Talk:Colon cleansing/colon hydrotherapy talk page

initial comment
In attempting to verify some of the claims of this article, I have removed an item that I could not verify:


 * congestive heart failure from fluid overload - the only references I could find to colonics and heart failure involved sodium phosphate taken orally before a colonic exam. This has nothing to do with colon hydrotherapy since most of the enemas given for a colonic are contrasts for the exam equipment, not for cleansing of the bowels and the trigger for heart failure is taken orally, not rectally.

Epolk 23:51, August 31, 2005 (UTC)

Deleted material
I've removed some content from this article and made some major changes. Here's what I've removed and why:


 * "However, there is reliable medical evidence that feces do not accumulate in the colon." This is incorrect. In fact there is overwhelming medical evidence to the contrary. See Diverticulosis and Constipation.
 * "High colonics, like any enema, only cleanse the last third of the colon." A strange and unsupported claim, perhaps true for poorly administered colonics or patients with severe problems. A good colon therapist will gradually work a small amount of water through the entire large colon - enough to lubricate and release.
 * "Dangers from high colonics include infections spread through equipment." The reference provides a single anecdotal report after the fact. The causality is not established.
 * "There have been some deaths from amebiasis spread by colonics" I've changed this to "There were a number of cases of amebiasis spread by a colon therapist in Colarado who failed to maintain sanitary conditions."
 * "There have been several rare cases of death in children from electrolyte imbalances brought on by colonics using softened water." I've changed this to "There have been reports of electrolyte imbalances brought on by colonics using softened water." If you read the abstract, the report establishes  a link between the electrolyte imbalances and enemas with softened water, but it does not seem  to establish a link with the children's deaths.
 * "It is also possible that these treatments may deplete healthy individuals of essential minerals." Unsupported and improbable claim.
 * "There is no reliable evidence that a high colonic treatment provides any benefits." Changed to There is limited scientific research to back these claims

I've also changed the bit about autointoxication being discredited. That's a subjective statement and is not really supported. --Lee Hunter 12:22, 27 September 2005 (UTC)


 * The deletions that were done are unfortunate. All the previous comments were based on literature which can be found by a few google searches.  The references that are now included were added by others separate from the references that supported the explained harms.  The edits done by LeeHunter were based only on the internal references listed here.  Additionally, the edits presumed equal strength to the given references, whis is not the case.  the characterization  of the statement that enemas are limited to the are of the colon distal to the splenic flexure being strange and unsupported reflects a lack of practical experience with cleansing enemas in the preoperative setting and lack of knowledge of the research on enema performance with radionucleide studies.  The belief that practioners are generally knowledgeable is in contradiction to the experience of patients who have related that the process consists of a tube up the butt and turning on of the enema flow.   My sense about this is that I will reedit the article and put supporting references here in the talk page to justify the changes.  However, for readability of the article intended for a general audience the references to more general literature is appropriate.  Stephen Holland, M.D. Kd4ttc 02:57, 4 January 2006 (UTC)


 * An enema is not the same thing as a colonic irrigation. Your information about enema performance should go in the enema article. Noone is suggesting that practitioners are generally knowledgable. Since it is an invasive procedure, practitioners should, at a minimum, be registered nurses but because colonics are unregulated in most jurisdictions there is obviously a wide range of skill and competence. There are many that simply put the tube up the butt, as you say, and even leave the room, but I can assure you that there are others (mostly nurses) that are highly knowledgable, trained and competent. --Lee Hunter 12:29, 4 January 2006 (UTC)


 * A tap water enema is a large volume lavage used for surgical preparation for inpatients in hospitals. Cleansing does not occur proximal (That means above) the splennic flexure (the turn of the colon by the spleel, located in the patient's upper left side of the abdomen).  Catheters inserted into the rectum do not get into the sigmoid colon unless they are guided with an endoscope.  Even under radiologic guidance they will not advance out of the rectum.  There are no regulations that require nurses to do the procedure.  As nurses cannot practice outside the scope of physician supervision I'd be interested to see how they are legally able to do colon hydrotherapy.  Kd4ttc 21:13, 4 January 2006 (UTC)


