Naturopathic Perspectivesby Jason Barker, ND
The Liver Cleanse andGallbladder Flush: SeparatingFact from
Fiction
Liver support and cleansing are popular topics inalternative
medicine. Liver support is perhaps one of themost widely employed
therapeutic options in standard-of-care naturopathic medicine. It
would seem that treatingthe liver is an integral step in the
journey from disease towellness for a huge range of medical
complaints to thenaturopathic physician. Liver cleansing has a rich
historicalbackground based in eclectic medicine and provides
afoundation on which general health restoration may befounded.
Despite this, liver cleansing remains a little-researched area of
modern medicine. Scientific study ofbotanical medicines and a
handful of nutraceuticals haveprovided sound evidence of liver
condition-specific efficacy,yet no studies exist in which liver
cleansing as a whole hasbeen explored. The therapeutic success of
liver cleansingat this time is mainly anecdotal; to bring this
therapy intogreater focus requires a case series or clinical study.
Whatwe do have is an increasingly growing field of research thatis
defining how liver-specific nutrients work as protectiveand
restorative medicine.
Liver Cleansing DefinedLiver cleansing can be loosely defined as
process in
which items with liver-specific restorative benefits are
takenorally by the patient, in orderto assist with removal of
storedchemicals that create negative health effects from withinthe
liver, and to improve liver function so that the bodyas a whole can
better utilize the organ for its physiologicpurposes.
Liver-cleansing protocols may also involve othertherapies such as
colonies, saunas, or dry skin brushing, allof which are integrated
for a systems approach to treatingliver conditions. The liver,
being the primary organ of detoxfor both exogenous and endogenous
chemicals, is itselfaffected by the toxicity and overall load ofthe
compounds towhich it is exposed, which is also affected by its
immediatesupply of nutrients and molecules needed for Phase I and
IIreactions.
Liver cleansing may be indicated as a result ofenvironmental
exposures, such as excessive prescriptionmedications and other
drugs (cigarettes, caffeine, alcohol,etc.), heavy metals, food
additives, pesticides, herbicides,solvents, and any other chemicals
for that matter. Livercleansing is also indicated in chronic
disease and otherstates of inadequate health, depending on the
condition.
What are we talking about when we refer to a livercleanse? What
are we trying to accomplish, and which toolshave the greatest
efficacy? Liver cleansing is big businessoutside the clinician's
office. A brief Internet search usingone popular search engine and
the term "liver cleanse"resulted in 2,130,000 results. A large
number of theseresults - the first ten or so pages, anyway - refer
to theinfamous "gallbladder flush." The gallbladder flush carries
aseemingly mystical notoriety on the multiple Internet
pagesprofessing its wonders, with many patients
enthusiasticallyrecommending the procedure after having experienced
itthemselves.
The gallbladderflush to which lam referring will producemultiple
greenish "stones" after the person consumesvarying combinations of
olive oil, apple or grapefruit juice,water, and Epsom salts.
Indeed, each Internet resourceproviding information also insists on
selling its own specialliver cleanse supplement that users are
instructed to usealong with the liver flush. While these sites are
rampant,there are no studies that show any clear benefit from
thesecleanses. However, it is well-known among the
scientificmedical community that the "stones" produced from
theinfamous gallbladder flush are not cholesterol gallstones.
Itappears that there are only two case reports investigating
theutility of the gallbladder flush; these were briefly discussedin
this journal (November 2005). In short, one report^reiterated the
theory that the "gallstones" produced by theflush are merely an
amalgam of the ingredients ingested toinstigate the flush - in
other words, no true gallstones wereproduced after the stones
produced from the flush were
144 TOWNSEND LETTER - DECEMBER 2007
dissected. The second report verified passage of gallstonesby
comparing before and after ultrasound analysis of onepatient's
gallbladder contents.* It would appear the juryis out on the
efficacy of the gallbladder flush using theaforementioned
ingredients until more rigorous study canbe undertaken.
Liver-Cleansing Nutrients
Fortunately, there is much more to liver cleansing thanthe
general liver flush, although "flushing" the liver seemsto be, in
theory, an important step in maintaining andregaining liver health.
