those are NOT gallstones, or:

"why liver/gallbladder flushes
don't work like they say
and could possibly harm you"

There's a subset of natural health enthusiasts who behave as though they feel that the first, and often best, strategy that can be taken to restore health is to cleanse, flush and purge.

I'm not one of those people. I'd rather start with nourishment, with activity, with gentle approaches taken before forceful ones whenever appropriate. Yes, absolutely, I'll use strong herbs when necessary, and I'll most certainly take advantage of the body's natural pathways of elimination if I need to remove obstacles that may stand in the way of what I'm trying to facilitate (a great article by Ryn & Katja at Commonwealth Herbs on approaching that more vitally here).

But, when this happens, I do it with sense. I'll educate myself, so I don't proceed on inaccurate assumptions, even if these can be found in some herb books by otherwise good herbalists or other holistic practitioners.

One area where I am constantly seeing problems related to people taking inaccurate information as truth and then developing a course of action based on this is the will-it-ever-go-away practice of liver cleansing/gall bladder flushing. This usually entails mixing some sour citrus juice (commonly lemon or grapefruit) with a too large quantity of olive oil and ingesting a whole bunch of it at a time. Sometimes people add garlic or cayenne to this. I'm sure there are infinite variations by now.

The purpose of this is to "cleanse the liver" (though the liver does not store toxins and doesn't really need any kind of cleansing) or to "remove gallstones". Removing "gallstones" has really caught on, because most people who try this will, as that super citrus oil potion works its way through you, pass a bunch of solid material that looks like this:

or this:

Seeing and feeling (really, really, viscerally feeling) those things come out of you makes for pretty good proof, right?

Well... proof that the "flush" did get stuff out of you, but not what.

I first heard about liver/gallbladder flushes in the early 90s, right when I got into herbalism. Some friends had tried it and suggested it but they looked pretty... miserable during it. It didn't make for a convincing sell.

Some years later, the renown herbalist Michael Moore (not the movie guy) wrote on Henriette Kress's herblist of "gallbladder flushes":

"In the early 1980s, after recommending and teaching Robert's protocol, a PhD physiologist STRONGLY suggested that these "stones" were probably artifacts of the therapy. The next time someone passed some, I took them in a cooler to a local Santa Fe medical lab I had a working relationship with. They showed only traces of chenic and cholic bile salts, and had no discernable cholesterol content. Their educated guess was that they were saponified fatty acids...probably linoleic or oleic acid salts. They were DEFINITELY not "gallstones". I have not recommended this grim regimen since...

Robert's protocol seems to result in the consistent passing of "stones" consisting of saponified olive oil, acted on as well as possible by the stressed digestive apparatus.

That doesn't mean that the shocked pancreas and gall bladder don't, on occasion, vomit out a small cholesterol stone. But, as anyone who has worked with cholelithiasis will vouch, this is risky stuff, since an obstruction by a REAL stone of the biliary duct or common duct from the gall bladder spasms may be just as likely. Most gallstones exist WITHOUT symptoms. Most obstructions require surgery."

So, yeah: those things aren't gallstones.

These things are (shown inside an actual gallbladder):

The large, yellow stone is largely cholesterol,
while the green-to-brown stones are mostly composed of bile pigments

Of course, though, people still insist that these are gallstones; after all, this is just some random guy's post (if you don't know me). Why should they trust me?

Maybe because this stance backed up by an actual chemical analysis of "liver flushed stones", published in 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. 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”.

The cholesterol stones noted on ultrasound were removed by surgery."

Alas, still, despite reading this, some people will still insist that the stuff they passed are legitimate gallstones. One person told me that The Lancet was controlled by "Big Pharma" and was surprised I would believe anything in there.

Okay, so yeah: The Lancet isn't my go-to source for info (though it does have some useful info if you look for it), but this is simple material analysis. And, it reflects the findings of Moore and other herbalists I've known who have also tested these "stones".

