Would you like a liver flush with that colon cleanse?

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, 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.

I have to apologize for last week’s Dose of Woo. No, I’m not apologizing for the subject matter (the obsession that reigns supreme among some alties with “cleansing” one’s colon to “purge toxins” and achieve the super-regularity of several bowel movements a day). Rather, I’m sorry I didn’t point out just how disgusting one of the links I included was, because among all the glowing testimonials for how great colon cleansers felt after having supposedly rid themselves of all that nasty fecal matter caked on the walls of their colons and achieved the Nirvana of many bowel movements a day (or, as one happy customer put it, “awesome adventures in the bathroom” and another put it, “I have not noticed anything really weird come out of me yet, but I am sure that there will be”), there were also links to various pictures people took of their own poop, complete with graphic descriptions. You’re warned now if you click. One reader asked if the Dr. Natura site was the “grossest thing on the Internet.” Sadly, I had to assure the reader, that is not the case, not by a longshot. However, I won’t reveal links to anything even grosser. I’ll leave that as an exercise for interested readers.

After having posted last week’s woo deconstruction, I thought about what a suitable followup would be for this week. I thought of going back to deconstruct quantum homeopathy, but realized that (1) even though I had intentionally dived into some really–shall we say?–earthbound stuff in order to purge my brain of the quantum woo, I had not yet achieved a total purge of my mind of that particular woo comparable to the total purge of the colon of its feces that Dr. Natura and its customers seek, which suggests that at least one more purge is needed; (2) I’m having trouble thinking of new jokes about quantum homeopathy and am therefore forced to regurgitate the same old material about quantum entanglement between my neurons and those of Lionel Milgrom every week (oops, I did it again); and (3) there is indeed a very logical followup to colon cleanses to discuss (logical as a followup, not as an actual treatment) that is very interrelated.

Are you ready for liver flushes? Of course you are. Don’t you want a way to “remove gallstones without surgery“?

Of course you do.

First off, so that I don’t repeat the same mistake as last week, be advised that some of the links mentioned here will lead to more disgusting pictures, particularly things that people have fished out of their own poop. (Don’t ask me why they spend so much time examining and picking through their own waste; if I understood it, it wouldn’t be a topic for Your Friday Dose of Woo.) Click at your own peril. So, that having been said, what sorts of benefits can you expect from liver flushes? Well, let’s go to that altie of alties, that woman who blames all cancer on a liver fluke (hence her interest in “flushing them out of the liver), Hulda Clark, for some input, from her book, The Cure for All Diseases (humble, isn’t she?):

“Cleansing the liver of gallstones dramatically improves digestion, which is the basis of your whole health. You can expect your allergies to disappear, too, more with each cleanse you do! Incredibly, it also eliminates shoulder, upper arm, and upper back pain. You have more energy and increased sense of well being.

Pretty amazing, eh? I can’t figure out why such flushing would eliminate shoulder, arm, and back pain, but then I’m not Hulda Clark.

It is the job of the liver to make bile, 1 to 1.5 quarts in a day! The liver is full of tubes (biliary tubing) that deliver the bile to one large tube (the common bile duct). The gallbladder is attached to the common bile duct and acts as a storage reservoir. Eating fat or protein triggers the gallbladder to squeeze itself empty after about twenty minutes, and the stored bile finishes its trip down the common bile duct to the intestine.

For many persons, including children, the biliary tubing is choked with gallstones. Some develop allergies or hives but some have no symptoms. When the gallbladder is scanned or X-rayed nothing is seen. Typically, they are not in the gallbladder. Not only that, most are too small and not calcified, a prerequisite for visibility on an X-ray. There are over half a dozen varieties of gallstones, most of which have cholesterol crystals in them. They can be black, red, white, green or tan colored. The green ones get their color from being coated with bile. Notice in the picture (pg. 545) how many have imbedded unidentified objects. Are they fluke remains? Notice how man are shaped like corks with longitudinal grooves below the tops. We can visualize the blocked bile ducts from such shapes. Other stones are composites- made of many smaller ones- showing that they regrouped in the bile ducts some time after the last cleanse.

