Be a Liver Caregiver:The Liver Support Guide

Your annual checkup. Hopefully the doctor says your heart and lungs sound great, as usual. But a seal of approval for your liver? Probably not. Chances are you’ve got nothing to worry about, but it’s all the more reason to provide yourself the best liver support by making the right diet and lifestyle choices every day. Or at least most days. That means less trips to the drive through and more trips to the produce section of the grocery store. Less time on your rear-end and more time on your feet. But that’s not all! Keep reading to learn all you need to know about keeping your liver in prime condition for many years to come.

Liver function

Once you hear about all the critical roles played by the human liver, you’ll quickly understand why it’s the largest and heaviest internal organ in the body. It occupies most of the space in your right-upper abdomen just beneath the rib cage, and weighs more than 3 pounds on average. At any given time, about 13% of your entire blood supply is inside your liver!

When you hear the word “metabolism” think about the liver, because it’s where virtually all the magic happens. Every bite of food. Every sip of drink. Every breath of air. Everything absorbed through the skin. It all passes through the liver eventually.

A healthy liver functions much like a mail sorting facility, separating the useful from the potentially harmful items, packaging and sending them off to the appropriate locations throughout the body. Not only that, but the liver serves as a factory too, using raw materials to produce all kinds of things the body needs to survive. In all, more than 500 separate liver functions have been identified! As well as doing many other jobs, your liver:

• Clears bilirubin, a toxic byproduct of red blood cell turnover
• Neutralizes and helps remove toxic chemicals, drugs and other harmful substances
• Converts ammonia, a toxic byproduct of protein metabolism, to urea for elimination in urine
• Makes a substance called bile, which carries waste products to the GI tract for eventual elimination as feces. It also contains ingredients that aid in the breakdown and digestion of fats.
• Makes proteins such as albumin, which help comprise healthy blood
• Makes certain types of cholesterol (HDL, LDL and others), which help deliver fatty nutrients around the body, as well as remove excessive amounts from the bloodstream
• Makes specialized proteins important in blood clotting
• Helps regulate blood sugar and energy by storing extra sugar (glucose, as glycogen) and converting it back to usable sugar as needed
• Stores vitamins and minerals, such as vitamin D, iron and copper, distributing them when needed
• Regulates amino acids, the individual protein building blocks used in numerous ways around the body
• Plays a key role in the immune system by helping produce and regulate immune factors, as well as remove bacteria from the bloodstream

Indeed, the liver is not only located quite centrally in the body, it plays a central role in maintaining health, while supporting and coordinating with other vital organs in the process. For example, the liver works in tandem with the gastrointestinal system to digest and extract nutrients from food. Then it returns waste products to the intestine (via bile) for elimination. Similarly, the liver teams up with the kidneys to dispose of urea, chemicals and other waste via urine. In tandem with the spleen, the liver acts as a key mediator in the immune system.

The liver sequesters excess fat and cholesterol, offering protection to the heart and blood vessels from cardiovascular disease. And perhaps most important of all, the liver provides direct aid to the brain by ensuring it has enough fuel (glucose or ketones) and also by shielding it against damage from toxic ammonia. (1)

Liver disease

The fact that your liver performs “hazmat” duty has its drawbacks. While it has the capacity to detoxify vast quantities of toxic chemicals, drugs and alcohol as well as saturated fat and cholesterol over a lifetime, your liver does have its breaking point.

