ArticleLiterature Review

A Critique of the Rationale for Cancer Treatment With Coffee Enemas and Diet

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Abstract

WHEN THE RATIONALES offered in support of most unorthodox medical treatments are critically examined, they are frequently found to be scientifically invalid. Yet, according to a recent survey,1 over 60% of the practitioners of "unproven treatments" for cancer hold an MD, a PhD, or both, from an accredited medical school or graduate school. Therefore, when a patient asks his or her physician for an explanation of an unproven medical treatment being offered by another trained and licensed physician, it is not enough for the patient's physician to simply label the "unorthodox" treatment as quackery. To make an effective contribution to the patient's understanding and decision-making process, the clinician must know whether the claims being made for the treatment are supported by scientific evidence and he or she must be able to discuss that evidence in language that is understood by the patient. The explanations justifying the use of coffee

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... Current examples include the no-dairy diet, the macrobiotic diet, fruit and vegetable cures, and metabolic therapies, offered in Tijuana, Mexico clinics. One of the best known sites for this questionable practice is the Gerson Clinic, where liver damage is counteracted with a low-salt, high-potassium diet, coffee enemas, and a gallon of fruit and vegetable juice daily [30]. Its use of oral crude liver extract was associated with repeated cases of bacterial contamination [31], although the Gerson.org ...
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Learning Objectives After completing this course, the reader will be able to: Describe the differences between complementary and alternative therapies. List common complementary and alternative therapies used by cancer patients. Know where to access reliable information. Access and take the CME test online and receive one hour of AMA PRA category 1 credit atCME.TheOncologist.com Many cancer patients use therapies promoted as literal alternatives to conventional medical care. Such “alternative” modalities are unproven or were studied and found worthless. These can be harmful. An even greater proportion of cancer patients uses “complementary” therapies along with mainstream cancer treatment. Most are helpful adjunctive approaches that control symptoms and enhance quality of life. This review describes alternative as well as complementary therapies commonly used today by cancer patients. Herbal remedies also are discussed. Evidence regarding the efficacy and safety of complementary/alternative medicine (CAM) is reviewed, and implications for oncologists are discussed. To encourage open communication of CAM use by patients, oncologists should be knowledgeable about the most popular remedies and know where to find reliable information for themselves and for their patients.
... Unfortunately, such enema therapy has resulted in electrolyte imbalance, bowel necrosis with perforation, amebiasis, and toxic colitis in some cases. 24 Views similar to Dr. Grierson's are advocated by other holistic practitioners, such as the Bristol Cancer Center in England, which also promotes the macrobiotic or Zen diet. 7 The macrobiotic diet consists of 10 sequential vegetarian stages, each of which is more restrictive and more dangerous. ...
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More than half of all cancer patients will try alternative therapy during their illness. Much of the appeal of alternative therapy is related to a dissatisfaction with the technological and impersonal nature of conventional medicine. Unproven or alternative therapies are often begun early in the patient's disease, and their use may not be revealed to health-care professionals. The range of alternative therapies is staggering, but multivitamins, diet and herbal therapy, and metabolic therapies are probably most commonly used. A few alternative therapies are harmful, and their promoters may be dishonest. Health-care professionals need to be aware of which alternative therapies are in vogue in their geographic area. The use of such therapies should be discussed early in the therapeutic relationship with each cancer patient. Attention has recently focused on incorporating those aspects of alternative therapy that make these treatments attractive to patients into the mainstream of cancer care.
... To the Editor: Coff ee enema has been used as an alternative therapy for various diseases, including cancer and constipation (1). However, its eff ect has not been proven and complications are not well known. ...
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The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print. www.amjgastro.com, *2007 Journal Citation Report (Thomson Reuters, 2008)
... Unfortunately for the proponents of these theories, the overwhelming weight of scientifi c evidence substantiates the concept that damage to DNA, disruption of gene regulation, and alterations in oncogenes are the genesis of rapidly cancerous cells. Th ese facts make the rationales off ered for coff ee enemas unacceptable (33) . ...
Article
The practice of colonic cleansing to promote general health and well-being continues to generate interest among the lay population. These practices are widely touted as adjuncts to improve vitality and as therapeutic modalities to minimize the symptoms, or prevent the actual development, of a variety of chronic disease states. The data supporting colonic cleansing and body "detoxification" have not been studied well in a systematic manner. This report describes a systematic review of the published literature of both the traditional and complementary and alternative medicine arenas that was performed in an attempt to qualify and quantify the value of colonic cleansing. The investigators concluded that there are no methodologically rigorous controlled trials of colonic cleansing to support the practice for general health promotion. Conversely, there are multiple case reports and case series that describe the adverse effects of colonic cleansing. The practice of colonic cleansing to improve or promote general health is not supported in the published literature and cannot be recommended at this time.
