Mere regularity is not enough

I'm currently in Las Vegas anxiously waiting for The Amazing Meeting to start. Believe it or not, I'll even be on a panel later today! While I'm gone, I'll probably manage to do a new post or two (or three), but, in the meantime, while I'm away communing with fellow skeptics at TAM7, I'll be reposting some Classic Insolence from the month of July in years past. (After all, if you haven't been following this blog at least a year, it'll be new to you. And if you have I hope you enjoy it again.) This particular post first appeared in July 2006.

Alright, I admit it.

I went a little overboard with last week's edition of Your Friday Dose of Woo. This feature was intended to be a light-hearted look at whatever particular woo target that catches my fancy on a given week, as opposed to the more serious discussions of alternative medicine I like to do at other times. However, it's a fine line between believing in a bit of strange altie woo and possibly being a disturbed individual, and I fear that last week's targets (the guy who wanted to sell the secrets of Jesus on Ebay and Alex Chiu, who claims to have figured out how humans can be immortal, all using little magnetized devices one wears on the hands and feet) crossed that line. Maybe it was too much quantum entanglement of my neurons--homeopathically, of course--with those of that quantum homeopathic guru, Lionel Milgrom, whom I discussed very early on.

So, this week, I want to pull back from the abyss, where woo drifts into possible insanity, and move on to other topics. I had thought of commenting on "spiritual healer" Adam the Dreamhealer, but Skeptico beat me to it in such a comprehensive fashion that I couldn't really think of anything new or amusing to add. In any case, I haven't yet recovered from my delving into the dizzying space of quantum homeopathy. Fortunately, I think I have just the thing to bring me back to earth: bowel cleansing. (If poop doesn't bring one back to earth after all that quantum woo and bizarre talk of immortality and Jesus bestowing His secrets upon us, I don't know what will.) Consider this phrase:

"Death begins in the colon."

Yes, it's time to emulate fellow skeptical blogger, The Pooflinger, and consider the topic of feces. However, unlike Matt, I won't just be flinging it; I'll be considering the strange obsession that many alties seem to have with their colons (and, by extension, the contents therein), leading to the belief that they can "purge" all their toxins by purging their colons with a fanatical single-mindedness that would give even our blog mascot pause.

I know what you're thinking. What right do I, a blogger whose mascot is a giant smiling enema bottle, have to make fun of these colon cleansing antitoxin crusaders? Isn't that a wee bit hypocritical of me? Not at all, and here's why: I'm joking about it; EneMan is simply a mechanism for satire, as warped as that mechanism may be. The colon cleansers are dead serious about their favored technique to maintain health and proselytize shamelessly (some of them making quite a bit of money in the process). It's that simple. (Besides, EneMan is so large that the thought of his ever actually exercising his intended function on any creatue smaller than an elephant scares--if you'll excuse the term--the crap out of me.)

So, let's see what these people say about colon health:

Have you ever considered this simple question: Are you clean inside?

Well, no, not really. I know that, like every other human, I'm most definitely not "clean inside," if by "inside" you mean my gastrointestinal tract and upper respiratory tract. As is the case for everyone, my colon is crawling with hundreds of species of bacteria, where the most common species (E. coli) makes up only 1% to 2% of the total bacterial count, where, by the time the stool makes it out around 10% of its mass is made up of dead bacteria. Heck, we humans aren't even "clean outside," given the bewildering variety of bacteria that live on our skin and mucous membranes. Any part of our body that comes into contact with the outside world, whether it be skin, pharynx, or GI tract, is most definitely not clean. Indeed, the variety and rich ecosystem of the bacteria living in various ecological niches in your body actually make it more difficult for pathogenic bacteria to gain a foothold and cause disease. Your little critters living all over and in your body are, your friends most of the time (on exception being when your immune system is suppressed).

