A gallbladder (or liver) flush is a home remedy that is said to be able to promote the passage of gallstones naturally. It is widely promoted on the internet these days. Just google it and you will find thousands of webpages, blog, and video introducing gallbladder flush. There are also commercial gallbladder flush kits specially made for such purpose. A popular remedy indeed.

Does gallbladder flush really work? Is there any credible evidence supporting its use? Let’s explore.

The flushing methods

There are several versions or protocols for gallbladder flush. One method involves fasting for 12 hours, then at 7pm, take four tablespoons of olive oil followed by one tablespoon of lemon juice every 15 minutes for a total of 8 times. Another method is to go on an apple and vegetable juice fast during the day until 5-6 pm and then take 18mL of olive oil followed by 9mL of fresh lemon juice every 15 minutes until about 224mL of olive oil have been consumed [1]. A third version involves eating 4-5 apples or drinking 4 glasses of apple juice daily for five days (under normal diet). On the sixth day, skip dinner, and by 6pm, drink one glass of warm water with 1 teaspoon of Epsom salt. Drink another glass of Epsom salt solution at 8pm. At half past ten at night, mix half a glass of fresh lemon juice with half a glass of olive oil and drink the mixture [2].

According to most anecdotal accounts, such treatments will induce stomach pain and diarrhoea, and by the next morning, the passage of multiple soft green spheroids presumed to be gallstones. Out of curiosity, I have tried the third method once. I did find many floating green stuffs in my stool indeed, but I was not sure what they were.

Plausible mechanism behind

One explanation states that, apple and lemon juices help to soften the gallstones, making them easier to pass through the bile duct [2]. Olive oil is used to trigger the excretion of bile since bile is needed to emulsify ingested fats to assist absorption. With a large amount of olive oil ingested within a short period of time, the continuous excretion of bile will help to flush out the soften gallstones. With the assistance of enema such as Epsom salt, these “stones” will be quickly expelled from the gastrointestinal tract.

Such idea of the dissolution of gallstones is not new, in fact, the idea had been debated in medicine as early as the 17th century! Various chemical substances have been explored for this purpose from mineral waters to lecithin to ether and its derivatives [3]. Of course, apple and lemon juices represent more palatable options. Olive oil has also been used to expel gallstones for a long time, and was discussed and documented in the British Medical Journal during the late 19th century [4,5]. However, the mechanism of treatment has never been studied scientifically.

The case for

Several case reports have been published by doctors in medical journals over the years regarding gallbladder flush. However, most of them were in the form of brief communications stating the observed effect of the treatment without detail data [6–9]. For example, two New York doctors in private practices wrote that they had prescribed gallbladder flushes to their patients for over 20 years, with most cases of symptomatic cholelithiasis (i.e. gallstones) resolved with only one patient in 20 years required surgery. However, they were not interested in reporting their experience in literature [8]. Nevertheless, one case report did document evidence of a reduction in the number of gallstones through ultrasound following the ingestion of olive oil and lemon juice [10].

A preliminary study on the effectiveness of gallbladder flush was reported in a poster presentation at a conference of North American Primary Care Research Group in 1998 [11]. Six patients with symptomatic cholelithiasis completed a three-day treatment protocol and the gallstones collected. Ultrasound was used to monitor before, during, and after the treatment. Five of the patients became symptom-free after the treatment with the follow-up periods ranging from two to 27 months. The treatment did not work for one patient and the patient had surgery to remove the gallbladder one month after the treatment. The investigators believed that, with modifications, this protocol could safely eliminate the need for surgery in many gallstones patients [11]. Unfortunately, the full paper of this study was never published and there was no follow up study to confirm the treatment. Hitherto, there is no credible evidence from any published scientific study to confirm such treatment works.

