DEAR DR. BLONZ: I am 45 years old, and quit smoking a year and a half ago as I have attempted to work back to better health. Since these stoppages I have gained 20 pounds and now have some gallstones. I was wondering whether a liver flush is a good thing to do to rid the liver of the gallstones and help return it to its optimal performance. -- F.S., San Jose, California

DEAR F.S.: It is not unusual to gain weight after quitting smoking. But, all things considered, that weight gain is less harmful than smoking. The best way to keep a lid on the poundage is to pay more attention to your diet, slow down at the table and increase your activity gradually. Check with your physician if there are health issues that need to be considered.

As you know, I am not a medical doctor, nor am I a specialist in liver ailments or problems with the gallbladder, but I can report that there is no solid basis to support the “liver flush” as a helpful procedure. I want to take you through my reasoning.

The gallbladder is a small gland in your midsection, close to the liver and the digestive tract. The liver produces bile, a substance that works like a detergent to help emulsify the fats in the foods we eat and make them easier to digest. Bile gets stored in the gallbladder, and when fat is present in food, a squirt of bile leaves the gallbladder, passes down the common bile duct and mixes with the food as it leaves the stomach.

Gallstones are hard, crystalline structures that vary in size from a grain of sand to the size of a golf ball. Most gallstones are made of hardened cholesterol, but some can be made of a pigment called bilirubin. Problems occur if stones clog things up in the liver or the gallbladder, or they block the common bile duct, which is also used by the pancreas. It is estimated that 10 to 15 percent of people in the U.S. have gallstones, but some may never experience symptoms. Check out a more in-depth explanation at blonz.org/v7qss.

The dubious procedure known as the “liver flush” is promoted as a natural, painless way to rid the body of its gallstones. There may be minor variations, but the flush usually involves a specialized fast or no-fat diet for a number of days, leading up to a day when you ingest Epsom salts (magnesium sulfate), followed by a hefty intake of olive oil together with some lemon juice before going to sleep.

The next day, your stool may contain some small, round opaque objects that are touted as the gallstones that have been hanging around your liver and gallbladder and causing all sorts of problems. Amazing! Or is it? These opaque globules, it turns out, are unlikely to be gallstones, but are more likely a product of the liver-flush recipe itself. A fascinating article in the April 16, 2005 issue of the prestigious medical journal Lancet titled "Could these be gallstones?" followed a 40-year-old patient who did a liver flush and passed a bunch of “stones” the following day. Upon a microscopic examination, it was discovered that those items were made up of congealed olive oil plus the other ingredients that had been administered the day before. Irrespective of the lack of evidence that it is effective, the concept of the “liver flush” continues to be promoted. My sincere congrats on stopping smoking, but please consider taking a pass on the flush.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: I was diagnosed with herpes simplex virus and have heard that the use of food-grade (35 percent), high-strength hydrogen peroxide taken internally shows some promise in dealing with this problem. I am seriously considering trying this but wanted to know your thoughts, and if there are drug interactions that I need to be concerned with before starting this. Also, any precautions in general that I need to keep in mind and watch for. -- S.H., via email

DEAR S.H.: Here’s hoping you are still in decision mode. The concept that taking 35 percent, high-strength hydrogen peroxide internally, i.e., swallowing it, to treat the herpes simplex virus is risky business. A review of the research on the internal use of hydrogen peroxide revealed nothing encouraging for its use on any health issue; if anything, there are plentiful warnings against such use. It is important to understand that the “food grade” descriptive relates to the absence of certain stabilizers found in the typical (3 percent) hydrogen peroxide found on store shelves and used as an external disinfectant, or diluted more and used as a mouthwash. If you were to swallow the 35 percent, high-concentrate hydrogen peroxide, drug interactions would be the least of your concerns as it would chemically burn the tissues it contacts. Give a read to the information at the Poison Control Center (blonz.org/6xz44) and also to an article at the Berkeley Wellness Letter (blonz.org/cb9ky) for more information.

