Liver and gallbladder flushes

1. Introduction

Version followed: the liver and gallbladder flush as presented in Andreas Moritz's The Amazing Liver and Gallbladder Flush (expanded edition, self-published, released 1 October 2012), with the general description of "gallbladder cleanses" given by Mayo Clinic and Full Fact. The psychotherapist works alongside this practice and never performs, sells, prescribes or recommends it.

What it is, as its promoters present it. A liver and gallbladder flush (also called a liver cleanse or gallbladder cleanse) is a home procedure that promoters say makes the gallbladder and bile ducts expel stones, which then appear in the stool. Moritz's publisher describes stones in the liver's bile ducts as "the most common but rarely recognized cause of illness", says these are mainly clumps of hardened bile that X-ray, ultrasound and CT cannot detect, and links them to conditions including obesity, diabetes, heart disease and cancer; the book offers home removal methods, prevention guidance and a wider programme based on Ayurveda [source: OverDrive publisher description; Smashwords author profile]. Social-media versions also claim effects on eye floaters and shoulder pain [source: Full Fact]. Hulda Clark is often linked with a liver cleanse within her parasite theory of disease [uncertain: not verified]; her parasite cleanse and "zapper" device are described in section 4.9.

Core idea of how change happens (attributed). Promoters hold that illness follows from congestion of the bile ducts by stones and that expelling the stones restores liver function and health; the visible green lumps passed afterwards are taken as proof that stones have left the body [source: OverDrive description; Full Fact; Mayo Clinic].

Founder. Andreas Moritz (born 1954, south-west Germany; died October 2012) described himself as a medical intuitive and practitioner of Ayurveda, iridology, shiatsu and vibrational medicine, and wrote 16 books on health and spirituality; his materials remain available through the Ener-Chi Wellness Center [source: Smashwords author profile].

What a client experiences, as sources describe it (qualitative only). A preparatory period of dietary change, then the flush itself, in which the person takes a series of drinks; afterwards the person passes diarrhoea containing soft green lumps [source: Mayo Clinic; Full Fact]. Common effects during the flush: nausea, vomiting, diarrhoea and abdominal pain [source: Mayo Clinic].

What the "stones" are. A 2005 letter in The Lancet reported a person who passed multiple semisolid green "stones" after a liver-cleansing regime; analysis found no crystalline structure and no cholesterol, bilirubin or calcium, and a mixture of the main fatty acid of olive oil with lemon juice produced similar balls, consistent with the lumps forming from the oil itself ("soap stones") [source: Full Fact, summarising the Lancet letter; bibliographic details Sies CW, Brooker J, Lancet 2005;365:1388: uncertain: secondary, unverified]. Mayo Clinic describes the material as globs of oil, juice and other substances [source: Mayo Clinic]. Herbalists who once taught a flush reported the same finding from laboratory analysis and some stopped recommending it [source: Henriette's Herbal FAQ].

Who practises it. Mainly self-administered at home from books, websites and social media; also suggested by some naturopaths and herbalists [source: Full Fact; Henriette's Herbal FAQ; Science Media Centre].

Regulation and licensing. The flush is a self-administered regime, not a licensed medical treatment or a regulated profession in itself [uncertain: not verified]. Practitioners who suggest it are regulated only as their own profession is (for example, naturopaths are licensed in some US states and Canadian provinces and unregulated elsewhere) [uncertain: not verified]. Ingredients sold as medicines, such as magnesium sulfate, fall under medicines regulation, and suspected adverse reactions to medicines, including herbal and homeopathic ones, can be reported in the UK through the MHRA Yellow Card scheme [source: GOV.UK Yellow Card guidance]. Health claims in advertising fall under advertising and consumer-protection law (for example the US FTC, which has acted against sellers of devices based on Hulda Clark's theories) [source: Science Feedback].