The natural response of any living tissue to insult or injury — whether it be external or internal — is inflammation, and the liver is no exception. A number of factors may affect a healthy liver – especially on the long run. Alcohol. Cigarettes. Prescription or recreational drugs. Poor diet. Poor sleep. Lack of exercise. Stress. High blood pressure … As it does, your liver may become slightly tender and enlarged. But, in the early stages you probably won’t feel a thing. For this reason, chronic liver disease is often called a “silent” killer. (2)

But here’s the good news: Your organs have incredible regenerative powers and you can learn how to clean your liver through various methods. In fact, evidence shows that up to 75% of a liver can be surgically removed, and the remnant portion will regrow to its original size within mere weeks. Even with regard to chronic inflammation, if the source of the problem is removed or otherwise addressed early enough, the liver can successfully return to full functioning capacity. (3,4)

On the other hand, a liver under severe duress of inflammation will eventually begin to develop scarring, known as fibrosis. If you’ve ever observed a jar of honey undergo the gradual process of crystallization, you can imagine the liver giving way to fibrosis. The scarred portions of the liver will begin to decline in function at this point, while the remaining healthy portions will redouble their efforts. Granted, it will now take a lot longer, but relatively normal liver function can still return if the damage can be stopped. (5)

If allowed to advance, however, the scar tissue will destroy underlying liver tissue, rendering it useless. This is known as cirrhosis. Once cirrhosis takes over a portion of the liver, it cannot be healed. Blood will not flow to that area and it will effectively die. The progression of cirrhosis can be slowed or even stopped altogether, but if allowed to spread it will eventually shut down all function within the liver, like power to a highrise building being cut off floor by floor until all is dark. At this point a timely liver transplant becomes the only path to survival.

There are a few primary liver conditions that can, and often do, worsen to the point of end-stage liver disease:

Alcoholic cirrhosis – This tends to require large amounts of alcohol consumed over several years. In its early stage, oddly enough the result is fat buildup in the liver, called steatosis — with fat being used as a storage vessel for the toxic byproducts of alcohol metabolism. This actually occurs even with moderate drinking over time. If the person continues drinking to excess, their fatty liver will soon become the target of inflammation, a condition known as steatohepatitis — which quite literally means “fatty, inflamed liver.” As mentioned earlier, despite how bad it sounds, the disease may remain silent even now, and many individuals are fortunate enough never to worsen to the point of feeling acute symptoms. Others, however, will experience degrees of fibrosis — while a smaller, unfortunate subset will develop cirrhosis. Unless the person stops drinking, the final step from cirrhosis to end-stage liver disease is all but inevitable. (6)

Non-alcoholic Fatty Liver Disease (NAFLD) and Non-alcoholic Steatohepatitis (NASH) – Certain individuals may be genetically predisposed to NAFLD, but otherwise it results from poor diet and lifestyle choices. In laboratory animals such as mice, NAFLD is commonly induced (for purposes of studying the disease state) by feeding them a high fat, high sugar diet. Unsurprisingly, these are the same conditions — along with lack of exercise, smoking and other factors — that tend to cause NAFLD in humans.

About one in three Americans is estimated to have some degree of NAFLD. In much the same way as alcoholic cirrhosis, NAFLD may begin with a fatty liver, followed by increasing levels of inflammation and possibly fibrosis. This is the point at which the condition evolves to NASH. In severe cases, the disease may progress further to cirrhosis and even total liver failure. Previously a liver biopsy was required to diagnose NAFLD, but new non-invasive techniques similar to ultrasound can now help with diagnosis even in the early stages. (7-10)

Again, the “silent” nature of liver disease can be a blessing and a curse, depending on how you look at it. On one hand, a person can live without the burden of symptoms for many years — yet once those symptoms do finally appear, the disease has often irrevocably damaged portions of the liver. Chronic problems with digestion and bowel movements, along with abdominal pain and/or tenderness may be among the earliest signs of liver trouble — and warrant a doctor’s appointment right away. If on the other hand you experience these symptoms of advanced liver disease, get medical attention immediately:

• Confusion, problems with memory or concentration, other mental impairment — which may signal hepatic encephalopathy, whereby the liver cannot properly dispose of ammonia and it begins to poison the brain
• Yellowish eyes and skin (jaundice)
• Swelling of the abdomen (ascites) or lower extremities (edema)
• Blood in vomit or dark, tarry stools — either of which may be a sign of esophageal varices, whereby blood flow to the liver backs up, causing vessels to bulge and sometimes rupture
• Easy bruising or excessive bleeding (11,12)

Other liver diseases include:

Hepatitis A – Viral infection that can be spread from person to person by anything contaminated with infected stool, typically food or water. Hepatitis A is an acute illness but, if you know how to heal your liver, it will go away in a few weeks. Since the Hepatitis A vaccine became available in 1995, the disease has become extremely rare in developed countries.

