CHAPTER 9
Colonics, Enemas, Diuretics and Fluid

Colonics and Enemas

          What are colonics? They involve using an enema to supposedly clean out your intestines. It has always amazed me that people think they need to clean their intestines out. The human body has been around for several thousands of years, and not until recent times has the body needed so many enemas. Those who preach the advantages of colonics suggest that the colon gets corroded like a galvanized pipe or your kitchen sink, and it needs the equivalent of a liquid plumber. This is anything but reality. The colon does not get plugged up with stool sticking to the sides of the colon and then get in such a fix that you get sick. If that were the case, the human race would never have made it as far as it has. If you believe in Darwin’s theories, our cousins, the monkeys, don’t take colonics on a regular basis, and the other animals that have colons such as horses and cows, don’t take them either. It always amazes me that people feel human beings are somehow weaker and inferior to the rest of the animal world and that we need them.
          The reality is that the intestinal system will work very well. If you find that your system is sluggish, then simply add fiber to your diet. Add in flax seed to your cereal in the morning. Start with one tablespoon; if that is not enough then go up to three tablespoons a day. Add in exercise, such as walking, and you will find that your bowels work great. The reason that most people have trouble with their bowels is lack of fiber and not enough exercise. If we ate more fruit and grains, nuts and fiber we would do much better. There are a few patients who develop constipation as a result of taking certain pain medicines, and they must take something to keep them regular. There are also some people who probably do not have the same nerve endings that most of us have, and they will not respond to fiber and walking. However, this is the minority; 95% or more will do great with fiber and exercise.
          Fads in health care come and go. Seventy-five years ago the craze was castor oil. There were many people who felt that you should take a dose of castor oil every Saturday, and many children grew up on it. They swore they would never make their children take it. Coffee enemas were in vogue approximately 25 years ago; then they went out of style and in some places they are back in. They do not purify the body; they will just give you a little caffeine hit. You will absorb some of the caffeine, but it will not help cleanse your body. If you choose to do colonics that is fine; that is your choice, and if you believe it makes you feel better that is great. However, the creator of mankind knew what he was doing when he developed our current intestinal system.
          What about using purgatives such as castor oil? Well, some people take them. This can become a form of bingeing. People will take a laxative after they have eaten to try to expel the food. Some people will go to the bathroom and vomit; this is not normal and people who do this need professional help. Binge eating and purging can be lethal. We are more likely to see it in women than men, but if anyone has the desire to eat and then go to the bathroom to make themselves vomit, they have a problem. It is true that if you stuff yourself, you will feel so miserable that you will wish you could vomit. That is different; that is just not knowing when to stop eating and overeating. It is one thing to feel bloated; it is another to make yourself vomit.
          I have done many a colonoscopy (looked in patients’ colons with a light); some had been cleaned out and others not. Stool does not stick to the sides and make you sick. It just does not happen. The reason that people have to take a laxative before someone looks into their colon is that lumps of stool--if still in the colon--will block the light and make it harder for the doctor to actually see the colon. Thus, taking a laxative in this instance simply makes it easier for the doctor to see while doing the procedure.

