Few issues divide the worlds of conventional and alternative medicine quite so starkly.
According to a profusion of Web sites, clinics and wellness spas, the typical American diet of processed foods, pharmaceuticals, stress and lack of exercise is clogging up our lower intestinal tracts, leaving them inflamed and lined with waste—and leaking toxins into the body that cause problems ranging from headaches and chronic fatigue to arthritis and cellulite. All that "stubborn fecal matter" also contributes to bulging bellies and expanding waistlines, cleansing proponents claim.
Eliminating the buildup, either with supplements or laxatives, or by flushing the colon with warm water—a practice known as "hydrotherapy" or "colonics"—can dramatically improve a person's health and well-being, proponents claim. "Colonics help people get rid of what's in there, so they have a sense of 'Wow! That's what I should feel like,' " says Kim Dupre, who is owner of WellvilleHealingArtsCenter in Durham, N.C., and certified by an international organization of colon hydrotherapists.
Gastroenterologists pooh-pooh many of those claims. Healthy colons are self-cleaning, they say, and evacuating the colon via other means can do serious harm, even causing the sluggishness the cleansing purports to fix. "I've seen a lot of colons and the notion that people have pounds of feces and evil toxins built up in there is pure fantasy," says John I. Allen, a Minnesota gastroenterologist who has performed more than 20,000 colonoscopies, including many in patients who haven't drunk the traditional medical cleansing preparation beforehand. Claims for colonics and other forms of cleansing, Dr. Allen says, "just play to people's fears and desire to lose weight."
The notion of emptying the intestines to cure illness was common in many ancient cultures, too. Egyptians performed enemas in rivers using hollow reeds. Colonic irrigation was been a staple of European spas for centuries, and it was all the rage in 17th-century Paris to have several enemas a day.
In the U.S., colon cleansing was common until the early 19th century, when conventional physicians began to challenge the lack of scientific evidence and condemn some practitioners as quacks.
In recent decades, colon cleansing has ridden a wave of interest in alternative medicines. Hydrotherapy spas—from storefront clinics to luxury resorts—have sprung up, especially in the South and West. And the Internet has fueled a boom in sales of at-home cleansing products. Generally combinations of fiber, herbs, vitamins and stimulants, they often make enticing claims ("Ever wonder how the stars lose weight so quickly?" "Flush out up to 30 pounds!"). Some Web sites feature photos of long strands of rubbery-looking goo that customers claim they have expelled. ("I have lost some of the most horrific things you could imagine, and I have proof!")
Gastroenterologists say that about 15% of the population suffers from constipation at some point, and some conditions and medications increase it. The best remedies are to increase dietary fiber, ideally from whole grains, fruits and vegetables, and to consult a physician before trying other measures.
Some gastroenterologists worry that colonics can wash out beneficial bacteria and create infections, abscesses and electrolyte imbalances; there have been cases of rectal perforations. That is one reason that some hydrotherapists are pushing states to have formal licensing procedures. As of now, only Florida licenses colon hydrotherapists. Texas requires patients to have a doctor's prescription; Rhode Island prohibits the practice.
Brian Landzberg, a Manhattan gastroenterologist, says people's notion that they have pounds of backed-up stool in their colons is helping to feed distorted body images. He says he frequently sees patients who have abused laxatives in an effort to lose weight or flatten their stomachs. "Those are some of my toughest patients to treat," he says, because overuse of some bowel stimulants can damage the nerves and walls of the colon and prevent it from functioning properly.
Some patients, he says, are so convinced they are constipated that only transit marker studies—which follow the passage of small markers through the intestine via X-ray—can persuade them that their "transit time" is normal. "There is a degree of obsession that goes along with this," says Dr. Landzberg. "You can't just accept a patient's report that they are constipated."
Even "natural" laxatives, such as the plants senna and cascara, can harm the bowel, Dr. Landzberg says, adding, "The public has grown increasingly wary of the side effects of pharmaceuticals. I would like to see people bring that same degree of healthy skepticism to 'natural' products."
Where practitioners of conventional and alternative medicine do agree is in recommending improvements in the average American diet, to avoid gastrointestinal problems and lower the risk of colon cancer.
"We do see a lot of constipation in Western civilization," says Dr. Landzberg. "We don't drink enough fluids. We are too sedentary, we have weakened abdominal muscles, and we don't take enough fiber in our diets. But the answer to that is not artificial colon cleansing. A well-balanced diet with a good portion of soluble fiber—with lower fat and a calcium supplement—makes a happy colon."