Ultimately, we need to understand that these stones are created by the "flush" itself. Kind of like how the mucoid plaque pictured in colon cleanse advertisements is also created by the practice said to "cleanse" it out of you (in that case, usually through a mixture of fiber and clay).

But still people choose to do this, usually because of some testimonial or claims from someone pitching ways to "detox". Olive oil and citrus juice are natural, after all, and can't hurt, right?

Well, it doesn't always, but it does sometimes. Consumption of oil stimulates the release of bile from the gallbladder, because bile is required to emulsify oils for digestion by pancreatic enzymes. Consume a lot of oil in one go, and you're asking a lot of the gallbladder. If you're doing this because your gallbladder is in some way stressed and giving you problems, you're asking a lot of a stressed gallbladder. And if you do have actual gallstones (which are really very common and largely don't produce any symptoms at all), there is a possibility that a strong gallbladder purge could evacuate a stone into the bile duct, and in doing so, there's a potential that it can pass out of you, for sure... but it could also cause an obstruction, which is not good at all. If your bile duct is already obstructed and that's why you feel miserable, it can cause severe complications. If the bile duct becomes obstructed, bile can back up into the liver (very bad) or pancreas (potentially life threatening).

Paul Bergner wrote in Medical Herbalism:

"A traditional remedy for sluggish liver is the “liver flush” comprising a tablespoon of olive oil and the juice of a lemon, sometimes with a pinch of cayenne pepper. A more vigorous application, with a pint of olive oil and the juice of ten lemons has been used to “expel gallstones.” There are many stories of the patient passing “gallstones” after such a treatment, but whenever the stones themselves have been carefully examined, they have not been gallstones but either intestinal cystoliths or emulsified oil.

Either treatment can be risky with gallstones, however. It is not uncommon for a fatty meal to provoke a gallbladder crisis and a trip to the hospital. Large amounts of olive oil might do the same.

We have received two cases reports of gall bladder crisis required emergency cholecystectomy, induced by a liver flush flushing a stone into the gall duct and causing its blockage."

A client of mine shared:

"I tried this a few times and had a horrific experience - 3 day attack ending in pancreatitis, 8 days of IV nutrition followed by surgery, an extreme example but man it sure sucked!"

Ryn and Katja at Commonwealth Herbs address this on a less extreme and more contextual level:

"...somewhat less drastic, nominally natural approaches (coffee enema, olive oil & grapefruit juice "gallbladder flush") – even if they did in fact work as claimed – would be forcing along a process of excretion via hyperstimulation. by design, that's overruling the efforts of the organizing principles of life, favoring mechanistic extraction – but we are organisms, not mechanisms."

If you have gallbladder issues, it's a really good idea to go and get an ultrasound to make sure there are no blockages (especially, and ASAP, if your stool has lost its color), and that will help you decide what kinds of treatment may be appropriate. Largely, this is to rule out any immediate threats to the liver or pancreas (pancreatitis is VERY dangerous). For treating acute gallbladder attacks, I've had good results suggesting wild yam tincture or decoction, which is an anti-spasmodic and anti-inflammatory, not something that "purges" stones. The regular use of bitters as foods and tinctures, while contraindicated in an acute crisis (until you rule out blockage), is often an excellent long term strategy.

Despite the seeming universal assumption, it's my strong opinion that gallbladder attacks are not caused by stones (though the presence of stones can certainly complicate gallbladder attacks). My clients have been about 50/50: half had stones confirmed by an ultrasound, half had no stones confirmed by an ultrasound. If stones are causing gallbladder attacks, what's causing them in the people to don't have them? I propose inflammation and spasm in the bile duct. I have clients with stones who I suggested wild yam for who recovered completely from their gallbladder crisis without passing or needing to address the presence of stones at all.

So, to review:

Gallbladder flushes don't flush out gallstones, they create soap balls in your GI tract.
Gallbladder flushes are harsh on your body.
Gallbladder flushes may remove stones, though in the process may create (and have created) acute health crises that required surgery.
Gallbladder flushes also just kinda make you feel lousy and give you super loose, messy stools.

Why do that?

My strong encouragement is don't.