If you suffer from poor brain function or chronic gastrointestinal complaints, you may benefit from improving the connection between the gut and the brain, called the gut-brain axis. Central to the gut-brain axis is the vagus nerve — a long, meandering nerve that extends from the base of the brainstem down to the major organs.
In functional medicine, we use a variety of exercises to improve vagal nerve function, and it may surprise to you learn that one of the best exercises is the coffee enema.
The idea of doing an enema makes some people squeamish, but it may help to first learn about the gut-brain axis and why it matters so much for the health of your body and brain.
Why the gut-brain axis is so important
From the base of the brain, the vagus nerve meanders down to the major organs, serving as a communication pathway to and from the brain. This pathway is known as the gut-brain axis or the brain-gut axis, and is bi-directional, meaning communication travels in both directions; the brain talks the gut, and the gut talks to the brain.
Brain-to-gut. Via the vagus nerve, the brain plays a major role in gastrointestinal function, including:
- Control of the movement of food through the intestines (motility)
- Releasing digestive enzymes to chemically break down food
- Regulating blood flow that carries vital nutrients and chemicals to support gut health and repair
There is no question poor brain function can compromise gut health. When the brain ages, degenerates, or otherwise becomes impaired, total nerve output to the body lowers, which decreases activation via the vagus.
As a result, the brain cannot sufficiently activate the gastrointestinal tract and digestive imbalances arise such as:
- Difficulty digesting foods
- Constipation or irregular bowel movements
- Increased bloating and gas
- Distention after meals
- Intolerance to food types such as proteins, starches, and/or fats
- Frequent abdominal discomfort after eating
- Difficulty swallowing supplements or large bites of food
- Abnormal gag reflex
One of the earliest signs of a poorly functioning brain is poor digestion. Frequently, the gut gives the first signs of what is going on in the brain. The brain-based causes behind poor memory, inability to find words, or difficulty learning new things leads to increasing difficulty digesting foods, constant episodes of bloating and gas, or alternating constipation and diarrhea.
Parkinson’s disease has been found to cause degeneration in the gut before the brain. In fact, chronic constipation occurs years before a Parkinson’s patient ever develops tremors and is now being seen as an early warning sign.
If your gastrointestinal symptoms are chronic and progressing, you need to take your brain health seriously. It may not be Parkinson’s disease, but it certainly suggests potential early neurodegeneration leading to failure of the gut-brain axis.
Gut-to-brain.The gut also sends messages to the brain along the vagus via chemical messengers that influence the brain’s immune system and its neurotransmitter pathways. These peptides from the gut have been shown to travel to the brain, enhancing memory and learning, and are also linked to:
- Depression and anxiety
- Parkinson’s disease
- Memory loss
Have you ever noticed that after eating a food, you became bloated and then suddenly you’re irritable, depressed, or so foggy-minded you want a nap? This is an example of how a substance introduced to your gut can immediately affect your brain chemistry.
I write more about the vagus nerve and the gut-brain axis in my brain book.
Improving your vagus nerve with coffee enemas
In functional medicine we use a variety of exercises to rehabilitate the vagus and make it stronger. Like muscles, neurons need constant stimulation to be healthy. If you break your arm and wear a cast, the muscles shrink within a few weeks from reduced activity. Neurons are no different. Without activation they lose function.
Vagal exercises are easy to perform at home. I commonly prescribe these exercises to my patients who have poor vagal tone and gut-brain axis failure: gargling, gagging reflex with a tongue depressor, loud singing, and coffee enemas.
The first three of these exercises activate tissues in the back of the throat that are connected to the vagus nerve. But how do coffee enemas play into the picture?
- Distending the intestines with an enema activates the vagus pathway, as does holding the enema for as long as possible.
- Compounds in coffee also stimulater cholinergic receptors that cause the gallbladder to contract, releasing liver metabolism end-products into the bowels for elimination.
- By flushing out bacteria, fungi, yeasts, and heavy metals from the intestines and liver, inflammatory factors are removed from the body.
With coffee enemas, many people notice their bowel function improves over time and they can begin weaning off the enemas. This is because the enemas help develop positive change in their vagal system pathways. Unfortunately, some people have such rapid brain degeneration that it outpaces the ability to gain positive changes. In this case, the coffee enema is used to prevent impacted bowels, which pose a risk for bacterial buildup, leaky gut, and toxicity.
What about the caffeine?
If you are sensitive to the caffeine in coffee, coffee enemas may not be a concern for you. While on rare occasions caffeine-sensitive people feel an effect, studies show that the bioavailability of caffeine during enemas is 3.5 times less than that of drinking coffee. If you are coffee sensitive, start with 1/2 teaspoon of coffee grounds and see how your body responds.
How to perform a coffee enema
Timing and setting
Try to do the enema when you won’t be disturbed for at least an hour. To make it more comfortable and more effective, make sure to time it just after your daily bowel movement.
Make sure your bathroom is warm enough that you won’t be chilled while doing the enema.
Make one to two cups of organic coffee (non-organic can contain toxic pesticides). Some people can handle up to 2 TBS of coffee grounds per enema, but if you are new to enemas or highly sensitive to coffee, start with 1/2 teaspoon and build up as you become used to the enemas. The stronger the coffee, the more stimulating it is to the vagus. Filtered or distilled water is best.