... That clinic's use of liquefied raw calf liver injections was suspended in 1997, following the development of sepsis in a number of patients. 41 Other Tijuana clinics provide their own versions of metabolic therapy, each applying an individualized dietary and detoxification regimen, with additional components according to practitioners' preferences. ...
Article
"Complementary and alternative" therapies are actually a vast collection of disparate, unrelated regimens and products, ranging from adjunctive modalities that effectively enhance quality of life and promising antitumor herbal remedies now under investigation, to bogus therapies that claim to cure cancer and that harm not only directly, but also indirectly by encouraging patients to avoid or postpone effective cancer care. Complementary therapies such as music and massage, herbal teas to aid digestion and relieve nausea, yoga, tai chi, meditation, and the many other well-documented techniques that relieve stress and enhance well-being should be made available to patients to augment and ease the experience of cancer treatment and recovery. Many time-tested herbal and diet-based remedies are now being studied for their abilities to induce or extend remission without toxicity. At the same time, lack of government regulatory authority leaves consumers at the mercy of those who promote unproved remedies, scores of which the grocery store and pharmacy shelves. Many of these over-the-counter products contain harmful ingredients. Herb-drug interactions, only some of which are documented, occur with frequency and are sufficiently problematic to require that patients stop taking herbal remedies prior to surgery (to prevent interactions with anesthetics and anticoagulant effects); before radiation (due to potential for increased photosensitivity); and during courses of chemotherapy (to prevent product-drug interactions). Moreover, both good information and misinformation that appear in printed materials and on the Internet appeal to better educated consumers, who are, in fact, the most likely to try complementary and alternative methods.
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The treatment for constipation should be individualized and dependent on the cause, coexisting morbidities, and patient's cognitive status. Although most cases of constipation respond to conservative treatment, including dietary and life-style changes, or mild laxatives, some patients still complain of consistent symptoms and need an assessment of defecatory dysfunction. There is insufficient evidence to support the use of enemas in chronic constipation, although many clinicians and patients find them useful and effective for the treatment of fecal impaction when used with other modalities. In addition, suppositories can be considered as an initial trial for the treatment of defecatory dysfunction, since they help to initiate or facilitate rectal evacuation. The routine use of enemas is typically discouraged, especially sodium phosphate enemas, although tap-water enemas seem safe for more regular use. Soapsuds enemas are not recommended due to possible rectal mucosal damage.
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Coffee enemas are believed to cause dilatation of bile ducts and excretion of bile through the colon wall. Proponents of coffee enemas claim that the cafestol palmitate in coffee enhances the activity of glutathione S-transferase, an enzyme that stimulates bile excretion. During video capsule endoscopy (VCE), excreted bile is one of the causes of poor preparation of the small bowel. This study aimed to evaluate the feasibility and effect of coffee enema for preparation of the small bowel during VCE. In this pilot study, 17 of 34 patients were assigned to the coffee enema plus polyethylene glycol (PEG) 2 L ingestion group, whereas the 17 remaining control patients received 2 L of PEG only. The quality of bowel preparation was evaluated in the two patient groups. Bowel preparations in the proximal segments of small bowel were not differ between two groups. In the mid and distal segments of the small intestine, bowel preparations tend to be better in patients who received coffee enemas plus PEG than in patients who received PEG only. The coffee enema group did not experience any complications or side effects. Coffee enemas may be a feasible option, and there were no clinically significant adverse events related to coffee enemas. More prospective randomized studies are warranted to improve small bowel preparation for VCE.
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The public is increasingly nutrition conscious and actively seeks reliable sources of nutrition education. Physicians with appropriate training in nutrition can and should be a powerful force in providing accurate nutrition information and quality health care. As physician educators, dietetics professionals can facilitate this outcome. Appropriate use of nutrition resources and professionals will efficiently and effectively maintain or improve the nutritional status of the public and, ultimately, the health of our nation.
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A coffee enema, which has been suggested as a part of cancer treatment, is a hazardous derivative of colon therapy and has been misused as a treatment for obesity and constipation among the general population. Its proponents claim that caffeine is absorbed in the colon and leads to vasodilatation in the liver, which in turn enhances the process of elimination of toxins. None of this is proven, nor is there any evidence for the clinical efficacy of coffee enemas. We experienced a patient who presented with abdominal pain and bloody stool after receiving a coffee enema to relieve constipation. We report this case of coffee-associated colitis with a review of the relevant literature.