Hepatitis B and C – Viral infections that can be acute or chronic, causing inflammation of the liver and, if left untreated, can progress to cirrhosis and end-stage liver disease. They can be transmitted from person to person by blood or, in the case of Hepatitis B, semen and other bodily fluids as well. An effective vaccine exists for Hepatitis B, but not for Hepatitis C.

Autoimmune Hepatitis – Inflammation of the liver caused by the body’s immune system inappropriately attacking liver cells. If left untreated can progress to cirrhosis.

Symptoms of hepatitis tend to be the same, including:

• Abdominal pain
• Nausea / Vomiting
• Fever
• Dark urine
• Grayish stool
• Jaundice (yellow hue to eyes and skin)

 Hemochromatosis – A condition whereby the body becomes overloaded with iron. Those affected usually have a genetic predisposition and/or chronic anemia that requires frequent blood transfusions. Symptoms include:

• Fatigue
• Weight loss
• Arthritis (joint pain)
• Abdominal pain
• Bronze or grayish hue to skin
• Low libido (sex drive)

Biliary Atresia – A condition affecting infants whereby the biliary tube are sealed off by scar tissue, thus preventing bile from flowing out of the liver as normal. The backflow of bile can damage the liver and ultimately cause cirrhosis if not treated promptly. Biliary atresia most often presents by six weeks of age, with jaundice as the tell-tale sign. Due to modern advances in surgery and transplant, between 80-90% of infants with biliary atresia survive to adulthood. (13)

How to prevent liver disease

Now that you understand how this wonder-organ works and which are its main enemies, there’s one thing left to find out: how to heal your liver and prevent diseases.When it comes to providing yourself the best long-term liver support, there are no shortcuts, unfortunately. It comes down to making the necessary changes to your lifestyle, such as adopting an effective liver detox diet. The diet part is relatively simple, but may not be easy (more about that soon). Same with the lifestyle part. Though here, the term “quick-fix” certainly does apply.

Do you want to know how to heal your liver? Then stop smoking. Drink too much? Stop that too. Again, not necessary an easy fix, but rather a quick liver cleansing method — assuming you’re a “cold turkey” type of person. If not, it may take a bit longer, but any effort to adopt a liver cleanse diet and lifestyle will still pay tremendous dividends for your overall health. Here’s a more detailed list of lifestyle factors you can get to work on today:

• Quit smoking – Studies suggest that if you smoke, and the more you smoke, your chances of developing fatty liver disease (NAFLD) are much higher. (14)
• Limit alcohol intake – General consensus is to advise a limit of one drink per day for women, and two drinks per day for men, up to age 65. Thereafter it’s one drink for men, as well.
• Maintain your weight in a healthy range – If you’re unsure about your weight, calculate your body mass index (BMI) and shoot for the normal range of 18.5-24.9. This is a crucial step that makes any liver detox diet much easier.
• Limit your exposure to chemicals and other toxins –  If you want to know how to clean your liver, here’s a way: wear a filtration mask, gloves and other protective clothing when working with pesticides, herbicides, paint thinners and other hazardous materials. Spend less time outside during “smog warnings” or high pollution days, if possible.
• Do not share needles – Regardless of whether you’re injecting a prescription drug like insulin or an illicit drug like heroin (hopefully not), reusing a needle from somebody else poses a risk of contracting hepatitis viruses.
• Know your tattoo artist – If you choose to get tattoos, take care to ensure the establishment follows safe practices and has been inspected by the appropriate health authorities.
• Practice safe sex – Some hepatitis viruses can be spread by bodily fluids other than blood, so always use a condom if there’s any doubt about your partner’s status.
• Be careful with drugs – Any drug is going to put some degree of stress on your liver. So only take prescription medicines as advised by your doctor, according to the directions. If it says not to mix with alcohol (most do) or other drugs, take this warning seriously. Use over-the-counter drugs per label directions as well, especially acetaminophen (Tylenol). (15)

 

Liver support diet

As discussed previously the liver is a major repository for fat, which has the potential to cause inflammation, leading to chronic liver disease. Given that’s a situation you want to avoid, adopting a diet rich in liver detox foods is essential.

