Physicians Weigh in on Coffee Enema Trends

Medscape

2 days ago

The social media trend of coffee enemas traces back to a medical tradition over 150 years old. Various enemas are integral to modern medicine and diagnostics.
Coffee consumption is associated with a reduced risk for certain cancers, cardiovascular disease, dementia, depression, and arrhythmias and is recommended as part of a healthy diet.
Enema History
Enemas have been used in Egyptian, Greek, and Roman medicine for several millennia. The Ebers Papyrus and texts by Hippocrates, Celsus, Galen, Oribasius, Aetius, and Avicenna document their use, as do Ayurveda in the sixth century BC and Chinese medicine in the third century AD.
Enemas reached their heyday under Louis XIV, and from the 19th century onward, physicians studied their applications and mechanisms.
Florence Nightingale, often regarded as the first modern nursing theorist, used coffee enemas to relieve soldiers' pain during the Crimean War. This practice reportedly continued during the First World War, when doctors turned to coffee enemas as an alternative because of opioid shortages. They were also included in nursing manuals and listed in the editions of the Merck Manual throughout the 20th century.
Max Gerson, MD, and William Donald Kelley, DDS, recommended several daily coffee enemas in addition to raw, plant-based diets for the treatment of cancer. Surgeon Ferdinand Sauerbruch observed benefits in advanced bone, joint, and skin tuberculosis.
Gerson therapy is claimed to aid migraine, multiple sclerosis, deforming arthritis, epilepsy, skin diseases, Graves disease, liver, gallbladder, gastrointestinal and cardiovascular disorders, obesity, hypertension, and end-stage cancer.
Several studies have reported no evidence of its effectiveness in cancer treatment. Patient well-being improvements are often attributed to the placebo effect, although practitioners such as Linda L. Isaacs, MD, argue that skeptical patients experienced genuine benefits despite the cumbersome procedure and required motivation.
Conventional Enemas
In modern practice, enemas are administered before diagnostic or surgical procedures in obstetrics and pediatrics for severe constipation, spinal cord injury, drug administration, or as part of bowel management in inflammatory bowel disease. Enemas act mechanically, thermally, and chemo-osmotically to stimulate the intestinal mucosa and peristalsis.
Prenatal bowel cleansing with an enema or suppository is now obsolete, as no reduction in perineal injuries, impaired wound healing, or infections has been observed. Increased intestinal peristalsis also increases uterine activity. Midwives use enemas to stimulate labor, but studies on their effect on the duration of labor are contradictory.
Healthcare professionals reported greater satisfaction with the labor process when enemas were used, yet women reported no difference. An enema may be administered during childbirth at the patient's request or when the rectal ampulla is full.
Coffee Effects
The alkaloid caffeine contained in coffee has positive inotropic and chronotropic effects on the heart via catecholamine release and raises systolic blood pressure; for instance, 250 mg raises systolic pressure by 10 mm Hg after 15 minutes. Caffeine causes mild cerebral vasoconstriction, relaxes bronchial smooth muscles, increases gastric acid secretion via gastrin release, and transiently increases diuresis. Theobromine and theophylline alkaloids in caffeine act as vasodilators, cough suppressants, and bronchodilators. The habituation effect occurs over time.
Four to five cups of coffee daily can reduce gout attacks in men by up to 40% through increased uric acid excretion, while more than six cups may reduce attacks by 59%, although decaffeinated coffee is preferable as a supportive measure.
Coffee enriched with chlorogenic acid–rich green coffee bean extracts showed increased DNA protection against oxidative damage and increased plasma-reduced glutathione via glutathione reductase activation. Roasting lowers chlorogenic acid, trigonelline, cafestol, and kahweol levels while increasing melanoidin and nicotinic acid levels.
Coffee also contains pro-oxide compounds, such as caffeic acid, which can cause cancer at high doses.
Moderate intake of three to five cups daily is linked to a reduced risk for endometrial and hepatocellular carcinoma and, to a lesser extent, melanoma, other skin cancers, breast cancer, and prostate cancer.
Six to seven cups daily were not significantly associated with a 30%-50% lower risk for type 2 diabetes. Chlorogenic acid inhibits intestinal glucose absorption and the hydrolysis of glucose-6-phosphate, and high-volume intake can increase homocysteine levels by 18%. Caffeine affects glucose storage, and quinic acid increases insulin sensitivity.
Caffeine may stimulate the liver, promote bile flow by dilating the bile ducts, and improve toxin elimination. High doses of kahweol and cafestol have anti-inflammatory and anticarcinogenic diterpenes and can inhibit cholesterol-7alpha-hydroxylase, which is crucial for the conversion of cholesterol to bile acids, leading to an increase in cholesterol levels by 11%.