And that's all normal. Unless you're a colon cleanser, that is, to whom the concept of commensal bacteria living within them is hateful:

We shower, brush our teeth and wash our hair on a daily basis, but we tend to ignore cleansing our insides until some form of disease sends us a wake-up call. Believe it or not, our insides, especially the colon which functions as the "sewer system" of our body, also requires regular cleaning. Constipation, parasites, IBS, gas, bloating, stomach pain, chronic fatigue, digestive problems can all be signs of a toxic colon. Don't be a victim, suffering silently from these painful and often embarrassing health conditions. Find out the truth about colon cleansing and how it can help you.

Yes, it all sounds perfectly reasonable, doesn't it? We clean other parts of our body regularly; so why don't we all clean our colons as well? Do I really have to point out the flaw in the logic of that question?

Here's the concept in brief, so that you don't have to wade through the websites that I'll be linking to (unless you really want to, that is). Colon cleansers claim that, thanks to our degenerate low fiber Western diets, the colon does not empty itself out properly when we defecate, and that we therefore build up layers of stool on the insides of our colons that slowly poison us, leading to all sorts of disease. True, low fiber diets may be responsible for health problems, but not in the way described by these alties. But, here, don't just take my word for it:

Many conventional doctors are under the misconception that having a bowel movement every two or three days is sufficient and even "normal" for some. This is a dangerous fallacy! A person with a healthy colon should in fact have two to three bowel movements per day, or one for each meal eaten. Elimination should be complete, fast and easy. The stool should be light brown in color, long and large in diameter, "fluffy" in texture and floating on top of the water. There should be no offensive odor and it should break apart with the toilet flushing. Going to the bathroom once every few days, sitting there straining for half-an-hour and passing black, hard "pebbles" that drop to the bottom is not only abnormal, it is also serious trouble waiting to happen.

"Long and large"? Uh, is this guy sure he's talking about stool?

In any case, most of the time, your stool shouldn't float. In fact, as strange as it may seem sometimes we ask patients that very question: "Does your stool float or sink?" Patients look at doctors as though they've lost their mind when this question is asked, but the question has a purpose: If your stool floats, it may have too much fat in it, which may mean that you're not absorbing enough fat, which can be a sign of pancreatic or biliar disease. It could also mean that you're not absorbing the nutrients other than fat in your food, thus letting more nutrient- or fat-rich material reach the colon, where your friendly neighborhood commensal bacteria feast on it, producing--you guessed it-- gas bubbles in the stool. These gas bubbles make the resultant stool less dense overall and thus more likely to float! Indeed the proverbial floating poop can be a sign of celiac sprue, cystic fibrosis, biliary disease resulting in inadequate bile flow to the bowel, or GI infections.

Moreover, if you eat any red meat at all, your stool won't be light brown, nor should it be. It shouldn't be black (which can be a sign of GI bleeding, as digested blood turns stools black), but it doesn't necessarily need to be light brown either. Indeed, if your stool is too light ("clay-colored"), that might be a sign of liver or biliary disease.

If you're not eliminating approximately the same amount that you are eating, then what do you think happens to the remainder? The accumulation of old, hardened feces sticks to the colon walls, inhibiting its proper function of absorbing the remaining nutrients from the fecal matter.

Instead it is forced to absorb toxins from the build-up and from the parasites that make this debris their breeding ground. The passage through which the feces are forced to travel is also greatly reduced in diameter so the stools become much narrower - even as thin as a pencil sometimes.

Hes, those evil unnamed toxins again. They're probably unnamed because it excuses these colon cleansers from having to provide some, oh, actual evidence for their woo. Here's a more pointed example of such thinking:

It may be said that almost every chronic disease known is directly or indirectly due to the influence of bacterial poisons absorbed from the intestine. The colon may be justly looked upon as a veritable Pandora's box, out of which come more human misery and suffering, mental and moral, as well as physical than from any other known source.

Every chronic disease? This is the sort of thinking that leads quacks like Hulda Clark to proclaim a liver fluke as the cause of all cancers.