 * It might depend on the jurisdiction. I understand that in the Canadian province of Ontario, nurses can and do perform colon hydrotherapy and physician supervision is not required. --Lee Hunter 16:25, 5 January 2006 (UTC)

References to start with
Posted by Kd4ttc

http://www.quackwatch.org/01QuackeryRelatedTopics/altmini.html

7. Eisele JW, Reay DT. Deaths related to coffee enemas. JAMA 244:1608-1609, 1980.

8. Amebiasis associated with colonic irrigation - Colorado. Morbidity and Mortality Weekly Report 30:101-102, 1981.

9. Istre GR and others. An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. New England Journal of Medicine 307:339-342, 1982.

10. Benjamin R and others. The case against colonic irrigation. California Morbidity, Sept 27, 1985.

Green S: A critique of the rationale for cancer treatment with coffee enemas and diet. JAMA 268 (22): 3224-7, 1992. [PUBMED Abstract]

Margolin KA, Green MR: Polymicrobial enteric septicemia from coffee enemas. West J Med 140 (3): 460, 1984. [PUBMED Abstract]

Brown BT: Treating cancer with coffee enemas and diet. JAMA 269 (13): 1635-6, 1993. [PUBMED Abstract]

Eisele JW, Reay DT: Deaths related to coffee enemas. JAMA 244 (14): 1608-9, 1980. [PUBMED Abstract]

http://www.naturesbestnews.com/Colonic_Irrigation_Historical_Review.pdf

http://www.ncahf.org/pp/colonic.html


 * A few comments. As I mentioned earlier, enemas and colonics are related procedures but with significant differences. Coffee enemas, in particular, were a fad in the late 70s and 80s, I'm not sure what this has to do with an article on colonic irrigation. At least a couple of the references to amebiasis seem to be about the same incident involving a single chiropractic clinic in Colorado that had sloppy sterilization procedures, something that's not entirely unknown even in hospital settings. --Lee Hunter 15:07, 8 January 2006 (UTC)


 * The risks of colonic irrigation are similar to other enemas since the process is similar. Since certain risks are volume dependent the expected rate of complications from colonics will be higher than from tap water enemas.  Injury risk for insertion of a foreign body should be similar.  Of course, all these treatments are pretty low risk in healthy adults.  Discussing risks of a procedure is appropriate.  The comment that hospitals have adverse events is not germaine to a discussion of risks of colonics.  However, given the higher reporting standards that hospitals have, similar risks in outpatient settings are expected to be higher.  Kd4ttc 18:51, 8 January 2006 (UTC)


 * There are important similarities and important differences. For examples, enemas are most often self-administered (especially if you're talking about coffee enemas), colonics are almost always given by a therapist. Enemas tend to be held and released, colonics are mostly a continuous flow. Enemas are generally given with one temperature, the temperature in colonics is generally varied. Much more water is used overall in a colonic but the flow rate is not much different. There are enough differences that one can't making predictions and sweeping generalizations without specific evidence. I also wanted to point out that the NCAHF article makes some pretty strange statements. For example, "Today we understand more clearly the importance of dietary fiber, hydration, and so forth. Medical scientists also know that these have nothing to do with intestinal toxicity. " I'm curious as to what these medical scientists think that dietary fiber is doing in the colon if not removing fecal matter, improving peristalsis, etc. If any of these scientists don't believe that the average North American colon is not packed with dry, black, crusted material they should just spend some time in a colonic clinic. They might be surprised. Bernard Jensen also has some amazing pictures in his books. As you know, the large intestine's role is to absorb water and some nutrients, to claim that a colon covered with dried and impacted fecal matter (and the resulting fissures and diverticulitis) has no impact on health defies logic. --Lee Hunter 21:44, 8 January 2006 (UTC)


