What to eat for a fatty liver

Share on PinterestGarlic may help reduce body fat in those with fatty liver disease.

A diet for fatty liver disease should include a wide variety of foods.

Reducing calorie intake and eating high fiber, natural foods is a good starting point. Eating foods that contain complex carbohydrates, fiber, and protein can provide sustained energy and promote satiety.

Foods that reduce inflammation or help the body repair its cells are equally important.

Some people choose to follow specific diet plans, such as a plant-based diet or the Mediterranean diet. A dietitian can often help a person create a customized diet plan that is right for their tastes, symptoms, and health status.

In addition to these basic guidelines, some specific foods may be especially helpful for people with fatty liver disease. These foods include:


Garlic is a staple in many diets, and it may provide benefits for people with fatty liver disease. A 2016 study in Advanced Biomedical Research found that garlic powder supplements appear to help reduce body weight and fat in those who have fatty liver disease.

Read more on the medicinal properties of garlic.

Omega-3 fatty acids

A 2016 review of current research suggests that consuming omega-3 fatty acids improves the levels of liver fat and high-density lipoprotein (HDL) cholesterol levels in people with nonalcoholic fatty liver disease.

Although more research is necessary to confirm this finding, eating foods that are high in omega-3 fatty acids may help lower liver fat. These foods include:

  • salmon
  • sardines
  • walnuts
  • flaxseed


Drinking coffee is a morning ritual for many people. However, it may provide benefits beyond a burst of energy for people with fatty liver disease.

A 2019 animal study found that decaffeinated coffee reduced liver damage and inflammation in mice that ate a diet containing high levels of fat, fructose, and cholesterol.

Another study in mice from the same year showed similar results. The researchers found that coffee reduced the amount of fat that built up in the mice’s livers and improved how their bodies metabolized energy.


Eating a variety of whole vegetables is helpful for people with fatty liver disease. However, broccoli is one vegetable that a person with fatty liver disease should seriously consider including in their diet.

A 2016 animal study in The Journal of Nutrition found that the long-term consumption of broccoli helped prevent the buildup of fat in murine livers.

Researchers still need to conduct further studies involving humans. However, early research into the effect of broccoli consumption on the development of fatty liver disease looks promising.

Green tea

Using tea for medicinal purposes is a practice that goes back thousands of years.

A 2015 review in the World Journal of Gastroenterology suggests that green tea may help lower levels of fat in the blood and throughout the body. One of the included studies reported reduced levels of fat in the liver in people who consumed 5–10 cups of green tea per day.

Green tea provides several antioxidants, such as catechin, which may help improve fatty liver disease.


While all tree nuts are a great addition to any diet plan, walnuts are especially high in omega-3 fatty acids and may provide benefits for people with fatty liver disease.

A review from 2015 found that eating walnuts improved liver function test results in people with nonalcoholic fatty liver disease.

Soy or whey protein

A 2019 review in the journal Nutrients found that both soy and whey protein reduced fat buildup in the liver.

The results of one study in the review showed that liver fat decreased by 20% in women with obesity who ate 60 grams of whey protein every day for 4 weeks. Soy protein contains antioxidants called isoflavones that help improve insulin sensitivity and reduce the levels of fats in the body.


People can purchase these beneficial foods in grocery stores and online:

  • garlic
  • flaxseed
  • coffee
  • tea
  • walnuts
  • soy protein

Bile is a vital fluid the body makes to digest fats and absorb fat-soluble vitamins. Bile supplements can eliminate gallstones, help the body detox, and improve liver and gut diseases. They come in a variety of forms, of which ox bile is the most common. Continue reading to learn about the function of bile and the health effects of bile supplements.

What is Bile?

Digests Fats

Bile is a complex, vital, and unique fluid produced by the liver to aid in the digestion of fats in the small intestine. The components of bile are actually quite eclectic. It’s yellow-green in color and composed of 95% water in which the following compounds are dissolved, such as :

  • Bile acids and salts
  • Phospholipids, cholesterol, and steroid hormones
  • Pigments and amino acids
  • Electrolytes and vitamins
  • Antioxidants like melatonin and glutathione
  • Antibodies like IgA
  • Heavy metals, drugs, and environmental toxins

The liver secretes about 600 ml of bile every day, which amounts to almost 3 cups .

Removes Toxins

Bile is the body’s main way of eliminating harmful fat-soluble substances like toxins, drugs, and heavy metals. It’s also the main pathway for eliminating excessive cholesterol from the body .

Helps You Absorb Nutrients

Bile dissolves dietary fats so that they can be more easily broken down by lipases. Bile acids enable the digestion and absorption of fats and fat-soluble vitamins like A, D, E, and K in the gut. Bile also protects the gut from infection by stimulating the gut immune system .

Bile Production

Signals from the Gallbladder

The liver constantly makes bile that’s transported to the gallbladder via bile ducts. The gallbladder, a small sac-like organ located below the liver, stores and concentrates bile. After food intake, the gallbladder delivers bile into the small intestine where it aids in the digestion of fats .

The main signal in the body for the gallbladder to contract and release bile is cholecystokinin. Others include secretin, gastrin, and somatostatin and the vagus nerve .

Bile salts are resistant to strong digestive enzymes in the gut are mostly reabsorbed after they achieve their effects. This way, the body recycles bile salts, which can be stored and used again .

Bile Acids & Bile Salts

Bile acids are made in the liver from cholesterol .

The 2 main bile acids made in the liver are cholic acid and chenodeoxycholic acid. Gut bacteria can modify these into 2 slightly different bile acids (into deoxycholic acid and lithocholic acid), but the liver still makes most bile acids overall .

Transforming cholesterol into bile acids is a multistep process that involves many different liver enzymes. Many of these enzymes are part of cytochrome P450, the body’s key detox pathway .

These are the most important cytochrome P450 enzymes for bile production :

  • CYP7A1
  • CYP8B1
  • CYP27A1

Bile acids can affect their own production in the body. If they increase too much, they stop their own production. If they’re not produced enough, low levels activate receptors that tell the body to make more bile. The most important one is called the bile acid receptor (FXR) .

The activity of these enzymes is also strictly controlled by hormone and drug levels in the body. Hormones, toxins, and drugs can activate certain receptors (so-called nuclear receptors, which include VDR) that affect gene expression. By turning on key genes, they help lower blood lipids, cholesterol, and detox drugs and toxins .

When bile acids are taken back to the liver and bound to the amino acids glycine or taurine when they become bile salts. An enzyme called n-acetyltransferase is crucial for this step known as conjugation .

If this enzyme is not working properly, free bile acids are released instead of bile salts. Bile acids are incapable of digesting fats. Only bile salts act as natural gut detergents – they have the power to emulsify, dissolve and digest fats in the gut .


1) Bile Salts Remove Excess Cholesterol

Bile salts are crucial for maintaining balanced cholesterol levels in the body .

Producing bile acids from cholesterol is the key pathway for removing cholesterol from the body. About half of the total cholesterol produced in the body is used to make bile acids .

2) Bile Eliminates Bilirubin From the Body

Bile salts play a key role in the removal of bilirubin from the body .

Bilirubin is the main pigment in bile. It’s a waste product of hemoglobin breakdown and has harmful effects in the body if accumulated. Bilirubin buildup in the body causes jaundice .

The liver takes bilirubin bound to proteins from the bloodstream and then modifies it to make it into a yellow water-soluble form. It then secretes this bilirubin into bile with bile salts. The gut microbiome then breaks down it down into its basic form (free bilirubin) that is darker in color and can finally be eliminated in the stool .

3) Bile Salts Digest Proteins and Starches

Bile salts are essential for digesting proteins and starches. They help break down dietary proteins by enhancing the digestive activity of protease enzymes in the pancreas .

4) Bile Salts Help Remove Toxins

Bile salts help the bile remove toxic substances from the body .

This includes drugs, environmental pollutants, and heavy metals such as mercury, lead, silver, and cadmium .

Scientists are still debating exactly how bile salts are able to do this. Toxins can activate genes that help make bile and phase II detox enzymes. Once the bile is produced, toxins are modified and added to bile along with bile salts. They travel along the gut and can be eliminated through the stool .

5) Bile Salts Help Absorb Fat-Soluble Vitamins

Without bile salts, fat-soluble vitamins (Vitamin A, D, E, and K) cannot be absorbed. Bile salts break down fats and the vitamins dissolved in it into small particles called “micelles”. This allows cells in the gut lining to transport them into the body .

And it’s not just that bile salts affect vitamin absorption. Some fat-soluble vitamins themselves can have an effect on the amount of bile the body makes. This way, vitamins regulate their own levels .

When the dietary intake of fat-soluble vitamins is high, Vitamin A and vitamin D can deactivate genes that make bile to reduce their own absorption and vice versa. Vitamin A and vitamin D have a strong effect on the receptors that affect bile gene expression (via RAR, RXR, and VDR). This prevents a buildup or deficiency of vitamins A, D, E, and K under normal conditions .

In fact, vitamin A may have specific therapeutic potential. It can help the bile re-establish its own feedback loops if it was interrupted for any reason. For example, vitamin A may help in cases when the body stops re-absorbing bile salts from the gut, which is needed to recycle bile salts that are re-used .