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DEAR DR. BLONZ: I read the nutrition content on food products, and I am concerned about potassium. Too little is bad, but too much can also be a problem. Why isn’t it listed on all labels? -- G.B., Oakland, California

DEAR G.B.: Potassium, which has a chemical symbol of K, is one of the body’s key electrolyte minerals. It regulates the water balance inside our cells. (Contrast this with sodium, which regulates water balance outside the cells.) Potassium is also involved in maintaining our body’s acid-base balance, and in the transmission of nerve signals, which makes it key to such activities as keeping our heart beating. You want to avoid having too much potassium, and supplementation is not usually needed unless there is a specific health problem, or medication is being used that might deplete the body of this mineral. If the kidneys are working normally, excess potassium gets excreted in the urine. The adult Daily Value for potassium is 4,700 milligrams per day. Recently, the FDA announced a new format for Nutrition Facts labels that use a larger font for serving size and calories and have more information that includes potassium content (see: blonz.org/pkxgq). You may already see these on food products from some manufacturers, but they are not mandated until 2020-2021, depending on the size of the company. The older-style label had not been required to indicate potassium content unless specific claims were made that mentioned or related to potassium content. The best food sources for potassium include fresh, whole foods such as potatoes, acorn squash, artichoke, pomegranate, bananas, legumes, citrus fruit and avocados.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: I wanted your take on the Alli diet pill, which I understand is based on the prescription drug Xenical. It is a product that prevents you from absorbing fat? What is your opinion about this type of product? -- F.S., Sacramento, California

DEAR F.S.: Alli is the only over-the-counter (OTC) weight-loss product; the fact that it is OTC means it has established safety and efficacy with the Food and Drug Administration (FDA). Consider it another soldier in the battle against obesity. Alli is a half-strength version of the prescription drug Xenical (Orlistat). These drugs work by inhibiting the action of lipase, a key fat-digesting enzyme that breaks apart the fat in the food we eat before absorption. When lipase is inhibited from doing its job, fats remain in your GI tract and are eventually eliminated. With Xenical, approximately 1/3 of the fat consumed is not absorbed; with Alli, the OTC version, only 1/4 of dietary fat is affected. There is no evidence that either will have any significant effect on calories from carbohydrates or proteins. A side-effect of unabsorbed fats is that they continue all the way though, and that can mean undesirable consequences. Something that allows fat to pass through undigested can also affect fat-soluble vitamins and certain medications, so be sure to check with your physician to see if there are specific cautions for you to consider.

I am not a fan of such drugs as a primary effort against obesity, but I recognize that they might be appropriate as part of a multifaceted effort. For anyone considering Alli, I encourage you to read all the information before you start. Once you purchase an Alli starter pack, you can access a free online counseling service at myalli.com and receive a personalized action plan and answers to your questions. More about this and other diet drugs at tinyurl.com/yb2gndyv.

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DEAR DR. BLONZ: I needed to reduce sodium, which I have done. For seasoning, I use various salt substitutes, but I have found it to be a bit of a zoo out there with many products containing various herbs, while others have potassium chloride to provide pseudo-saltiness of a sort. I would like to know whether any of the ingredients or the potassium chloride are harmful. -- H.T., Dallas, Texas

DEAR H.T.: As you have discovered, there are different takes on the concept of the “salt substitute.” Some rely on herbs and spices, and they should be thought of as “salt-free seasoning blends.” Others rely on potassium chloride, which provides a salty, but slightly bitter, taste that many characterize as metallic. There are formulations designed to eliminate the bad taste. But there is no standard formulation, the only shared trait being the absence or very low level of sodium. This leaves it up to you, the consumer, to sample and find which one works with which dishes. You may be able to get product samples by contacting manufacturers. Also, consider checking among the many low-sodium cookbooks to provide additional guidance. I am not aware of any general safety issues with the herbal components of the seasoning blends.

The potassium-based salt substitutes should not represent a health risk when used sparingly. They should, however, be used with caution by anyone with kidney or other health problems that involve the way the body handles potassium. Ask your health professional if you have questions. Those taking diuretics or medications that prevent potassium from being eliminated through the urine should also speak with their physician before they use this type of product.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.