The case against

Excretion of greenish stones is not evidence. Not all agree that the greenish stones were indeed gallstones. One case study published in The Lancet in 2005 reported the analysis of the greenish stones collected by a 40-year-old patient who was self-treated with gallbladder flush. The stones lacked crystalline structure, composed mainly of fatty acids, melted to an oily green liquid after 10 min at 40^oC, and contained no cholesterol, bilirubin, or calcium. Similar hard and solid stones were recreated in laboratory experiments by the investigators using the mixture of oleic acid (main component of olive oil), lemon juice, potassium hydroxide. Hence, the authors concluded that the greenish stones were merely “soap stones” resulting from the interaction of olive oil, lemon juice and gastric juices. The 40-year-old patient subsequently underwent surgery to remove her gallstones [12].

Unless proven otherwise, at present, the accepted view of the scientific and medical community, even among naturopaths subscribing to evidence-based practice, is that the “stones” produced by the flush are merely an amalgam of the original ingredients ingested, not actual gallstones in the gallbladder [13]. Nonetheless, the possibility that, amid all the amalgams, one or two true stones may present, cannot be ruled out [8]. The case against gallbladder flush is equally weak in the absence of any more rigorous study.

Any potential harm?

Some have suggested that if the gallbladder flush can promote the passage of gallstones, then there is a risk of displaced gallstones to become trapped in the common bile duct leading to a medical emergency [1]. However, such concern is also theoretical, and there is no adverse event report of this nature reported to date in the medical literature. Hence, with the treatment involving the use of only common food items, the gallbladder flush is seemed to be harmless.

Conclusion

Case studies are very poor sources of evidence for evaluation of any treatment, since they are not objectively evaluated and with high risk of bias. With only case studies available, I find neither any credible evidence supports the claim that gallbladder flush can successfully expel gallstones, nor dispel it totally. So, it remains a household remedy that is unproven and will be frowned upon if you talk to your doctor. Exercise your own discretion if you want to give it a try.

References

1. A. Gaby, Nutritional approaches to prevention and treatment of gallstones . PubMed Commons, Altern. Med. Rev. 14 (2009) 258–268. doi:10.1177/1043454204265840.
2. C.-N. Lai, [Return to the joy of the body] (Chinese Edition), Nothern Art Press, Harbin, China, 2010. http://www.bfwy.com.
3. A. Helmstädter, Ether and the chemical-contact dissolution of gallstones, Lancet. 354 (1999) 1376–1377. doi:10.1016/S0140-6736(99)04136-7.
4. W.H. Stephenson, Treatment of gall stones by large doses of olive oil, Br. Med. J. 1 (1895) 1144.
5. J.F. Goodhart, Remarks on Gall Stones and on their Treatment by the Administration of Large Doses of Olive Oil, Br. Med. J. 1 (1892) 219–22.
6. L.J. Kotkas, Spontaneous passage of gallstones, J. R. Soc. Med. 78 (1985) 971.
7. R. Dekkers, Apple juice and the chemical-contact softening of gallstones, Lancet. 354 (1999) 2171.
8. L.L. Issacs, N.J. Gonzalez, More on gallbladder flush, Townsend Lett. 57 (2008) 113–4.
9. E.W. Mcdonagh, Liver Flush : Help or Hoax ?, Orig. Internist. 16 (2009) 193–4.
10. A.P. Savage, T. O’Brien, P.M. Lamont, Case report. Adjuvant herbal treatment for gallstones, Br. J. Surg. 79 (1992) 168–168. doi:10.1002/bjs.1800790224.
11. V. Rose, Conference highlights, Am. Fam. Physician. 57 (1998) 785–786.
12. C.W. Sies, J. Brooker, Could be these gallstones?, Lancet. 365 (2005) 2171. doi:10.1016/S0140-6736(05)66373-8.
13. B. Jason, The liver cleanse and gallbladder flush: separating fact from fiction, Townsend Lett. 56 (2007) 144–146. http://www.townsendletter.com/Dec2007/Dec2007.htm.