Adie-hard fan of deep-fried nibbles, Sirima Mongkolkulasat was recently diagnosed with a fatty liver _ a condition that often left her with lingering fatigue and could potentially lead to cirrhosis if left unattended. But instead of bidding farewell to the overly greasy snacks for good, Sirima had her own alternative.
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"It was like I got my liver thoroughly washed," recalled the 35-year-old office lady of the three-day detoxification course she attended a few months ago at a centre in Pathum Thani. "During the treatment, I wasn't allowed to eat anything. I could only to drink several types of herbal tea and fruit juice. The therapy also included an enema twice a day."
According to Sirima, the liver detox began with an initial physical examination. After that, each participant was given a big glass mug to use during the entire programme. With that mug, everybody was encouraged to drink several types of herbal tea and fruit juice, including tamarind, apple and lemon juice, and papaya tea. At designated times, they were also asked to drink an Epsom salt drink and 150ml of olive oil.
"There were green lumps coming with the stool. The sizes and the number of these lumps vary with each individual," Sirima explained. "And the green lumps, we were told, were gallstones."
These days, liver detoxification programmes are widely promoted _ especially in online advertisements _ as an alternative recipe to a healthier liver and the overall good health.
Although steps are different from one detox centre to another, most health-conscious participants are required to do the same thing: abstain from eating food. Only juice, herbal tea, olive oil and an Epsom salt drink is allowed. An enema is carried out several times a day after which the waste will be carefully examined. In most cases, green lumpy substances thought to be gallstones from gallbladder are spotted.
According to gastroenterologist and hepatologist Asst Prof Yudhtana Sattawatthamrong, medically speaking, it is very unlikely for the green lumpy chunks _ either big or tiny _ to simply come out from the gallbladder through the bile duct, which is approximately only 2-4mm in diameter.
''In normal circumstances, if gallstones are detected in a patient, they will not naturally come out through the bile duct. Even if they do make their way out without medical treatments or surgery, patients will suffer severe abdominal pain.
''Unfortunately if the stone obstructs the bile duct, it will cause jaundice because of the inability of the body to get rid of the bile,'' Dr Yudhtana explained.
Gastroenterologist Dr Surasak Aekpongpaisit shared the same view. The green lumpy substances cannot be scientifically identified as gallstones. ''Liver detox programmes claim they are able to remove gallstones from the gallbladder through the bile duct. But through the entire process when the gallstones move from the gallbladder, patients will suffer almost unbearable pain. To my knowledge, there is no report of someone with severe pain during liver detox. And the green lumps are from 4mm to 1cm in size and it is not possible that lumps of such size will come out through the very tiny bile duct,'' Dr Surasak added.
If the green substances are not gallstones, then what are they?
Dr Yudhtana explained that the formation of the green lumps that are spotted in the stool of liver detox participants is in fact caused by a chemical reaction called saponification. Saponification occurs when fat is mixed with a base. The result is a soap-like substance.
''At some point in the programme, you drink Epsom salts and some good amount of olive oil,'' said the liver specialist. ''Epsom salt is a base. When fat from the olive oil mixes with a base, it produces soap. And it comes out green because it blends with the bile naturally released from the body.''
While both Dr Yudhtana and Dr Surasak affirms the unlikelihood of the liver detox to get rid of gallstones, does the programme, which costs up to 3,500 baht for a three-day course, detoxify the liver at all?
The therapy, Dr Yudhtana said, does nothing to the liver. But what it does is to cleanse the intestines.
''Look at what people are served during the treatment,'' he said. ''The programme involves the consumption of, apart from an Epsom salt drink and olive oil, apple cider, several kinds of herbal teas and fresh fruits. These things are known to be able to trigger bowel movements. As a result, participants excrete several times a day. What comes out is waste from the intestinal walls. So basically, it cleans the intestines, not the liver.''
And although a liver detox is only seen as an alternative approach, Dr Surasak has a word of warning for those opting for the therapy.
''If you suffer any kidney-related abnormalities, you should not undergo liver detox,'' the said. ''During the programme, you will be asked to eat a lot of fruit and drink a large amount of juice. If your kidney does not function properly, your body will not be able to get rid of excessive amounts of certain types of minerals, which may potentially bring about mineral imbalance. Also if you fall prey to any chronic diseases, you should discuss with your physician before deciding to attend the programme.
''There was this one patient who was earlier diagnosed as having gallstones and decided to sign in for liver detox,'' the doctor recounted. ''After returning from the treatment, this patient came for an X-ray. It turned out that there was no change in the gallstones both in numbers and in size. So if you hope the detox will help remove gallstones, you are absolutely wrong.''
During a cleansing programme, participants are required to consume olive oil. After the oil mixes with Epsom salts, taken earlier, it causes a reaction called saponification. The soap-like lumps that come with the stool are misunderstood as gallstones.
FLUSHING THE SYSTEM
The liver plays a major role in the body's detoxification process. After the prism-shaped organ receives blood that transports digested nutrients from the intestines, it checks for toxic substances. If these are found, the liver detoxifies to get rid of the poison. The organ may then deactivate the substances so they do not create unwanted effects.
The body may sometimes receive more toxins than the liver is able to get rid of, and in such cases, medication may be needed.
An example is an overdose of paracetamol. Too much can cause severe damage to the liver cells. To fix it, a patient requires a certain type of drug which will turn the paracetamol into a non-toxic form.
"Doctors need to know what kind of toxin the body has received so they can prescribe the right medication to tackle it," said gastroenterologist Dr Surasak Aekpongpaisit. "When it comes to washing away toxic substances from the body, there is no such thing as a universal drug."
In patients who suffer severe liver damage, a specialist might consider using dialysis _ a detoxification treatment for liver failure. However, this method of treatment is only considered a temporary solution to prolong the patient's life until a transplant can be performed.
In order to maintain a healthy liver, Dr Surasak suggested that there is no better way than living in moderation.
"Some types of dietary supplements have been thought to help enhance liver function," he commented. "But many of them are yet to be medically proven, so the best way is to avoid things that could damage the liver, including the overuse and overdose of medication, alcoholic beverages and food that may contain aflatoxins such as peanuts, and ground pepper or rice that are not stored in a dry place.
"Eating or drinking too much of something in the hope they can strengthen or clean the liver might do more harm than good," the specialist added. "If you eat too much fruit, for example, your body will receive too much sugar. So my advice is to get enough rest, drink enough water and eat the right balance of food each day. This allows the liver to function as it naturally does and you will not put yourself at risk of developing an imbalance inside your body."
If not stored in a dry place, peanuts, ground chilli pepper and rice can produce a fungus, which in turn creates aflatoxins. The toxic substance is a potential cause of liver cancer.