6) Bile Protects the Gut from Infections

Bile protects the organism from gut infections by :

  • Making immunoglobulin A (IgA), the first line of defense against harmful microbes
  • Stimulating the gut immune system

On the other hand, chronic inflammation reduces bile production in the body. Increased inflammatory substances ( IL-1 beta, IL-6, TNF-alpha, and nitric oxide) all reduce bile secretion, this way making the gut vulnerable to infections .

When Bile Flow Becomes Dysfunctional

Dysfunctional bile flow reduces the digestion of fats, absorption of vitamins, and toxins detox in the small intestine .

This leads to a condition known as cholestasis, which means “blocked bile flow”. Dysfunctional bile flow causes :

  • Fats to build up in the gut instead of being broken down, which causes indigestion, stomach pain, loss of appetite, and greasy or gray-colored stools
  • Vitamin A, D, E, and K deficiencies
  • A buildup of toxic substances such as bilirubin. Increased bilirubin causes jaundice – itchy yellow-colored skin and eyes. Bilirubin has to be eliminated via urine, coloring it light-brown.
  • Bile acid buildup increases oxidative stress, which can damage the liver and may even increase the risk of cancer
  • Bile cholesterol buildup that forms gallstones in the gallbladder
  • Gallstones cause inflammation not only of the gallbladder but also of the liver and pancreas. In such cases, the surgical removal of the gallbladder is recommended .
  • Increased susceptibility to gut infections

Bile production and flow can become dysfunctional due to various causes. Some conditions that worsen the flow of bile salts include chronic inflammation, liver diseases such as hepatitis or cirrhosis, cystic fibrosis, and diabetes .

Bile Supplements: What Are the Options?

How They Work

Under normal conditions, the gallbladder releases the stored bile into the small intestine in response to food. Bile, containing bile salts, initiates the breakdown and absorption of fats .

But under abnormal conditions caused by diseases of the pancreas, liver, or hormones, bile salts are not properly absorbed, leading to the increased accumulation of fats in the gut .

Bile supplements (like ox bile, other animal biles, UDCA, TUDCA, or other bile acids) act to counter bile salts deficiency in the gut and may :

  • Break down and eliminate cholesterol gallstones .
  • Protect the gut from damage and infections .
  • Protect the liver and restore natural bile acid production and bile flow .
  • Help absorb fats and fat-soluble vitamins, reducing symptoms of indigestion and greasy stools .
  • Restore the cholesterol-lowering effect of bile salts. Once supplemented bile is mixed up with gut contents, it’s removed with the stool. This loss of bile acids forces the liver to release more bile acids to compensate, transforming more cholesterol to bile acids.
  • Reduce cholesterol production in the liver mediating the cholesterol-lowering effects .
  • Reduce anxiety and promote sleep, due to their melatonin content .

Types of Supplements

Various types of bile supplements are available, including all of the following:

  • Ox bile
  • Ox bile combined with various digestive enzymes (such as Pancrelipase, Pancreatic Protease, Pancreatic Amylase, Pancreatic Lipase, Papain, Bromelain) and/or Betaine HCl
  • Ox bile combined with herbs such as dandelion root or artichoke
  • Ox bile in combination with probiotics
  • Ox bile combined with Taurine
  • Purified bile salts such as TUDCA, ursodeoxycholic acid (Ursodiol or UDCA), cholic acid
  • TCM bile supplements (see below)

In most supplements, the dosage of ox bile varies between 100 – 500 mg.

The content of pure bile acids in ox bile is about 40%. Some supplements may be purified to contain higher amounts .

In Traditional Chinese Medicine

Ox bile and other animal bile supplements were an important part of Traditional Chinese Medicine (TCM) since ancient times. There was a wide assortment of animal biles for medicinal use, the total number adding up to 44, of which ox bile was perhaps the most important one .

The first mention of bile in TCM dates back to scriptures from 500 BC that mention the use of ox and dog bile for therapeutic purposes. Biles mentioned in other TCM books are from: the common carp fish, goat, sheep, mouse, shark, wild boar, elephant, tiger, and even bile from pythons and venomous vipers !

Interestingly, python bile was traditionally used to eliminate parasites and reduce gum inflammation and tooth cavities.

Ox bile was used in combination with gentian root, other herbs, and honey to combat jaundice or used on the skin for hemorrhoids.

A recent analysis showed that different animal biles have different components. Accordingly, specific animal bile supplements are used for a variety of acute and chronic diseases in TCM .

Only pig, ox and bear biles are extensively used in China today.

Health Benefits of Ox Bile Supplements

1) Eliminate Gallstones

Bile supplements may reduce cholesterol gallstones in the gallbladder (cholelithiasis), potentially reducing the need for surgical removal of the gallbladder.

In one clinical trial of 24 people, bile acids (UDCA up to 1,000 mg/day) reduced cholesterol in gallstones after one month .

Bile acids (UDCA) reduced gallstones in 6 people with hepatitis B after 3 – 20 months (daily dose of 8 – 11 mg/kg). It completely dissolved the stones in 5 people and reduced liver enzymes. They remained gallstone free for at least 2 years .

The primary bile acid chenodeoxycholic acid (0.75 – 4.5 g/day) eliminated gallstones in a trial of 7 women with 6 – 22 months. It also restored bile acid production in the liver .

2) Help Remove Toxic Substances From the Body

Bile supplements assist in the removal of toxic substances from the body .

Toxins that enter the body via pollution, food, or medications, as well as those that build up in the body, are usually broken down by the liver. They are then combined with bile salts, secreted into the gut as bile, and removed through the stool. However, they lack bile salt production results in the accumulation of these toxins in the liver, which can trigger many chronic diseases .

Bile acids and toxins activate the same receptors in the body, which increase liver detox pathways. In a way, the body views all fat-soluble pollutants (and the majority of environmental pollutants and drugs are fat-soluble) as “toxic bile acids”, which triggers the detox process .

Aside from bile supplements themselves, herbal supplements that activate this pathway (PXR activators) may also be useful for people with bile issues .

3) May Help Clear Gut Infections and SIBO

Impaired bile salts production creates favorable conditions for intestinal bacterial overgrowth. Bacterial toxins, known as endotoxins, can damage the gut. If the gut damage is severe enough and gut immunity low, the result is a leaky gut barrier that can cause bacteria to enter the bloodstream and cause a systemic infection. On the other hand, lack of bile salts can also cause small intestinal overgrowth (SIBO) .

Bile salts have antimicrobial activity and protect the body against harmful bacteria .

Bile salt supplements may be especially useful for people with liver cirrhosis who are very susceptible to SIBO and bacterial infections .

In several studies of rats with liver damage, bile acids supplements reduced bacterial overgrowth and prevented the bacteria and their toxins from entering the blood .

In mice, bile salt supplements could turn on genes that activate the defense system against harmful bacteria .

4) May Help with Psoriasis

Bacterial endotoxins might play a role in developing psoriasis. People with psoriasis have detectable levels of endotoxins in the blood, which can cause or worsen inflammation. Bile deficiency may be the underlying cause, as it allows endotoxin to enter the blood and reach the skin. People with psoriasis also often complain of gut and gallbladder problems .

The buildup of toxins and inflammatory substances in the skin can cause red, itchy, and scaly skin patches in psoriasis. Bile acids can balance the gut microbiome, protect from bacterial gut endotoxins, and reduce inflammation .

In a large clinical trial of 800 patients with psoriasis, oral bile acid supplementation (dehydrocholic acid) resolved psoriasis symptoms in 79% of all cases after 1 – 8 weeks. It had even better results in people with acute psoriasis, clearing symptoms in 95% of the cases. Two years later, 58% of chronic psoriasis patients were also symptom-free, compared to only 6% of those on conventional treatment .

In bile-deficient rats, bile acid supplements caused helped blocked gut toxins from entering the blood and helped detox them from the body. Enhancing detox with bile salts may also be useful for viral infections, herpes, and clogged arteries in heart disease – all conditions in which bacterial toxins build up in the body .

5) May Improve Liver Disease

Bile supplements are used for a number of diseases including cystic fibrosis (a genetic disease) and chronic liver diseases such as primary biliary cirrhosis and non-alcoholic fatty liver disease.

Cystic fibrosis is a genetic disease that affects many organs of the body including the liver. It leads to an abnormal structure and function of the liver .

In one clinical study, the bile acid UDCA improved liver function, reduced liver enzymes, and reversed damage in people with cystic fibrosis. All participants were also supplementing with pancreatic enzymes and taurine .

Primary biliary cirrhosis is a chronic liver disease in which the bile ducts become dysfunctional.

Immune system dysfunction has been linked to its development. Bile supplements may help reduce and reverse the symptoms and bile duct damage .

In one clinical trial, the bile acid UDCA (13 – 16 mg/kg/day) prevented the worsening, improved symptoms, and prolonged survival in people with primary biliary cirrhosis .

In one study, UDCA had even more striking benefits when combined with s-adenosylmethionine (SAM-e) in 19 people with this disease. The combination of prolonged remission, reduced elevated liver enzymes, bilirubin, and cholesterol .

Non-alcoholic fatty liver disease happens when the liver can’t break down fats, so fat builds up in the liver. It’s not caused by alcohol use and is most common in obese people. People with this disease don’t have functional bile salts, which worsens inflammation and damage. Bile supplements may help, but more research is needed .

6) Help with Diarrhea and Fatty Stool

Disrupted bile flow leads to fat buildup in the gut and stool, which causes diarrhea and stomach pain. This condition is known as steatorrhea.