Diuretics

          Many people believe that taking a diuretic will help them lose weight. But will it work? Diuretics are fluid pills that rid your body of excess salt and water. Some people take in more salt than their body can handle. Older people, in particular, do not handle salt as easily as a 20-year-old.
          As people age, their kidneys do not filter and excrete the salt as easily and their heart may not pump blood to the kidneys quite as well. Therefore, the kidneys do not work as effectively. Diuretics get rid of excess salt. If you retain salt, then you will retain water as well. If you do not eat excess salt, then you do not have to get rid of it. When people get older, they may get rid of the salt shaker and the box of salt in the cabinet, but there’s still a lot of salt in food and if they do not read the labels, then they can still get too much salt in their diet. This is why we tell people to read the labels. Who would think that low-fat salad dressing would be filled with salt, for example? Most people don’t think of soft drinks as salty, but most have sodium bicarbonate in them to make them fizz. Sodium is salt. The sport drinks are also filled with sodium. Obviously, we need some sodium in our diet; it’s just that if you are not careful--and if you have a tendency to retain salt-- then you can get too much in your diet.
          Diuretics are great for patients who retain a lot of fluid; they get rid of the excess salt and water. These individuals will lose some weight that is related to the fluid. However, they will not lose fat. So they may lose a few pounds of water, but this is not the goal when we seek long-term weight loss. Instead, we are looking for a reduction of fat. So if patients lose a few pounds of water they may like the way the scales look, but if they are honest with themselves they know they have not lost fat tissue--only salt and water. Generally, a physician does not put people on diuretics unless they are very concerned about health outcomes related to the edema or swelling.
          Why shouldn’t everyone go on a diuretic? Well, diuretics—like all drugs—have side effects, some of which are serious. Diuretics can cause you to become dehydrated, lose potassium, become very weak, or develop problems with your blood pressure and kidneys--just to name a few of the potential complications. They are great medicines if they are needed, but individuals should strive to be on as few medicines as possible. Once patients start a weight-loss program, they will lose a significant amount of water in the first month anyway, so diuretics are not needed for the vast majority of people. In general, you should avoid diuretics unless your physician feels they would be beneficial. As with any medicine, people have to weigh the benefits and downsides to see if it is something that is right for them. You should not use diuretics to help you lose weight. Another problem with diuretics is that if you are on an exercise program and you are exercising strenuously, you will be sweating, and you can get dehydrated just from that. If you are also talking diuretics, then you are at an even greater risk of dehydration. You are also more prone to complications such as heat stroke, death, and muscle damage.
          Certain beverages are also mild diuretics, such as coffee, tea and alcohol. If you drink these beverages and also work out, then you have to be careful that you do not get dehydrated. You need to be aware of how much you are sweating. You are not able to absorb fluids from your stomach as fast as you can sweat. When people do long-distance exercises like running a marathon, they try to limit their caffeine that morning so that they do not get dehydrated. If they do get dehydrated, then it will significantly impair their ability to exercise, as well as increase the probability that they will get injured in one form or another during the run.
          To sum up, diuretics are not drugs to help you lose fat--only salt and water. So if your goal is to reduce your body fat, this is not the solution. Diuretics are not diet pills. They are medicines that help your kidneys excrete salt in the urine. It is best to begin to experiment with other seasonings and start avoiding salt.