The colon is a sewerage system, but by neglect and abuse it becomes a cesspool. When it is clean and normal we are well and happy; let it stagnate, and it will distill the poisons of decay, fermentation and putrefaction, into the blood, poisoning the brain and nervous system so that we become mentally depressed and irritable; it will poison the heart so that we are weak and listless; poisons the lungs so that the breath is foul; poisons the digestive organs so that we are distressed and bloated; and poisons the blood so that the skin is sallow and unhealthy. In short, every organ of the body is poisoned, and we age prematurely, look and feel old, the joints are stiff and painful, neuritis, dull eyes and a sluggish brain overtake us; the pleasure of living is gone. The preceding information should impress you with the vital importance of bowel regularity to you and every member of your family.

And here's more:

When the colon does not do its job, all organs suffer. Uneliminated waste material soaks back through the colon into the lymph glands throughout the system. When these glands become overloaded with toxins, disease will set in. Cellular mutation will take place and abnormal growth will form in the body. It is not hard to understand why the sensitive mammary glands are one of the first targets for disease. One of the largest sites for lymph elimination is the underarm. If the lymph is congested, the toxins flow into the mammary glands. The breast will also take on toxic overload when underarm toxic elimination is decreased through the use of antiperspirants.

Lymph is also dumped into the colon wall. If the colon is backed up with debris, lymph congestion cannot be relieved. It will back up within the lymph system causing even further congestion, and affects the liver. The toxins taken up by the liver are excreted as part of the bile. When the bile toxins become excessive, the bile backs up into the intestine and the result is nausea.

[...]

Toxins and poisons are given off by the body but may become dry and hard as the material becomes glued to the pocket of the colon wall. A person must do a colon cleanse to get this matter out. Most people have a transit time (for food to completely pass through the intestinal tract) of seventy-two hours. After a colon cleansing, however, this time is reduced to twenty-four to forty-eight hours (digestion and elimination).

An English doctor tested a lady by giving her a marker pellet. Every day she moved her bowel after taking the pellet, but it took one week for the marker pellet to come out. Even though your bowels may move every day, you can still be constipated.

So what's the answer? Super-regularity above and beyond the call of duty, or, as I call it, regularity über alles! It's not enough to have a bowel movement a day. Oh, no. That's for putrefaction-poisoned wimps. Real alties poop way more often than that, helped along by a wide array of enemas, herbal laxatives, and purgatives.

Look at these testimonials for Colonix, a typical product designed to remove all these evil humors:

"I had a bowel movement once every two weeks, and now I am going 3 to 5 times a day."

"We are having awesome adventures in the bathroom."

"I am now at the point where I experience anywhere from 14-20 bowel movements per week. For me that's an absolutely amazing thing."

Yeah, that'd be so amazing in an "oops, I crapped my pants" sort of way. I mean, why would you want to have to drop a bowel movement three to five times a day? It's bad enough having to urinate multiple times every day. Having that many bowel movements a day may be desirable if you've had a total proctocolectomy and had to have an ileal pouch reconstruction, using a small bowel loop to replace the reservoir function of the rectum, but that's only because these patients sometimes have 10-12 bowel movements a day after such surgery.

But is there anything to all this? Does decaying, nasty crap stuck to the insides of your colon poison you with toxins and lead to disease?

Not really, except under very uncommon circumstances.