Without question, fatty liver is a metabolic disease. It’s strongly associated with both obesity and insulin resistance (pre-diabetes or diabetes), so there’s also no doubt that diet and lifestyle modifications are the very best path to prevention. Indeed there’s a mountain of scientific evidence to show that two dietary factors in particular massively increase risk for fatty liver disease.

Saturated fat – This is the type of fat contained in (non-seafood) animal products such as beef, pork and dairy, including butter and cheese. Processed meats like hot dogs, bologna and sausage are especially high in saturated fat, along with many baked goods like donuts, pastries and muffins. (16,17,18)

Healthy sources of fat accepted in a liver cleansing diet include fish, nuts, seeds, avocados and olive oil, which happen to be staples of the Mediterranean diet.

Added sugars, especially fructose – Keep in mind that any sugar your body does not immediately need will be stored as glycogen in your muscles and liver. Yet those glycogen reserves are quite small. Once full, any extra sugar becomes fat in your liver. For most people, sugar requirements are quite small. In fact, it’s possible to survive — and some would argue, to thrive — on a diet very low in all forms of sugar (carbohydrates). This is often called a ketogenic diet, because it requires the liver to produce ketones, a substance that your body can burn for energy similar to sugar.

It’s not essential that you convert to a ketogenic diet, however, in order to reach a healthy liver cleanse diet. For sure, any reduction in sugar intake will help — in particular soft drinks, fruit juices and sweets that are high in fructose (often as high fructose corn syrup). (19–23)

The best carbohydrate sources include vegetables (other than white potatoes, corn and peas), fruits, legumes and whole grains. Coincidentally, these also happen to be common components of the Mediterranean diet.

Another reason the Mediterranean diet may be so effective in preventing fatty liver disease is the fact that it also tends to promote a healthy gut. We know that an unhealthy gut — that is, one without the proper balance of good bacteria — is often a “leaky gut.” And we further know a leaky gut creates inflammation throughout the body, including the liver, thus increasing the risk for liver disease. As a result, maintaining a healthy gut with a high fiber diet, along with probiotic foods such as low fat yogurt and fermented vegetables (kimchi, sauerkraut, etc.) is likely beneficial. (24–27)

Beyond that, it may come as a great relief to you that both coffee and tea (especially green tea) have demonstrated to be a good natural liver detox method — so drink up! (28–34)

 

Liver supplements

Once again, the foundation of lifelong liver support is a healthy diet and clean, active lifestyle. No amount of supplements will rescue you if this advice falls on deaf ears! If you want to know how to detox your liver, there are some liver supplements you may consider as an enhancement to your other fine efforts.

Dandelion Root Extract – This plant has been known for centuries, not only for it’s cute yellow flowers but it’s nutritious greens and medicinal properties. When given to laboratory animals poisoned with acetaminophen (Tylenol) and lead, dandelion helped protect the liver against critical damage. It has also been shown to alleviate oxidative stress from alcohol and slow the advancement of fatty liver disease. (35–38)

Milk Thistle Extract – Silymarin, the bioactive component of milk thistle, helps lower fasting glucose and triglyceride levels, these being two key aspects of metabolic syndrome and liver detox foods. Moreover, in a study of patients with alcoholic cirrhosis, those who took silymarin lived significantly longer than those who took a placebo instead. (39,40)