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Cancer survivors are often highly motivated to seek information about food choices, physical activity, dietary supplement use, and complementary nutritional therapies to improve their treatment outcomes, quality of life, and survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information on which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity issues during the phases of cancer treatment and recovery, living after recovery from treatment, and living with advanced cancer; selected nutritional and physical activity issues such as body weight, food choices, and complementary and alternative nutritional options; and selected issues related to breast, colorectal, lung, prostate, head and neck, and upper gastrointestinal cancers. In addition, handouts containing commonly asked questions and answers and a resource list are provided for survivors and families. Tables that grade the scientific evidence for benefit versus harm related to nutrition and physical activity for breast, colorectal, lung, and prostate cancers are also included for this growing body of knowledge to provide guidance for informed decision making and to identify areas for future research.
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IntroductionComplementary and alternative medicine todayAlternative medical systemsComplementary therapiesConclusion ReferencesSelf-assessment questionsSelf-assessment answers
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The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print. www.amjgastro.com, *2007 Journal Citation Report (Thomson Reuters, 2008)
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To the Editor. —It is crucial that we, as physician-scientists, remain objective especially when dealing with matters that are as emotive as the diet and cancer issue. The Special Communication entitled "A Critique of the Rationale for Cancer Treatment With Coffee Enemas and Diet"1 carries a proselytizing tone against this therapy, as much as those who proselytize for the therapy. Can't we in the medical profession rise above this type of subjectivity?The author identified only those aspects of the Gerson therapy that cannot be supported by current scientific knowledge. He conspicuously omits references to the Gerson therapy's emphasis on fresh fruits and vegetables as a high-quality vitamin source, which has been strongly suggested to be of potential benefit in recent medical literature. He does not comment on the proposed long-term effects of our contemporary sodium-rich, potassium-poor diet on cellular function, the reversal of which formed a large part of
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Autointoxication is an ancient theory based on the belief that intestinal waste products can poison the body and are a major contributor to many, if not all, diseases. In the 19th century, it was the ruling doctrine of medicine and led "colonic quackery" in various guises. By the turn of the century, it had received some apparent backing from science. When it became clear that the scientific rationale was wrong and colonic irrigation was not merely useless but potentially dangerous, it was exposed as quackery and subsequently went into a decline. Today we are witnessing a resurgence of colonic irrigation based on little less than the old bogus claims and the impressive power of vested interests. Even today's experts on colonic irrigation can only provide theories and anecdotes in its support. It seems, therefore, that ignorance is celebrating a triumph over science.
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The coffee constituents cafestol and kahweol are inducers of the activity of the detoxifying enzyme, glutathione S-transferase in laboratory animals. The two active functional groups, furan and glycol, on opposite ends of the diterpene nucleus of these two compounds have been modified. The resulting derivatives were evaluated for their ability to induce glutathione S-transferase activity in different tissues of the ICR/Ha mice. Derivatives of both cafestol and kahweol, which were the products of the modifications on the glycol function, retained much of the inducing properties of the parent compounds in the liver and mucosa of the small bowel. The effects of these compounds on the tissue acid-soluble sulfhydryl level, in general, were similar to those of the parent compounds. Some derivatives of kahweol, however, appeared to have lost their ability to induce increased levels of sulfhydryls in the liver. Catalytic hydrogenation of the furan moiety gave two products, the dihydro and tetrahydro derivatives. Both compounds and their corresponding acetates lost their effectiveness as inducers of glutathione S-transferase activity. In contrast, these compounds still retained their ability to induce increased levels of acid-soluble sulfhydryls in both the liver and the mucosa of the small bowel. These findings indicate that the furan moiety of cafestol and kahweol is vital to their biological activity as inducers of increased glutathione S-transferase activity.
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From June 1978 through December 1980, at least 36 cases of amebiasis occurred in persons who had had colonic-irrigation therapy at a chiropractic clinic in western Colorado. Of 10 persons who required colectomy, six did. Of 176 persons who had been to the clinic in the last four months of 1980, 80 had received other forms of treatment. Twenty-one per cent of the colonic-irrigation group had bloody diarrhea, as compared with 1 per cent of the non-irrigation group (P = 0.00013). Thirty-seven per cent of the colonic-irrigation group who submitted specimens had evidence of amebic infection on either stool examination or serum titer, as compared with 2.4 per cent in the non-irrigation group (P = 0.00012). Persons who were given colonic irrigation immediately after a person with bloody diarrhea received it were at the highest risk for the development of amebiasis. Tests of the colonic-irrigation machine after routine cleaning showed heavy contamination with fecal coliform bacteria. The severity of disease in this outbreak may have been related to the route of inoculation.