Several diseases are linked to it: gut diseases like Celiac and Crohn’s, cystic fibrosis, kidney, pancreas, and liver diseases. A diet high in hard-to-digest fats, fibers, grains, and excessive drinking can also trigger it.

Bile supplements can help make up for the lack of bile salts and reduce steatorrhea.

A synthetic bile salt cholylsarcosine (2 g/meal) greatly improved fat absorption in the gut and reduced steatorrhea and diarrhea in a clinical trial of 4 people who had part of their bowel surgically removed (short bowel syndrome). In comparison, natural bile salts improved steatorrhea but worsened diarrhea .

Taurine, an amino acid that conjugates with bile acids in the bile, can also help the body make more bile salts. It’s needed to conjugate bile acids into bile salts, which is key for their digestive action .

In one clinical trial, taurine (30 mg/kg/day) increased fat digestion and absorption in 22 children with cystic fibrosis over six months .

Taurine supplementation enhanced the activity of the key enzyme needed to convert cholesterol into bile acids (called 7α-hydroxylase) in animals. That’s why it’s also used for people with heart disease and high cholesterol levels .

7) Help People without a Gallbladder

People who have had their gallbladder removed suffer from a deficiency of bile acids.

Without the gallbladder, they are unable to control bile secretion to the intestines. This causes many digestive problems such as constipation, bloating, and diarrhea .

The use of bile supplements can make up for the lack of bile, helps in the digestion of fats and absorption of fat-soluble vitamins.

The bile acid TUDCA reduced indigestion and improved symptoms in one trial of 203 people without a gallbladder .

8) May Improve Eye Health

The bile acid TUDCA improved eye health in mice and reduced the buildup of harmful free radicals. It may help prevent eye damage .

9) May Enhance Weight Loss

Bile acids may help prevent or reverse obesity by enhancing fat-burning. In animal studies, they helped with weight loss, improved insulin sensitivity and protected the heart.

In fat cells, the bile acid chenodeoxycholic acid increased fat breakdown and energy use. This bile acid also reversed obesity in mice fed a high-fat diet by reducing food intake .

In obese mice fed a high-fat diet, bile acids increased energy use, fat-burning, lowered glucose and improved the gut microbiome. They improved the overall metabolic profile .

Another bile acid – deoxycholic acid – helps break down fat cells when injected directly under the skin into the fat tissue. Solutions of this bile acid are used in the USA and EU to improve the appearance of neck and chin fat. Several clinical trials proved its effectiveness in improving the appearance of neck and chin fullness. It seems to be a well-tolerated and safe option in plastic surgery .

10) Help Heal Skin Burns and Infections

In Traditional Chinese Medicine (TCM), animal bile is used to form an “artificial skin” to dress and cover burns and wounds. Bile fats are isolated from bile have unique properties, which enables them to form a protective layer on the damaged skin. They also act as an antioxidant and anti-inflammatory due to the fat-soluble vitamins content while bile acids can kill bacteria .

As appealing or repelling as it may sound, bile has some great potential for repairing damaged skin. These studies are still limited to TCM, though, and more research is needed.

Limitations and Caveats

Although the knowledge about the function of bile and various bile salts is growing, the information about bile supplements themselves is limited. The additional difficulty is that there are big differences between various bile acids as well as between different types of animal bile supplements.

Some studies are limited to specific bile salts or TCM observations. Proper, larger, clinical trials are needed, especially with popular ox bile supplements.

Side Effects of Bile Supplements


It’s important to note these side effects really depend on the exact composition of bile salts and other ingredients in the supplement. Taking purified bile salts is not the same as taking mixed salts or various animal bile supplements.

The side effects also depend on your health condition. The side effects in people with a surgically removed gallbladder or bowel part will not necessarily be the same as in someone with mild indigestion.

Digestive Problems

Bile supplements can cause digestive problems such as diarrhea, constipation, stomach pain, and vomiting. Although recommended for diarrhea, some natural bile salts may worsen diarrhea, as was the case with ox bile in people with a short bowel .

Chenodeoxycholic acid, present in some bile supplements, can too much water to be secreted into the gut, worsening diarrhea. It may even impair the gut barrier .

Gut Inflammation

Some components in bile supplements may cause gut inflammation.

Deoxycholic acid is a bile acid produced by gut bacteria and an ingredient in some supplements. In IBS, this acid is probably elevated, which worsens inflammation. In mice, deoxycholate supplementation triggered IBS and DNA/RNA damage .

Skin Inflammation (Rare)

In one clinical trial of 24 people, direct exposure to bile salts caused skin itching and blisters .

Oral bile supplements probably can’t cause skin inflammation, but skin application of the purified salts or their waste products found in the stool can. Purified digestive enzymes from the stool caused redness and irritation in a skin study. However, the mixture used also contained protein-degrading (proteolytic) and fat-degrading (lipolytic) enzymes that are not found in pure bile .

Also, this would be relevant perhaps only if applying bile supplements to the skin, which is not typical. Bile supplements that are applied to the skin are only occasionally used in China and specially modified and prepared.

Possible Cancer Risk

In a mice study, excessive and long-term exposure to bile salts caused colon cancer .

Some bile acids have been linked to a number of different cancers in animal studies, such as intestinal, stomach, pancreas, breast, and esophageal cancer .

It was first reported that bile acids may be carcinogenic in the 1930s .

Recent reports point to the cancer-promoting activity of bile acids .

Evidence suggests that high amounts of bile acids in the gastrointestinal tract might increase oxidative stress and DNA damage. High exposure to bile acids also happens in people with high dietary fat intake. However, the exact mechanism of how bile salts may promote cancer upon chronic exposure remains unknown .

A clear link between supplementing with bile salts and cancer is missing, though. A lot of the studies looked at high bile acid production caused by a high-fat diet in people, not at the use of bile supplements .

Bile acids can cause damage if they accumulate in the gut or liver. But a lot of the seen cancer-promoting effects could be a result of factors that cause increased bile acid production in the first place – such as a high-fat, unhealthy diet, or obesity – and not directly from bile salts themselves. More research is needed to shed light on this

Genetic Factors

1% – 2% of bile duct disorders in children are caused by defects in bile acid production .

Some other genetic mutations in enzymes that make bile acids or aid in their activity can cause liver disease or fat-soluble vitamin deficiencies. Some examples include defects in the following genes :

  • CYP7A1
  • CYP7B1
  • VDR
  • RAR and RXR
  • FXR

These variations may also affect the efficacy and side effects of bile supplements.

Bile Salts

Bile Salts for Weight Management

A commercial research made by Marketdata LLC, a market research firm following the weight loss industry since 1989, confirms that there are about 97 million active dieters in the US alone. This huge chunk of the population is responsible for boosting the weight loss business to as much as $3 billion in 2017. Medical weight loss clinics, gyms, and other avenues for working out also abound. Sales for meal replacements, diet pills, low-calorie foods, and diet apps have also been steadily increasing in the last decades.

Ironically, CDC statistics states that 80% of American weight watchers try to do it by themselves and the majority fail. In fact, instead of getting thinner, they get fatter. More so, many of those who lose weight drastically are also expected to gain the weight back within a year or so.

But why?

The most popular reason is still the lack of commitment to a serious lifestyle change which requires making better food choices and engaging in regular physical activity. On top of that, other reasons why people on a diet do not succeed (or why those who lose weight eventually gain them back) include:

  • Poor digestion
  • Slow metabolism
  • Insulin resistance and abnormal glucose levels
  • Integration of something unnatural that cannot be sustained (diet pills, meal replacements, etc.)

Ox Bile Weight Loss – How are bile salts different from diet pills and supplements?

To explicitly define and classify what diet pills and supplements are would require one whole research article. But for the purpose of discussion, let us just describe it as any product ingested that aims to promote weight loss, curb appetite, provide nutritional or meal replacement, or block the absorption of fats, carbohydrates, or calories from your food intake so as not to affect your weight. Some of these pills work, and some don’t but to what extent?

Did you know that many of the ingredients used by common diet pills have already been prohibited by the FDA because of their side-effects? Some trigger symptoms that can increase risk for heart attack and other related diseases. There are even claims that diet pills contain addictive substances that may eventually lead to dependence on these drugs.

Having said that, the major advantages of using bile salts for weight management are as follows:

  • Bile salts are natural.

Our bodies already have natural bile salts. However, a number of factors and poor habits may affect its rate of production and release, thus affecting digestion and metabolism. Bile salt supplements simply aim to reinforce and support whatever naturally exists within each of us.

  • Bile salts pose no serious side effects

Numerous studies have already proven that bile salts pose no real danger. Aside from the rare discomfort due to diarrhea experienced by some, there are no major side-effects brought about by taking this supplement because again, they are natural. And that can usually be control by dosage, unless, of course, diarrhea is a pre-existing occurrence.

  • Bile salts do not aim to replace any nutrients or alter natural body functions.

Unlike many diet pills, bile salts won’t make your body do something it is not naturally designed to do.

How can Bile Salts help with Weight Management?

There are many ways that bile salts can help those who are trying to manage their weight or maintain the status quo.

First, bile salts can improve digestion by breaking down the large fat molecules and breaking them down into simpler fats. This is a natural process that happens as the liver and gallbladder releases bile. However, there are cases when fat intake is much more than what the body is prepared to handle. Some liver or gallbladder concerns may also affect the quality and quantity of bile released for fat digestion. This means that even fat-soluble molecules like vitamins A, D, E, and K are affected. Aside from the accumulation of fats, insufficient bile salts in the body may lead to vitamin and nutrient deficiency. That is how bile salts are necessary for digestion. Bile salts also make simple fats more water soluble, and the bile itself, less toxic.

