I was looking at the data for internal search for this blog (the little search box in the upper right hand corner) and noticed that quite a few people had searched for liver flushing. It’s not something I would normally write about (given how implausible the whole thing is), but since minds are boggling to learn about it, I shall oblige.
The web suffers not from shortage of liver flush nonsense, and it’s seemingly 100% cure for acne too. What I wanted to do in this article is to approach liver flush with a skeptical perspective, and perhaps highlight some points the, shall we say, more enthusiastic websites leave out. So that you can decide whether liver flush is worth your time and effort and make an informed decisions about it.
What the heck is liver flushing anyway?
It’s a procedure that’s supposed to flush toxins and gallstones from your liver. There are many variations to it, but they usually involve fasting for a half a day and then consuming a mixture of olive oil and lemon juice (and no, that’s not like salad dressing) and Epsom salts. Enemas are also frequently called for.
You drink the mixture in the evening and go to bed immediately. The next morning you should see lots of ‘green stones’ in your bowel movement. The theory goes that consuming a lot of fat (hence the olive oil) forces the gallbladder to contract and expel bile, this literally flushes the liver as the bile goes through it. Apparently the acids from lemon juice help to soften the ‘stones’ and make them easier to pass.
Why would you do that?
The alt-med world has an obsession with the liver and the colon. They claim that modern life exposes us to so many ‘toxins’ that the elimination mechanisms in the body can’t keep up, and therefore the liver becomes congested. And because the toxins can’t be eliminated, they stay in the body and cause all manner of problems, including acne. They also claim that congested liver cannot properly regulate hormone levels, and thus we have a convenient ‘explanation’ for hormonal acne.
Some skeptical perspective
So what you just read is more or less the explanation and rationale the proponents give. Now, let’s look at these things with a skeptical eye.
What are the stones?
If you look at various liver flushing and cleansing forums, after a night of ‘successful flushing’ the proponents post pictures of stones they flushed out. These are offered as evidence that the flush worked.
Yet, are these green globs really gallstones?
The Lancet published an interesting case study in 2005. Apparently, a 40-year old woman with diagnosed gallstones (real ones) following advice from an herbalist did the liver flush and expelled ‘green stones’ (picture here). She then took the stones to her doctor.
The doctor examined the stones and concluded:
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.1 Traditional faecal fat extraction techniques2 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”.
The so-called stoned had none of the characteristics of real gallstones, and the doctor was able to create these stones by mixing the ingredients in the liver flush with base (exactly what happens when the liver flush mixture mixes with alkaline bile in the small intestine).
In other words, the stones are almost certain the result of the flush itself and have nothing to do with actual gallstones. Without any evidence to indicate otherwise, my guess is that this process explains the vast majority of all the expelled ‘stones’.
Of course it’s possible that the liver flush also expels real gallstones, but so does eating a fatty meal.
This is a good example of the difference between real scientists and much of the alternative medicine world. The proponents offer these stones as proof that the flush works, without actually bothering to examine them and look for alternative explanation. Scientists examine the stones and try to figure out what happened, and whether the procedure actually works.
No evidence of real stones
The proponents claim that the stones block the small ducts in the gallbladder and the liver. This creates congestion and prevents the liver from doing its job properly. There’s just one problem with that explanation, as Dr. David Gorski explains over at Science-Based Medicine.
If true obstruction were present and increasing the “back pressure” on the liver, it would be fairly straightforward to demonstrate 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 blocked, pressure behind the blockage causes them to dilate proximal to the cause of the obstruction, in the case of chronic obstruction quite impressively. Distal to the obstruction they tend to be normal in caliber or even collapsed (otherwise known as “distal collapse”). 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. This part of surgery is not particularly complicated. It’s simple fluid dynamics, and that’s how we can usually tell where an obstruction is. It ain’t rocket science, as they say.
Despite being very simple and cheap to demonstrate with ultrasound, the proponents have never bothered to show that these obstructions even exist. They just think just about everybody should do the liver flush. Why bother with such silly things like evidence and reason? Bah, waste of time!
Do acne patients really have liver problems?
As discussed above, the whole point of the liver flush is to rid the liver of ‘toxins’ and so help it to function better. The proponents take liver congestion and liver problems as given. But is it really so? Do acne patients have liver problems not found in people with clear skin?
The proponents, to my knowledge, have never presented any evidence for this. Even the so-called Liver Doctor, Dr. Sandra Cabot, uses a dubious questionnaire to ‘diagnose’ liver problems. She makes up the abundance of dubious information with complete lack of scientific evidence. Her website has no references to scientific studies showing liver congestion causes any health problems, or that it’s even real. Neither has she ever published any scientific papers, at least nothing that’s indexed by PubMed.
So if there is evidence for liver congestion, the proponents are doing their very best to hide it. On the other hand, there is a lot of evidence against liver congestion and liver abnormalities in acne.
A 2006 study published in the Archives or Dermatology looked at the liver tests for 13,772 acne patients before and after Accutane treatment. Out of these, 94.9% showed normal liver enzyme levels at the baseline (before treatment) and 4.7% showed mildly increased levels. I’m fairly certain that if you were to take 14,000 healthy people without acne and compare their liver test values, you wouldn’t find any differences between the groups.
