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Internationally recognized as a pioneer in the fields of dietary, environmental, and women’s health, Ann Louise Gittleman, PhD, CNS, has long been a trendsetter in functional and integrative medicine. She has won numerous awards, including the American Medical Writers Association Award for Excellence and the Cancer Control Society Humanitarian Award. She sits on the advisory boards of several nutrition-based organizations, including the Nutritional Therapy Association and Price-Pottenger.
Ann Louise is also a New York Times bestselling author of over 30 books on health and nutrition. Her latest book, The New Fat Flush Plan, updates and expands upon the revolutionary dietary program she introduced over 15 years ago, presenting evidence-based strategies for weight loss, metabolic and hormonal balance, liver cleansing, and overall wellness. This interview focuses on some of the important new information found in the book.
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Ed Bennett: Your recently released book The New Fat Flush Plan discusses the significance of the liver in weight control – a topic we usually don’t hear much about. What is the function of the liver and what is its connection to body weight?
Ann Louise Gittleman: The liver is the key organ for fat metabolism, and keeping it healthy is one of the best-kept secrets in weight control. We really have not devoted as much attention as we should to its connection to weight loss and fat burning.
Actually, the liver performs about 500 different tasks. It functions as a living filter to cleanse the blood of toxins, controls hormonal balance, produces immune-boosting factors, and helps metabolize proteins and carbohydrates. While all of these tasks are essential to overall health, they don’t have a direct bearing on weight loss the way the liver’s production of bile does. The real key to its fat-burning ability and its connection to body weight is bile, a yellowish-green liquid that is stored in the gallbladder and released when needed to facilitate the emulsification and absorption of fats in the small intestine. Bile is also one of the liver’s primary detoxification methods, as it carries toxins out of the liver for excretion from the body.
When the bile becomes thick and congested or does not flow properly through the bile ducts, you lose the ability to burn and metabolize fats efficiently, and your ability to move toxins through the bile is hampered. The worse the quality of the bile, the less your body can break down and use fat, and the more you will store as excess pounds, particularly around your midsection. Weight-loss efforts are sabotaged and overall health is affected when the liver becomes overloaded and can no longer perform as it should because it lacks essential nutrients or is overwhelmed by toxins.
EB: What are some of the common dietary and environmental toxins that contribute to this problem?
ALG: All dietary and environmental toxins contribute to the development of an overloaded and tired liver. In fact, many of us consume substances that compromise liver function on a daily basis. Alcohol is certainly the best known of these. Other common dietary toxins include sugar – especially fructose, which is metabolized in the liver and can play a role in development of nonalcoholic fatty liver disease – and caffeine. Certainly, many over-the-counter and prescription medications are extremely toxic to the liver. For example, acetaminophen has a disastrous, almost legendary, reputation for causing liver failure. Thousands of other substances that we breathe, consume, or touch – including pesticides, parabens, secondhand smoke, chemical food additives, and indoor pollutants from cleaners, carpets, and paint – have toxic effects and contribute to liver overload.
The liver has several methods of detoxifying these in the body, including the filtering of the blood and the production of bile, as I mentioned. However, there is also another method, a two-phase system called the cytochrome P450 process. This system has two pathways that break down, eliminate, and neutralize toxins. But sometimes a particular poison or pollutant is not completely deactivated in the system because of a lack of certain amino acids, enzymes, antioxidants, or other nutrients. The metabolic byproducts resulting from this incomplete detoxification process are often more toxic than the original substance itself, and they can remain in the body if the liver does not have the proper support.
That is why it’s vitally important to eat foods on a daily basis that can help the liver in this detoxification process. It’s not a matter of cleansing the liver but rather of nourishing it with supportive elements – a variety of nutrients that the liver needs to break down toxins thoroughly. This is essential when anybody goes on a weight-loss or detox program, such as my Fat Flush Plan. Because of this, I have built in many different foods, beverages, and spices that nourish and support these detoxification pathways.
EB: What strategies do you recommend for supporting the liver?
ALG: First, I’m recommending food. Certain foods are very helpful for the liver, and if we integrate them into a daily program, they become part and parcel of what we do to keep ourselves well on an ongoing basis. To me, detoxification is a daily event. It’s not just a seasonal practice that we do in the spring or fall.