Secondly, bile salts support thermogenesis. The metabolic effect of bile salts increases activity in brown fat. The thermogenesis prompted by the bile and bile salts help waste calories for fat loss. Bile salts also interact with the TGR5 receptor resulting in increased fatty acid oxidation. Through all these mechanisms, bile salt is able to support healthy metabolism.

Lastly, bile salts help with glycemic control. Bile salt supplements can support glucose regulation in the bloodstream. Aside from lowering the risk of diseases related to insulin resistance, this mechanism of bile salts can also control hunger pangs (when you’re really not hungry) as well as sweet cravings.

So do I buy bile salts to lose weight?

Weight loss and weight management is not the primary purpose of bile salts. However, as explained earlier, the various effects of bile salts on digestion, metabolism, and glycemic control prove it to be an effective supporter for a healthy weight loss journey. There is no shortcut and alternative to a healthier lifestyle but it wouldn’t hurt getting the natural help available for you that supplemental bile salts can provide.

Bile Salts with Taurine

Bile Salts Booster

With all the available ox bile and ursodeoxycholic acid (UDCA) supplements available in the market, it might be confusing and difficult to use. So if you need bile salts with a boost, get Bile Salts Booster with Taurine. Taurine isn’t just another additional nutrient. It does a lot more for your overall health. Moreover, research proves that taurine-conjugated bile acids are less toxic than glycine-conjugated bile acids, contributing to healthier bile.

Taurine supports…

  • detoxification
  • heart health
  • weight management
  • brain function
  • immunity
  • overall physical performance
  • digestion and metabolism

Is your gallbladder (or lack of) stopping your weight loss?

If you’ve never had gallstones, you’ve probably never thought about your gallbladder. However, if you have had gallstones, chances are good that you have had your gallbladder removed. Either situation has its own inherent issues, and one thing that healthcare providers rarely tell gallbladder patients is that surgery will forever impair their digestion and may make losing weight very, very difficult.

The gallbladder is a small, pear-shaped organ under your liver that concentrates and stores the bile that your liver produces to aid fat digestion. Most people don’t give it a second thought until it starts to trouble them, and unfortunately, for many years, the medical establishment didn’t realize the full importance of healthy gallbladder function. They felt its removal had few, if any consequences. I am of the opinion that we were not designed with unnecessary parts, and the gallbladder is no exception. In fact, science is just beginning to understand the true importance of healthy gallbladder function and the detrimental consequences of its dysfunction or removal.

Each day, your liver produces ~27-34 ounces of greenish-brownish-yellow bile, which is concentrated anywhere from 5-18 times, and then 1-3 oz is stored in the gallbladder awaiting your next meal. When you consume foods containing dietary fats, your gallbladder is triggered to release this concentrated bile into the first part of the small intestine, the duodenum, where it acts as an emulsifier to break down those fats and aids in the absorption of the fat soluble vitamins, A,D,E, & K, and any essential fatty acids. If you have ever vomited until a bitter, yellow substance came up — that was bile, and while you may not have thought so at the time – bile itself is an amazing substance. Comprised of bile acids, bile salts, cholesterol, phospholipids, pigments, water, electrolytes, and amino acids, bile is a bitter, acidic substance that breaks down fats into components that the body can use. Healthy fat absorption is crucial to our health. In fact, we were designed to eat fats rich in healthy fats. Our brains, our hormones, and even our very cell walls are dependent on a steady and healthy supply of fat soluble vitamins and essential fatty acids.1 Vitamin A is an important antioxidant that plays a crucial role in cell division, cell differentiation, reproduction, immune function, growth, and vision. Vitamin D is a prohormone which not only regulates calcium metabolism, but is essential for the functioning of the nervous system, for bone health, for muscle strength, for immune function, regulating blood pressure, hormone production and for cell differentiation. Vitamin E is a blanket term for eight different nutrients (4 types of tocopherols and 4 types of tocotrienols) that have string antioxidant properties and also play a role in immune function, healing, repair, and cardiovascular functioning. Vitamin K is a nutrient that scientists are just starting to devote research time to. It is known to play a key role in bone health, blood clotting, and heart disease, but studies are showing that it may have many more far-reaching effects. Essential fatty acids (EFA’s), such as omega-3 fatty acids, are ESSENTIAL to human functioning. Long recognized for its powerful anti-inflammatory benefits, EFA’s are required to make the cell walls of every cell in your body and they play a key role in immune functioning, musculoskeletal health, cognitive function, and heart disease. Considering the overwhelming importance of fatty acids and fat soluble nutrients to general health, it makes no sense to willingly cut out gallbladders with no plan of action to compensate for the deficit caused by its dysfunction or removal. Whether you have a gallbladder that isn’t doing its job or you have already lost yours – there is a solution.

So, how does all of this apply to lack of weight loss — or worse, weight gain?

In simplistic terms, the body is a finely tuned organism. We need 17 nutrients in specific quantities just to make adequate levels of stomach acid and other digestive substances. When gallbladders dysfunction, two things can happen: First, the bile gets too thick and stagnant, which creates an ideal situation for gallstone formation. Second, when gallstones impair or block the emptying of the gallbladder, fat digestion decreases dramatically, which in turn, puts your body into starvation mode. The body requires the absorption of those fat soluble vitamins and essential fatty acids, but it recognizes it is in a chronically deficient state – so it hangs on to the fat it has (which unfortunately may be that stomach pooch) for dear life. You in turn want to lose that stored fat, and may erroneously take on a low-fat diet at the advice of your healthcare provider, which only makes the matter worse.

Causes/Risk of Gallbladder Dysfunction

  • hypochlorhydria (low stomach acid)
  • low fat diets
  • high fat diets
  • food allergies and sensitivities
  • gluten intolerance
  • being overweight
  • dieting, rapid weight loss
  • pregnancy
  • sedentary lifestyle
  • birth control pills or hormone replacement therapy
  • heartburn
  • use of antacids and Proton Pump Inhibitors (PPIs)
  • 40+ years of age
  • females are at greater risk in the United States (in other countries, males can be at higher risk – it is thought that alcohol consumption plays a causative factor there). Women that have birthed children also have a greater risk of developing gallbladder dysfunction
  • alcohol use (the more you drink, the greater your risk)
  • bariatric surgery
  • ethnicity (more prevalent in Native American populations and Hispanics)
  • family history of gallbladder issues
  • extreme diets which eliminate any key food group
  • elevated cholesterol, especially high triglycerides or LDL
  • consumption of statin medication or immunosuppressive medication
  • medical conditions including hypothyroidism, diabetes, insulin resistance, inflammatory bowel disease, PCOS, hemolytic anemia, etc.
  • western diets, diets high in refined carbohydrates and sugars

That’s a long list of risk factors – it’s a miracle that anyone has a normal functioning gallbladder given our Standard American Diet (SAD) and reliance on fried and processed foods. In fact, gallbladder dysfunction is so common that clinicians refer to it as the 4-F syndrome: Female, Fat, Forty+, Flatulent. However, most people with gallbladder dysfunction are asymptomatic. Studies estimate that anywhere from 67-80% of people with gallstones have no symptoms. That said, many people discount gallbladder symptoms as being related to poor digestion or other factors. Everyone with gallstones started off with thick or stagnant bile. You have to have one to lead to the other. The pattern of symptoms associated with gallbladder dysfunction is so varied that many people without digestive pain may not associate their muscle pain, dry skin, poor wound healing, dry (or shedding) hair, headaches, heel calluses, or inability to lose weight despite doing everything right with a gallbladder that is not operating at par.

Symptoms of gallbladder dysfunction: Most commonly: pain or discomfort after eating. This can include gas, bloating, belching, heartburn, nausea, queasiness abdominal discomfort, extreme fatigue, pain under the ribs, particularly on the right side, or shoulder pain. Additional symptoms include headaches over the right eye, constipation or diarrhea, light colored or ‘floating’ stools, dark urine, offensive body odor or breath. People with gallbladder dysfunction tend to have bowel extremes — they experience diarrhea (up to 10 bowel movements per day) or constipation (often having days between bowel movements) and rarely have normal bathroom habits.

Have you had your gallbladder removed? You are not alone. Over half a million gallbladders are removed every year in the US. It is one of the most commonly performed surgical procedures. Symptoms of postcholecystectomy syndrome (PCS): gas, bloating, belching, heartburn, nausea, queasiness abdominal discomfort, extreme fatigue, pain under the ribs, particularly on the right side, or shoulder pain. The need to run to the bathroom immediately after eating is fairly common. Additional symptoms include headaches over the right eye, constipation or diarrhea. Notice the symptoms are almost exactly the same for people with NO gallbladder as for those with a dysfunctional one? Researchers estimate that at least 40% of people who have had gallbladder removal continue to experience significant abdominal pain.2 It is estimated that 5-40% of people who have had a cholecystectomy experience long term symptoms from it . 3 One British study looking at the after-effects of gallbladder surgery found that 87% of men and 68% of women experienced weight gain after cholecystectomy and urged physicians to caution patients about this ‘side-effect.4 I can easily say that in my 12 years of practice, I have NEVER had a gallbladder patient tell me that they were informed of the likelihood of weight gain prior to their surgery!