 * Hey, Lee. I run a colonic clinic.  Actually a colonoscopy clinic.  I have had times when patients were done unprepped.  You NEVER see hard stool along the side of the colon.  It is always in the middle, rolling around.  This is due to mucus preventing adherence to the wall of the colon.  It is wrong to think fiber removes fecal matter.  Fiber is part of the fecal matter.  Does constipation make you feel bad? Yes.  Does I high colonic catheter get above the rectum when placed? No.  Does a $2 dose of oral phosphasoda work as well as a colonic (priced at 6 colonics for $400)?  About 98% get a complete prep with the oral phospha-soda, the other 2 % do well with a 2 day prep.  Fissures are an anal disease, not a colonic disease.  S Holland, M.D.  Kd4ttc 21:56, 8 January 2006 (UTC)


 * You never see hard stool along the side of the colon? Well, I'm not an expert in this field, but if you what you're saying is true, we should also be making changes to the constipation article. --Lee Hunter 00:10, 9 January 2006 (UTC)


 * Where does that article say the hard stool is stuck up on the side in the folds? Kd4ttc 18:16, 9 January 2006 (UTC)


 * I was extrapolating from the article. Point taken. --Lee Hunter 18:44, 9 January 2006 (UTC)

Cost of hydrotherapy
Cost is a legitimate issue to include in this article. The cost is quite high, especially compared to simple alternatives such as laxatives. Kd4ttc 14:20, 23 February 2006 (UTC)
 * The cost itself is entirely legitimate, but comparisons are tricky. Colon therapists would argue that the purpose of colon hydrotherapy is not simply to evacuate the colon (it also stimulates and tones muscles and relieves spasticity), that it reaches areas that laxatives cannot touch and that chemicals like Phospho Soda can have severe side effects. I've provided a link from a GI expert who believes that "sodium phosphate is not safe for routine clinical use". You keep trying to hide this with a general warning about contraindications re daily use of either Phospho Soda and colonics for people with heart problems and renal failure whereas the link indicates Phospho Soda can be problem for anyone (and NOT just for daily use)  Also, in the case of colonics, my understanding is that people with those problems should never have colonics except under certain circumstances, so saying "daily use" is contraindicated is also misleading.   --Lee Hunter 16:16, 23 February 2006 (UTC)


 * Well, no. When I worked with Jack DiPalma during my fellowship at the University of Alabama he never mentioned any concerns about use of Phosphasoda, though that was before 1999 when he wrote that letter.  Please note that a single report of an adverse event is not enough to make a reference.  Additionally, the FDA did not take the laxative off the market.  The FDA is pretty conservative about these things, and will pull something off the market with adverse event rates as low a 2 per 10000.  My personal experience with 2000 preps in the last two years is no adverse events.  At a clinic I worked the year before that we had 7500 colonoscopies done, most with oral phospha-soda, and no adverse events.  Jack's letter stated he thought it ought to be pulled off the market.  Obviously it has not.  If you think it is appropriate to discuss FDA advisories here I think you will find that there are more advisories against Colon hydrotherapy equipment than against oral phospha-soda.  There is no evidence that a colonic achieves stimulation and tone or relieves spasticity.  There is also no evidence that the colononics get past the splenic flexure, nor that the catheters even get higher than the rectosigmoid junction.  The general warnings about use in CHF and renal failure are well established.  It was incorrect to say that it has risk of kidney failure.  It has risk when used in someone with kidney failure, but doesn't cause kidney failure.  I believe deaths have been reported, but only in those with underlying disease.  There is no need to say some experts warn of ... .   The package labelling advises against use in CHF or renal failure. Kd4ttc 23:08, 23 February 2006 (UTC)


