Gilbert’s Syndrome – Reduce Symptoms & Support Liver Health

Gilbert’s syndrome, pronounced jeel-bears, is a common, harmless liver condition in which the liver doesn’t properly process bilirubin.

Although Gilbert’s syndrome does not usually cause serious problems and does not need treatment, you can avoid triggers that raise your bilirubin levels to keep jaundice, (the yellowing of the skin and whites of the eyes), at bay.

Generally, eating a healthy diet, staying hydrated, avoiding alcohol, avoiding dieting, fasting and skipping meals, and managing your stress levels will keep your symptoms under control.

What exactly is Gilbert’s Syndrome?

Gilbert syndrome, also known as benign unconjugated hyperbilirubinaemia, is named after the French doctor who first described it in 1901.

It affects about 5 per cent of the Australian population, with men being more often affected than women. It’s most often diagnosed in people who are in their late teens or early 20s. [1]

Gilbert syndrome is an inherited genetic condition and is usually discovered by chance when someone has a routine or unrelated blood test. [2]

If you have Gilbert syndrome, you have a deficiency of the enzyme (referred to as UGT) that is responsible for processing bilirubin in the liver. Genetic changes in this gene cause reduced levels of a liver enzyme needed to eliminate bilirubin from the body, causing bilirubin to accumulate. People with Gilbert syndrome have about one third of the normal enzyme activity, which usually is enough to prevent symptoms from developing. [3]

Bilirubin is a by-product of broken-down old red blood cells. When red blood cells finish their life cycles in your body, they break down and pass through your bloodstream to your liver for processing. Your liver sorts bilirubin with other waste products into bile. Bile exits your body through your intestines. Bilirubin is the pigment that gives bile its distinctive yellow colour. It also colours faeces brown. [4]

In a person with Gilbert’s syndrome, your deficiency in UGT means that the liver can’t keep up with processing the bilirubin and so it builds up in the blood stream.

Often, high bilirubin is a sign that there’s something going on with your liver function but if you have Gilbert’s syndrome, your liver is usually otherwise normal.

Blood levels of bilirubin in someone with Gilbert syndrome go up and down and sometimes they will be normal. [5]

Symptoms and triggers

Jaundice is the only recognised clinical symptom of Gilbert syndrome, some people with the condition have reported other symptoms while they’ve having an episode of jaundice, such as:

• tiredness and fatigue
• weakness
• nausea
• poor appetite
• dizziness
• stomach pain
• IBS-type symptoms such as stomach cramps, constipation, diarrhoea and bloating
• poor concentration
• dark-coloured urine
• general feeling of being unwell

If you do have Gilbert syndrome, you may find certain things make an episode of jaundice more likely. Some of these triggers include the following:

• dieting or not eating for a long time
• not drinking enough (being dehydrated can trigger Gilbert syndrome)
• being under a lot of stress
• anxiety
• exerting yourself physically
• not getting enough sleep
• having an infection
• having surgery
• having your period
• drinking alcohol
• taking certain medicines (these include some cancer treatments, a cholesterol medicine called gemfibrozil and some antiretroviral drugs used to treat HIV) [6]
• illness such as influenza
• taking large amounts of Vitamin B3 (niacin)

Diagnosing Gilbert Syndrome

Often, people with Gilbert’s syndrome have no obvious symptoms and, in these cases, it is often diagnosed by accident. In other cases, Gilbert’s syndrome may be accompanied by symptoms similar to more serious liver diseases, so thorough medical investigation is needed.

Diagnostic tests include:

• medical history
• physical examination
• blood tests
• urine tests

A genetic test exists that can detect the gene that causes Gilbert’s syndrome, but this is not usually necessary for a diagnosis and is not widely available. [7]

How to reduce the symptoms of Gilbert syndrome the natural way

As Gilbert syndrome is generally harmless, conventional medicine does not usually treat the condition. It will not damage the liver and apart from jaundice, there are no known complications.

It can, however, complicate other conditions. Specifically, people with the syndrome who also have another condition that increases bilirubin levels, such as sickle cell anaemia, run a higher risk of getting gallstones. [8]

It’s important to note that Gilbert syndrome can interact with some medications, including cancer therapy drugs.

Drugs that should be avoided, if possible, are:

• Atazanavir and indinavir, used to treat HIV infection
• Gemfibrozil, for lowering cholesterol
• Statins, also used for reducing cholesterol, when taken with gemfibrozil
• Irinotecan, used to treat advanced bowel cancer
• Nilotinib, for the treatment of some blood cancers [9]

If you know that you have Gilbert’s syndrome, you may find that you are sensitive to alcohol and its best to avoid consuming it. In Functional Medicine, however, we can treat symptoms with lifestyle and diet changes and supplements to reduce symptoms of jaundice and associated symptoms, as well as boost the function of the liver.