Where Weight Gain & Weight Loss Issues Come into Play

Having a dysfunctioning gallbladder or having no gallbladder are both associated not only with difficulty losing weight, but with weight gain. Anecdotal reports are abound of women having few issues maintaining their healthy weight until they had gallbladder removal surgery. On a functional level, we know that nutritional deficiencies are associated with difficulty losing weight, and by drastically impairing fat digestion through having stagnant bile or by surgical removal of the gallbladder – we create the foundation for broad-spectrum health disorders. Our bodies are designed to maintain an equilibrium, or steady state. It craves balance. So when we have gross nutritional deficiencies, our bodies inherently want to hang on to its stores of fat and nutrients. It doesn’t want to exacerbate its deficient status by losing more of anything – and that includes your love handles.

So, what can you do about it?

1) First and foremost, you need to concentrate on eliminating the nutritional deficiencies. This is imperative if you want to get your body out of starvation mode. I suggest that you take a high-quality, highly absorbable multivitamin. Look for a high potency multivitamin that contains more than the 100% RDA amounts. Those amounts were designed to keep a person out of gross deficiency status, they are not amounts your body needs for optimal functioning.

2) The second thing I recommend is supplementing with pancrealipase and organic beet extract. I carry two different formulas – one for people with gallbladders who need to thin their bile so their digestion works better and another for people who no longer have a gallbladder and who need to add ox bile extract in addition to the pancrealipase and organic beet extract so they can start breaking down those dietary fats , get themselves out of a deficient status, and start losing weight. Either formula can be ordered directly from me (message me through facebook), or through the manufacturer. These supplements are only sold through licensed healthcare providers, and I am prohibited from publishing prices publicly, but if you visit my facebook group and check the FILES section. I have included complete ordering information along with a discount code for my clients.

3) Limit your intake of refined carbohydrates. Not only are these typically ’empty’ calories, but they rob you of minerals like magnesium and chromium, and your b-vitamins. They also induce insulin spikes which further stress your liver and gallbladder.

4) Increase your magnesium intake. Whether you take oral magnesium preparations, or you use epsom salt baths – magnesium has been shown to prevent gallstone formation. It is also required for making appropriate levels of stomach acid.

5) Increase your intake of taurine-rich foods. Taurine is one of the major amino acids found in bile. Healthy digestion depends on getting adequate supplies of taurine. Meat, eggs, seafood, certain dairy products, and brewers years are all good sources of dietary taurine.

6) Eat healthy fats! Your body needs fat in order to lose fat. If fat digestion troubles you, start slowly with small amounts of unrefined organic coconut oil and slowly add other healthy oils into your diet. Let your body accommodate to them. Healthy fats include grass-fed butter (which is a source of vitamins A,D,E,K, as well as selenium, and CLA), ghee, lard, egg yolks, organ meat, palm oil, olive oil, most nut oils, etc. Bad fats include corn oil, soy oil, canola oil, sunflower oil, safflower oil, cottonseed oil, margarine, and anything listed as ‘hydrogenated’. These refined oils are a source of omega-6 fatty acids which not only contribute to obesity but cause inflammation within the body, and that includes liver and gallbladder inflammation.

In short, having gallbladder problems or no gallbladder whatsoever need not cause you issues. There are simple solutions that allow your body to work the way it was intended to. You can get the weight off and avoid the bizarre food cravings that come along with those nutrient deficiencies. You can feel normal after meals. You can have normal bowel movements, and you can get rid of the fatigue that overwhelms you. If you combine healthy food choices along with the simple supplements I suggest, you will see results. If you are able to combine the two with lifestyle improvements you will see results that much faster. I sincerely wish that more medical providers educated their patients on the detriments of gallbladder surgery before they submitted to it, so they could take preemptive action, however, in the words of Mick Jagger, “you can’t always get what you want, but if you try sometime, you just might end up with what you need”. So, in closing, I hope this information is what you need. Please visit me on facebook at Weight Loss Resources with Dr. Miranda. If abdominal pain persists, you may have a problem caused by something other than the gallbladder. Other possible causes of abdominal pain include irritable bowel syndrome, inflammatory bowel disease, stomach ulcers, or pancreatitis. Please seek the advice of your licensed healthcare provider to rule out serious health conditions.

♥♥♥Other posts of mine that you may find helpful (click on any of the blue text below to open) :

  1. What happens to your body after gallbladder surgery

  2. When good gallbladders go bad

  3. Weight Loss that Really Works

  4. Are these 4 hormones making you fat?

2) Hearing, L Thomas, K Heaton, L Hunt
Post-cholecystectomy diarrhoea: a running commentary Copyright © 1999 BMJ Publishing Group Ltd & British Society of Gastroenterology.

Other sources:

1. Bates T; Ebbs SR; Harrison M; A’Hern RP.Influence of cholecystectomy on symptoms.
Br J Surg. 78(8):964-7, 1991 Aug.
2. E Ros, D Zambon . Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. 1987 BMJ Publishing Group Ltd & British Society of Gastroenterology

3. CAROLE MACARON, MD,MOHAMMED A. QADEER, MD, MPH, JOHN J. VARGO, MD, MPH, Cleveland Clinic Journal of Medicine March 2011 vol. 78 3 171-178, Recurrent abdominal pain after laparoscopic cholecystectomy
  1. -(graphic)

When the liver gets fatty

Weight loss is the key to combating fatty liver.

Updated: May 9, 2018Published: January, 2011

There’s a fair amount of guesswork to the estimates, but perhaps as many as 20% of American adults have some degree of fatty liver disease, a condition that used to occur almost exclusively in people who drink excessively. The epidemics of obesity and diabetes are to blame. Fatty liver affects between 70% and 90% of people with those conditions, so as obesity and diabetes have become more common, so has fatty liver disease.

Fatty liver disease isn’t confined to any one group, and there doesn’t seem to be pronounced gender differences, but studies suggest that Latinos are disproportionately affected. It’s primarily a condition of middle age, although children may get it, too. Fatty liver disease is rapidly becoming more common in Asia, and some research suggests that men in India may be especially susceptible.

Fatty liver cells

The prevailing theory is that the condition gets started because of insulin resistance, which is, in turn, frequently a consequence of obesity and excess fat tissue in the abdomen. When people are insulin resistant, their muscle, fat, and liver cells don’t respond normally to insulin, so levels of the hormone — and the blood sugar it ushers into cells — build up in the blood. As a result, the risk of developing diabetes and heart disease increases. But insulin resistance is a complicated metabolic state that also includes an increase in the amount of free fatty acids circulating in the blood.

Fatty liver disease occurs when some of those fat molecules accumulate inside liver cells. The presence of those fattened cells can then lead to inflammation in the liver and damage to surrounding liver tissue. Once that happens, if excess alcohol is not involved, the condition is called nonalcoholic steatohepatitis (steato- for fat and –hepatitis because the liver is inflamed). Fortunately, that unwieldy name boils down to a handier acronym, NASH. Estimates vary quite a bit, but it seems that 5% to 10% of people with fatty liver disease go on to develop NASH.

NASH is often a relatively stable, low-grade condition that people live with for years, with few if any symptoms. But it can also start a cascade of serious damage to the liver and attempts by the organ to regenerate itself that culminate in an abundance of scar tissue and impaired liver function — a condition called cirrhosis. Cirrhosis is irreversible and can lead to total failure of the liver. It also is associated with an increased risk for developing liver cancer.

Some studies have shown as few as 3% of people with NASH developing cirrhosis, while others have shown as many as 26% doing so. There’s no test or risk factor that predicts who will develop cirrhosis and who won’t, although one study did find that people who are older or whose initial liver biopsies showed more inflammation were at greater risk. It’s clear, though, that the prognosis for NASH is far better than it is for steatohepatitis that’s the result of heavy alcohol consumption. Perhaps as many as half of all those with alcoholic steatohepatitis (which lacks a handy acronym) go on to develop cirrhosis.

In addition to liver problems, people with fatty liver disease and NASH need to be more worried about heart disease and stroke. Their risk of dying from cardiovascular disease is twice as high as people that don’t have NASH. One reason may be related to the inflammatory and other factors pumped out by a fat-afflicted liver cells that promote damage to the insides of arteries and make blood more likely to clot, a combination that can lead to heart attack or stroke.

The fatty liver process

Abdominal obesity and metabolic syndrome* cause insulin resistance

Insulin resistance increases fatty acid levels in the blood

Fat accumulates in liver cells

  • Up to 20% of Americans have fatty livers
  • Usually there are no symptoms
  • Weight loss can make the liver less fatty
  • Excessive alcohol use also makes the liver fatty

Fat in liver cells causes inflammation and damage to liver tissue

  • The medical term is steatohepatitis (steato- for fat and -hepatitis for liver inflammation)
  • Steatohepatitis that’s not related to alcohol is called nonalcoholic steatohepatitis, or NASH
  • A liver biopsy is the only way to definitely diagnose NASH
  • Weight loss and exercise is the main treatment.

Further liver damage results in liver fibrosis and cirrhosis

  • Fibrosis is a buildup of fibrous tissue; cirrhosis is a buildup of scar tissue
  • Between 3% and 26% of NASH patients develop cirrhosis
  • A small number of people with cirrhosis develop liver cancer

NASH has been linked to an increased risk of heart attack and stroke

  • A liver affected by NASH may produce inflammatory factors that promote the atherosclerotic process that narrows blood vessels
  • NASH may be just another aspect of metabolic syndrome
  • The cause of NASH, not NASH itself, may increase heart attack and stroke risk

*Metabolic syndrome is abdominal obesity along with high triglycerides, high blood pressure, high blood sugar, and low HDL cholesterol.

