Re:2nd Flush with a Friend Success

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A 40-year-old woman was referred to the outpatient clinic with a 3-month

history of recurrent severe right hypochondrial pain after fatty food.

[Note: Here " hypochondrial " means " below the ribcage,' not " hypochondriac. " ]

Abdominal ultrasound showed multiple 1-2 mm gallstones in the gallbladder.

She had recently followed a “liver cleansing” regime on the advice of a

herbalist. This regime consisted of free intake of apple and vegetable juice

until 1800 h, but no food, followed by the consumption of 600 mL of olive

oil and 300 mL of lemon juice over several hours. This activity resulted in

the painless passage of multiple semisolid green “stones” per rectum in the

early hours of the next morning. She collected them, stored them in the

freezer, and presented them in the clinic.

Microscopic examination of our patient’s stones revealed that they lacked

any crystalline structure, melted to an oily green liquid after 10 min at

40°C, and contained no cholesterol, bilirubin, or calcium by established wet

chemical methods. Traditional faecal fat extraction techniques indicated

that the stones contained fatty acids that required acid hydrolysis to give

free fatty acids before extraction into ether. These fatty acids accounted

for 75% of the original material.

Experimentation revealed that mixing equal volumes of oleic acid (the major

component of olive oil) and lemon juice produced several semi solid white

balls after the addition of a small volume of a potassium hydroxide

solution. On air drying at room temperature, these balls became quite solid

and hard.

We conclude, therefore, that these green “stones” resulted from the action

of gastric lipases on the simple and mixed triacylglycerols that make up

olive oil, yielding long chain carboxylic acids (mainly oleic acid). This

process was followed by saponification into large insoluble micelles of

potassium carboxylates (lemon juice contains a high concentration of

potassium) or “soap stones”.