Since liver damage is a known side-effect of Accutane treatment, several studies have looked at liver function before and after Accutane treatment. Yet, there’s nothing in the medical literature showing liver damage or liver abnormalities among acne patients.
It strains credibility to the breaking point to claim that acne is a sign of ‘congested’ liver, yet medical scientists actively looking for liver abnormalities can’t seem to find anything wrong. Everything is, of course, possible, but I find this highly unlikely, especially considering that the stones itself are more likely to be the result of the flush itself than actual gallstones.
Does it work?
Well, as long as it works, who cares if the rationale and explanations for the liver flush are a bit wonky? Let’s face it. People who end up trying the liver flush aren’t exactly drowning in options. Most are people at the end of the road who feel they’ve already tried everything.
Encouraged by positive testimonials, like this one, they feel what the heck. It doesn’t really cost anything and there doesn’t seem to be any downside to it. If it does work, great, if it doesn’t, well nothing ventured, nothing gained. And I can totally understand that.
So does it actually work? Nobody has ever studied the liver flush, for anything. So we have no reliable data to draw from. So we are left with only testimonials and user reports. Many of those are positive, but there are a few things you should keep in mind while reading the testimonials:
- People are far more likely to leave a positive report than a negative one. People who got good results from such a weird procedure want to tell others about it, because it makes them look smart and ‘in the know’. And people want to share things that work, that’s why acne forums are full of weird stories. Whereas people who got no results are less likely to fill the internet with their stories, because, well, trying such a weird thing with no results just makes them look silly. Even if only 3 people out of 100 got good results with the flush, you are still going to see more positive than negative stories.
- Most positive stories come from dark corners of the internet dedicated to alternative medicine. And people who venture into those corners believe strongly into alternative medicine. So their observations are colored by their own biases, you really, really, really have to read this article about confirmation bias. This means any and all improvements in acne are automatically attributed to the flush. Even if it was just normal fluctuation or caused by something else, the person still fervently believes it’s because of the flush.
- People often require many, many liver flushes before they see good results. It’s not uncommon for someone to do it 20 to 30 times before declaring ‘success’. The standard interval between flushes is 2 weeks, so this whole thing can take 6 to 12 months before success is declared.
- The flush is almost never the only thing they do. People into alternative medicine usually also improve their diet, practice stress reduction, and do other healthy things. All of which can help acne.
The honest truth is that you can’t conclude anything from the testimonials. There are just too many confounding variables to be able to say anything about the liver flush. Maybe it works for some people, but given how implausible it is, I find it highly unlikely to be useful.
And though there are far more positive testimonials, there are also negative reports, such as this one:
I hate to say this but i followed that protocol to the T and my skin literally got 10 times worse. After the 5th LF [liver flush] my face was covered with literally 100’s of pimples ( like trying to count the stars). I know it may help many people but it was without a doubt the worst thing to ever happen to me (i came dangerously close to suicide) and now have permanent scars for life.
Is it dangerous? Are there any downsides to it?
In the vast majority of the cases doing the liver flush is harmless. Not that different from eating a really, really fatty meal. That said, if you have real gallstones, consuming so much fat can put a lot of pressure on the gallbladder and cause ruptures if the real stones block the small tubes.
So I wouldn’t do this if you feel pain after eating a fatty meal (possible indication of real gallstones).
The flush can also make you feel nauseated and dizzy. During my alternative medicine years, I did the flush quite a few times. Most times it went just fine, but the last time I did I started feeling really, really sick and ended up spending half the night vomiting in the toilet. Ahh.. the joys of experimentation. That also happened to be my last liver flush.
The basic liver flush is also really cheap; just olive oil, lemon juice and Epsom salts. Some variations may require herbs or detox kits that can end up costing more.
The proponents also claim you need to do colon cleansing and maybe even parasite cleansing before the liver flush. Because apparently otherwise it doesn’t work, and going through all that will cost far more than a bottle of olive oil and lemon juice.
Anyway, going through the basic liver flush seems harmless – even if it doesn’t do any good either.
Liver flush is one of the more popular alt-med therapies. Probably because alt-med proponents blame toxins for just about every disease out there, and detoxification is one of the jobs of the liver, and apparently your liver needs little flushing to keep up with things. Therefore the liver flush will help with just about every disease. So goes the loopy logic.
The whole premise of the liver flush is extremely shaky. Despite tens of thousands of acne patients undergoing liver function tests, scientists have never found real abnormalities in acne patients. And despite being very easy to test with ultrasound, there’s no evidence that obstructions in the gallbladder or the liver would be common. Despite the fact that the proponents claim modern life exposes all of us to so many toxins the liver just can’t keep up.
What we do know is that acne is a result of hormones, inflammation and genetics. And that it responds to diet changes, stress reduction, gut healing and other such things, none of which have any real connection to the liver.
All the evidence points to the liver flush being highly implausible and, at best, waste of time. Still, if you feel like you have no other options and want to try it, by all accounts it seems more or less harmless.