My plan includes many things that you can use to reset and restore liver function. First and foremost would be the beverages that we take on a daily basis. The one that has been our main signature drink is cran-water, a diluted mixture of unsweetened cranberry juice and water. It’s a very rich source of potent phytonutrients, including anthocyanins, catechins, lutein, and quercetin, that act as antioxidants. These specific antioxidants provide nutritional support and serve as cofactors for the liver’s two-phase detoxification pathways. This beverage also is very helpful in terms of balancing pH and regulating the blood sugar. In addition, cranberry contains organic acids that assist in digesting fatty globules in the lymph that contribute to the creation of cellulite. That’s why the Fat Flush program is known to help remove cellulite.
Cran-water is a vitally important beverage that also works wonders in cleaning the lymphatic system, the liver’s partner in toxic waste removal. This is an old trick that we’ve used for years. There’s nothing else – other than exercise, which people are sometimes loath to do – that can really target the lymphatic system. Cran-water can also help decrease stubborn fat stores because the liver becomes much more efficient in using stored fat for energy when the body is well hydrated. For some people, cranberry has a mild blood-thinning quality, so that’s a caveat to keep in mind. But for many people, cran-water can be taken on a daily basis.
Lemon water is also helpful in thinning the bile and toning the liver. When taken with food, it can also help to balance blood sugar. I recommend a daily morning drink of hot water with lemon or lime juice added, and optional pinches of ginger and cardamom.
Another beverage that is important in terms of detoxifying and supporting the liver is dandelion root tea. It is my favorite liver-loving beverage because it’s gentle, it promotes liver health, and it provides an energy boost. An herbal bitter, it stimulates the flow of bile and can lower elevated liver enzymes for those who have overdone sugar, trans fats, medications, and alcohol. It’s also a good source of a number of vitamins and minerals, including potassium, which is a very underappreciated mineral needed to support the body during detoxification. I recommend drinking at least one to two cups a day. I also suggest taking a cup of the tea and putting perhaps a tablespoon of coconut oil or MCT (medium-chain triglyceride) oil in it. That’s good for the liver and the thyroid, as well as being very satisfying. Personally, I prefer roasted dandelion root tea, which is much more palatable and better tolerated than raw dandelion tea by many people.
In terms of foods that support liver health, I consider daily consumption of eight ounces or more of protein to be important. This not only raises the metabolism but can also trigger the production of enzymes that help break down toxins for excretion. I particularly like a hormone-free whey, which has the precursor amino acids needed for the production of glutathione, an antioxidant that plays a leading role in the liver’s detoxification processes.
I also recommend including in the diet certain plant-based oils that bind to fat-soluble toxins lodged in the liver and help carry them out for excretion. That’s where flaxseed oil, coconut oil, and MCT oil come into play. These are all built into my daily menu plan. Flaxseed oil is essential for its high omega-3 content, which is important in fighting fat. It’s a “skinny” fat, meaning that it helps reduce belly fat, and it has an insulin-regulating potential. Coconut oil, a rich source of medium-chain fatty acids, boosts metabolism significantly and increases thyroid activity, so it is a skinny fat as well. MCT oil, a fractionated coconut oil, can be more efficient for certain people and seems to be better tolerated by some who genetically can’t tolerate coconut oil. Avocado oil is another beneficial fat. It triggers a particular appetite hormone, adiponectin, that is essential for satiety, and it’s a rich source of glutathione.
The spices we use that support the liver and boost metabolism include garlic and onion, which encourage bile secretion; and ginger root, which reduces toxic buildup in fat cells and increases bile flow. Of course, there is also the all-important turmeric, which is a very healing and helpful antioxidant-rich herb that decongests the bile.
There are a lot of traditional foods that I would recommend. For example, beets and artichokes are very important for liver health. The betaine in beets thins the bile and helps protect the liver against the damaging effects of alcohol, while artichokes are high in antioxidants and boost bile production.
EB: Are some types of animal or vegetable protein more supportive to the liver than others?