Regulatory status (one line): not an approved treatment for any condition; the main regulatory touchpoints are medicines safety reporting and advertising/consumer law [synthesis].
Evidence status (one line): Mayo Clinic finds "no reliable evidence" that a cleanse prevents or treats gallstones or any other disease, and Full Fact rates it "not a proven treatment" [source: Mayo Clinic; Full Fact].

2. Framework

The method's own stages (as described, qualitative). (1) Preparation: dietary change before the flush; (2) the flush itself: a series of drinks; (3) elimination: passing the lumps, which promoters read as stones; (4) repetition: promoters present the flush as something to repeat and combine with a wider cleansing and prevention programme [source: Mayo Clinic; Full Fact; OverDrive description; repetition schedules: uncertain: not verified]. No amounts, timings, schedules or recipes are given here.

The psychotherapist's frame alongside it. This is not a therapy with phases; it is a set of tasks woven into ordinary psychotherapy whenever the client mentions cleansing [synthesis]:

Phase A: Ask and record (any session). Goal: know whether the client is planning, doing or recovering from a flush, and why. Moves on when use, intentions and any symptoms are documented.
Phase B: Understand (integrated). Goal: the client's explanatory model, hopes and what the visible "stones" mean to them. Moves on when the therapist can summarise the client's view in a way the client accepts.
Phase C: Decide and coordinate (as needed). Goal: an informed, values-based decision, and with consent, the GP, specialist or pharmacist informed. Moves on when the client has the medical information they want and a named medical contact.
Phase D: Monitor risk (throughout). Goal: catch biliary or other medical warning signs, delayed treatment, eating-disorder patterns, safeguarding issues and financial or group pressure. Any red flag interrupts the sequence and takes priority.
Phase E: Address the psychological driver (ongoing therapy). Where cleansing is driven by health anxiety, somatic distress, disordered eating or a wish for control, treat that with established approaches (cross-reference Domain II).

Format: individual sessions, inside existing therapy; no separate session count is defined by any source [synthesis].

3. Guiding principles

[synthesis unless tagged]

Curiosity before correction. Ask about cleansing the same way you ask about sleep or alcohol; correction first closes the conversation.
Attribute, do not adjudicate. Describe claims as the client's or the promoter's ("Moritz's book says..."); where facts matter for safety, cite the medical source plainly.
Never perform, sell, prescribe or recommend. You do not supply instructions, ingredients, schedules or opinions on which version is best; you also do not advise starting or stopping any medicine.
Medical questions go to medical people. Gallstones, abdominal pain, jaundice and medicines are for the GP, specialist or pharmacist; your job is to make that contact easier [source: Mayo Clinic advises discussing gallstone treatment with a doctor].
Safety outranks rapport. Warning signs of biliary obstruction, infection, pancreatitis or liver injury mean same-day medical advice, even if the client is irritated.
Autonomy is real. Adults may choose practices you would not; your role is that the choice is informed, uncoerced and does not displace needed care.
The visible result is powerful. Seeing lumps in the stool feels like proof; respect the experience while making the alternative explanation available if the client wants it [source for the explanation: Full Fact; Mayo Clinic].
Look beneath the cleanse. Purging and purity themes can carry health anxiety, disgust, control needs, eating-disorder risk, grief or distrust of medicine.
Protect children. Children and dependent adults are not given purgative regimes without medical involvement; safeguarding duties apply.
No conflicts of interest. You do not sell or refer to sellers of cleanses, books or courses.
Document. Record what the client reports, what was discussed, risks identified, consent to contact others and actions taken.

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside a client's interest in flushing. None involves instructing, supervising or endorsing a flush. Many versions include a saline laxative (Epsom salts, magnesium sulfate) and an oily drink [source: Full Fact; Mayo Clinic]; these are named only because they matter for risk.