Boil the coffee for about 10 minutes and strain out the grounds.
Let the coffee cool to room temperature. It’s very important that it be cool enough to put your entire hand in the coffee for a full five seconds comfortably; the tissues inside the intestines are very sensitive to temperature.
What coffee to use
- Use organic coffee to avoid exposure to pesticides.
- Avoid decaf, flavored, very oily, and light or gold roasts.
- Avoid instant coffee, as most tested showed presence of gluten. However, I have my busier patients use Starbucks instant coffee; it’s the only instant brand we’re aware of that is gluten-free, although it’s not organic.
If you can, grind your own beans right before the enema. Oils in pre-ground coffee can be oxidized and go rancid. If you use pre-ground beans, store them in the fridge to keep the oils fresher.
The enema process
As a beginner it’s best to take the enema in the bathtub since it’s possible you won’t be able to hold the enema for long and a “spill” could happen. As an alternative, place a waterproof layer on the bathroom floor such as an old shower curtain or tarp and pad it with some bath towels. Make sure the enema bag’s hose clip is closed (keep it at the end near your body) and fill the bag with the cooled coffee.
Release any air from the tube by holding the bag over the sink with the tip slightly lower and letting liquid flow till it just comes out.
Hang the enema bag or bucket so it’s situated 2 to 4 feet above where you will be laying down (a sturdy towel rod or shower curtain will do). The end of the hose must reach your body easily.
Lubricate the plastic hose tip with a lubricant such as KY jelly or olive oil. Traditionally people have been instructed to lie on their right side so the coffee solution can better access the portal vein to the liver, however experiment with which side feels most comfortable and works best for you. Fold your knees toward your abdomen and gently insert the tube a couple inches into the rectum.
Release the water slowly from the tube into your body, controlling the flow with the hose clamp. Start slowly. If you are new to doing enemas, you may experience some cramping and urgency to eliminate as the liquid moves up into the intestines.
If you cramp, close the clamp to stop the flow, then turn from side to side and take some deep breaths. Cramping typically passes quickly. Once the cramp is gone, gently open the clamp again.
The presence of gas is the main reason some people have trouble holding a coffee enema. If you have gas that is making it difficult to hold the enema, you can leave the enema tip inserted — the gas will flow out the tube and this makes it easier to hold the enema.
You may have urges to have a bowel movement, but breathe steadily, and exhale deeply to relax the abdomen. For some, leaving the plastic enema tip in the rectum assists in preventing leaks.
Take in as much of the liquid as your body will allow. Two cups is an average, and everyone is different.
Try to hold the contents in your bowel for 5 to 15 minutes. Hold the contents for as long as you can. It may help to relax the abdomen by laying on your back.
Once the time has passed, move to the toilet and allow the liquid to flow from the body freely. Don’t worry if less comes out than went in; you may have been dehydrated and the body kept some water.
Post-enema cleanup and care
Separate the enema bag and hose, rinse them thoroughly, and wash the plastic tube tip with hot water and soap. If you use a stainless steel enema bucket, wash it with soap and water to avoid the acidity of the coffee degrading the metal.
Some people like to run some hydrogen peroxide through the bag and hose after washing it. If you do so, make sure to rinse it well with water afterward so no peroxide goes into your intestines the next time.
Hang the hose and bag/bucket in a warm dry place until they are completely dry. Store in a dry location.
Tips and common issues
For the purpose of activating the vagus nerve, it’s important to hold the enema for as long as you can. If you are sensitive to coffee, go for longer holding and weaker coffee, versus stronger coffee and shorter holdings.
As you become more experienced with the enemas, you may find you can tolerate stronger coffee and longer holdings.
To best activate the vagus nerve, the enema should be very difficult to hold so that you suppress the urge as long as you can. Over time, you do this by saturating the solution with enough coffee to the point where it’s a challenge to hold. The amount of coffee will be different for everyone.
Some people prefer to do an initial plain water enema first (a very mild saline solution is ideal: use a ratio of 1 tsp salt to 2 cups water), to clear the intestines more thoroughly before the coffee enema. This is especially so if you tend to have multiple bowel movements a day; having fecal matter waiting in the lower intestines will make you release the coffee enema too early.
Don’t be discouraged if you can’t hold the liquid for long in the beginning and experience leaks. It’s quite common and you will get better at it.
I write in more depth about vagal nerve function in my brain book, Why Isn’t My Brain Working? In addition, I invite you to check out my online brain health course, Save Your Brain — the Six Week Rescue Plan. The course guides you step-by-step through the same brain health strategies that I use with my patients.
If you are on an elimination diet for chronic illness, have leaky gut, or suffer from unexplained food intolerances, I invite you to take my self-paced online course, Food Sensitivity Solutions — 11 Steps to Restoring Oral Tolerance. In the course you will learn what oral tolerance is, what causes its loss, and the role it plays in recovering from or managing chronic illness. You will then learn how to improve your oral tolerance so you can eat a wider variety of foods, and what factors can thwart attempts to recover oral tolerance.