If we are to accept the liver flush as auseful tool, the only
benefit it does provide is the expellingof bile (and stones?) from
the liver and gallbladder. It doesnot provide any direct benefit
for the individual cellularmechanisms of the liver, other than
possibly ridding theliver of bile (which is continuously
manufactured), and thegallbladder also releases bile any time fats
are consumed inthe diet, regardless of plant or animal origin.
What works for "cleansing" the liver, and how can wedescribe it
in more exacting words? The following are someof the more widely
employed agents for use in liver health,be it for "cleansing" or
"support."
Methionine: This essential amino acid is often found in
liverformulations. It can be considered a liver-defense nutrient,as
its main role is to promote synthesis of the powerfulantioxidant
glutathione. In turn, glutathione can be used toprevent toxic liver
damage from the drug acetaminophen.However, as an individual
supplement, it can be cost-prohibitive. Another one of the
metabolic end-products ofmethionine metabolism is the amino acid
taurine, which isa major contributor to bile acid conjugation.
Conjugationis the marriage of taurine to bile salts, which then
allowsbile to act as a detergent in fat absorbtion. Methioninehas
been linked to liver toxicity in those with severe liverdisease, as
well as in those undergoing long-term parenteralnutrition.''
However, these problems are seen with the useof excessively high
doses of methionine that are far beyondthose found in
liver-supportive products.
Choline: Choline is a nutrient that is involved in liver
fatmetabolism. Choline can be synthesized in the body. Itsmain
action in the liver is in fat transport; the action ofcholine is
often referred to as "lipotropic," meaning it assistswith fat
removal. Deficiency of choline contributes to liverdisease in the
form of fatty liver and resulting damage.While choline deficiency
and resulting disease is rare, it isavailable in protein-rich foods
such as meats, eggs, beans,and legumes, among others.
Greater Celandine (Chelidonium mafus): This herb has astrong
traditional use in liver disease. However, it is nowmore commonly
used for cases of "indigestion" than forliver disease; it has
recently been implicated as a causativefactor in cases of
hepatotoxicity. '̂̂ Older studies on GreaterCelandine have shown it
to be a potent producer of bile
and pancreatic digestive enzymes.^ Proponents of itsuse have
claimed the herb has two opposing actions: itis thought to relieve
gallbladder spasmŝ and to stimulatea hypo-functioning
gallbladder.'̂ Other effects of GreaterCelandine qualify as
liver-protective; animal studies showeda protective effect ofthe
herb when exposed to hepatotoxicagents.'"'" Use of this herb as
part of a liver protective/cleansing plan should be undertaken by
those with athorough understanding of its safe-dosing use in
liver-supportive protocols.
Fringe Tree (Cbionanthus virginicus): This herb also has astrong
history for treatment of liver conditions and was usedas a
choleretic, or bile flow stimulant. There are no modernstudies
looking at the physiologic basis for its use.
Black Radish (Raphanus sativus): The root of this plantwill
stimulate upper gastrointestinal tract secretions as wellas bile
flow. It is indicated in conditions of sluggish flowand generalized
liver disease.'̂ Because it is a choleretic, itshould be used with
caution in gallbladder disease wherestones are present. There are
no clinical studies looking atthe clinical efficacy of this
herb.
Burdock (Arctium lappa): Burdock is thought to have
strongantioxidative properties that lend to its
hepatoprotectiveproperties. Clinically, burdock has been shown to
improvethe biochemical and pathological markers
(decreasedcytochrome P-450, increased serum triglycerides,
lipidperoxidation, elevated serum transaminase, and
reducedNADPH-cytochrome C reducatase) of liver damageinduced by
experimental exposure to ethanol andcarbon tetrachloride.'' In a
similar study looking at thehepatoprotective effects, burdock was
also shown to protectthe liver from the toxic metabolites of
acetaminophen aswell.''