4.1 Routine, non-judgemental inquiry and recording

Purpose / when: at intake and whenever diet, detox, gut symptoms, gallstones, "toxins" or self-healing come up. Many clients do not volunteer complementary use unless asked neutrally [synthesis].
Steps: (1) Normalise: many people use cleanses. (2) Ask open questions: what, when, how often, from which book, website, group or practitioner, and for what reason. (3) Ask about current symptoms, diagnoses (especially known gallstones, liver, pancreatic or kidney disease, diabetes, pregnancy), medicines, and whether their doctor knows. (4) Ask about money spent and who else is involved. (5) Record in the client's words, without evaluative language.
Example language (illustrative): "Lots of people try cleanses or flushes. Is that something you've done or are thinking about? I ask everyone, so I can understand the whole picture of how you look after your health."
Watch for: defensiveness (pause, re-explain the reason for asking); disclosures of current abdominal pain, yellowing of skin or eyes, fever or repeated vomiting (go to 4.5); flushes repeated frequently or alongside restrictive eating (4.6). Working if the client discusses it openly in later sessions.

4.2 Exploring meaning, hopes and the explanatory model

Purpose / when: once use or intention is known, to understand what draws the client: relief from symptoms, a sense of control, purity or renewal, distrust of medicine or surgery, identity, a community of fellow cleansers, or a loved one's influence [synthesis].
Steps: (1) Ask what they believe is happening in the body and where that idea came from (book, friend, practitioner, video). (2) Ask what they hope will change and how they will know. (3) Ask what worries them about the medical route (e.g. fear of surgery). (4) Reflect back the model accurately before adding anything. (5) Note emotional themes: disgust, contamination, guilt, fear of illness, grief.
Example language (illustrative): "So the idea, as you understand it, is that stones build up in the liver and the flush clears them, and you've felt heavy and unwell for a long time. What would be different for you if this worked?"
Watch for: fixed certainty that brooks no discussion (slow down; stay with values); contamination or purity themes that extend beyond the body (possible OCD, cross-reference Domain II); fear of medical procedures driving avoidance (a target for therapy in itself). Working if the client starts reflecting on their own reasons and doubts.

4.3 Discussing the passed "stones" when the client raises them

Purpose / when: clients often cite the green lumps as proof. Use only when the client brings it up or asks your view; the aim is information, not winning an argument [synthesis].
Steps: (1) Ask what they saw and what it meant to them. (2) Ask permission before offering another explanation. (3) If invited, state it briefly and attribute it: Mayo Clinic describes the lumps as globs of oil, juice and other material, and a case analysed in The Lancet found no cholesterol, bilirubin or calcium, the components of typical gallstones [source: Mayo Clinic; Full Fact]. (4) Suggest the medical way to settle it: discuss with their doctor whether imaging is indicated [synthesis]. (5) Leave the conclusion with the client.
Example language (illustrative): "Would it help to hear what doctors who've studied this say those lumps are? You can take it or leave it." ... "Some doctors analysed them and found they didn't contain what gallstones are made of. If knowing whether you still have stones matters to you, your GP is the person who can check."
Watch for: feeling shamed or foolish (validate that the result looks convincing); escalation into repeated flushes to "get them all out" (risk, 4.5 and 4.6). Working if the client is willing to talk to their doctor.

4.4 Supporting an informed, values-based decision

Purpose / when: when the client is deciding whether to flush, to continue, or to choose a flush instead of medical assessment or treatment of gallstones.
Steps: (1) Clarify the decision in the client's words. (2) Elicit values (avoiding surgery, natural living, being in control, staying well for family). (3) Identify what information they lack and who can give it (GP, gastroenterologist, surgeon, pharmacist). Mayo Clinic lists established gallstone treatments as surgical removal, bile salt tablets and sound-wave therapy, and notes that gallstones without symptoms usually need no treatment [source: Mayo Clinic]. (4) Help them prepare questions for the doctor. (5) Explore consequences of each option for their values. (6) Confirm the decision is their own, free of pressure from sellers, groups or family. No published decision aid specific to cleanses is cited here [synthesis].
Example language (illustrative): "It sounds like avoiding an operation really matters to you. What do you need to know from your surgeon to feel you're making the choice with your eyes open?"
Watch for: your own pull to persuade (a sign to step back); a choice that delays assessment of symptoms (4.5). Working if the client can state the options, the trade-offs and the next step.

