Wednesday, December 13, 2006

The Civilized Bowel

Does "death begin in the colon"? Patients may be asking about the virtues of colon cleansing products on TV such as Almighty Cleanse or Dual Action Cleanse. The latter is marketed by a man possessing the dubious name of Klee Irwin and an even more dubious-appearing pencil mustache. All of these informercials essentially resurrect the concept of colon autointoxication made popular by John Harvey Kellog (inventor of corn flake cereal) around the turn of the 20th century. In fact, Kellogg's practices at his Battle Creek Sanitarium in Michigan were what prompted T. Coraghessan Boyle to write "The Road to Wellville".

The theory of autointoxication is that fecal matter adheres to the walls of the colon, allowing toxins or bacteria to enter while preventing nutrients from gaining access by "clogging up your colon". Remember that this idea was refuted back then (JAMA 72:8-13, 1919; JAMA 78:884-888, 1922) and today (J Clin Gastroenterol 1997 Jun; 24(4):196-8). Besides, we've all seen the intestines intraoperatively or during colonoscopy enough times to know that this is simply untrue.

In addition to citing the urban legend that John Wayne had 40 pounds of stool in his colon at the time of autopsy, Mr. Irwin guarantees a "buoyant sense of energy and cleanness". According to him, the benefits of Dual Action Cleanse include several nebulous claims such as "supports the liver", "blood purifier", and "digestive support". The numerous ingredients range from the relatively benign (Milk Thistle) to the potentially dangerous (garlic and ginger inhibit platelet aggregation; Hawthorn can augment effects of vasodilators and digoxin).

Incidently (or not), Mr. Irwin has received warning letters and "cease and desist" letters from the FDA and FTC for some of his prior marketing effots.

If you're like me, you must first resist the urge to tell your patients that the reason people like Irwin are fascinated with cleansing the colon is because that is where their heads are permanently located. Instead, inform them that while constipation can be a real problem in clinical practice, there is no evidence that these aggressive bowel cleansing products are able to cure fatigue, sinus problems, skin blemishes, mood swings or other maladies. They can lead to electrolyte disturbances and would be dangerous with ongoing colitis conditions. Educate them that it is not necessary to have 2-3 bowel movements daily, nor is it even possible to achieve the kind of surgical sterility of the colon that they insist is important. Remind them that the colon is designed specifically for the purpose of eliminating fecal matter, which is by definition "dirty".

In the 1994 movie adaption of "The Road to Wellville", the character Goodloe Bender exclaimed, "Health! The 'open sesame' to the sucker's purse!" Before your patients "waste" their money, you might consider referring them to the following website:

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