COFFEE: THE ROYAL FLUSH

The most controversial alternative procedures has to be the coffee enema. Along with other detoxification routines, the coffee enema is a central part of both the Gerson and the Kelley programs. It is always good for a laugh: "with milk or sugar?" This bizarre-sounding treatment can also be used to scare people away from alternatives in general. No quack busting article these days is complete without a reference to "enemas made from roasted coffee beans." So what's the story? Is the coffee enema crackpot faddism or is there some rationale behind this procedure?

An enema is "a fluid injected into the rectum for the purpose of clearing out the bowel, or of administering drugs or food." The word itself comes from the Greek en-hienai, meaning to "send or inject into." The enema has been called "one of the oldest medical procedures still in use today." Tribal women in Africa, and elsewhere, routinely use it on their children. The earliest medical text in existence, the Egyptian Ebers Papyrus, (1,500 B.C.) mentions it. Millennia before, the Pharaoh had a "guardian of the anus," a special doctor one of whose purposes was to administer the royal enema.

The Greeks wrote of the fabled cleanliness of the Egyptians, which included the internal cleansing of their systems through emetics and enemas. They employed these on three consecutive days every month said Herodotus (II.77) or at intervals of three or four days, according to the later historian Diodorus. The Egyptians explained to their visitors that they did this because they "believed that diseases were engendered by superfluities of the food", a modern-sounding theory!

Enemas were known in ancient Sumeria, Babylonia, India, Greece and China. 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 the first rubber enema bags and tubes. In fact, there is hardly a region of the world where people did not discover or adapt the enema. It is more ubiquitous than the wheel. Enemas are found in world literature from Aristophanes to Shakespeare, Gulliver Travels to Peyton Place.

In pre-revolutionary France a daily enema after dinner was de rigueur. It was not only considered indispensable for health but practiced for good complexion as well. 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? For centuries, enemas were a routine home remedy. Then, within living memory, the routine use of enemas died out. The main times that doctors employ them nowadays is before or after surgery and childbirth. Difficult and potentially dangerous barium enemas before colonic X rays are of course still a favorite of allopathic doctors.

But why coffee? This bean has an interesting history. It was imported in Arabia in the early 1500's by the Sufi religious mystics, who used it to fight drowsiness while praying. It was especially prized for its medicinal qualities, in both the Near East and Europe. No one knows when the first daring soul filled the enema bag with a quart of java. What is known is that the coffee enema appeared at least as early as 1917 and was found in the prestigious Merck Manual until 1972. In the 1920s German scientists found that a caffeine solution could open the bile ducts and stimulate the production of bile in the liver of experimental animals.

Dr. Max Gerson used this clinically as part of a general detoxification regimen, first for tuberculosis, then cancer. Caffeine, he postulated, will travel up the hemorrhoidal to the portal vein and thence to the liver itself. Gerson noted some remarkable effects of this procedure. For instance, patients could dispense with all pain-killers once on the enemas. Many people have noted the paradoxical calming effect of coffee enemas. And while coffee enemas can relieve constipation, Gerson cautioned:

"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 were an established part of medical practice when Dr. Max Gerson introduced them into cancer therapy in the 1930s. Basing himself on German laboratory work, Gerson believed that caffeine could stimulate the liver and gall bladder to discharge bile. He felt this process could contribute to the health of the cancer patient.

Although the coffee enema has been heaped with scorn, there has been some independent scientific work that gives credence to this concept. In 1981, for instance, Dr. Lee Wattenberg and his colleagues were able to show that substances found in coffee—kahweol and cafestol palmitate—promote the activity of a key enzyme system, glutathione S-transferase, above the norm. This system detoxifies a vast array of electrophiles from the bloodstream and, according to Gar Hildenbrand of the Gerson Institute, "must be regarded as an important mechanism for carcinogen detoxification." This enzyme group is responsible for neutralizing free radicals, harmful chemicals now commonly implicated in the initiation of cancer. In mice, for example, these systems are enhanced 600 percent in the liver and 700 percent in the bowel when coffee beans are added to the mice's diet.

Dr. Peter Lechner, who is investigating the Gerson method at the Landeskrankenhaus of Graz, Austria, has reported that "coffee enemas have a definite effect on the colon which can be observed with an endoscope." F.W. Cope (1977) has postulated the existence of a "tissue damage syndrome." When cells are challenged by poison, oxygen deprivation, malnutrition or a physical trauma they lose potassium, take on sodium and chloride, and swell up with excess water.

Another scientist (Ling) has suggested that water in a normal cell is contained in an "ice-like" structure. Being alive requires not just the right chemicals but the right chemical structure. Cells normally have a preference for potassium over sodium but when a cell is damaged it begins to prefer sodium. This craving results in a damaged ability of cells to repair themselves and to utilize energy. Further, damaged cells produce toxins; around tumors are zones of "wounded" but still non-malignant tissue, swollen with salt and water.

Gerson believed it axiomatic that cancer could not exist in normal metabolism. He pointed to the fact that scientists often had to damage an animal's thyroid and adrenals just to get a transplanted tumor to "take." He directed his efforts toward creating normal metabolism in the tissue surrounding a tumor.

It is the liver and small bowel which neutralize the most common tissue toxins: polyamines, ammonia, toxic-bound nitrogen, and electrophiles. These detoxification systems are probably enhanced by the coffee enema. Physiological Chemistry and Physics has stated that "caffeine enemas cause dilation of bile ducts, which facilitates excretion of toxic cancer breakdown products by the liver and dialysis of toxic products across the colonic wall."

In addition, theophylline and theobromine (two other chemicals in coffee) dilate blood vessels and counter inflammation of the gut; the palmitates enhance the enzyme system responsible for the removal of toxic free radicals from the serum; and the fluid of the enema then stimulates the visceral nervous system to promote peristalsis and the transit of diluted toxic bile from the duodenum and out the rectum.

Since the enema is generally held for 15 minutes, and all the blood in the body passes through the liver every three minutes, "these enemas represent a form of dialysis of blood across the gut wall" (Healing Newsletter, #13, May-June, 1986).

Prejudice against coffee enemas continues, however. Although this data was made available to Office of Technology Assessment it was largely ignored in their box on the procedure. They dismissively state "there is no scientific evidence to support the claim that coffee enemas detoxify the blood or liver."

No medical procedure is without risk and OTA is quick to point out alleged dangers of the coffee enemas. For instance, they cite one doctor's opinion that coffee "taken by this route is a strong stimulant and can be at least as addictive as coffee taken regularly by mouth." This may indeed be true. Yet one wonders where the data is on this, and whether OTA would issue a similar warning about the perils of coffee drinking.

Another potential danger, they say, is physical damage to the rectum—"fatal bowel perforation and necrosis" which have been associated with "various other types of enema." The risk of perforation comes from the insertion device used. At the Gerson clinic, for instance, they use a short nozzle which couldn't inflict much harm; Gonzalez uses a soft rubber colon tube. In neither case would this caveat seem to apply. On thin evidence, OTA also suggests enemas can cause colitis.

The agency also cites the case of the two Seattle women who died following excessive enema use. Their deaths were attributed to fluid and electrolyte abnormalities. 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 daily. As OTA points out, "in both cases, the enemas were taken much more frequently than is recommended in the Gerson treatment."

In general, coffee enemas are an important tool for physicians who try to detoxify the body. This is not to say they are a panacea. They certainly require much more research. But coffee enemas are serious business: their potential should be explored by good research—not mined for cheap shots at alternative medicine or derisively dismissed as yet another crackpot fad.

From The Cancer Chronicles #6 and #7
© Ralph W. Moss, Ph.D.