Chlorella – Called a “superfood” for good reason due to its impressive array of vitamins, minerals, omega-3s and antioxidants, this green algae has shown great promise among liver supplements. In studies it has demonstrated ability to help lower cholesterol, triglycerides, blood sugar and liver function tests — while possibly even promoting weight loss too. (41,42,43)

Alpha Lipoic Acid (ALA) – Known for decades as a potent antioxidant capable of defending cells against free radicals, evidence also suggests ALA may be worth adding to your natural liver detox package. Several studies have concluded that ALA can help protect the liver against chemical toxicity and fibrosis, as well as improve insulin sensitivity and inflammatory markers. (44–47)

As an honorable mention, some evidence has shown that anti-inflammatory supplements such as curcumin, and also gut nourishing amino acids such as glutamine and arginine, may have a positive effect on liver function by way of reducing inflammation, gut permeability and bacterial translocation from the GI tract. (48,49,50)

Given that these are all natural remedies, you may think you know how to detox your liver right at home. However, it’s always best to consult with a doctor, pharmacist or registered dietitian before taking any liver supplements — especially if you take prescription medicines.

 

Gallbladder function

Sitting between the liver and small intestine, the gallbladder is a pear-shaped organ measuring about 7-10 cm long and 5 cm wide. It’s often regarded as merely a hollow sack for temporary storage of bile acids produced by the liver, but really it’s so much more. Using hormonal receptors, the gallbladder empties and refills itself according to well-orchestrated endocrine signals. It also contributes to the makeup of bile, specifically by producing substances (bicarbonate and mucin) that help protect intestinal cells from the harsh acidity of bile fluid.

Bile acids passing through the gallbladder also contain high concentrations of cholesterol and other waste products tagged for elimination from the body. The downside of cholesterol, being a waxy type of substance, is that it often clumps together to form what are commonly known as gallstones. In fact, evidence shows that of all patients known to have gallstones, 80% have cholesterol-based stones. (51)

While removal of the gallbladder is necessary in certain situations, the fact remains that individuals without a gallbladder are at higher risk for fatty liver disease, cirrhosis and intestinal cancer. This is believed to be due to the higher degree of recirculation of bile acids in those having had a gallbladder removal procedure (cholecystectomy). (52,53)

 

Gallbladder disease

The more cholesterol and other waste products you have exiting the liver via the biliary system, the thicker and more sludge-like the bile becomes. As it collects in the gallbladder, this tends to be an environment rife for infection, as well as the formation of gallstones. In turn, sludgy bile and more often gallstones themselves may clog the biliary tubes and trigger inflammation, a hallmark of gallbladder problems. (54,55)

The condition whereby the gallbladder itself becomes infected and inflamed is called cholecystitis — again, most often caused by a blockage in the flow of bile. While less common, a tumor or biliary defect may cause this type of problem also. (56)

If there’s good news in all of this, it’s that most people with gallbladder disease do not experience any acute gallstone symptoms, such as:

• Nausea/Vomiting
• Abdominal pain and/or tenderness (usually on the right side)
• Pain radiating to the back or shoulder
• Fever

If you experience gallstone symptoms, in particular if they get worse during or after a meal and are more concerning than typical indigestion, you should see your doctor. Ignoring symptomatic gallbladder disease can cause acute pancreatitis in rare cases, which often requires urgent care. (57,58,59)

How to prevent gallbladder disease

There’s more at stake in preventing gallbladder health problems than just avoiding a surgery to remove your gallbladder. Individuals who develop gallbladder illnesses are more likely to get heart disease and cancer — not to mention the fact that, on average, they die sooner than those without gallbladder problems.

Also, given the constellation of other health problems linked to both liver disease and gallbladder issues, employing good liver support and gallbladder support practices is virtually guaranteed to make you healthier overall.

