Gerson Research Organization, San Diego CA
It was in the summer of 1997 that I found myself seated at a conference table in the National Institutes of Health (NIH) opposite the “grand dean” of American cancer epidemiology, Dr. Ernst Wynder, whose seminal study was published in 1950,[i] the year I was born. Also at the table were NIH Office of Alternative Medicine Director Lt. Col. Wayne Jonas, MD, several program officers from the Office of the Director of NIH, and other contributors, including clinical trialist Paul Carbone, MD, Steven Ayers, MD, and Keith Block, MD. We were planning an upcoming NIH-sponsored methodology conference intended to validate the structure and function of a Practice-based Outcomes Monitoring and Evaluation System (POMES). The plan was refreshingly bold, to create a mechanism to provide logistic support in order to gather data and assess the outcomes of existing alternative, complementary, and integrative cancer treatment systems. Treatments would not have to be imported into NIH for study but would be, instead, observed “in the wild” with the original practitioners and developers involved.
The discussion intensified as we took up the challenge of how to screen cancer practices for inclusion in POMES, and our focus turned to the Best Case Series, a methodology innovated by famed biometrist Dr. David Byar.[ii] The logic of the Best Case Series, now US federal policy, is simple: as few as 10 to 12 documented remissions are necessary, no matter how many patients were treated and failed to respond, because tumors don’t go away by themselves. Some readers may be thinking, “But spontaneous remissions do occur. Couldn’t such cases be argued away?” In short, no, because spontaneous remissions are so rare that, in order to generate a dozen of them, a practice would have to follow half a million, or more, cancer patients.
With the Best Case Series accepted, along with other methodologies including our own, our discussion turned to evaluation of outcomes. Once a practice had submitted cataloged cases as putative evidence of efficacy, an expert panel would review them. Questions flew. What kind of experts were we talking about? If the reviewers were conventional oncologists, would it be necessary to blind them to information about the unconventional practitioners, or the unconventional practices themselves?
I raised a specific concern. Might an oncologist be so taken aback by the knowledge that the treatment under review included coffee enemas that he would be unable to avoid emotional and/or experiential bias? Dr. Jonas made reference to the writings of mathematical philosopher Imre Lakatos,[iii] quipping, “a negative heuristic.” It was an understated but wickedly clever double entendre. A physician familiar and comfortable with the intravenous injection of cytotoxic cancer drugs might, nonetheless, be sufficiently anal-retentive to develop a high antibody titer to even the thought, much less serious consideration, of a coffee enema. Oh, the visual!
Dr. Wynder broke the ice speaking in a booming, German-accented voice, and with a twinkle in his eye, “I don’t know about you gentlemen, but I would rather have a coffee enema any day than a bone marrow transplant.” Laughter exploded around the table.
Had I heard correctly? Had this august researcher, this pillar of the cancer-prevention community, just associated himself with a procedure often described in such pejorative terms as “bizarre”[iv] and “ludicrous?”[v] Moreover, had he really categorized it with and contrasted it favorably against bone marrow transplantation?
The picture was accidentally clarified during the August 4-7, 1997, POMES Conference. On the first day, we met from 7:00 a.m. until the lunch break, which was just before our presentations. Although Dr. Wynder and I were both to be presenting within several hours, we had not talked since the planning session in June. During the break, my wife Christeene found herself speaking with Dr. Wynder’s secretary, who noticed Christeene’s nametag and asked if she was related to Gar Hildenbrand. Christeene acknowledged that we were married, that we conducted research and published together, and then she pointed me out, at which point Dr. Wynder’s secretary exclaimed, “Oh my, he’s so young. I thought he would be an old German scientist. You know, your names are all over our grant proposals.”
Grant proposals? As it turned out, Dr. Wynder was using the machinery and clout of his American Health Foundation to pursue funding for research focused on the management of pancreas cancer with the Gerson-inspired treatment of Dr. Nick Gonzalez, a treatment in which patients are prescribed multiple daily coffee enemas.[vi] At Dr. Wynder’s invitation, several possible granting organizations had flown representatives to the conference, Swiss giant Nestle, and Procter and Gamble, both of which have gigantic coffee holdings. The only clinical and laboratory investigations on coffee enemas available to Dr. Wynder were those of Dr. Peter Lechner and myself, so these were referenced and discussed in detail in Dr. Wynder’s grant applications.
