on the history of enemas is rated number one. I have found my ticket to immortality. When all my books have crumbled to dust, my little coffee enema article will still be kicking around the Internet.

When I first heard the words "coffee" and "enema" 25 years ago, I almost fell off my chair laughing. At Sloan-Kettering, the big joke was, "With cream or sugar?" Eventually that joke wore thin, when I discovered that coffee enemas were a serious part of alternative medicine (CAM). The National Institutes of Health has even given $1.4 million to find out if coffee enemas, along with supplements and diet, can fight pancreatic cancer.

An enema is defined as "a fluid injected into the rectum for the purpose of clearing out the bowel, or of administering drugs or food." It is one of humanity's oldest medical procedures still in use. Tribal women in Africa routinely administer it to their children. The earliest medical text in existence, the Egyptian Ebers Papyrus, mentions it. Millennia before, the Pharaoh had a "guardian of the anus," a special doctor whose purpose was to administer his enema. This was truly a Royal Flush.

Enemas sprang up from ancient Greece to India. American Indians independently invented it, using a syringe made of an animal bladder and a hollow leg bone. Pre-Columbian South Americans fashioned latex into rubber enema bags and tubes (the world's first use of rubber). It is more ubiquitous than the wheel. Enemas are also found in world literature from Aristophanes to Shakespeare, Gulliver's Travels to Peyton Place. Louis XIV is said to have taken over 2,000 in his lifetime. Could this have been the source of the Sun King's sunny disposition?

No one knows when the first daring soul filled an enema bag with Java. What is known is that the coffee enema was recorded as early as 1917 and was recommended in the prestigious Merck Manual until the mid-1970s. In the 1920s, German scientists claimed that a caffeine solution could open the bile ducts and stimulate the production of bile in the liver of experimental animals. The CAM pioneer Max Gerson, MD, used this clinically as part of his detoxification regimen. The effects of caffeine, he postulated, travel upward to the liver. He noted that patients could dispense with pain-killers once on the enemas. Many people have noted a paradoxical calming effect. But while coffee enemas can relieve constipation, Gerson emphasized: "Patients have to know that the coffee enemas are not given for the function of the intestines but for the stimulation of the liver."

Coffee enemas are still the butt of many jokes. However, in 1981, Dr. Lee Wattenberg showed that substances found in coffee promote the activity of a key enzyme system that detoxifies the blood. Dr. Peter Lechner, of Graz, Austria, has reported that "coffee enemas have a definite effect on the colon which can be observed with an endoscope."

Opponents--and they are many claim that coffee enemas can be at least as habit forming as coffee taken by mouth. They say there is also a potential danger to the rectum, since bowel perforation has been associated with hard insertion devices. However, at the Gerson-oriented clinics, they use a short nozzle, which is not likely to inflict any harm. Dr. Nicholas Gonzalez, a proponent of coffee enemas, advocates a soft rubber tube.

Critics always cite the deaths of two Seattle women, which was attributed to fluid and electrolyte abnormalities, following enema abuse. One took 10 to 12 coffee enemas in a single night and then continued at a rate of one per hour. The other took four enemas daily. Drinking orange or pineapple juice just before taking the enemas should help with the electrolytes. Obviously, one can't go crazy with any procedure and not expect consequences.

In a coffee enema, the coffee has to be of the regular caffeinated kind and preferably organic. There is even a special brand of coffee that was created just for enema users (www.sawilson.com). The coffee should be about half the strength of coffee used for drinking, and should be served warm, not so hot as to hurt tender tissues, but not so cold that it will bring on cramps. Finally, one should not do more than one quart per day, except under a physician's guidance. If you have trouble retaining an enema, add a tablespoon of blackstrap molasses. One then holds the enema in, while lying on your side for 15 to 20 minutes.

But which side? The conventional medical protocol is to have patients lie on their left side while taking an enema. But Gerson insisted that patients lie on their right sides, with their legs comfortably pulled up, relaxed and breathing deeply. I have seen grown people nearly come to blows over this question. This is the CAM equivalent of the war of the Big-Endians vs. Little-Endians in Gulliver's Travels, where thousands were killed over which end of the egg to break first. Ordered to break the small end, "The orthodox deemed it their duty to resent this innovation, and declared a war of extermination against the heretical Lilliputians," wrote Jonathan Swift.

A Certain Ambivalence

I believe, on empirical grounds, that coffee enemas are helpful to many people. But I admit to a certain ambivalence about their long-term effects. Here's why. In 1990, my son and I crossed the country in his old Grand Am, stopping at the homes of many celebrated CAM practitioners. We visited a man I will call the Enema Master. He told me of his life's work, which included promoting coffee enemas. And, true to his word, there in his bathroom, hung his own worn enema bag, Naturally, I was awestruck. Who wouldn't be? This was an icon of Americana, worthy to hang next to Mr. Roger's cardigan sweater in the Smithsonian!

The Enema Master presented me with long screeds about the Jews and Satan which he read with shaky hands. He assured me that Chinese Communists were taking over America by planting garrisons (known to us as Karate studios) in every community. As he spoke, flecks of white spittle gathered at the corners of his mouth. As soon as we could, my son and I escaped back to enema-free America. As Matthew Broderick said in The Road to Wellville, "With friends like this, who needs enemas?"

Maybe this individual was drawn to detoxification because he already had mental or emotional problems. Or maybe he had pushed the coffee enema beyond the bounds of common sense. In any case, while I do look favorably on coffee enemas, I would look out for tell-tale signs of mental instability which include foaming at the mouth.

Here at the Moss Reports

I continue to make progress on my book on radiation therapy. I have been working on the chapters on bone and joint cancers. We have Moss Reports on many of these cancers, such as the Ewing's Family of Tumors and Osteogenic Sarcoma.

Midway through the book I decided that I needed to focus more attention on the Physicians' Data Query (PDQ) statements of the National Cancer Institute. This collection of documents, available at www.cancer.gov, has become the definitive statement on the orthodox treatment of cancer. I happen to be an advisor to the adult treatment PDQ and so have a certain proprietary feeling, but that doesn't mean I can't criticize, if criticism is warranted.

Online Notes

I also want to bring to your attention the fact that a major cancer textbook is now available online. I am speaking of the 5th edition of Cancer Medicine (formerly edited by Holland-Frei and now edited by R.C. Bast). This would cost you $275 to buy, but is now available free of charge at PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed). Plus it is fully searchable online in the easy-to-use PubMed format. No one should rush into alternative treatments without first fully understanding what conventional medicine has to offer. PDQ, PubMed and now Cancer Medicine are excellent resources to help you do that. And if you get stuck on a word you can click over to www.dictionary.com, another excellent and free internet resource.

--Ralph W. Moss, Ph.D.