Salt

          So what is so bad about salt? It won’t make you gain weight, will it? Well, the answer is no; you will not increase your percentage of body fat when you use salt, but you will tend to retain fluid. Most of us have had the pleasure of eating or drinking something that was very salty and the rings on our fingers became tight due to swelling, or our watchband became tight, or there was some swelling in our feet.
          Retaining fluid is not a problem for most people when you are young. During your youth, your entire body—including your kidneys--can take a lot of abuse. As you age, however, it is less forgiving. When you are twenty, the excess salt is just excreted in the urine and no one is the wiser. You might have had an extra glass of water or two; but you just thought you were thirsty and did not even think it was related to the pretzels, hot dog, pizza, or margarita you just had. By the time you are forty, your kidneys are not quite so forgiving. When you take in a load of salt, you have some swelling until your kidneys have time to get rid of it. It takes them an extra day or so to excrete the salt.
          Wait, you may say; your kidneys work fine--you go to the bathroom several times a day. What is the problem? You cannot measure how well your kidneys work by how many times a day you urinate. When your kidneys are healthy, they put a lot of sodium in a small amount of urine. As you get older, it requires a lot more urine to get rid of the same amount of sodium. The problem is that as people get older, they do not cut down on the salt in their diet; if anything, it seems to increase. People then begin to chronically retain fluid in their feet; their shoes don’t fit as well and they develop chronic edema or swelling.
          Another problem that occurs as you age is that your heart may not pump blood as well as it used to. It may no longer be pumping it to the kidneys as effectively. This causes the kidneys to retain fluid and, thus, you have more trouble getting rid of salt. The result is heart failure. If you cut the salt in your diet to as little as possible, but still retain most of the salt between the heart and kidneys not working up to par, you will have more swelling. In this instance, the swelling usually gets worse during the day and improves at night. The problem is that at night, the fluid in the legs gets back into circulation and then your kidneys think you just had 2 or 3 glasses of water and now you are getting up several times a night just to empty your bladder.
          Sometimes when you are trying to lose weight you hit a plateau, and occasionally it may be that you are getting such a salt load that even though you are still losing fat, you are retaining fluid because of the sodium. One of my patients named Nancy experienced this. She was using a low-fat salad dressing and it was loaded with sodium; as a result, she was getting close to 5 grams of salt a day from the dressing. Once she changed what she was doing and ate low-salt foods, she was able to get off the plateau and begin to lose weight again.
          People put salt on all sorts of foods. Actually, if you do not use any salt you can still get too much in your diet. Food has natural salts that it gets from the soil, and when the canning industry processes food, it adds salt. So even if you put the salt shakers in the trashcan, you can still get too much. It can be lethal. If you happen to have kidney failure or congestive heart failure, then a salt load could kill you. You would become unable to breathe and then die.
          Salt is very important for people who work outside, especially in the summer. If you are sweating, then you need to increase your intake of sodium. Construction workers frequently take salt tablets in the summer so that they do not become sodium-depleted due to sweating. Gatorade, the sports drink, was invented by analyzing the sweat of the Florida Gator football team to see what electrolytes they were losing and what needed to be replaced, so that they could play a better game. When you sweat you can lose a lot of sodium, so if you are doing a lot of strenuous exercise then you can lose a lot. If you are running a marathon in the summer, you may want to drink a sports drink so that you do not get depleted. Usually it is not a problem, but you can see how it could be if you were playing football in the summer.
          People with hypertension also need to reduce their intake of sodium to as little as possible. The more sodium that they put in their diet, the more blood pressure medicines they will have to take. Salt is directly related to your blood pressure; the more you eat, the higher it goes. If you want to limit the amount of money that you give to pharmacies, then you need to begin by cutting out the sodium. You can learn to eat foods without salt. Many of us have. It all depends on what you get used to. The food still tastes good; you just don’t have the salt taste--you have the taste of the food instead.
          When you have hypertension for a long time, then the heart has to work harder to pump the blood. The pump has to strain to keep the blood going. When any pump has to work against a high pressure, the pump does not last as long. When you look at the oil pump in your car, if the pressure is at 90 you would probably take it to the shop and see what the problem was. The same is true with the heart. If the pressure is high for too long, then the pump fails and we call it heart failure. Many times it is due to long- standing hypertension, aggravated by salt.
          Salt can be important both in health and disease. Most of the time in medicine, we see it in disease. One patient I saw said she was going to call me Dr. Salt if I did not stop reminding her to consume less salt. The problem is that salt is going to kill her a lot sooner then anything else. Cancer is not a problem for her, but salt and congestive heart failure will kill her sooner if she is not able to redouble her efforts to keep the sodium out of her diet. You might want to try to cut back on the amount of salt that you use. Eventually as you get older, you will have to cut it out sooner or later. So it might as well be sooner.