 * Did you actually bother to read DiPalma's letter? He certainly wasn't referring to a "single event". He was citing his own research which showed "significant changes in serum electrolytes" and unexpectedly large increases in serum PTH and urine cAMP ... that persisted even 24 hours after preparation." He says that "oral sodium phosphate is not safe for routine clinical use due to these significant biochemical effects." He says "indeed there are numerous published reports of hypocalcemia resulting from oral Phospho-Soda bowel preparation (some of which resulted in death)" He does refer in passing to a specific alendronate case but only as an example of the hazards. His final conclusion is pretty much unequivocal "I remain convinced that the oral sodium phosphate bowel preparations are not safe for routine clinical use because they induce many biochemical changes. As the Campisi report indicates, these changes can have unexpected and sometimes disastrous effect. Many (if not most) patients requiring bowel preparation for diagnostic examination are elderaly with reduced bone metabolic capacity. Such patients are ill equipped to withstand the biochemical effects of oral sodium phosphate ingestion. The addition of drugs like alendronate further reduces their capacity to respond to these changes. Therefore I urge you to restrict these products from routine clinical use." Its interesting that the FDA did not take his advice, but the fact that a respected GI researcher took this stance, is certainly relevant if you want to start comparing the safety and cost of cleansing the colon with water as opposed to purging with chemical solutions. --Lee Hunter 00:15, 24 February 2006 (UTC)


 * Yes, I did read it. He saw changes of PTH and dAMP.  He did not show important clinical outcomes to those changes.  He asserted it was not safe but did not offer any cases that showed any toxicity.  His conclusion was rejected by FDA.  The numerous clinical reports he alluded to are not referenced.  He also has a conflict of interest (he works for Braintree - http://www.drugs.com/halflytely.html).  So this is just a lousy reference about other references.  So at this point you can say "A clinician at the University of Alabama who is paid by a company that makes a bowel prep that competes with oral phospha-soda once wrote a letter to the FDA saying he didn't think Oral phosphasoda was safe and he gave some references which are unavailable but the FDA did not do anything about it."  Of course, that is not very compelling, but it is what the reference says. In addition, there is only one case report in the entire medical literature about a problem with alendronate and hypocalcemia in a Crohn's patient, and all that happened to her was she had some arm and leg cramps that went away.  Also, consider that one of the other case reports of the complications alluded to was when a 240 ml dose of oral phospha-soda was given inadvertently, and all other case reports have been in patients with either medical risk factors or who took over 45 ml of Phospha soda in a 24 hour period (which is 1.5 times the recommended dose).  Essentially, renal failure and CHF are the main medical contraindications.  Now, the problem with the use of Colon hydrotherapy is that safety and efficacy have not been evaluated by the FDA.  So, given that you have a drug that is well studied with a history of millions of doses and a handful of case reports some of which were peculiar as noted above, do you think you can say reliably that Colon hydrotherapy is safe (nevver mind effectiveness issues) in patients with CHF or renal failure?  And, do you have any way to tell that colon hydrotherapy is even as safe as oral phospha-soda or MgCitrate when used as directed? Kd4ttc 01:35, 24 February 2006 (UTC)


 * From the phospha-soda website:
 * PROFESSIONAL USE WARNINGS AND PRECAUTIONS.  Do not use in patients with megacolon, gastrointestinal obstruction, ascites, congestive heart failure, kidney disease or in children under 5 years of age. Use with caution in patients with impaired renal function, heart disease, acute myocardial infarction, unstable angina, pre-existing electrolyte disturbances, increased risk for electrolyte disturbances (e.g., dehydration, gastric retention, bowel perforation, colitis, ileus, inability to take adequate oral fluid, concomitant use of diuretics or other medications that affect electrolytes), with debilitated or elderly patients or with patients who are taking medications known to prolong the QT interval. In at-risk patients, including elderly patients, consider obtaining baseline and post-treatment sodium, potassium, calcium, chloride, bicarbonate, phosphate, blood urea nitrogen and creatinine values, and consider using the lower end of the dosage range. There is a risk of elevated serum levels of sodium and phosphate and decreased levels of calcium and potassium; consequently, hypernatremia, hyperphosphatemia, hypocalcemia, hypokalemia, and acidosis may occur. Nephrocalcinosis associated with transient renal insufficiency and renal failure has been very rarely reported in patients using sodium phosphates for bowel cleansing.
 * You're the one who wants to compare plain water which has been used in the colon for thousands of years which noone has shown any harm when properly administered with a blast of chemicals that mess with the bodies electrolyte balance. If you're going to make that comparison, we have to make it fair. --Lee Hunter 02:49, 24 February 2006 (UTC)