ALG: I think most of us need a balance of both animal and vegetable proteins. Certain people seem to do very well on some of the cleaner animal proteins. I personally like a hormone-free whey made with A2 milk, a non-mutated type of milk, rather than the A1 milk that is so prevalent in this country. We import this whey from New Zealand. (It is available at unikeyhealth.com.) Many people who don’t do well with other whey protein powders do exceedingly well with the Fat Flush whey protein.
For some people, I suggest a non-GMO brown rice and pea protein that has been heavy-metal checked, so we know that there’s not a lot of arsenic in it. I also recommend lamb and organic, grassfed beef because of their L-carnitine content, which promotes the metabolization of fatty acids and assists in the normalization of liver enzymes in the blood; and a mixture of wild-caught fish, taken in moderation. Of course, the plan includes options and substitutions for those who are vegetarian or vegan.
Egg, which used to be a required food for the program because of its lecithin and phosphatidylcholine content, is now an optional food. Pastured eggs, high in omega-3, are a wonderful source of inexpensive, high-quality protein. However, eggs can be problematic for those individuals who have issues with their gallbladders. In the 1960s, a leading allergist, Dr. James Breneman, found that eggs were the number one allergy-producing food for people with gallbladder problems. When eggs were removed from the diet, a lot of their gallbladder pain disappeared. We know that egg – both the yolk and the white – is a highly allergy-producing food for many other individuals, as well.
EB: Would you discuss the relative importance of the essential fatty acids?
ALG: Most people today know that the omega-3s are absolutely foundational for good health. In relation to weight loss, they raise the metabolism, help flush water from the kidneys, and increase the activity of L-carnitine to facilitate the burning of fat. But what is not generally recognized is the importance of certain omega-6s. We’ve gone way over the line in terms of promoting omega-3s, which are now displacing the good omega-6s. Our cell membranes require linoleic acid, which is an omega-6, as well as the omega-3s. I believe that the ideal ratio of omega-6 to omega-3 in the diet is 4:1 in favor of omega-6. Although many people are getting a huge amount of omega-6s from processed and refined seed oils, these omega-6s are not biologically potent. What I’m talking about is healthy omega-6s, which we need in our diet.
One omega-6 fatty acid that is particularly important is gamma linolenic acid (GLA). This is produced by the body from linoleic acid, which we can obtain from unheated and unprocessed safflower, sunflower, and corn oils. Since various factors can interfere with the conversion process, it is usually advisable to rely on preformed GLA, which is found in evening primrose oil, blackcurrant seed oil, and borage oil. That being said, I have also integrated into my program non-GMO sunflower lecithin and soy lecithin, which are rich in linoleic acid. Lecithin was an old-time diet aid that we used back in the 1970s, and I find that it’s more important today than ever before. It acts as a detergent for fat and bile, and it keeps everything flowing.
I’ll be proven right about the need to increase healthy omega-6s, because we’ll do a lot of clinical testing. I’m in touch now with biochemists who are having dramatic results with children who have all kinds of brain dysfunctions, from autism to developmental problems, and adults with Alzheimer’s and so forth, just by switching the ratio of essential fatty acids and supporting the brain cell membranes.
EB: Are there other supplements that you would recommend to aid liver functioning?
ALG: A number of supplements can be used as adjuncts to the program, including several lipotrophic herbs, which increase fat metabolism. Milk thistle is very helpful for many people, as it boosts production of liver enzymes, helps repair damaged liver tissue, and blocks the effects of some toxins. However, I would err on the side of caution with this herb because some people are allergic to it. Oregon grape root stimulates the liver by helping to regulate bile production. I like tinctures of this herb that contain a bit of ethanol, which can move the herb through the blood-brain barrier. Another nice thing about Oregon grape is that it’s a natural source of berberine, which is very helpful in terms of blood sugar regulation. Other lipotropic substances that can be used include dandelion, which we spoke about, some of the B vitamins, phosphatidylcholine, inositol, the amino acid methionine, and the fat-digesting enzyme lipase.
EB: How can we tell if our bile is insufficient in quality or quantity?