We were very fortunate that Dr. Lechner’s position as chief of the 2nd Surgery Department of the University of Austria’s Graz National Hospital allowed for technical and personnel support. With these resources, it was possible to test our hypothesis that the palmitates of roasted, boiled coffee, when administered as a retention enema, function as a choleretic in humans. The known target of cafestol and kahweol palmitate is the liver’s powerful detoxification enzyme system, glutathione-S-transferase (GST),[vii] a ligand that catalyzes the binding by glutathione, and the subsequent detoxification through hepatic transport and bile secretion, of a vast variety of electrophils (free-radical mutagens, teratogens, and carcinogens) and many other substrates. Despite their powerful stimulation of GST, both palmitates are remarkably nontoxic.[viii]
Key findings published by Dr. Lechner and myself in1994 in the pages of this journal[ix] were as follows:
By following the steps laid out by Beilstein,[x] approximately 1 gram of cafestol diacetate can be extracted from unfiltered, boiled beverage coffee prepared for an enema in the manner described by Gerson.[xi]
Cafestol applied rectally to Wistar rats resulted in a statistically significant 28% increase in bile output. Because the Wistar rat’s glutathione-S-transferase system is a direct human analog, these results apply to humans, and cafestol may be understood to be (along with kahweol) a putative human choleretic.
In the University of Austria, Graz, National Hospital, two coffee enemas daily reduced the need for pain medications by 71.3%, 59%, and 22% respectively in cancer patients with WHO cancer pain level 1 (n = 91, p<0.001), level 2 (n = 68, p<0.05) and level 3 (n = 19 not significant due to small sample).[xii]
Apparently, these findings were sufficiently compelling that Dr. Wynder was moved to recruit support from Nestle and Procter & Gamble. Although it was clearly Dr. Wynder’s intent to advance the science of coffee, specifically the pharmacology and physiology of coffee enemas, nothing particularly noteworthy has been published since that time. What happened?
With Dr. Wynder’s untimely and unfortunate death in April 1999, Proctor & Gamble backed out after having seriously discussed an $8 million award. Perhaps the loss of Wynder, the 800-pound gorilla, left them too weak in the knees to continue the project. Fortunately, Nestle continued its involvement and granted substantial support toward Dr. Gonzalez’ pilot study.[xiii] The results of the pilot study triggered funding (from the National Center for Complementary and Alternative Medicine) of Gonzalez’ current Columbia University-based clinical trial in pancreatic cancer.[xiv]
So there you have it. The only real progress to be made recently in the study of coffee enemas has been in the realm of perception, the very realm to which Dr. Jonas alluded with his comment on the “negative heuristic.”[xv] Almost entirely because of Dr. Wynder, his immense stature as a policy-oriented scientist, and his ingrained scientific activism, coffee enemas are no longer being demonized or ridiculed by NIH, NCI, FDA, or any other federal health agency, at least not officially and, most importantly, not on record. In fact, if only in a clinical sense, coffee enemas are being researched. Bravo, Dr. Wynder.
In a Physicians’ Data Query (PDQ) publication on Dr. Gonzalez’ trial, which is now closed to recruiting, the NCI expresses the official NIH (US federal government) position on coffee enemas, simply that they are harmless. In its current web post, the NCI states: “The cases found in the literature on coffee enema are not adequate to support an adverse effect from coffee enemas alone. There are rare reports of adverse events unrelated to the coffee enemas in patients receiving them.”[xvi]
The battle for perception supremacy regarding coffee enemas has been remarkably devoid of one element, an old-fashioned interest in the people who use them and benefit from them. People are so much more interesting than abstract arguments about enzymes and bile. So, now that coffee enemas are no longer anathema to the realm, at least officially, it seems germane to offer here several of my favorite anecdotes.
The first that comes to mind is a scene that occurred at an AIDS and cancer leadership conference hosted in 1990 in New York City by Dr. Ralph W. Moss. After a rousing, spirited morning session, we broke for lunch. At the back of the conference room was a tabouli bar, at which I was approached by my friend, Dr. Nick Gonzalez. Nick has a booming, broadcast quality baritone. As I loaded my plate, he asked in a room-filling, full-throated voice, “So, Gar, how many coffee enemas a day do you do?” I cringed and quickly looked around to see who might have overheard, but rapidly abandoned my concerns to pursue the discussion. “One or two,” I answered. “So do I,” Nick replied. He went on to tell me that he had a younger brother, an environmentalist no less, who was unwilling to consider this simple means of detoxification along with lifestyle control. “He’s younger than I am,” Nick related, “but he looks ten years older.”