Dandelion Root (Taraxacum officinale): Considered anoverall
digestive tonic, dandelion is found incorporated inmany
liver-specific products. The use of this particular herbis heavily
influenced more so historical use rather than thefindings of modern
study. Yet, this is another plant withemerging details that
validate its historical use as a liver herb.Dandelion has been
employed as a digestive tract herb,used for treating indigestion,
gas, and anorexia. For liver-specific complaints, it is used for
treating gallstones and as abile flow stimulant. One constituent of
the root, taraxacin, isthought to increase bile flow in laboratory
studies.'̂
Milk Thistle (Silybum marianum): Perhaps the most welt-known and
researched liver herb (also one ofthe top-sellingherbs year after
year in the US and elsewhere), milk thistleprovides the foundation
of all liver-specific treatment.The properties of this herb are
best expressed as liver-protective; an oft-repeated benefit is the
ability to preventcellular damage from toxins by inducing changes
in livercell membranes. Milk thistle is also widely reputed as
a
TOWNSEND LETTER - DECEMBER 2007 145
Liver Cleanse and Gallbladder Flush
liver cell regenerator, an exclusive property limited to
thisherb only. Silymarin, the active constituent in milk
thistle,has the ability to inhibit the enzyme
beta-glucuronidase,which prevents hepatic cellular injury by
reducing thisenzyme's ability to convert glucuronide conjugates
intotoxic metabolites in the liver and intestine.'*'
Turmeric (Curcuma longa): Turmeric is a traditionalAyurvedic
liver herb that purportedly stimulates thegallbladder and has
antioxidative, anti-inflammatory,antifungai, and antibacterial
properties. The main activeconstituent of turmeric is curcumin, a
yellow-coloredpigment. The anti-inflammatory, immunostimulatory,
andanticancer effects of this herb are well-known and makeit the
subject of ongoing research.'^'^ Turmeric is alsothe subject of
much investigation into its liver-protectivequalities. Curcumin is
showing promise as a preventiveagent in alcohol-induced liver
enzyme elevation^" andin experimentally induced liver cirrhosis.^'
Investigatorsconclude that curcumin exerts its protective effects
byimproving antioxidant status and decreasing oxidation offats in
the liver.
Artichoke (Cynara scolymus): Artichoke is a potent herb inthe
realm of cholesterol metabolism and liver health. Themain active
constituents of artichoke, cynarin, chlorogenicacid, caffeic acid,
and polyphenol and flavonoid compoundsare thought to contribute to
the plant's ability to regenerateliver cells, lower serum
cholesterol and triglycerides, andact a digestive tonic.̂ ^ And the
prior reference claims thatartichoke is an effective choleretic as
well. Artichoke isseemingly incorporated in relatively few liver
products;however, from the data revealing its effect on
overallcholesterol metabolism and choleretic effects, it may makea
useful addition to any liver protocol.
Liver CleansingIndications for a liver cleansing protocol are
varied.
However, as stated earlier, addressing the liver is part ofa
foundational approach to overall health and thus shouldbe
considered by clinicians as part of a treatment plan.An important
aspect of preparing for a liver cleanse is toaddress the purpose(s)
behind it. Liver protocols result in themost success when lifestyle
alterations (diet) are continuedbeyond the period of treatment.
Simply following a liver-specific protocol for a week or two will
provide no reallong-term relief if permanent changes are not
made.
There are numerous, high-quality, liver-specific
productsavailable today. This author advises that
liver-supportiveprotocols only be undertaken under the care of a
clinicianwith an understanding of the objectives behind
liversupport. Adequate preparation for a liver protocol shouldbe
undertaken. A shift in dietary habits should precedethe cleanse by
one to two weeks. The cleanse itself willbe rigorous enough,
without the added "shock" of sudden
discontinuation of habitual foods rich in fats, sugar,
andcaffeine. Other important aspects of a liver cleanse includea
fiber supplement, colonies, saunas, and exercise. Each ofthese are
important contributors to assisting the body withelimination, which
is an integral part of any liver protocol.Frequency of said
protocols will vary on a person's state ofheaith. Typically a
period of several months in between eachcleanse is advised. These
protocols are typically rigorous,and those undergoing them may be
more compliant andderive the greatest benefit.
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