Hulda’s apparently never heard of ultrasound, which is very good at visualizing both gallbladder and liver stones. If there were gallstones or liver stones there, ultrasound would be able to pick them up in the vast majority of cases. Certainly, ultrasound is also very good at detecting bile duct obstruction as well. Best of all, it’s a noninvasive, relatively inexpensive, and radiation-free test–just the sort of test that alties would like, one would think. And, in the case where ultrasound fails, CT scans can often see biliary obstruction and stones. Also, I don’t know where Hulda got the idea that gallstones are common in children, but they aren’t. Just ask yourself: How many children do you know or have you seen who have needed gallbladder surgery? Not very many. I will give Hulda credit for one thing, though. Many cases of gallstones are completely asymptomatic or vaguely symptomatic (with bloating or other vague GI symptoms). And guess what? These days, we generally don’t recommend the removal of the gallbladder just for stones. If they’re asymptomatic, we usually leave them alone, except in cases where a case of cholecystitis would be very dangerous, as in diabetics or patients with other comorbidities. We usually wait for symptoms to occur, and in many cases they never do. In the case of vague symptoms that might or might not be attributable to gallstones, before taking out his gallblader, we will tell the patient that his symptoms are probably due to gallstones but we can’t be sure that something else isn’t going on.

At the very center of each stone is found a clump of bacteria, according to scientists, suggesting a dead bit of parasite might have started the stone forming.

Wrong. Most gallstones do not contain any such thing. Gallstones and liver stones form when cholesterol and/or bile salts in the bile form tiny crystals, which then enlarge. Most gallstones are cholesteral gallstones, and liver stones are pretty uncommon.

As the stones grow and become more numerous the back pressure on the liver causes it to make less bile. Imagine the situation if your garden hose had marbles in it. Much less water would flow, which in turn would decrease the ability of the hose to squirt out the marbles. With gallstones, much less cholesterol leaves the body, and cholesterol levels rise.

Not quite. In any case, if true obstruction were present, increasing the “back pressure” on the liver, you’d be able to see it easily by observing dilated biliary ducts in the liver on ultrasound. As is the case with most tubular structures in the body (small bowel, colon, bile ducts, ureters, etc.), when bile ducts are clogged, they dilate proximal to the source of obstruction, often quite impressively. Distal to the obstruction they are shrunken or normal sized. That’s how we figure out initially whether the obstruction is somewhere within the liver or if it’s in the bile duct outside of the liver. It’s simple fluid dynamics, and that’s how we often can tell where an obstruction is. It ain’t rocket science. So why don’t we see dilated bile ducts in all of these patients complaining about “liver stones” (which, by the way, are pretty uncommon).

Gallstones, being porous, can pick up all the bacteria, cysts, viruses and parasites that are passing through the liver. In this way “nests” of infection are formed, forever supplying the body with fresh bacteria. No stomach infection such as ulcers or intestinal bloating can be cured permanently without removing these gallstones from the liver.

The vast majority of stomach and duodenal ulcers are caused by H. pylori. Is Hulda claiming that gallstones form a “nest” in which H. pylori dwell? On what evidence? None, of course.

Hulda’s a bit different than most liver flushers in that she emphasizes her liver fluke as the cause of cancer and “all disease.” She thus recommends the use of her “zapper” to “kill parasites” before doing a “liver flush” to flush them out. Most practitioners selling liver “cleanses” emphasize their flushy goodness as a means of eliminating “liver toxins” and “stones”:

The liver is the gateway to the body and in this chemical age its detoxification systems are easily overloaded. Thousands of chemicals are added to food and over 700 have been identified in drinking water. Plants are sprayed with toxic chemicals, animals are injected with potent hormones and antibiotics and a significant amount of our food is genetically engineered, processed, refined, frozen and cooked. All this can lead to destruction of delicate vitamins and minerals, which are needed for the detoxification pathways in the liver. The liver must try to cope with every toxic chemical in our environment, as well as damaged fats that are present in processed and fried foods.

So what, exactly, does a liver flush entail? Well, most liver flushes involve drinking large quantities of fruit juices of some kind, usually along with epsom salts and oils such as olive oil. For example, here’s one protocol found (where else?) on CureZone:

Materials:

1 gallon apple juice (freshly pressed)

2 ounces orthophosphoric acid (Phosfood from Standard Process or Ortho phos from Nutra-Dyn)

Enema bag and colon tube

Coffee

Epsom Salts

Whipping cream and berries

Olive oil

Protocol:

Add one bottle (2 ounces) of orthophosphoric acid to the gallon of apple juice. Shake and refrigerate. Over the next three to five days, drink the gallon of juice (3 to 4 8-ounce glasses a day) between meals. Be sure to rinse your mouth out with baking soda and/or brush your teeth after drinking the juice to prevent the acid from damaging the teeth. Eat normally during the liver flush.

On the day following whatever day you finish the gallon of juice, eat your normal breakfast and lunch.

Two hours after lunch, drink 1-2 tablespoons of Epsom Salts dissolved in warm water.

Four hours after lunch, do a one pint coffee enema.

Five hours after lunch, drink 1 tablespoon of Epsom Salts dissolved in warm water.

Six or seven hours after lunch, eat a dinner of heavy whipping cream and frozen or fresh berries – as much as desired.

