by Julia Hudson, RD
Why this article?
This article on colon cleansing was chosen as it increasingly is important for dietitians to be informed about alternative medicine and nutrition. The practice of colon cleansing and detoxification diets are becoming more popular in today’s society. However, many people who practice these types of cleanses are often unaware of the potential health risks.
Mishori, R., Otubu, A., & Alleyne Jones, A. (2011). The dangers of colon cleansing. Journal of Family Practice, 60(8), 454-457.
Type of Study:
Practice Guidance Summary
Colon cleansing and detoxification has made a comeback in recent years. Celebrities and natural health practitioners have promoted cleanses to alleviate a variety of ailments such as fatigue, headache, weight gain and low energy. Colon cleansing products can be taken orally or through the rectum and can be found in the form of laxatives, teas, powders or capsules. The ingredients in these products vary and may include sodium phosphate, coffee, probiotics, enzymes or herbs. Other popular ingredients include psyllium, flaxseed, licorice root or other fibres. Practitioners called colon therapists often perform colon cleansing through colon hydrotherapy or colonic irrigation. These methods involve using a large volume of water (up to 60 liters), which is introduced into the rectum.
This article highlights two patient cases involving adverse health effects due to colon cleansing.
31-year-old African American woman was admitted to the emergency department (ED) experiencing nausea, vomiting, and diarrhea. She was also weak, feverish, light-headed and showed signs of dehydration.
The patient, who had Crohn’s disease and a partial colectomy, had undergone colonic cleansing two days earlier.
Lab results at the time of admission showed her serum potassium was 2.9 mEq/L, blood urea nitrogen was 26 mg/dL, and creatinine was 1.9 mg/dL.
She was also afebrile, with a blood pressure of 135/75 mm Hg and a heart rate of 113 beats per minute.
She received 2 liters of normal saline and 90 mEq of potassium chloride replacement, was later discharged from the ED.
The patient was instructed to follow her normal diet, as tolerated, and drink plenty of fluids to maintain good hydration. Her symptoms resolved and her vitals returned to normal within one week.
49-year-old African American man experiencing vomiting, diarrhea, and abdominal pain for 4 days.
Multiple episodes of nonbloody, nonbilious vomiting, nonbloody watery diarrhea, and “twisting” abdominal pain.
The patient stated that he had used a colon cleanser a few days earlier. A review showed that he had lost 24 pounds in 10 days. Vitals were within normal limits.
A scan of the abdomen revealed moderate to moderately severe dilatation of multiple small bowel loops with multiple air fluid levels, suggesting an early or partial small bowel obstruction. Surgery was not required.
The patient returned to the hospital 3 days later with similar symptoms and severe weakness associated with dizziness. At that time vitals were not normal.
The patient was readmitted for dehydration, hypokalemia, and pancreatitis and, following a colonoscopy and biopsy that revealed chronic and acute inflammation
Diagnosis of “herbal intoxication.” The patient was hydrated, his electrolytes were replaced, and diet was returned to normal. He was discharged after 5 days.
The evidence to support the supposed benefits of colon cleansing is very limited. Reviews of literature pertaining to colon irrigation, detoxification, and herbal colon cleansing have shown to lack clinically accurate evidence.
Healthcare professionals should advise patients of possible adverse effects to colon cleansing which include cramping, abdominal pain, fullness, bloating, nausea, vomiting, perianal irritation and soreness. Colon cleansing can also cause more serious side effects such as aplastic anemia and liver toxicity. Case reports of pelvic and back absesses, rectal perforations, acute water intoxication, septicemia and even death due to amebiases have been observed with colonic hydrotherapy procedures.
Patients should also be made aware of the insufficient evidence to support the benefits of colon cleansing and colon therapists are not a regulated profession. In the US, the FDA has issued many warning letters to the manufacturers of colon cleansing products. In order to be approved by the FDA they must be evaluated for safety and effectiveness, which is based on scientific evidence and current regulations.