First of all, the bacteria decryed by alties are in reality completely normal and do not "poison" their host, except occasionally, such as when a new strain (such as pathogenic strains of E. coli that cause food poisoning or simply bacterial strains that "don't belong" and cause travellers' diarrhea). They are even beneficial in that they help with the breakdown of bile salts in the stool, among other things. Indeed, one of the reasons that antibiotics often cause diarrhea or a secondary infection known as Clostridium difficile colitis (which can be life-threatening) is because antibiotics kill the normal bacterial flora of the colon, allowing pathogenic bacteria to grow into the niche left behind by the dead normal bacteria. Second of all, yes there are parasitic diseases of the colon (Giardia or entamoeba, anyone?), but worms and gastrointestinal parasites are relatively uncommon causes of colon disease in the developed world. Third, as a surgeon, I can tell you from simple experience operating on the colon that hardened feces do not accumulate on the walls of the colon as the colon cleansers claim. Any gastroenterologist who does a lot of colonoscopies could tell you that too. Even in disease states in which colon motility is impaired, we generally do not see the feces "caking" on the walls. Even in the case of mechanical obstruction by, for instance, a colon or rectal cancer, what we see is lots of fecal matter fairly evenly distributed in the lumen of the colon.

The problem all boils down to an altie obsession with "toxins," "waste," and "putrefaction." These colon cleansing alties seem to view their own waste products as somehow inherently "harmful," obsessing about them in much the same way as General Jack T. Ripper obsessed about his "purity of essence." Indeed, if you hang around on enough altie discussion forums, you will get the distinct sense that they find the very thought that they have feces accumulating in them all the time, loaded with bacteria, to be hateful. This attitude is, of course, odd, to say the least, given that the very function the colon evolved to have is to remove our digestive wastes safely and efficiently, extracting water, electrolytes, and what little other nutrients are left over, before depositing the waste into whatever receptical the body sees fit to sit on. For the vast majority of people, whether it does it three times a day or once every three days does not matter much. Worse, in the cases of people who do have a real parasitic infection, all the purging in the world won't get rid of the critters causing the disease, no matter how many times a day one drives oneself to go. Only appropriate drugs to kill the parasites will.

In any case, constipation is determined more by the hardness of the stool and the difficulty a person has expelling it, rather than any arbitrarily determined frequency of bowel movements. Mild constipation can be treated with fiber-containing laxatives, although occasionally a purge with magnesium citrate or even GoLytely may be necessary for very severe cases. However, in general, stimulant laxatives, enemas, and purgatories can mess your colon up real bad and should be avoided when possible. They can make you dependent on them over time just to be able to defecate. Another altie favorite, colonic irrigation, has risks, too, including excessive fluid absoption leading to electrolyte abnormalities and, if too much pressure is used, it can even cause colon perforation! During my residency, I encountered a couple of patients who had abused laxatives. They were truly miserable, and totally depended on their laxatives just to have a normal bowel movement.

In reality, there is a great deal of similarity between the concept of "autointoxication" and certain religions. In the case of "autointoxication," the body of the person with a disease is viewed as "unclean," contaminated by itself, and, of course, in dire need of cleansing. Does anyone see the parallels to Christian doctrine,? Consider: In Christianity, people are inherently "unclean" because of original sin that, no matter what they do themselves, they cannot remove. Now consider the beliefs that drive colon cleansing, in which adherents believe that they are inherently unclean, full of "putrefaction," and poisoning them from within through the absorption of "toxins" (whose exact identities are conveniently rarely, if ever, specified). They believe that they need something to "cleanse" that uncleanliness before they can be well. Compare that to not just Christianity, but to a number of religions in which adherents must "cleanse" themselves of evil and putrefaction by various acts and rituals. This should not be surprising, as the beliefs that drive people to cleanse their colons by various means are not based in science, but rather seem to be more religious or quasireligious in nature.

Am I stretching the analogy a bit? Maybe, but not as much as you might think, but I did just have a rather nasty thought. You see, all of this discussion of the quasireligious beliefs about uncleanliness that must be purged has lead me to wonder:

Is EneMan a Christ figure, as some describe superheroes like Superman?

That's an admittedly bizarre thought, even from me. Next, I'll be discussing quantum colonics.

In any case, while doing this piece, through a Google search, I did happen upon what is perhaps the coolest name for a blog, though: Death Begins in the Colon. (No, the blog has nothing to do with colon cleansing, as far as I can tell, just a very cool name.)

I wish I'd thought of it first.