Colonic Therapy

***Disclaimer: This blog is not meant to be used as legal or medical advice.  It is written as my person perspective on how medical professionals could blend western medicine with other modalities***

Gut health is a growing topic in the medical community.  With emerging evidence about the gut microbiome, scientists and doctors are reevaluating how we treat the gut.  Today on The Integrated Pharmacist Podcast, I'm going to discuss colonic therapy.  Historically, pharmacy walls were lined with elixirs, formulas, and herbs meant to treat diarrhea and constipation.  Even today, we have medication that help use evacuate our bowels such as Magnesium Citrate and MiraLax.  Intuitively, we recognize the danger of not being able to defecate.  If constipation is left untreated, it can lead to bowel impaction which is where the stool becomes so big or hard that the bowels are unable to pass it on their own.  If impaction is not treated, it can lead to serious illness and even death.

Although the root rational for colonic therapy is unclear, we do have medical records from Ancient Egypt describing the process of a similar therapy involving a reed and standing in a river.  I will let your imagination deal with that one.  In more recent history, colonic therapy has been challenged by sanitary complications and cross contamination.  With the emergence of serious bowel infections like Clostridioides difficile (or C. diff), colonic therapists have had to modify their practices to insure a higher quality of sterility.  Current theories that motivate patients to seek colonic therapy are rooted in the idea that feces that lingers in the bowels might rot and leech toxins into the blood.  This is called auto-intoxication.  Although this has not been proven, it may be reinforced by the fact that stool impaction can be fatal.  Because the intestines are a major site of potential infection, the body has an advanced neural and lymphatic system surrounding the bowels.  Large veins line the intestines to help transport nutrients through our liver and then throughout our bodies.  When viewed as a central part of human health, a weakened or diseased gut could potentially affect mood, mental capacity, immunological defenses, and other organ and tissue health.  So it seems easy to conclude that regularly assisting the bowels flush the system would make sense.  It might help bits and pieces of rotting matter move along, stimulate gentle peristalsis, and hydrate the tissues and normal gut flora.
Unfortunately, I was unable to find much evidence to support this theory.  I did find articles that referenced science that refutes the idea of auto-intoxication, but I could not find the direct report.  What I can say about this therapy is that people have reported feeling very good afterward, and that many colonic therapy facilities report gentle methods that have very low incidence of injury.  Western medicine also recognizes the need for a healthy gut.  It is recommended that people obtain a colonoscopy to screen for colon cancer by the time they are 45 years old.  In order to receive a proper colonoscopy, the bowels must be flushed.  Several methods can be used to flush out the system.  The most popular method is with 4 liters of polyethelene glycol or PEG.  There are different formulations and different methods, but this has been the standard.  I found a trial that compares 3 different preparations to clear out the colon in preparation for a colonoscopy.  The control arm received the

standard 4 liters of PEG, the second arm received sulfate-free PEG, and the third group received 90 milliliters of sodium phosphate.  Four hundred twenty two patients complete the trial.  The evaluators measured a number of outcomes including electrolyte imbalances, weight change, patient satisfaction, and how clean and clear the bowel walls appeared to the blinded endoscopists.  This study found that although weight and electrolytes were consistent among the three arms, the small dose of sodium phosphate had better satisfaction among participants and better bowel ratings from the doctors.  So as far as western medicine goes, it looks as though the better option is 90 ml of sodium phosphate.
At this point in the episode, I usually try to integrate the modality into western medicine.  However, my findings were really unclear.  Western medicine practices one version of colonic therapy, but to a very specific end - not as a form of increasing general health.  I think one of the barriers I ran up against was that colonic therapy as a complementary modality does not have a specific outcome.  It is a way of reducing toxin exposure which enhances overall health.  The necessary research would take hundreds of rounds of therapy across years to determine if this way of life is associated with improved health outcomes.
Colonics can cost $80-$100.  Without more evidence, this treatment is really about whether it makes you feel good or not.  If you like how it feels, and it's worth the price to you, I would advise that you research the companies in your area.  Make sure they use disposable equipment and do not reuse them from one patient to the next.  Sterility is of great concern for this kind of therapy.  Also, look into reviews to see if anyone has experienced injuries from their treatment methods.  To learn more about colonic hydrotherapy, you can visit the International Association for Colonic Hydrotherapy at www.i-act.org.

I would like to thank you for listening.  In order for this podcast to grow, I need your help - please rate and review it and tell others about it who would be interested.  If you'd like to reach me for comments, questions, concerns, or suggestions, please email me at www.integratedpharmacist@gmail.com.  To read the transcript and find the reference to the study, visit the blog at www.integratedpharmacist.blogspot.com.  Please join us again for next week's episode of The Integrated Pharmacist Podcast
References:
Cohen SM, Wexner SD, Binderow SR.  Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods.  Dis Colon Rectum. 1994 Jul;37(7):689-96.