4.5 Recognising and responding to medical risk

Purpose / when: throughout, because flushes are often attempted by people with real gallstones or other illness.
What sources report:
- During a flush: nausea, vomiting, diarrhoea and abdominal pain; the ingredients carry their own hazards [source: Mayo Clinic].
- Real gallstones can block the bile ducts; herbalists who stopped teaching the flush cite this risk [source: Henriette's Herbal FAQ]. Symptoms of troublesome gallstones include abdominal pain, jaundice, diarrhoea, fever and shivering [source: Full Fact citing NHS].
- Biliary pancreatitis after a liver cleanse has been reported in a German case report (Christl 2006) [uncertain: secondary, unverified].
- Severe liver injury attributed to Epsom-salt naturopathy for gallstones was reported in a 38-year-old man in BMJ Case Reports (Philips et al., 2017); liver function returned to normal after stopping [source: Science Media Centre; ScienceAlert; BMJ Case Reports article info].
- Near-fatal hypermagnesaemia after Epsom salts as bowel preparation has been reported in a person with normal kidney function, with gastrointestinal conditions and dehydration as possible contributors (Si et al., 2024; not a flush case) [source: Frontiers in Medicine].
Steps: (1) If the client reports severe or persistent abdominal pain, yellow skin or eyes, fever or shivering, repeated vomiting, confusion, faintness or marked weakness during or after a flush: advise same-day urgent medical assessment and help them make the call; with consent, contact their doctor. (2) Ask about kidney disease, pregnancy, diabetes, gut surgery and medicines, and encourage them to tell their doctor or pharmacist before any flush [synthesis]. (3) Never comment on whether to take or stop a medicine; refer to the prescriber or pharmacist. (4) Document advice given.
Example language (illustrative): "Pain like that, with your eyes looking yellow, needs a doctor today, not tomorrow. Can we ring now together?"
Watch for: minimising symptoms as "detox reactions" or a "healing crisis" (treat as medical until a doctor says otherwise) [synthesis]. Working if the client gets assessed and you know the outcome.

4.6 Eating-disorder and restrictive-pattern screening

Purpose / when: whenever cleansing is repeated, combined with fasting or restrictive "clean" eating, or linked to weight, shape or purity [synthesis; no clinical eating-disorder source cited here].
Steps: (1) Ask about frequency of cleanses, fasting, laxative use, vomiting, rigid food rules and distress when rules are broken. (2) Ask about weight change, dizziness, palpitations and menstrual change. (3) Use a validated brief eating-disorder screen in your service, then a full assessment if positive. (4) Note orthorexic patterns: preoccupation with purity of food, rising rigidity, social withdrawal around eating. (5) If purging or restriction is significant, arrange medical review (electrolytes and physical risk are a medical matter) and eating-disorder pathway referral.
Example language (illustrative): "How often are you doing cleanses now? And between them, are there foods or rules that feel very hard to break?"
Watch for: laxative misuse framed as cleansing; secrecy; flushes as compensation after eating. Working if patterns are named and the client accepts assessment.

4.7 Health anxiety and somatic symptom presentations

Purpose / when: when the flush is one of many attempts to rid the body of feared illness or unexplained symptoms (cross-reference Domain II for full protocols) [synthesis].
Steps: (1) Map the cycle: bodily sensation, threat interpretation ("toxins", "stones"), safety behaviour (cleansing, checking stool, searching online), short-term relief, return of doubt. (2) Use a shared formulation. (3) Offer established CBT for health anxiety or somatic symptom approaches: attention training, behavioural experiments on checking, reducing reassurance-seeking and repeated cleansing. (4) Coordinate with one named doctor to limit fragmented care.
Example language (illustrative): "Each flush gives you a few days of relief, then the worry comes back. Could we look at that cycle together, rather than the stones?"
Watch for: stool-checking or repeated cleanses as compulsive safety behaviours. Working if frequency of cleansing and checking falls and the client tolerates uncertainty better.