Risk factors for gallbladder issues include:

• Obesity
• Insulin resistance / Diabetes
• High cholesterol
• High triglycerides
• High blood pressure
• Altered / Unhealthy gut bacteria
• Chronic inflammation
• Low physical activity
• Exposure to chemicals (i.e. herbicides, pesticides, industrial)
• Exposure to heavy metals (i.e. mercury, lead, cadmium) (60–76)

 

Gallbladder diet

Because gallbladder function is so interdependent upon liver function, it should come as no surprise that the dietary recommendations for gallbladder support and liver support are virtually identical. To review, your first goal is to reduce intake of saturated fat and trans fat while increasing consumption of polyunsaturated, monounsaturated and omega-3 fats with foods such as:

• Vegetable oils such as olive, sunflower and flax (do not cook with flax)
• Fish, especially fatty cold-water fish such as salmon, cod, herring, mahi mahi and tuna
• Avocados
• Nuts such as walnuts, cashews and pecans
• Seeds such as pumpkin, sunflower and chia

Next, cut out refined sugars, especially fructose, from soda, fruit juice, baked goods, sweets, and other processed foods. Replace these with high-fiber carbohydrate sources like:

• Vegetables such as broccoli, artichokes, Swiss chard and sweet potatoes
• Fruits such as berries, kiwi, apples, pears and oranges
• Whole grains such as barley, spelt, oats and quinoa

Normally, legumes would make this list as well, however there is some evidence legumes are associated with increased gallstones. The data is largely inconclusive, so it’s not necessary to omit legumes from your diet if you enjoy them. Likewise, following a vegetarian diet may further help to prevent gallstones, but likely a Mediterranean style diet high in vegetables and low in red and processed meat will be enough. With regard to meal frequency, it’s generally best not to skip meals — but not to eat constantly throughout the day either. (77–83)

If you’re the type of person who needs a strong cup of (caffeinated) coffee to get going, great news here. Drinking two or more cups of coffee per day has been associated with significantly lower risk for gallbladder health problems. This effect was not seen with decaffeinated coffee, leading to the conclusion that the caffeine itself may be responsible for the benefits. (84,85)

Finally, if you’re someone who experiences occasional flare-ups of mild gallstone symptoms (see section above), it’s possible you may suffer from food allergies or intolerances. Certain foods may cause your gallbladder to empty slower or develop stones more rapidly. The most common offenders are eggs, pork, onions, milk and poultry (chicken, turkey, etc.). (86)

You may consider trying an elimination diet to see if this improves your gallstone symptoms. This means eliminating a number of foods, such as those just mentioned, for a period of time. Then you’ll reintroduce foods one at a time, perhaps one food per week, taking careful note of how your body responds. During reintroduction it can also be quite useful to try the suspect foods by themselves, for example eating a breakfast of only eggs, or a dinner of simple baked chicken with no sides. This takes time, patience and attention to detail, but can be very worthwhile — especially if it prevents unnecessary removal of your gallbladder!

 

Gallbladder supplements

After you’ve addressed your diet, it’s worth considering some gallbladder supplements that may help to prevent gallbladder disease.

Soy Lecithin – a few very small studies have shown soy lecithin supplementation may slow the development of gallstones. (87,88,89)

Rowachol – A combination of six plant extracts, this is one of the few natural compounds shown in clinical trials to dissolve gallstones. It does so by stimulating bile production in the liver and also inhibiting the crystallization of biliary cholesterol. (90–93)

Vitamin C – Some evidence shows an inverse relationship between vitamin C intake and incidence of gallstones. That is, individuals with higher intakes of vitamin C tend to have fewer gallstones. However, more research is needed on dosage and outcomes before a health practitioners may confidently recommend vitamin C for the treatment of gallstones. (94–97)

Fenugreek – Commonly used in Indian cuisine, this herb has not been widely studied for its medicinal properties — although some encouraging science suggests it may help in preventing gallstones. (98–101)

d-Limonene – An active ingredient in citrus oils such as orange, lemon, lime and grapefruit. Some laboratory experiments have demonstrated an ability to dissolve cholesterol gallstones. (102,103,104)