 * You don't have the clinical sense to understand the data. Megacolon develops in patients with colitis.  Gatrointestinal obstruction puts you in the hospital.  There you then have CHF and renal faliure as the two important remaining problems. So essentially you are looking at CHF and renal failure as the important clinical situations that will arise in ambulatory individuals.  So, are you proposing to recommend high volume cononic irrigation in the diseases where caution would be needed in the use of oral phoshpo-soda?  Kd4ttc 04:43, 24 February 2006 (UTC)


 * On the last edit: Much, much, much better reference!  That speaks authoritatively and is in line with the safety study that FDA did in 1991 2001.  Magnesium citrate is available OTC, so I pulled that out.  It seems to be less used, anyway.  I am glad you dropped the insertion of the reference by DiPalma.  It is interesitng to see how policy is made, but is also a good example of why peer reviewed studies are preferred.  There are similar safety issues to be considered with MgCitrate, but with there being a magnesioum load renal failiure is relatively stronger a consideration.  Of course, the discussion has not gotten into PEG solutions as those are prescription only ... for now. Kd4ttc 04:56, 24 February 2006 (UTC)  -  Ooops - The safety study was 2001 Kd4ttc 23:37, 24 February 2006 (UTC)


 * You're overlooking a range of other contraindications that are listed above (elderly patients, dehydration, gastric retention, bowel perforation, colitis, ileus, inability to take adequate oral fluid, concomitant use of diuretics or other medications that affect electrolytes). What comes through quite clearly from these warnings is that this is something that seriously messes with the body's electrolytes. It's a shock treatment that the body struggles to eliminate (hence its effect). Having recently watched an elderly family member go through a crisis involving a slight disruption in electrolytes, I don't know if I would brush off these effects so lightly. --Lee Hunter 13:57, 24 February 2006 (UTC)


 * I don't mean to overlook the precautions. But in the context of the encyclopedia article I thought the important ones should be listed.  The context for the encylcopedia article is someone comparing colon hydrotherapy to a laxative.  No one with a perforated bowel is going the the colonic clinic, for example.  However, someone with CHF or renal failure might well go, so those groups are most relevent.  The context was also for the person comparing colon hydrotherapy.  I really like the current reference, because it does spell out in more detail the problems.  It is incorrect to characterize that a "shock" to the system is why you get diarrhea.  You get diarrhea due to the osmotice effect of the laxative.  I have had about 2000 bowel preps for colonoscopy done for my patients in the last 2 years and I only get a patient with some nausea and vomiting about once every three months, and that is with the bowel prep dose.  I use a PEG solution in folks at risk.  But here again you are talking about higer doses copared to the 15 ml dose for laxative dosing for OTC use.  If there were really a big mess with the body's electrolytes do you think it would still be on the market?  Consider that Vioxx got pulled for only about 20 adverse events per 10000 and the rotavirus vaccine was pulled for only 2 events per 10000, and you will see the FDA is really quite conservative. Kd4ttc 23:37, 24 February 2006 (UTC)

allendronate reference
The reference that was included was a single report of an adverse event to the FDA regarding alendronate and orla phosphasoda. In that reference there was a comment on phospha-soda being reported elsewhere as problematic. The appropriate reference would be a direct reference, not a reference of a reference. Kd4ttc 16:46, 23 February 2006 (UTC)

Anachronism
Not sure where (if anywhere) this should go, but in its original location it implied bypass or colectomy was performed in ancient Egypt.

In some cases, colon bypass or a colectomy was done. 217.44.18.77 02:26, 16 February 2007 (UTC)

Surprisingly balanced
This article has achieved surprising balance. Kd4ttc 22:38, 2 March 2007 (UTC)
 * Not only that, but the discussion between you and Lee has been very entertaining. It's nice to see editors discuss differing points of view without getting so ego-involved as to lose grasp on the intent of the encyclopedia. - Tenmiles 22:59, 14 May 2007 (UTC).