The comment was inspired by a perception shared by a number of us who have actually investigated coffee enemas in a medical-science context, that detoxification with coffee enemas actually contributes to the health of the skin, hair, eyes, nails, etc. In addition to a high-micronutrient, calorie-restricted diet and regular exercise, coffee enemas are at the top of the thinking person’s list of alternatives to cosmetic interventions (surgery, dermabrasion, etc.) and the many and varied topical cosmetic medications that pack the shelves of pharmacies and supermarkets worldwide. Perhaps Ponce de Leon, in his search for a “fountain of youth,” was looking in all the wrong places.
I have never written of the second anecdote that I would like to present here. It was in the spring of 1991, a weekend day, and I was lounging in a hot tub when my wife, Christeene, brought me the cordless phone.
“It’s Cindy Landon,” she said. “She wants to talk to you about Michael.” I took the phone and within a few seconds Cindy cut to the chase, telling me that Michael had been recently diagnosed with pancreatic cancer. She asked if I would be willing to speak with him. I said yes, of course, and with that she put Michael on the line.
Michael told me that he was miserable, using a phrase often quoted in accounts of his ordeal: “I’m walking around the house in pajamas, like a zombie, on pain medication.” He went on to say, “My doctor prescribed a protein shake that I fix in the blender, but every time I drink, it I double over in pain.”
I told him that I was sorry that he was suffering, but I couldn’t resist telling him how much I admired his work as an actor, writer, and director. I confessed that I had spent some years in the professional theater before embarking on a career at the margins of medical science. Then I got down to business. I walked him through the clinical benefits of Dr. Max Gerson’s high-potassium, low-sodium, essentially vegetarian diet with its fruit and vegetable juices and, of course, coffee enemas.
Michael said, “Look, I live on a ten-acre walled estate, and I don’t want to go anywhere. I don’t want to be hounded like Steve McQueen.” Then he asked, “What can I do here?” I made a quick judgment. The information regarding Gerson’s cancer therapy was in the public sector, and this man deserved to know what it said. I explained in detail how to make juices, foods, and how to prepare the coffee enemas. In addition, I pointed out that there were prescription medications in Gerson’s treatment, and that Gerson considered them to be integral to his approach. Michael asked if he could achieve benefit without them. I acknowledged that Gerson’s earliest successful treatments of cancer employed his tuberculosis dietotherapy, which contained none of the later cancer therapy medications.
We had been on the phone for hours and I had long since become a prune. At last, Michael thanked me and assured me that he was going to give this a try. We said goodbye, and that was the last time I talked with him. But it wasn’t the last time I would see him.
By sheer chance, Christeene and I were watching the Johnny Carson Show several months later when Ed McMahon announced a special guest appearance by Michael Landon. A noticeably thin but energetic Michael took the stage and regaled Carson with stories about his diagnosis and suffering with pancreatic cancer. He talked about people who recommended interventions as unusual as swimming with dolphins. Johnny was the first to break the ice on the unspoken question: Was Michael doing something strange with coffee? Michael put it right out there saying, “I take coffee enemas.” He made a point of the fact that he used only organic coffee. He joked that he and Johnny were going to get together for coffee, but that Johnny had wanted cream and sugar and, said Michael, “I’m not going to pour.”
At the same time, Life Magazine published an interview with Michael.[xvii] His description of his cancer experience is remarkable, and is punctuated by a penetrating question.
“I’m on a radical diet. Worked it out with the help of my wife, who’s a health nut, and knows a lot about nutrition. No animal fat or protein. I get everything I need from fruits and vegetables. My wife makes a wonderful hearty soup and every day 13 times a day I chop up a few organic apples and a bunch of organic carrots along with maybe some beet tops and dump them in the blender. Makes a 12 ounce glass of juice and I drink it right down. The pectin in the apples helps digestion and the carotene in the carrots is thought to kill cancer cells.
“Damn carrots are turning me orange. And every time I eat or drink I swallow digestive enzymes to replace what the pancreas has stopped producing. And then once a day I take a tried and true remedy for intestinal irritation, a coffee enema. Yup, I get filled to the rim. Organic coffee, I might add.
“And you know what? The same day I started this new program the cramps stopped. And they’ve never come back. I have a feeling of fullness but no pain. No pain! I feel great. Crazy isn’t it? I may be dying and I feel great. But you know what irks me. I’m dealing with some of the best cancer specialists. If I get stomach cramps they know exactly what drugs will block the pain. They also know that when you block pain you dull your mind and lower your energy. But they figure that’s a price you have to pay. It never occurs to them that you could stop the pain just by changing your diet. Why in God’s name don’t they know that? Why is it they only know what kind of chemicals to pump into people?”