Psyllium Husk – This one might be overkill if your diet is already high in fiber-rich foods such as vegetables, fruits, whole grains, legumes, nuts and seeds. But if not, or you struggle with high cholesterol, psyllium just might be worth adding to your list of gallbladder supplements. (105,106,107)

Turmeric/Curcumin – For you “health nuts” out there, no doubt this yellow spice hit your radar screen years ago, and you may be thinking, What can turmeric NOT do? Well, guess what, possibly by virtue of its anti-inflammatory prowess turmeric likely will help prevent gallstones and gallbladder disease, as well! If you’re not already taking it … what are you waiting for? (108,109,110)

 

Alternative therapies

So you’ve gotten your diet in ship shape. Made some much-needed lifestyle changes. Stocked up on gallbladder supplements … what else can you do to maintain good gallbladder function and ward off disease?

A large number of alternative therapies fall under the umbrella of a so-called “gallbladder flush.” That is, a means of flushing sludge and gallstones out of the body — also sometimes referred to as a “gallbladder cleanse.” While it’s certainly possible some of these techniques have benefits (from placebo effect, if nothing else), according to the Mayo Clinic there is no reliable scientific evidence to support the use of these programs. (111)

In studies of those engaged in gallbladder flushes, analysis of passed stool failed to show any material resembling gallstones at all. Instead, they did find “soap stones” formed by the chemical reaction between flush ingredients (olive oil, lemon juice, etc.) and digestive juices. On the other hand, at least one case report showed a reduction of gallstones on ultrasound after a liver flush program was completed. And needless to say there are also many anecdotal (word-of-mouth) reports of gallstone symptoms resolving after a liver flush or series of flushes. (112,113,114)

Common ingredients in gallbladder flushes include:

Apple Juice / Malic acid — Malic acid, which is found in apples, is widely claimed to “dissolve” gallstones. As such, many so-called “gallbladder flush” home remedies include apple juice and/or malic acid supplements. According to the late author and alternative health practitioner Andreas Moritz, malic acid “softens any stone in the body and makes their passage through the bile ducts (or uretha) easy.” His liver and gallbladder flush protocol involves consuming large quantities of apple juice, along with Epsom salts, olive oil and grapefruit over the course of seven days. Unfortunately there is no scientific evidence to support his claims. In fact, consuming large amounts of sugary apple juice may do more harm than good. (115,116,117)

Olive oil – A component of many gallbladder flush programs, likely because it’s a healthy fat source known to stimulate bile flow. In promoting his own gallbladder flush program, chiropractor and author John Douillard points out that “using olive oil to successfully flush the gallbladder first appeared in the British Medical Journal in 1882 and 1885.” While some slightly more contemporary literature points to regular olive oil consumption as a potential mitigating factor for gallstones, the evidence for its use as part of an intermittent “flushing” protocol is soundly lacking. (118,119,120)

Lemon juice – High in citric acid, lemon juice is believed to help dissolve gallstones in much the same way malic acid is purported to do. For this reason, and likely due to it’s pleasant flavor, lemon is a staple in most gallbladder flushes, including that offered by Hulda Clark, PhD.

Grapefruit – Another good source of citric acid, grapefruit is another ingredient of gallbladder flushes often substituted for lemon or apple.

Rosemary oil – This essential oil is promoted by chiropractor “Doctor” Josh Axe and others as a liver and gallbladder tonic. It has been demonstrated to increase bile flow in animals, yet has never been proven to successfully treat liver or gallbladder problems in humans.

Bile salts — For decades ursodeoxycholic acid (UDCA) or ursodiol has been used to treat primary biliary cholangitis and also more experimentally in the treatment and prevention of gallstones. UDCA dosed at 13-15 mg/kg/day has been shown to have a positive effect on liver function and may help slow the progression of liver disease toward cirrhosis. (121,122)

Some patients with gallstones have reportedly seen positive results from using UDCA, namely avoiding acute complications. However, this evidence is not highly convincing and still subject to much debate. (123)