When coffee is filtered through a paper filter, most harmful compounds are removed, unlike boiled coffee or metal filters, such as those used in espresso machines. As a result, this method of preparation is considered healthier and does not increase cardiovascular risk.
Low to moderate coffee consumption was associated with an 11%-20% lower risk for stroke and a reduced risk for dementia. However, drinking more than six cups of caffeinated coffee per day was associated with a smaller total brain volume and a 53% higher risk for dementia.
High coffee and tea intake may reduce the risk for depression, unlike soft drinks. Coffee elevates mood and improves cognitive performance. Four to five cups can reduce the mortality risk by up to 12%. Increased caffeine intake is also associated with a lower risk for arrhythmias, such as atrial fibrillation and supraventricular tachycardia, independent of genetically varying caffeine metabolism.
Moderate coffee consumption is recommended, as it may alkalize the body. Caution is advised in peptic ulcer disease, cardiovascular disease, renal impairment, hyperthyroidism, seizure disorders, histamine intolerance, attention-deficit/hyperactivity disorder, and high doses during pregnancy.
Interactions with certain antibiotics, specifically gyrase inhibitors, can interact with caffeine, leading to reduced caffeine metabolism, prolonged effects, and potentially increased gastrointestinal side effects or, with caffeine intake exceeding 1.5 g, restlessness, insomnia, palpitations, dizziness, hypertension, headaches, and vomiting. Therefore, active ingredient extracts should be investigated rather than whole coffee for therapeutic benefits. However, coffee can be used in unexpected ways beyond mere consumption.
Positive Effects
Patients reported relief from headaches, myalgia, arthralgia, chronic fatigue, cognitive difficulties, malaise, and constipation, as well as improved well-being; these effects were not observed with coffee alone.
Physicians use coffee enemas to support the treatment of atropine poisoning, postoperative anesthetic effects, shock, and pyloric obstruction. The controversial self-poisoning hypothesis, which links intestinal disorders to psychological conditions, is gaining renewed attention amid emerging microbiota research on the gut-brain axis.
Enemas may enhance bile flow in the liver and gallbladder, stimulate peristalsis, and promote excretion of metabolic by-products and bowel emptying. The isolated caffeine was ineffective, suggesting that other compounds were responsible. A gallbladder-cleansing study before capsule endoscopy demonstrated increased bile flow using a coffee enema.
Oral coffee increases gallbladder contraction and plasma cholecystokinin and glutathione levels. Oral absorption of caffeine is more efficient than rectal absorption, although rectal delivery is slightly faster, which is potentially true for other compounds.
Coffee enemas may exhibit detoxification, cleansing, anti-inflammatory, antioxidant, metabolism-stimulating, and pain-relieving effects. However, they should be prepared using green coffee rather than roasted or decaffeinated varieties because of their higher caffeine and palmitic acid content.
These active compounds reach the liver directly via portal circulation, thereby avoiding irritation of the gastric mucosa. As a result, even individuals with coffee intolerance may tolerate the procedure when used at a reduced dose and for a shorter duration.
For administration, the brewed coffee was diluted and cooled to a body temperature not exceeding 40 °C. Low volume and gentle pressure were intended to target the rectum and extend only to the descending colon.
Side Effects
Proctocolitis
Rectal burns at temperatures above 37 °C
Electrolyte disturbances such as hypokalemia, hyponatremia with dehydration, nausea, muscle weakness, cardiac arrhythmias, and seizures
Weakening of the rectal/intestinal muscles with a tendency to constipation and inflammation
Hemorrhoidal injury
Disruption of intestinal microbiota with cramps, diarrhea, bloating, and infection risk
Circulatory strain
Water intoxication due to non-isotonic fluids
Rare fatalities attributed to coffee enemas likely reflect underlying terminal illnesses with vomiting-related electrolyte disturbances, ascites, pleural and pericardial effusions, immunosuppression, and susceptibility to infection with sepsis.
Caution
Enemas should be used with caution or avoided in early pregnancy in cases of vomiting, acute abdomen, post-intestinal surgery, gastrointestinal bleeding, inflammatory bowel disease, mechanical ileus, immunosuppression, fluid overload, renal insufficiency, and severe cardiac disease.
Conclusion
Regular defecation supports natural cleansing of the body. A diet rich in fiber, fruits, vegetables, whole grains, pseudocereals, nuts, seeds, and fermented foods with adequate hydration underpins good intestinal health and reduces the risk for cancer.
Intermittent or short-term fasting is effective without colon cleansing. Enemas may support preparation for therapeutic fasting lasting several days by preventing hunger pangs or fasting crises.
This story was translated from Univadis Germany.