At bedtime, drink 1/2 cup of olive oil. A small amount of orange, grapefruit, or lemon juice may be added if desired. Immediately after drinking the oil, go to bed and lie on your right side with knees drawn up for 30 minutes. You may feel nauseated during the night. This is due to the release of stored toxins from the gallbladder and liver. This is normal and a sign that the protocol is working.

Upon arising in the morning, do a coffee enema.

I still haven’t figured out how the coffee enema “flushes” the liver. I also still haven’t figured out why anyone would want to partake of the glorious coffee bean in any way other than the usual way. Certainly, this is a rather difficult way to get your caffeine fix!

There are, of course, many variations. Here are but a few:

1. Hulda Clark’s Liver Cleanse-Gallbladder Cleanse
2. Dr. Kelley’s Liver-Gallbladder flush

3. Are You Stoned? Liver-Gallbladder flush
4. Liver flush protocol with apple juice and orthophosphoric acid
5. “Classic Coke” liver flush and gallbladder flush (Egads, this one requires a good slug of magnesium citrate!)
6. “Cleansing or Surgery” liver and gallbladder cleanse (with four gallons of apple juice!)
7. Olive oil liver/gallbladder cleanse
8. Seven day program liver/gallbladder cleanse
9. Dushan’s grandmother’s liver/gallbladder cleanse

And the list goes on and on and on and on. (And so will you if you try these cleanses.)

So what will happen if you do this (besides your inducing a lot of poop)? Well, certainly you will find things in your stool. If you read the many testimonials and look at the disgusting pictures on all the websites touting liver flushes, you will see photos proudly displayed of greenish balls or various other things that sort of look like–well, sort of “stone”-like. Naturally, the liver flushers claim that these are gallstones–without actually proving that’s what they are. Indeed, although it is possible to pass gallstones into your stool and occasionally even find one, it’s highly unlikely to pass such copious amounts of stones (as claimed by testimonials) without having had clinical symptoms of gallbladder disease. In some cases, the number of “stones” observed in the stool would have required a gallbladder the size of a basketball to hold them all! And, given that more always seem to “come out” when additional flushes are done, it would seem to imply that there is an endless supply there to be “dumped” out. In any case, check out this testimonial to see what I mean:

I just completed my 3rd liver cleanse. Whew! 1st cleanse 250 small stones pea size or less brown and green. 2nd cleanse 460 stones, small stones pea size or less brown and green. 3rd cleanse 260 stones light and dark green. Many marble size and 2 almost as big as golf balls (I saved these!) I highly recommend Andreas Moritz’s book, “The Amazing Liver Cleanse”. I followed to the letter and did colosan and colonics before and after. I read your testimonials and thought I would add my information.

This testimonial gets a bit closer to what may be the truth behind liver cleansing:

I did a ‘liver cleanse’ or gallbladder flush about 6 nights ago! I’m a 50 year old female in good health. I’m not overweight and have no health problems. I’m active and have been a schoolteacher for 25 years.

I did not have any symptoms of gallstones nor did I have an ultrasound. I just had always been curious to try a gallbladder flush and see if anything came out- as they say most everyone has these gallstones and it’s good to get them OUT.

I did the flush at about 9:30 p.m. And I vomited about 12:30!!! I thought oh hell what an un-pleasant waste of time. BUT the next morning I DID pass some (25?) gelatinous looking things that were greenish – none larger than a small pea. I felt lousey – bloated and not hungry the next day. But since then I’ve felt great!!

I think I vomited because I ate some plain white rice and drank some carrot juice about 5pm. I have been researching various liver/gallbladder cleanses and most say NOT to eat all day and to drink organic apple juice and only that for at least 2 days prior. I took only 4oz of fresh squeezed lemon juice followed by 4 oz of olive oil at about 10 pm. I nearly gagged **YUK** as I was taking it! I will do it again but will follow your directions. I wish I had come across this website BEFORE I did my flush!

Note that this is an asymptomatic woman with absolutely no evidence of gallbladder or liver disease and without even any GI symptoms. Because of a vague curiosity, she made herself miserable for a couple of days with this “liver flush” and then noticed something “coming out.” These “gelatinous things” were almost certainly not gallstones. There are several varieties of gallstones. Of these, cholesterol stones can be kind of soft and easily broken, but I don’t think they could be correctly described as “gelatinous.” In any case, if these “flushes” actually removed gallstones, it would be easy to show scientifically, as I’ve pointed out time and time again, going back to my Usenet days even, when I answered an altie who complained that “healers” don’t have access to CT scanners to “prove” that stones were being removed:

Healers” don’t need a CT machine. They just need an ultrasound machine, which is less expensive by a factor of at least 25-50. Ultrasound machines have become quite ubiquitous, as the price has fallen dramatically (and the quality has increased dramatically) in recent years. Virtually every OB/GYN practice that does prenatal care has at least one in their office. Many general surgeons have them now, too; as do most big emergency rooms. They now make portable ultrasound machines that fit into briefcases….Heck, you can find ultrasound machines in very poor parts of China and India, where, unfortunately, they are used to determine the sex of fetuses, so that parents can abort females they don’t want. So don’t tell me alt-med “healers” can’t get access to basic ultrasound machines. I don’t buy it for one minute, particularly since I’ve seen ads from such “healers” claiming to use ultrasound as part of their approach.