4.8 Coordination with the doctor or pharmacist

Purpose / when: whenever the client has symptoms, a diagnosis, takes medicines, is pregnant, or is considering a flush instead of medical care.
Steps: (1) Ask consent to share, specifying what. (2) Encourage the client to tell their GP or pharmacist themselves; offer a letter or joint call. (3) Share factual information: what the client is doing, any symptoms observed, psychological factors relevant to care. (4) Do not request or relay medicine changes yourself. (5) Record consent and contact.
Example language (illustrative): "Would you be okay with me letting Dr [name] know you're planning a flush, so they can check it's safe with your tablets?"
Watch for: fear of being judged by the doctor (rehearse the conversation). Working if the doctor knows and the client feels able to raise it.

4.9 Serious illness, delayed treatment and psycho-oncology alongside

Purpose / when: when a client with cancer or other serious disease sees cleansing as treatment, or a promoter has urged them to cancel treatment. Moritz's publisher links bile-duct stones to cancer [source: OverDrive]; Hulda Clark attributed cancer and other diseases to a parasite, promoted a gut cleanse and a "zapper" device, and encouraged people to cancel surgery, radiation or chemotherapy; the FTC acted against companies selling zappers based on her theories, and she died of multiple myeloma in 2009 [source: Science Feedback]. Science Feedback also cites studies linking refusal of standard cancer treatment with higher mortality [source: Science Feedback].
Steps: (1) Explore hope, fear of treatment and what the cleanse represents. (2) Separate "in addition to" from "instead of". (3) With consent, involve the oncology team, and palliative care where relevant. (4) Support family members in conflict without taking sides. (5) Later, work with grief and regret if alternatives were chosen.
Example language (illustrative): "Would doing this alongside your treatment feel different from doing it instead of treatment? What would your oncologist need to know?"
Watch for: sudden withdrawal from treatment; pressure from a seller or group. Working if the client keeps contact with their treating team.

4.10 Children, pregnancy and safeguarding

Purpose / when: when a parent or carer plans to give a child a flush or purging regime, or a pregnant client plans one [synthesis].
Steps: (1) Ask the parent's reasons and the child's symptoms. (2) Encourage medical assessment of the child. (3) Consider the child's assent and the parent's consent separately, and the child's welfare as paramount. (4) If a child is being given harmful purgatives or deprived of needed medical care, follow your local safeguarding procedure and consult your safeguarding lead. (5) For pregnancy, urge discussion with the midwife or obstetrician before any cleanse.
Example language (illustrative): "Because she's still so young, I'd like her doctor to look at her tummy pains before anything else is tried. Can we arrange that today?"
Watch for: repeated purging of a child, missed medical appointments. Working if the child is medically assessed.

4.11 Financial exploitation, group and multi-level-marketing pressure

Purpose / when: when the client is buying expensive kits, retreats, coaching or courses, or belongs to an online group that shames doubt [synthesis].
Steps: (1) Ask what has been spent and on what. (2) Ask how the group responds to questions or side effects. (3) Explore recruitment or selling obligations. (4) Support the client to set their own limits. (5) Keep your own boundary: you do not sell, recommend or refer to sellers of cleanses, books or courses, and you manage any conflict of interest under your professional ethics code.
Example language (illustrative): "What happens in the group when someone says the flush made them ill?"
Watch for: debt, isolation from family, testimonials replacing medical advice. Working if the client can weigh the group's view against their own.