ALG: There are a lot of signs and symptoms that may be related to either low bile quality or insufficient production. For example, impaired bile flow will induce queasiness after eating a fatty meal. Having light-colored (clay-colored) or floating stools can be a strong indication that there is a lack of bile output. Nausea or very dry skin and hair can mean that you may not be absorbing enough essential fatty acids due to inadequate bile. Constipation is a major warning sign. It’s much more related to insufficient bile for lubrication than it is to a lack of fiber. Hemorrhoids can reflect a congested liver condition, which can be due to bile problems. Bloating, gas, food sensitivities, and a bitter taste in your mouth after eating are other potential symptoms. Even hypothyroidism can be related, because bile is needed to activate thyroid hormones in the fat cells. So, there’s a thyroid connection, which most people aren’t aware of. We’re now calling bile support the secret thyroid cure.
A study conducted in Finland found that people with reduced bile flow had a sevenfold increase in risk of hypothyroidism. Another study showed that the release of bile triggered the release of an enzyme that converts the prohormone thyroxine (T4) to the more active hormone triiodothyronine (T3) in the thyroid – a process that allows cell metabolism to take place. The researchers found that people who improved their bile health saw a dramatic increase in their metabolic rate. In addition, many functional medicine doctors have observed that when individuals have their gallbladders – the storage tanks for bile – removed, they start evidencing symptoms of hypothyroidism that they never had before.
EB: If a person has had their gallbladder removed, what do you recommend they do?
ALG: The job of the gallbladder is to contract, sending bile into the small intestine, when fat needs to be digested. Without a gallbladder, people cannot regulate the release of bile, and they will experience bile deficiency. What they have to do is replace the bile salts, a component of bile that plays a vital role in the emulsification of fats and the absorption of essential fatty acids and fat-soluble vitamins. They can do that with ox bile, which is easily available on the market, or herbal bitters if they are vegetarians or vegans. There are a lot of herbal bitters, such as dandelion and gentian root, that function much the way bile salts do.
Whenever such people eat fats, they need to take a bile salt replacement. My first choice would be ox bile. In fact, I have formulated a supplement called Bile Builder (available at unikeyhealth.com) that includes ox bile, for individuals who have had their gallbladders removed. We’ve had people who used to throw up on a daily or weekly basis because they did not produce enough bile after having had their gallbladders removed. This supplement changed their lives. Among its other ingredients are choline, which assists in fat digestion, and taurine, which promotes bile production.
EB: What is the relationship between stomach acid and bile, and what should we do if we have low stomach acid?
ALG: Stomach acid is bile’s fat-fighting partner. It is important for people to understand that we need hydrochloric acid (HCl) to trigger secretion of the hormone cholecystokinin (CCK), which helps the gallbladder release bile for fat emulsification. Without sufficient HCl, bile production is hampered and the digestion of fat is impaired. Low HCl levels – resulting from aging, stress, or a lack of nutrients – are epidemic in this country.
Some of the symptoms that can indicate low stomach acid include bloating, gas, an inability to digest protein efficiently, and a problem with iron, magnesium, or calcium metabolism. We also find that rosacea may be linked to it. In fact, there are many visual and digestive signs and symptoms that can indicate low HCl. If you find that you no longer like to eat meat, it may be because you lack sufficient stomach acid to actually digest it. That is the case with a lot of people who want to begin a vegetarian or vegan diet because of digestive issues, not ethical or moral ones.
There are various ways you can test your HCl level. One way, certainly, is to use the Heidelberg test, in which you swallow a little radio transmitter and a computer records the pH of your stomach as you drink a baking soda solution. However, if you simply eat a little something – maybe a proteinaceous food – and then take your salivary pH 20 minutes later using a strip of litmus paper, you will see whether it is too acidic. HCl has an alkaline residue, so if your saliva remains too acidic after you eat, you are not producing enough stomach acid. There are lots of easy-to-do little tests that you can use in this day and age. If you find you have low stomach acid, you can take an HCl supplement. Alternatively, taking two teaspoons of apple cider vinegar in eight ounces of water 20 minutes before a meal can be helpful for many people.
EB: You mentioned that the lymphatic system is the liver’s partner in removing toxins from the body. How can we best support the lymphatic system?
ALG: The lymphatic system is a very underrecognized secondary circulatory system. If the liver is the body’s filter, the lymphatic channels are its drainage system. The lymph extracts viruses, bacteria, toxins, and wastes from the cells and helps rid the body of them. Most of us are very familiar with the role of the cardiovascular system in keeping us healthy, but the lymphatic system really needs to get better press. It’s well known in Europe but not so much in this country.
