Hello, No...I did not use the ES. Some folks said I did not have to so I did it without it so mine was not caused by ES. I have never used it because I was told it can excellerate the heart and I already have a heart condition so I did not want to do anything to over stress my heart. I have never done another flush since. Instead I have 1 16 oz glass of organic apple juice per day and I have only have some light pains periodically (mostly after eating very greasy food or forgetting to drink the appple juice for a few days) but otherwise have been doing just fine. Hope this helps. Mom