Fatty liver diagnosis

Most people with fatty liver disease don’t have symptoms, and that’s true even if it has developed into NASH. Only occasionally do people feel run-down, or they have an achy feeling in the upper right side of the abdomen, where the liver is located. So, more often than not, fatty liver disease and NASH are discovered incidentally, starting with higher than normal levels of liver enzymes on a routine blood test. Ultrasound imaging, the same technology used to get pictures of developing fetuses, can be informative: the liver looks bright because the fat shows up as white on the image. But neither an ultrasound nor a CT or MRI scan is completely reliable for making a diagnosis. The fat in the liver is visible, but not the NASH-related inflammation. Some researchers have developed formulas that use a simple blood test and measurements of various hormones, inflammatory factors, and liver enzymes to arrive at a diagnosis, but this work is at a preliminary stage.

Currently, a liver biopsy is the only way to make a definitive diagnosis of fatty liver or NASH. Liver biopsies involve inserting a long needle into the right side of the abdomen and extracting a small piece of liver tissue that can be examined under a microscope. Liver biopsies are an invasive procedure, so they aren’t entirely free of risk and complications, but they’re also fairly routine these days and can be done on an outpatient basis.

Whether a doctor will order a biopsy to nail down a diagnosis depends on many factors, including whether the person is obese or has diabetes or shows other signs of liver trouble.

Weight loss is the treatment

Weight loss, from changes in diet and an increase in physical activity, is the primary treatment for most cases of fatty liver disease and NASH. In many cases, weight loss seems to have a very direct effect: as people lose weight, the fatty liver becomes less fatty. Crash dieting is a bad idea, though, because rapid weight loss (losing 4 pounds a week or more) can wind up damaging the liver. Of course, if sustained weight loss were easy, a lot of today’s health problems would be solved, not just fatty liver disease and NASH.

In addition to encouraging people to lose weight, doctors will often advise people with diabetes who have fatty liver disease or NASH to be vigilant about controlling their blood sugar.

The final say on fatty livers

Many parts of the body come to grief once people become obese or develop diabetes. It’s not surprising that our livers do too, given how central they are to a whole suite of metabolic processes. There’s some evidence that a fatty liver may add to the already high risk of heart disease among people who are obese or have diabetes. Fatty livers can also develop into cirrhotic ones if the inflammatory processes take off.

But there are two bright spots in the take-home message about fatty livers. First, most cases stay relatively stable and don’t result in serious liver disease. Second, the treatment is not an expensive drug with side effects, but losing weight — and that will benefit many other parts of the body besides the liver.

Image: © Kateryna Kon | Dreamstime

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Is Liver Toxicity Preventing Your Weight Loss?

Symptoms of a poorly functioning liver may include:

* Low energy

* Indigestion, bloating, constipation, gas or diarrhea

* Foggy thinking

* Weight gain

* Stiff, aching, weak muscles

* Altered cholesterol levels

* Blood sugar abnormalities

* Sleep disturbances

* Easy bruising

* Brittle bones

* Fluid retention

* Kidney problems

* Slow wound healing

Action Steps for Optimal Liver Health

1. Start the day with ½ lemon squeezed into 1 cup of warm water.

2. Consume half your body weight in ounces of filtered water daily.

3. Increase fiber consumption to 35 grams per day to assist in the elimination of fat soluble toxins. Choose high fiber foods such as ground flax seeds, psyllium, apple pectin, rice bran, beet fiber, oat fiber, chia seeds and sun fiber.

4. Consume liver cleansing foods such as beets, bitter greens, apples, lemons, garlic, onions, cabbage, broccoli, Brussels sprouts, kale, collards and cauliflower.

5. Use liver cleansing herbs such as Dandelion root, Artichoke, Milk thistle, Burdock root and Turmeric.

6. Detox the liver with Alpha lipoic acid, Calcium D-Glucarate, NAC, Selenium, Choline and Methionine.

7. Drink liver detoxifying tea with dandelion root, nettle root, red clover, licorice root, burdock root and cleavers.

8. Support the digestion with probiotics and digestive enzymes.

9. Avoid toxic foods such as sugar, processed foods, refined carbohydrates, pesticides, hydrogenated fats and artificial sugars.

10. Avoid smoking, alcohol, caffeine, pop and energy drinks.

11. Exercise regularly.

Fatty Liver Disease (NAFLD)

Fatty liver, or hepatic steatosis, refers to excessive fat accumulation in the liver. In the absence of high alcohol consumption, it is termed non-alcoholic fatty liver disease (NAFLD). Obesity, and medical conditions such as hypertension, hypercholesterolemia, and diabetes, are risk factors for the development of NAFLD. In some patients, fat causes liver inflammation, or steatohepatitis; also referred to as non-alcoholic steatohepatitis (NASH). NASH may eventually cause liver scarring (fibrosis), leading to cirrhosis.

How do I know if I have fatty liver disease?

Fatty liver disease does not cause symptoms. However, your doctor may find elevated liver enzymes after a routine blood test. The liver releases the enzymes ALT and AST when there is inflammation.

Obesity and fatty liver disease

Non-alcoholic fatty liver disease is strongly associated with obesity. Excess fat causes insulin resistance and inflammatory signals. Insulin resistance means that the pancreas has to produce more insulin in order to maintain normal blood glucose levels, and is the first step towards developing diabetes.

Patients who have hypertension (high blood pressure), have high cholesterol, are overweight or obese, and have diabetes or insulin resistance are at greater risk to develop fatty liver disease. Physicians and scientists do not fully understand why the excess fat causes these liver changes. They do know that by losing weight, liver enzymes may normalize and liver inflammation may improve.

How much weight do I have to lose so I can cure my fatty liver disease?

Studies show that losing 10 percent of your weight causes the liver enzymes to improve, which correlates with a reduction in the liver inflammation caused by the extra fat.

Can fatty liver disease make it harder for me to lose weight?

Fatty liver disease should not make it harder for you to lose weight. However, you will have to follow a strict eating and exercise plan in order to lose weight. The doctors at Johns Hopkins may need to treat your fatty liver disease with a combination of medications in order to achieve adequate glucose control and normal cholesterol levels.

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Diet, weight loss, and liver health in nonalcoholic fatty liver disease: Pathophysiology, evidence, and practice

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  • 59 Hickman IE, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, Powell EE. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut 2004; 53: 413‐ 419.
  • 60 Kantartzis K, Thamer C, Peter A, Machann J, Schick F, Schraml C, et al. High cardiorespiratory fitness is an independent predictor of the reduction in liver fat during a lifestyle intervention in non‐alcoholic fatty liver disease. Gut 2009; 58: 1281‐ 1288.
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  • Does the liver play a role in weight control?

    The liver is your largest internal organ, but you may not realise it is also the major fat burning organ in your body. How well your liver functions has an enormous bearing on your metabolic rate and your energy level.

    The liver is definitely a busy organ; it is responsible for a large number of important functions that affect your overall wellbeing and quality of life. The liver can burn fat or create fat out of glucose or protein. A healthy liver is also able to pump excess fat out of the body via the gallbladder and bowel.

    The liver is also responsible for metabolising hormones; it can break down excess hormones your body no longer requires and it is responsible for activating other hormones involved in metabolism.

    If the liver filter is healthy, it allows dietary cholesterol to be shunted into the liver for metabolism or excretion through the bile. A healthy liver filter is essential to properly regulate blood cholesterol levels. Poor liver function may increase your chances of cardiovascular diseases such as atherosclerosis, high blood pressure, heart attacks and strokes.

    If the liver does not regulate fat metabolism efficiently, weight gain tends to occur around the abdominal area and a protuberant abdomen (pot belly) will develop. This is not good for the waistline! Another sign can be a roll of fat around the upper abdomen, which I call the “liver roll.” This is often a sign of a fatty liver. It can be almost impossible to lose this abdominal fat until the liver function is improved. Once this is done the liver will start burning fat efficiently again and the weight comes off gradually and without too much effort from you.

    It is not necessary to follow a very restrictive low fat, low calorie diet. What is effective in the long term is to eat the correct foods and nutrients for the liver to improve its fat burning function. I explain what these foods are in my book Fatty Liver: You Can Reverse It.

    Many middle-aged people with excess fat in the abdominal area have a “fatty liver”. In this condition the liver has stopped burning fat and has turned into a fat storing organ. It becomes enlarged and swollen with greasy deposits of fatty tissue. Those with a fatty liver will not be able to lose weight unless they first improve liver function, with an appropriate diet and a good liver tonic.

    If you have a fatty liver it is vital to be patient, as it can take between 3 and 6 months, depending upon the amount of fat deposited in the liver, to remove the excess fat from the liver. After this accumulated liver fat has been removed, weight loss will be much easier.
    If you have a very severe case of fatty liver it can take 12 months to lose all of the excessive weight. However, this is very successful in the long term and provides the best chance of restoring your figure and your health.

    Fatty liver is common and doctors often tell their patients with this problem not to worry too much because it is not serious. I disagree with this, because if you have a fatty liver, your chances of high cholesterol, cardiovascular disease and type 2 diabetes are significantly higher. Unfortunately, it is not uncommon to find a fatty liver in adolescents who consume a diet high in processed foods and soda.