The word lymph comes from a Latin word that means “water goddess,” referring to the fluid’s watery nature. Indeed, healthy lymph is very transparent. Unlike blood, which is pumped by the heart, lymphatic fluid has no pump. Instead, what moves it through its many ducts and channels are muscle contractions. Thus, regular exercise is extremely important. One of the reasons we know that we are intended to be very active – not sedentary couch potatoes – is because that’s the only way our lymph moves efficiently.
The lymph moves through a complex network of tubes known as lymphatic vessels, which collect excess interstitial fluid from the tissues. When the lymph is not flowing properly, the excess fluid doesn’t drain well from our tissues, and they become bloated and water logged, adding water weight to the body. Poor lymphatic circulation also means that the nutrients in the fats we ingest don’t get properly absorbed and transported to the bloodstream.
My plan targets the lymphatic system with a particular exercise program. For one thing, we jump up and down on a mini-trampoline for five to ten minutes. Brisk walking is also part of the program. Jumping rope is also healthy for some people, depending upon the condition of their joints, and laying on one’s back and performing bicycling movements in the air is very good for lymphatic drainage. In addition to exercise, massage and deep breathing are beneficial for lymphatic flow. There are all sorts of built-in protocols to boost lymphatic function and support the liver and intestines, to make people lean and clean and help them digest their fats properly so that they can detoxify and lose weight.
EB: While the liver and the bile play important roles in weight loss, you also cover much more in The New Fat Flush Plan. Is there anything in particular that you would like to add in closing?
ALG: What’s important is that we look outside the box to identify the unexpected root causes of weight-loss difficulties. To that end, I introduce about ten hidden weight-gain factors that explain why, in most cases, it’s not your fault that you’re fat. Whether you’re dealing with an inability to lose weight or you’re simply not feeling well, I believe you can get to the underlying cause if you just address some of these hidden weight-gain factors.
My new book also includes a Three-Day Ultra Fat Flush Tune-Up for a quick metabolism boost. We have new information on the best slimming “smart fats” and some of the best sweeteners, and we present up-to-date gluten research. We also have a new Fat Flush Bone Broth and recipes that are paleo-, ketogenic-, and vegan-friendly. So, we’re right up to date with the latest diet trends.
Ed Bennett is president of the Price-Pottenger Board of Directors and editor-in-chief of the Journal of Health and Healing. Contact him at [email protected]
Fat Flush Smoothie
8 ounces water or cran-water (1 ounce of unsweetened cranberry juice with 7 ounces of water)
Small handful of romaine, kale, or spinach or a scoop of green powder
1 fruit serving of your choosing (e.g., 1 small apple, ½ grapefruit, 10 large cherries, 1 peach, 1 cup blueberries)
1 scoop whey or pea and rice protein powder
1 tablespoon flaxseed or coconut oil
1 tablespoon ground flax seeds, chia seeds, or hemp seeds
1 scoop powdered probiotic (such as Flora-Key)
1 tablespoon non-GMO soy or sunflower lecithin
Ice cubes (optional)
Blend the water, powder, and fruit until smooth. Then add the other ingredients.
If using flaxseed oil, stream it in while the blender is running. Make 2 smoothies at a time – put the extra in the refrigerator to enjoy later.
To burn more fat, support the thyroid, and slow down carb absorption for lower insulin, try adding a dash of turmeric, Ceylon cinnamon, cream of tartar, or collagen powder or 1 tablespoon of apple cider vinegar or coconut vinegar.
Blueberry Mint Smoothie. Use 1 cup fresh or frozen blueberries, 3-4 fresh mint leaves (or to taste).
Choco-Cherry Smoothie. Use 10 large fresh or frozen cherries, 1 scoop chocolate whey protein.
Citrus Surprise Smoothie. Use flesh of ¼ grapefruit, flesh of ½ orange, a touch of Ceylon cinnamon.
For more variations, see Ann Louise Gittleman’s book The New Fat Flush Plan, from which this recipe is reprinted.
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Published in the Price-Pottenger Journal of Health and Healing
Winter 2017 | Volume 40, Number 4
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