Generally, our advice is to stay healthy – eat well, sleep well, avoid restrictive diets, avoid alcohol, exercise regularly and stay hydrated. You may also like to try some supplements and teas to detoxify and keep your liver healthy.

Some foods can exacerbate symptoms so it’s good to avoid the following foods:

• processed foods
• vegetable oils
• fried foods
• preserved or fatty meats
• artificial sweeteners
• conventional fruits and vegetables
• white processed sugar
• sugary soft drinks

It is also important to try to avoid drugs that require detoxification by the liver, including acetaminophen which is an active ingredient in Panadol. Also avoid any nutritional supplements containing high doses of niacin, vitamin A or Vitamin D or cod liver oil.

Increase your intake of the following liver cleansing foods:

• grapefruit
• berries
• grapes
• beetroot juice
• cruciferous vegetables such as mustard greens, broccoli, cabbage, cauliflower, radish, bok choy and brussels sprouts
• coffee [10]

Recommended foods and supplements to support Gilbert’s syndrome

• Fish oil supplement

Take 1,000 milligrams of a high-quality fish oil supplement daily to improve liver function.

• Milk thistle

Milk thistle has long been recognised as a potent herb that helps detox the liver. Take 150 milligrams of milk thistle twice a day.

• Probiotics

In addition to eating probiotic-rich foods, take a high-quality probiotic supplement daily.

• Livatone Plus Powder or Capsules

Take 1 teaspoon twice daily in juices or water, or 2 capsules twice daily – A good formula consisting of B vitamins, taurine, St Mary’s Thistle should be included to help the liver excrete bile pigment.

• N Acetyl L Cysteine (NAC)

Take 2 capsules daily. N-acetyl cysteine increases glutathione production, which reduces inflammation and enhances detoxification.

• MSM Plus Vitamin C

Take 1/2 teaspoon twice daily in juices or water – MSM is an organic sulphur which is vital for efficient liver function and detoxification.

• Fibertone

Take 2 teaspoons and built up to 1 – 2 tablespoons over 2 weeks if necessary – A gluten free fibre powder is appropriate for everyone including vegetarians.

• Selenomune

Take 1-2 capsules daily in water or raw juice – Selenium possesses anti-inflammatory effects and is an essential trace mineral that assists in the protection of many parts of the body. [11]

• Teas

Try green tea and black tea which improve fat levels in the liver and improve enzyme activity. The herbal tea combination of slippery elm, burdock, Turkish rhubarb, and sheep sorrel is also great for cleansing the liver.

Lifestyle changes you can make to reduce the symptoms of Gilbert syndrome

Eat regularly and avoid strict, restrictive diets

Going too long without eating can bring on the symptoms of Gilbert’s syndrome, as can extremely low-calorie diets. Stick to a routine eating schedule and avoid fasting or skipping meals. Include plenty of fibre-rich foods in your diet to keep your liver healthy. These include fruits, vegetables, whole grains and beans.

Exercise regularly

Exercise reduces inflammation in the liver and many studies have shown a correlation between increased exercising and improvement in liver function. If you haven’t exercised much before, yoga, walking, swimming, and gym workouts are a great way to start.

Manage your stress

Stress can cause an inflammatory response in the liver so if you have Gilbert syndrome, it can exacerbate symptoms. Work with your Functional Medicine health practitioner to create a plan to reduce your stress. This may include exercise, yoga, meditation, essential oil therapy, spending time in nature or managing your work-life balance, if possible. The overall benefits from reducing your stress won’t just help your liver, but your whole being.

Reduce toxin exposure

The liver is responsible for processing and removing toxins from the body, so it’s important to reduce its workload if you have been diagnosed with Gilbert syndrome. Limit your exposure to pesticides and other chemicals as much as possible, choose organic fruits and vegetables, wild-caught fish, grass-fed lamb and beef and cage-free eggs whenever you can. Look for natural cleaning products, aerosols, and insecticides to use in your home. [12]

How we can help

At Advanced Functional Medicine, our team of experts can assist you in restoring your liver to its optimal health. If you have had a diagnosis of Gilbert’s syndrome, we will take a holistic view of your overall health to reduce any symptoms you may be experiencing and ensure you are as well as you can be.

Call us to find out more about how we can help you.