Christeene and I never heard from the Landons again. It is a matter of record that Michael died of pancreas cancer, as might have been expected, only several months after his diagnosis. But his reversal of the pain and suffering typical of pancreatic cancer stands out as one type of clinical benefit that can be achieved even with an unsupervised application of nutritional control and detoxification through coffee enemas. For that, we are eternally grateful to him.
Finally, speaking of Christeene, I hope she will not hold it against me that I find her account of her first coffee enema to be so charming, that I would like relate it to conclude this set of anecdotes.
With the onset of menarche at 11 years of age, Christeene developed an idiopathic exfoliative dermatitis chiefly affecting her hands. Tiny blisters erupted constantly under her skin creating sponge-like inflammatory lesions in which her skin would actually tear and bleed with any extension. She played guitar, but could not perform barre chords due to repeated tears and bleeding. Her family practitioner finally resorted to prescribing, instead of dose packs, bottles of prednisone tablets, as well as 1-lb jars of hydrocortisone cream. At one point, he expressed concern, telling her, “You have had more steroids in your young life than anyone should have in a lifetime.”
By the time we met, in 1983, while I was moonlighting as director of San Diego Lyric Opera’s production of Engelbert Humperdinck’s Hansel and Gretel, Christeene (the Dew Fairy) had been taking steroids for 21 years. Dr. Walter Teutsch and I cast Christeene in the ingénue role for Rossini’s Cambiale de Matrimonio, to be staged by the Lyric Opera in early 1984. As we began rehearsals, at one point in the staging I took Christeene’s hand and felt a crustiness very familiar to me, because I had suffered the same condition. From then on, I provided her with information about the treatments that had helped me to heal.
Diet was the first and easiest priority. Christeene raised much of the food for her family in her home garden. Her skin improved, but the stress of her life and her pre-existing condition presented in a new and dangerous form, stroke-level migraines with hemidysesthesia (numbness on one entire side of the body). She was worked up by Dr. David Simon of Scripps Clinic, who told her that an EEG had revealed a right temporal lobe lesion. The effect of this lesion during attacks was remarkable. Christeene could hear that people were speaking, but she could not understand them. Unexplainably, she found this funny and responded with irrepressible giggling. Dr. Simon begged this operatic young mother of 6 children to slow down. He explained that nothing else could be done for these migraines, and that he was concerned that the next one might result in irreversible damage.
After many months of dietary control and reading, mostly the literature of Dr. Max Gerson, one day during the onset of a migraine prodromal syndrome with flashing lights in the peripheral vision fields, Christeene decided to try a coffee enema. She put coffee on to boil, and then had to drive to town to purchase enema gear. When she returned home, she laid towels in the bathtub where she positioned herself out of concern that she might not be able to control things.
She reported, “As soon as the coffee entered my body, the migraine broke, it just disappeared, and I was so overcome with joy that I sobbed. It was a religious experience. I felt filled with love, I felt love through the whole universe, and I felt loved, myself. It was like an opening. I also noticed that the bathroom wallpaper was suddenly brightly colored. As I released the coffee, I realized that it was time to pick up my children from school. I drove out to get them and, for the first time in years, I was genuinely glad to see them.”
After more than 25 years, Christeene remains free from skin eruptions, and her migraines have become history. Like Dr. Gonzalez, she continues to use coffee enemas because they make her feel better. Unlike Dr. Gonzalez, whose use of coffee enemas is anchored in prevention, Christeene started with a threatening illness that resolved through the use of dietotherapy with coffee enemas.
To review, these anecdotes suggest several potentially fruitful avenues for research. Might a Gerson-like diet-based lifestyle makeover with detoxification enhanced by coffee enemas retard age-related deterioration? How and under what circumstances do coffee enemas ameliorate cancer pain? What are the mechanisms by which dietotherapy with coffee enemas counter the damages of autoimmune disease of the skin as well as migraines?
It has been reported to me that Dr. Wynder was being treated for advanced cancer by Dr. Gonzalez at the time of Wynder’s endorsement and activism regarding dietotherapy and coffee enemas. I have no further knowledge of this; however, it stands to reason that Dr. Wynder would champion a treatment if he perceived it to be of personal benefit. If it was so, his voice was simply the most powerful in a chorus echoing Michael Landon’s piercing and poignant question: “It never occurs to them that you could stop the pain just by changing your diet. Why in God’s name don’t they know that?”
Gerson Research Organization
San Diego, California
[i] Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchogenic carcinoma: a study of six hundred and eighty-four proved cases. JAMA. 1950;143:329-336.