Fluids

          Why does it matter what you drink? Fluids are fluids, and that’s all there is to it, right? Wrong. How much you need to drink depends on where you live in the world and what you are doing. If you live in the desert and are very active, you may need to drink a couple of gallons of fluids a day or more, just to replace what you lose by sweating. If you lose more fluids then you take in, you will become dehydrated. Some fluids also tend to act as a diuretic, causing you to urinate; they include alcoholic beverages and drinks with caffeine. Drinking them will result in some dehydration. So if you consume a lot of coffee, tea and beer, you may find that you are a little on the dry side.
          What is the best fluid to drink? For most people, it’s water. The majority of us do not need to drink power drinks, sport drinks, or dietary supplements. Even when you are exercising on a regular basis, you do not need to use sport drinks unless you are exercising for at least an hour.
          Why not drink the dietary supplements? Well, most people do not need them. They are good if you need to gain weight, but most people are trying to do just the opposite. If you have a person who is underweight, then drinking a beverage containing 250 to 355 calories can be helpful. Many times people drink one a day and wonder why they do not gain weight. The reason is that if you are not eating very much, you will need to drink 6 to 8 cans a day if you want to gain weight. A person who burns 1500 calories a day will have to drink at least 1500 calories a day to keep his weight stable, assuming he’s not eating anything. Such individuals who want to gain weight will have to take in more calories than they are using up. If they drink 1600 calories a day or 100 calories more than what they use, then they can gain 1 pound a month. At 250 calories per can, it will take 6 cans a day to reach 1500 calories.
          Soft drinks are very popular among people around the world. The problem is that each can has a lot of calories. It may be 140 to 160 per drink, but for people who drink 2 or 3 drinks a day it can add up to 300 or 450 calories a day. For some people that could mean the addition of 3 to 4.5 pounds a month to their weight. So, you might ask, why not just drink the diet drinks? There is controversy surrounding these drinks. Some people believe that if you consume artificial sweeteners, you may actually crave sugar more then if you had the real thing to drink. I do not know if that is true, but there are those who think it is.
          It seems the best approach is to simply drink water. The good thing about water is that it is calorie-free. If you get it from the faucet, it is very cheap and good for you. You will also get fluoride that will help your bones to stay strong and keep your teeth healthy, with fewer cavities. Tap water is generally preferable to bottled water unless you live in areas that have contaminated water or water that has an offensive taste to you. In those parts of the world, then you probably need to drink bottled water. When you exercise, you will sweat and will lose electrolytes from your body. If you exercise for less than 1 to 1.5 hours, you will not lose enough electrolytes to make a difference. For those who exercise longer, some people like to use sport drinks to get a little sugar and some electrolytes.
          When you exercise hard, you can lose more fluids then you can absorb from the intestinal tract. Therefore, you may become dehydrated even if you try to drink a lot of fluids. If you run a marathon over a 3 to 5 hour period, you could become dehydrated if you are not careful. You have to drink a lot of fluids during the 26 mile run. You need to take fluids at each stop. Many people also recommend that you weigh yourself before the run and afterwards. If you have lost 1 or more pounds, you need to drink a lot of fluids to replace the ones that you’ve lost. You need to drink until you are passing a lot of urine and it is not yellow, but clear. Then you should be rehydrated. You can always get back on the scales and make sure that your weight is back to what it was. If it is, then you know you are back to baseline with your fluid status. When you exercise, remember that it is hydrate or die. Don’t forget it; you must remain hydrated.
          It is important to remember that if you drink fluids that do not contain calories, such as water, then you won’t have to burn off the calories that you just drank. If you want to drink something with calories, that is okay--just remember what you are doing and realize that you have chosen to do it.
          Fluids can help you lose weight by filling your stomach when you are a little hungry, causing you to not eat quite as much. It will also quench your thirst, so you may avoid other drinks that are not as good for you.
          When you are losing weight, you are also breaking down fatty acids to become the fuel that your body is using. As a result, you produce ketones Ketones are the byproduct of incomplete oxidation of fatty acids. When fatty acids are broken down to their main building blocks, one of the byproducts is the formation of ketones. They are excreted in the urine; if you drink enough fluids, you can keep the ketones flushed out of your body. Some diets require people to check their urine to see if they are excreting ketones. If they are, then they are doing well with their diet. I don’t think that is necessary; instead, I think that common sense will work quite well.
          So the fluid of choice is water; it has no calories, will add fluid to your stomach to fill it up and is good for you. So why do we drink soft drinks, sport drinks, and supplements? The answer is easy: advertisements. The advertising industry has sold us a lot of products that we don’t need. The sugar also tastes good, and most people like sweet things. The industries have figured out what people want and then mass produced it for us. We are the ones that will have to tell them that we don’t want them any more. Try to switch to water if your goal is to lose weight.

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