    If you overload the liver with the wrong type of hormone replacement therapy, hormonal contraceptives, multiple medications, excess alcohol or toxins, the liver’s biochemical pathways will have less energy reserves left over to perform their function of fat metabolism. Thus these things can lead to weight gain.

    The liver also plays a vital role in regulating sex hormones in women. A healthy liver will break down excess estrogen and eliminate it via the gallbladder and bowel motions. Women with a sluggish liver typically do not break down estrogen adequately. This can lead to a situation called estrogen dominance and progesterone deficiency. In essence there is too much estrogen relative to progesterone in the body.

    Excess estrogen promotes weight gain, cellulite and fluid retention on the lower body; typically the hips, thighs and buttocks. This hormone imbalance also promotes premenstrual syndrome and bloating before menstruation. Using a natural progesterone cream can help to correct this imbalance.

    The liver plays a vital role in thyroid hormone metabolism. The main thyroid hormone is called T4 and is produced in the thyroid gland. However this is an inactive hormone and it must be converted to its active form, known as T3. The majority of this conversion occurs in the liver. People with a fatty or sluggish liver do not make this conversion easily. This can result in a slowed metabolic rate, fluid retention, constipation, weight gain and other symptoms of an under active thyroid gland.

    Selenium is required for this conversion to take place and I have found that many cases of a sluggish thyroid gland can be improved with a selenium supplement. Selenium also helps to increase energy levels and it supports the immune system.

    Anyone wishing to lose weight or maintain a healthy weight must pay attention to the health of their liver. You can improve the health of your liver by following the eating principles in my books Fatty Liver: You Can Reverse it and/or The Liver Cleansing Diet and by taking a good quality comprehensive liver tonic such as Livatone Plus, which contains St Mary’s thistle, taurine, selenium and B vitamins.

    The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.

    Numerous Conditions Can Increase Risk of Fatty Liver Disease

    December 14, 2012

    Dear Mayo Clinic:

    Is nonalcoholic fatty liver disease treatable?


    Nonalcoholic fatty liver disease (NAFLD) — a condition in which excess fat accumulates in the liver of people who drink little or no alcohol — has become one of the most common liver diseases in the U.S. It’s estimated that the disorder affects up to 20 percent of American adults. Researchers believe this is associated with rising rates of obesity. While some studies have shown a benefit from vitamin E and the prescription medication pioglitazone, the focus is generally on treating the risk factors.

    The liver performs many tasks, including processing what you eat and drink into energy and nutrients and filtering harmful substances from your blood. With NAFLD, fat builds up in liver tissue. Some people may experience nonspecific symptoms; however, most individuals with NAFLD experience no symptoms at all.

    The buildup of fat in the liver can result in inflammation and scarring (fibrosis). This more serious form of NAFLD — called nonalcoholic steatohepatitis, or NASH — can cause severe liver damage and eventually lead to liver failure or liver cancer in a small percentage of people. Although rare, the scarring can also harden the liver and impair its ability to function properly — a condition known as cirrhosis.

    NAFLD may not be discovered until blood tests show an elevation in certain liver enzymes. Additional blood tests may be ordered to rule out other causes of liver disease. To confirm the presence of fat in your liver, doctors often perform an imaging procedure — such as ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI) — and may also recommend a liver biopsy to examine a sample of tissue for signs of inflammation and scarring.

    A number of diseases and conditions can increase the risk of fatty liver disease. These include obesity, high blood cholesterol, and type 2 diabetes. Other risk factors include malnutrition and rapid weight loss. Certain medications, such as corticosteroids, and exposure to some toxins and chemicals also may contribute to fatty liver disease.

    Although no specific treatment exists, weight loss can improve and possibly even reverse fatty liver disease to some degree. Shedding excess pounds through diet and exercise or with the help of weight-loss (bariatric) surgery can prevent additional liver damage when inflammation and scarring is already present. However, any weight loss should be gradual — no more than a few pounds a week — because losing weight too quickly can actually worsen fatty liver disease.

    Eating a diet rich in fruits, vegetables and whole grains, and limiting the consumption of cholesterol and saturated fats also can help. Cutting out fast food may be particularly helpful, because research has found that the high level of cholesterol, saturated fat and fructose in fast food is associated with progressive inflammation and scarring in people with NAFLD and NASH.

    A recent study of adults with NAFLD suggests that vigorous physical activity may also help reduce damage from fatty liver disease. Government guidelines advise that healthy adults get at least 150 minutes per week of moderate physical activity, such as walking, or 75 minutes of vigorous physical activity, such as running on a treadmill. Increasing that time to 300 minutes of moderate physical activity or 150 minutes of vigorous physical activity each week can yield even greater benefits, such as weight loss. But if you don’t already exercise regularly, talk with your doctor first about the best way to start.

    It’s also important that people with fatty liver disease avoid excessive alcohol and unnecessary use of medications, which can put stress on the liver. Carefully follow medication instructions and warnings. For instance, acetaminophen — a pain reliever found in many prescription and nonprescription drugs — can cause liver damage if more than the recommended amount is taken. The risk of liver injury primarily occurs when people exceed the current maximum dose of 4,000 mg within a 24-hour period.

    Finally, people who have diabetes, high blood cholesterol or medical problems that may be contributing to fatty liver disease should work with their doctor to keep these conditions well managed, which in turn will help manage NAFLD.

    — Vijay Shah, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

    How To Burn Fat In Your Liver

    Have you been diagnosed with a fatty liver? Do you carry excess fat over your torso? Fatty liver is a modern day epidemic. It affects approximately one in four people in many parts of the world. If your liver is clogged with fat, it will not be able to burn fat efficiently. That means weight loss feels impossible.

    Your liver performs more than 400 functions in your body. Its main functions involve energy production, fat metabolism, and the processing of sugar and protein. If your liver isn’t functioning well, you will be tired and have a slow metabolism.

    If you consume more carbohydrate than your body can tolerate, your blood sugar may rise excessively. Insulin is released by your pancreas, into your bloodstream. Insulin is a trigger for your liver to begin storing the excess glucose inside its own cells. When your liver is full of glucose (glycogen), it begins storing the calories you ingest as body fat.

    People with a fatty liver usually have too much insulin in their bloodstream. They are said to have syndrome X. This is a problem because insulin blocks your fat burning hormones from being able to work. So you could be on a low calorie diet and exercising regularly, yet not be able to lose weight. It’s a cruel reality for millions of people with a fatty liver.

    The liver possesses remarkable abilities to repair and renew itself. That means fatty liver can be completely reversed, if it’s detected early enough. This is why it’s so important to ask your doctor for a liver function test if you are unfamiliar with the health status of your liver. Fatty liver is increasingly seen in children. This is worrying because the earlier in life you develop a fatty liver, the more likely you are to develop complications. Potential complications include cirrhosis of the liver or liver cancer. People with a fatty liver are also at heightened risk of developing type 2 diabetes. This makes weight loss even more difficult.

    I have developed a very specific way of eating, which is designed to:

    • Reduce the fat in your liver
    • Minimize liver damage
    • Improve the function of insulin
    • Make weight loss easier

    This is not a low-fat low-calorie diet. It will not leave you hungry and tired, and after a couple of weeks your cravings will disappear. My eating plan provides you with first class protein regularly throughout the day, along with plenty of vegetables and some good fats.

    My plan for burning fat in your liver

    1. Follow a low carbohydrate diet
      This needs to exclude sugar, flour and foods containing these things. Avoid all foods with added sugar. If you are overweight and find it very difficult to lose weight, it is more effective to exclude all grains and follow a “no grain diet”.
    2. Increase the amount of raw plant food in your diet
      Raw vegetables and fruits are the most powerful liver healing foods. These raw foods help to cleanse and repair the liver filter, so that it can trap and remove more fat and toxins from the blood stream. Eat an abundance of vegetables (cooked and raw salads). Limit fruit to no more than 2 servings per day. Eat a large salad every day, or better still twice a day and use a nice dressing made with cold pressed oils and apple cider vinegar and lemon juice.
    3. Eat first class protein with every meal
      Good sources of protein include –
      – Free range, pastured eggs
      – All seafood, fresh or canned (avoid deep-fried seafood)
      – Free range poultry
      – Pastured fresh meat
      – Whey protein powder
      There is an easy to follow lower carbohydrate, higher protein eating plan in my book Fatty Liver: You Can Reverse It.
    4. Avoid unhealthy fats
      These include all deep fried foods, processed and preserved meat, partially hydrogenated vegetable oils and trans-fatty acids found in margarines and cheap cooking oils. Avoid hydrogenated oils found in processed foods and snacks (read the labels on foods to see if they contain hydrogenated vegetable oils).
      You do not need to follow a low fat diet and indeed you need to eat the healthy fats found in seafood, cold pressed vegetable and seed oils, free range organic eggs, avocados, raw nuts and seeds.
    5. Drink raw vegetable juices regularly
      A fatty liver is an inflamed liver and raw juices are a powerful natural anti-inflammatory remedy. If you have a fatty liver, your liver cells desperately need the vitamins, minerals and antioxidant pigments in fresh raw vegetables. Juices are therapeutic because they provide an added boost of nutrients, on top of the vegetables I’d like you to eat in salads for lunch and dinner. There are specific juices for the liver in my book Raw Juices Can Save Your Life.
    6. Try to exercise regularly
      A regular exercise program is important as it speeds up your metabolism and reduces insulin levels. It is important to find an activity you enjoy, and start slowly and gently. It takes time to build up fitness and strength. We all have to start somewhere. If you are extremely busy and don’t have the time or energy for exercise, even a ten minute gentle walk will help you.
    7. Take a liver tonic every day
      Take a liver tonic every day and use a tonic that combines the clinically proven dose of St Mary’s Thistle combined with B group vitamins, antioxidants and sulphur rich amino acids. Livatone Plus contains everything you need in one powder or capsule; this enables you to avoid having to take multiple tablets of the individual ingredients. Suitable liver tonics promote repair of damaged liver cells, and facilitate the fat burning and detoxification functions of the liver; they can also speed up weight loss.
    8. Help insulin to work better
      There are certain herbs and nutrients that help to make insulin more effective in your body. This is a good thing because if it’s more effective, you won’t need to secrete as much of it into your bloodstream.