4.12 Reporting routes

Purpose / when: after an adverse reaction, misleading advertising, or harm by a practitioner.
Steps: (1) Ensure the client gets medical care first. (2) Suspected adverse reactions to medicines, including herbal and homeopathic medicines, and to medical devices can be reported in the UK through the MHRA Yellow Card scheme, by health professionals and the public, online, by app, post, email or phone [source: GOV.UK Yellow Card guidance]. Elsewhere, use the national medicines regulator (e.g. FDA MedWatch, TGA, Health Canada) [uncertain: not verified]. (3) Misleading health claims: the advertising or consumer regulator (e.g. FTC in the US, ASA in the UK) [synthesis; FTC role per Science Feedback]. (4) A regulated practitioner causing harm: their professional board. (5) Children or adults at risk: safeguarding. (6) Document what was reported, with consent where required.
Example language (illustrative): "What happened to you can be reported, so it's recorded and others are warned. Would you like to do that together?"
Watch for: the client's fear of blame or of the group's reaction. Working if the client decides with full information.

5. Handling problems

All guidance in this section is [synthesis] unless a source is tagged; the promoters' and medical sources do not address psychotherapy problems directly.

The client asks you for instructions, a recipe or your endorsement. Decline warmly and explain your role; redirect to their doctor or pharmacist for safety questions. (Illustrative: "That's outside what I can advise on, and I don't want to guess about something that affects your body. What I can do is help you think it through and get the medical answers you need.")
The client is certain the stones prove it works. Do not debate. Explore what certainty gives them; offer the attributed alternative explanation only with permission (4.3) [source for explanation: Mayo Clinic; Full Fact]. Return to their goals.
Resistance to medical contact ("doctors just want to operate"). Validate fears about surgery; separate assessment from treatment; rehearse questions; offer a joint call or letter. If symptoms are dangerous, state your concern plainly and document it.
Overwhelm or shame after learning the lumps may not be stones, or after a bad reaction. Normalise (many intelligent people try cleanses); focus on self-compassion and what they want now; check for risk if shame is intense.
Rupture: the client feels judged. Name it, own your part, restate that the choice is theirs and your interest is their safety and goals. Repair before returning to the topic.
Non-adherence to agreed safety steps (e.g. not telling the doctor). Explore barriers without blame; make the step smaller; if risk is high, consider, with consent where possible, contacting the doctor yourself, within your confidentiality limits.
"Healing crisis" framing of new symptoms. Promoters' frames may cast worsening as cleansing working [uncertain: not verified as a Moritz term]. Treat new pain, jaundice, fever or vomiting as medical until a doctor says otherwise (4.5).
Repeated or escalating flushes. Screen for eating-disorder patterns (4.6) and compulsive safety behaviours (4.7); arrange medical review.
Serious illness and alternatives instead of treatment. Keep the alliance, involve the treating team with consent, offer palliative-care links where relevant, and support the family (4.9).
Family conflict (one member promoting flushes, another opposed). Meet the family's shared aim (the person's wellbeing); avoid becoming the referee on the science; help each person speak about fear.
Group or seller pressure (4.11): support autonomy, track isolation and spending; consider consumer or advertising reports.
Your own reactions (irritation, rescuing, or wishing to agree to keep rapport). Use supervision; document your reasoning.
Children (4.10): when in doubt, consult the safeguarding lead the same day.
Cultural or spiritual meanings of purification. Respect the meaning, attribute the claims, and keep safety and medical coordination separate from belief; consult culturally informed colleagues where needed.

Sources

Web sources:

Books and articles cited:

Moritz, A. (2012). The Amazing Liver and Gallbladder Flush (expanded edition). Self-published.
Sies, C. W., & Brooker, J. (2005). Could these be gallstones? The Lancet, 365(9468), 1388. [uncertain: secondary, unverified]
Christl, S. U. (2006). Biliäre Pankreatitis nach alternativmedizinischer Leberreinigung. Die Medizinische Welt, 57(12), 596-598. [uncertain: secondary, unverified]
Philips, C. A., et al. (2017). Severe liver injury due to Epsom salt naturopathy. BMJ Case Reports.

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