[ii] Every year, the American Statistical Association (ASA) gives out the David P. Byar Young Investigator Award. The ASA explains, “The award is in memory of David Byar, an internationally known biostatistician who made significant contributions to the development and application of statistical methods and was esteemed as an exceptional mentor during his career at the National Cancer Institute.” http://www.bio.ri.ccf.org/Biometrics/dbyar.html, May 8, 2006.
[iii] Imre Lakatos, Ed. Proofs and Refutations: The Logic of Mathematical Discovery. 1976; Cambridge University Press.
[iv] Regelson WD, “The conspiracy against the cancer cure.” JAMA 1980;234(4). “We may shortly have to ask if Gerson’s low-sodium diet, with its bizarre coffee enemas and thyroid supplementation, was an approach that altered the mitotic regulating effect of intracellular sodium for occasional clinical validity in those patients with the stamina to survive it. Was the Establishment correct in turning its back on these programs?”
[v] Michael Specter. “The outlaw doctor.” The New Yorker. February 5, 2001. Regarding the Gonzalez clinical trial: Critics have singled out the coffee enemas for particular ridicule. “I respect his willingness to have his regime studied,” Barrie R. Cassileth, a medical sociologist who is chief of integrative medicine at Sloan-Kettering, told me. Cassileth has published some of the most influential articles demonstrating how important alternative therapies and supplements have become. “But the coffee enemas are ludicrous,” she said. “He ought to just get rid of them.”
[vi] National Cancer Institute;U.S. National Institutes of Health. Gonzalez Regimen (PDQ)®. May 15, 2006; http://www.cancer.gov/cancertopics/pdq/cam/gonzalez/HealthProfessional/page2
[vii]Lam LKT, Sparnins VL and Wattenberg LW. Isolation and identification of kahweol palmitate and cafestol palmitate as active constituents of green coffee beans that enhance glutathione S-transferase activity in the mouse. Cancer Res. 1982;42:1193-1198.
[viii] Raymond Tice, Ph.D. Cafestol [CASRN 469-83-0] and Kahweol [CASRN 6894-43-5]: Review of Toxicological Literature. National Institute of Environmental Health Sciences; Contract No. N01-ES-65402: October 1999.
http://ntp.niehs.nih.gov/ntp/htdocs/Chem_Background/ExSumPdf/Cafestol.pdf. May 18, 2006.
[ix] Hildenbrand GLG, Lechner P. A reply to Saul Green’s critique of the rationale for cancer treatment with coffee enemas and diet: cafestol derived from beverage coffee increases bile production in rats; and coffee enemas and diet ameliorate human cancer pain in stages I and II. Townsend Letter for Doctors. May, 1994. The text is available at http://gerson-research.org/docs/HildenbrandGLG-1994-1/index.html.
[x] Beilstein. Handbuch der Organischen Chemie-Heterozyklische Verbindungen. Berlin; Springer Verlag;1933:2251-2252.
[xi] Gerson M. A Cancer Therapy, Results of Fifty Cases. Hildenbrand GLG (Editor) 4th and 5th editions. San Diego, CA; Gerson Institute; 1986, 1990:247.
[xii] World Health Organization. WHO’s pain ladder. http://www.who.int/cancer/palliative/painladder/en. May 18, 2006.
[xiii] Gonzalez NJ, Isaacs LL: Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with nutrition and detoxification support. Nutr Cancer 33 (2): 117-24, 1999.
[xiv] Clinical Trials.Gov. Gemcitabine Compared With Pancreatic Enzyme Therapy Plus Specialized Diet (Gonzalez Regimen) in Treating Patients Who Have Stage II, Stage III, or Stage IV Pancreatic Cancer http://clinicaltrials.gov/ct/show/NCT00003851
[xv] Imre Lakatos (reference 3 above) held that a Research Program tends to build walls and a moat around itself to repel observations that conflict with its central hypothesis. This insures a “positive heuristic” in which only supportive findings are valid. By inference, the “negative heuristic” represents observations and resultant hypotheses that lead away from the central hypothesis of the Research Program.
[xvi] National Cancer Institute;U.S. National Institutes of Health. Gonzalez Regimen (PDQ)®. May 15, 2006; http://www.cancer.gov/cancertopics/pdq/cam/gonzalez/HealthProfessional/page6
[xvii] Michael Landon, as told to Brad Darrach, Michael Landon Discusses His Illness. Life Magazine. May 1991. http://members.aol.com/Tvfanteel/life.htm.