All you would need to do such a pilot study is a interested and/or sympathetic radiologist to team up with a “healer” who has an ultrasound machine–and, of course, the will to document symptoms, physical examination, diagnosis, pre-flush stone load in the gallbladder, and post-flush stone load in the gallbladder rigorously.

So, given how easy it would be to do such a pilot study, why haven’t alties pushing these flushes done it? It’s perhaps among the easiest of their claims to prove or disprove.

Not surprisingly, it’s still never been done, as far as I can tell.

What has been done, however, is a study that suggests just how much self-delusion is involved in liver flushes. It is based on a case report that a group in New Zealand contributed to the Lancet:

A 40-year-old woman was referred to the outpatient clinic with a 3-month history of recurrent severe right hypochondrial pain after fatty food. [Note: Here “hypochondrial” means “below the ribcage,’ not “hypochondriac.”] Abdominal ultrasound showed multiple 1-2 mm gallstones in the gallbladder.

She had recently followed a “liver cleansing” regime on the advice of a herbalist. This regime consisted of free intake of apple and vegetable juice until 1800 h, but no food, followed by the consumption of 600 mL of olive oil and 300 mL of lemon juice over several hours. This activity resulted in the painless passage of multiple semisolid green “stones” per rectum in the early hours of the next morning. She collected them, stored them in the freezer, and presented them in the clinic.

Microscopic examination of our patient’s stones revealed that they lacked any crystalline structure, melted to an oily green liquid after 10 min at 40°C, and contained no cholesterol, bilirubin, or calcium by established wet chemical methods. Traditional faecal fat extraction techniques indicated that the stones contained fatty acids that required acid hydrolysis to give free fatty acids before extraction into ether. These fatty acids accounted for 75% of the original material.

Experimentation revealed that mixing equal volumes of oleic acid (the major component of olive oil) and lemon juice produced several semi solid white balls after the addition of a small volume of a potassium hydroxide solution. On air drying at room temperature, these balls became quite solid and hard.

We conclude, therefore, that these green “stones” resulted from the action of gastric lipases on the simple and mixed triacylglycerols that make up olive oil, yielding long chain carboxylic acids (mainly oleic acid). This process was followed by saponification into large insoluble micelles of potassium carboxylates (lemon juice contains a high concentration of potassium) or “soap stones”.

In other words, the “stones” that liver cleansers are so proud of and go to such effort to strain their poo for after doing their flushes are not gallstones and were almost certainly the result of the actual flush itself! It makes perfect sense, if you think about it. These protocols usually involve fasting and then up to a half liter or more of olive oil at one time. That could easily provide the conditions for this sort of reaction to take place. Neat, isn’t it? The very sign of “success” of the liver flush is something that has nothing to do with gallstones and everything to do with the results of the flush itself. Indeed, it’s quite clear that, even if you don’t have gallstones, if you do a liver flush and then look, you’ll find things in your stool that very much look like gallstones due to saponified oil. (Now I know why pretty much every liver flush protocol includes large amounts of olive oil or similar oils plus epsom salts or orthophophoric acid and fruit juices).

It’s a beautiful scam. People do these flushes, they see things that look to them like gallstones being “flushed” out, and they believe it works. Consequently, they keep doing it. Because these flushes involve materials that don’t have to be purchased from a “healer” (although certainly many “healers” sell various “supplements” to “aid” liver flushes), they can be viewed more as a means of healers to demonstrate their skill and keep the patient coming (and going). It also serves as a way of “demonstrating” the efficacy of “detoxification.” After all, if this “flush” appears to cause “gallstones” to be “flushed out,” then perhaps the other detoxification altie woo will similarly “flush out toxins,” as claimed and might be worth a try. (Liver cleanses might indeed be a gateway altie therapy.) To me the ironic thing about liver flushes is that they are so strongly advocated by alties, and alties frequently castigate “conventional” medicine for “iatrogenic diseases or complications” (iatrogenic=caused by doctors). What, then, can we call these “stones” coming out of people using liver flushes, but a case of i-altie-ogenic disease?

Technorati tags: quackery, alternative medicine, liver cleanse, liver flush, colon cleanse.