    The most important nutrients for insulin action are chromium and magnesium. You have probably heard that chromium helps to reduce sugar cravings and it’s true. It does this by helping to keep your blood sugar stable throughout the day. Chromium deficiency is incredibly common because not many foods are a good source of this mineral. Also when you eat sugar or high carb foods, it flushes chromium out of your body through your urine.

    Magnesium is also necessary for healthy insulin action. People who take blood pressure medication or diuretics (fluid tablets) are typically low in magnesium. Magnesium helps to relax your nervous system and makes you feel less stressed. Thus it is fantastic for people who eat when they feel stressed.

    Gymnema sylvestre is an herb that helps to keep your blood sugar stable and it helps to reduce sugar cravings. It is also very good for diabetics. Bitter melon is a vegetable that is commonly used in Asian cuisine. True to its name, it is an extremely bitter vegetable and many people are not able to handle the intense flavor at all. You can find all of these nutrients and herbs combined together in Glicemic Balance capsules. When taken with meals they help to reduce hunger and cravings and help to lower your blood insulin level. Berberine helps to improve insulin sensitivity, cholesterol metabolism and assists weight loss. It is very helpful for those with type 2 diabetes or pre-diabetes.

    Fatty liver is a complex condition but there are ways to overcome it.

    The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.

    Jupiterimages/ Images

    The liver plays an important role in fat metabolism and when it cannot perform this function as efficiently, fat stores, primarily in the form of triglycerides, build up in the liver. While it typically does not cause any damage, it can lead to inflammation and scarring. Fatty liver disease most commonly results from obesity, but has also been linked with diabetes, high triglycerides, alcoholism and the use of certain medications. Treatment primarily lies in addressing the underlying conditions causing fatty liver. Lifestyle changes can also help. You should talk to your doctor for guidance in designing a treatment strategy and before making any drastic changes to your diet.

    gorgev/iStock/Getty Images

    Reduce your intake of refined, quick-burning carbohydrates like white-flour foods and sugar. A study published in a 2007 issue of “Obesity,” led by Dr. David Ludwig of the Children’s Hospital of Boston, fed rats a diet either a low-glycemic diet, which raises blood sugar more steadily, or a high-glycemic diet, which causes a rapid rise. Those fed a diet mirroring unhealthy carbohydrates had twice the amount of fat in their livers, as well as in the rest of their bodies.

    mythja/iStock/Getty Images

    Eat fewer carbohydrates overall; a study conducted at the University of Texas Southwestern that appeared in a 2009 issue of “Hepatology” found that eating fewer carbohydrates caused the liver to burn its fat stores as a source of energy. Foods particularly high in carbohydrates include starches such as bread, pasta, rice, potatoes and corn and sugar. You do not need to completely cut out these foods, but keep servings small and aim for whole grain choices when applicable.

    Michał Różewski/iStock/Getty Images

    Limit alcohol consumption. Excess alcohol intake has been linked with increasing triglyceride levels, the primary form of fat found in the liver.

    Lcc54613/iStock/Getty Images

    Include more plant foods in your diet such as fruits, vegetables, plant proteins like soy and healthy fats like nuts and seeds. These foods will promote weight loss and keep cholesterol and triglyceride levels under control.

    Warren Goldswain/iStock/Getty Images

    Exercise at a moderate pace at least 30 minutes a day most days of the week. Moderately intense exercise should raise your heart and breathing rate beyond what you experience during day-to-day activity.

    What Your Liver Can Teach You About Burning Fat

    Although your body works as a holistic organism consisting of multiple systems, it is important to look at various organs and systems in order to learn how they affect the overall health of your body. In this installment of “Organ Examination,” we will be looking at your liver. This is appropriate, as readers of The Beauty Detox Solution read how much I talk about it!

    Anatomy of the Liver

    Your liver sits in the upper right-hand side of your abdominal cavity. It is protected by the rib cage, and sits just in front of the gallbladder. It rests on top of your stomach, just below your diaphragm. It weighs around three pounds, and is a dark red color. Your liver has two lobes, separated by a series of ligaments. In each lobe, the liver contains lobules that connect via a complex duct system, which transports bile produced in the liver to the gallbladder and duodenum.

    The liver receives blood and oxygenation from two sources. The hepatic artery brings oxygenated blood to the liver, while the hepatic portal vein delivers nutrient rich blood.

    The liver is part of your biliary system with the gallbladder and bile ducts, which creates, transports, and stores bile for digestion. It is also part of the digestive system, which breaks the foods you eat down into smaller, more accessible particles. Other organs that work with the liver in the digestive system are the stomach, pancreas, and intestines.

    Liver Functions

    Your liver performs more than 500 vital functions in your body. While I am not going to list all of them here, I will share some of the most important roles the liver plays.

    1. All blood leaving the stomach and intestines passes through the liver.
    2. When that blood reaches the liver, it processes it, converting nutrients and medications into more usable forms.
    3. The liver contains about 13 percent of the body’s blood at any given time. As the blood passes through the liver, the organ balances the blood’s chemical composition and produces bile from the waste products.
    4. Bile carries those waste products away from the liver, allowing it to continuously detoxify the blood.
    5. It is your body’s main fat burning organ, regulating fat metabolism and carrying fat out of the body via bile.
    6. The liver produces blood proteins necessary for plasma, which is an essential component of blood.
    7. The liver produces cholesterol. While many people think this is a bad thing, cholesterol actually plays an important role in the body. It is the precursor for testosterone and estrogen. Cholesterol also supports cell structure and helps maintain healthy neurological function. Note: This is different than foreign cholesterol, which is derived from animal products.
    8. The liver further detoxifies by removing bacteria from the blood stream. This is essential for healthy immune function. Additionally, a healthy liver produces immune factors that fight disease.
    9. It regulates blood clotting. Inefficient blood clotting can lead to bleeding disorders and anemia, while overabundant blood clotting can lead to an array of health and clotting disorders including embolism and deep vein thrombosis.
    10. It detoxifies, removing harmful medications and toxic substances from your blood.
    11. The liver stores iron, which it processes from hemoglobin.
    12. It converts blood sugar (glucose) to glycogen (stored energy), and then back to glucose (active energy).
    13. It regulates amino acids in the blood.

    Effects of an Unhealthy Liver

    What happens when your liver doesn’t function properly? An unhealthy liver may obstruct bile flow, resulting in inefficient toxin removal. Resultantly, the liver may fail to remove bacteria from the bloodstream, leading to decreased immunity and increased illness. It may also fail to break down the nutrients you need for health. In some cases, the blood may even bypass an unhealthy liver, turning medications toxic. In extreme cases of liver damage, the liver may develop scarring called cirrhosis, and it may function poorly or not at all.

    Substances that Damage the Liver

    With all of those functions and negative effects of an unhealthy liver, it’s easy to see why it is so essential to keep your liver healthy. The Beauty Detox Solution is designed to minimize toxins in your body, which supports liver function and keeps you healthy and strong. Some substances, however, can cause liver damage.

    • Chronic alcohol intake
    • Overuse of prescription and over the counter medications
    • Excessive use of herbal remedies
    • High-fructose corn syrup
    • Refined sugar and fructose (including agave)
    • MSG
    • Artificial sweeteners
    • Pesticides
    • Artificial flavors
    • Food dyes
    • Deep fried foods
    • Processed foods

    Protecting Your Liver

    Your daily habits can help protect this valuable organ.

    • Eat an organic, plant-based diet rich in Omega-3 fats.
    • Cut out caffeine, sugar, artificial sweeteners, and avoid high-fructose corn syrup at all costs.
    • Drink plenty of pure water to flush your liver.
    • Avoid animal products and processed foods.
    • Drink water with organic lemon every day.
    • Start your day with a Glowing Green Smoothie

    Liver Detox

    While cleansing should be an ongoing process, you can incorporate certain foods for a deeper cleansing.

    • Make detox tea from lemon, ginger, and cayenne and drink it throughout the day.
    • Eat only raw dark leafy greens for an entire day, cutting out fats and oils, salt, vinegar, and other substances.
    • For even more detoxification, add cayenne to your vegetables to get your blood flowing as you detox.
    • Drink plenty of pure water (not tap water), avoiding any water from bottles made from bisphenol A.
    • Continue with The Beauty Detox Solution diet.

    Now that you know a little more about your liver, you probably understand why maintaining the health of this vital organ is so important. By cleansing your liver and eating a diet that supports healthy function, your body will be much better able to eliminate toxins, fight off disease, and process nutrients from the foods you eat. The cleaner your liver, the more clear and beautiful your skin will become as well.

    Weight loss and liver

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