Getting to know Gilbert’s Syndrome which is a liver disorder that can be easily missed or dismissed. Here at the clinic, we are no strangers to interpreting blood test results and from time to time a patient presents seeking advice regarding abnormal blood tests from their doctor which have remained unexplained. One such time this occurs is with high bilirubin levels, which can be an indicator of a benign condition called Gilbert’s Syndrome.
Gilbert’s syndrome (GS) is a hereditary pathology that affects approximately 10% of the world’s population. (1) GS is a disorder of bilirubin metabolism within the liver (2) causing hyperbilirubinemia. Reduced glucuronidation of bilirubin in the liver leads to unconjugated hyperbilirubinemia and can cause recurrent episodes of jaundice, (2) (yellowing the skin and whites of the eyes).
Assessment of bilirubin is usually conducted as part of a routine blood test, known as the Electrolyte/Liver Function Test (E/LFT). While this makes GS easy enough to detect, since the causes of elevated serum bilirubin are diverse, it’s important to distinguish GS from other causes, including fatty liver disease, hepatitis, cirrhosis, or liver cancer. (3) If test results show mildly elevated total bilirubin with other liver markers and red blood cells appearing normal (3) there is a good chance it’s Gilbert’s. Nowadays additional screening can include testing for the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene (4) to confirm the diagnosis.
From a conventional medicine viewpoint, GS does not require treatment (2) From a naturopathic perspective, impaired glucuronidation has consequences but overall, Gilberts is considered to be completely benign with some research indicating that there can even be advantages to having elevated bilirubin levels. (More on this below)
As usual, it comes down to the individual as to how their symptoms may manifest and there are some basic factors to consider, including the fact that having GS may affect drug metabolism. (4) Some GS patients may experience symptoms triggered by increased bilirubin production, including fasting, intercurrent illness, menstruation, and dehydration. (2)
Breastfeeding with GS may be a risk factor for developing more severe hyperbilirubinemia and/or cholelithiasis (gallstone formation), while GS can also have this impact when there is a concurrent serious condition such as G-6-PD deficiency, thalassemia, spherocytosis, or cystic fibrosis. (4)
The latest findings
The latest research has shifted the focus around GS to the possible advantages of having mildly elevated levels of unconjugated bilirubin, which has anti-inflammatory, anti-oxidative and anti-mutagenic effects. (5) Reports are showing that GS can reduce the risk of various age-related diseases (6) and is strongly associated with reduced prevalence of chronic diseases, particularly cardiovascular diseases (CVD) and type 2 diabetes mellitus. (3)
Getting guidance with natural medicine
While Gilbert’s can be well managed and may even have some protective effects, it shouldn’t be entirely dismissed. If your Doctor has mentioned GS to you in the past, or you’ve noticed high bilirubin levels in your blood tests, don’t forget to bring it up during your appointment at the clinic. Your natural healthcare practitioner may help you to start connecting the dots – from unexplained test results to unexplained symptoms. Supporting liver function, enhancing antioxidant pathways, and identifying the root cause are the hallmarks of naturopathic practice, which those with Gilbert’s get a great benefit from.