Gilbert’s syndrome

Although Gilbert’s Syndrome is common, many people have never heard of it. Gilbert’s Syndrome is also known as familial hyperbilirubinemia.

Gilbert’s Syndrome (GS) is a genetic liver disorder that decreases the activity and expression of certain enzymes essential for a liver detoxification process called glucuronidation. About 10% of the world's population has GS.

In the glucuronidation pathway, bilirubin—a breakdown product of heme—undergoes detoxification. Individuals with Gilbert’s Syndrome have about 30% less activity in a set of enzymes responsible for properly processing and eliminating bilirubin from the body. The primary enzyme affected in this condition is UGTA1A.

As a result of poor elimination, more bilirubin remains in the bloodstream, as it isn’t detoxified as effectively as it should be. A consistently high level of total bilirubin, specifically “unconjugated bilirubin,” across multiple blood tests is a key indicator of Gilbert’s Syndrome—especially if levels repeatedly exceed 15 µmol/L, rather than showing just a single elevated result.

The general medical opinion is that Gilbert’s Syndrome is benign. Unfortunately, this is just not true. Many people with GS have symptoms. It is just that their symptoms have never been linked with Gilbert’s syndrome.

SOME OF THE SYMPTOMS OF GILBERT’S SYNDROME INCLUDE

Gastrointestinal symptoms

• Nausea

• Abdominal pain

• Diarrhoea

• Bloating

• Fatty stools

Mental wellbeing

• Anxiety

• Depression

• Mood swings

Hormonal

• Irregular cycles

• Estrogen excess

Other

• Fatigue

• Dizziness

• Flu-like symptoms

WHAT CAN MAKE THE SYMPTOMS OF GILBERT’S SYNDROME WORSE?

Anything that INCREASES bilirubin levels, such as:

• Fasting

• Stress

• Constipation

• Vigorous exercise

• Paracetamol, Aspirin, Non-steroidal anti-inflammatory drugs (NSAIDs), Benzodiazapenes

You may live longer if you have Gilbert’s syndrome!

Finding out you have Gilbert’s Syndrome isn’t all negative—bilirubin is a powerful antioxidant that helps protect DNA from damage, promotes telomere lengthening, and has notable anti-aging effects.

It offers multiple protective benefits, as people with Gilbert’s Syndrome often experience lower rates of cardiovascular disease, improved blood sugar control in diabetes, and reduced mortality in hereditary hemochromatosis, as well as decreased risks of lung and colon cancers.

To avoid symptoms associated with elevated unconjugated bilirubin (UCB) levels, it’s essential to support the glucuronidation pathway and maintain gut health.

FOUR KEY DIETARY STRATEGIES TO HELP MANAGE GILBERT’S SYNDROME

1) Maintain a high-fibre dietary approach

• Fibre mix: 1 tbsp freshly ground chia, 1 tbsp flaxseed freshly ground, 1 tbsp psyllium. We want to aim for 35g/day to really boost liver detoxification, excess hormone clearance, and gut healing. Start slow - you may experience some bloating as you start out. If doing freshly ground is too time consuming, you can grind/blitz the chia seeds, psyllium husk, and flaxseeds together and freeze. Use as desired. Freezing helps to prevent the ground seeds from going rancid.

• Consume 2 kiwi fruit daily to help reduce constipation. Kiwi fruit are a great after-dinner treat as they contain a small amount of melatonin.

2) Increase bile flow

• A simple way to do this is with lemon juice in water three times daily.

• Foods such as parsley, granny smith apples and olive oil help to support bile flow.

• You may also like to ask your naturopath for a herbal blend to support your liver and gallbladder.

3) Low fat diets

• A lack of dietary fats can raise bilirubin levels, so it’s important to include sufficient amounts of healthy oils in meals.

4) Skip the alcohol

• Alcohol puts extra strain on the liver, which in people with Gilbert’s syndrome already has a limited capacity to process bilirubin. Drinking alcohol can make the liver less effective at handling bilirubin and other toxins

DO I RECOMMEND SUPPLEMENTS IN GILBERT’S SYNDROME?

Absolutely! BUT, I believe that it is very important for you to have these tailoured to your personal case. Self-prescribing can be dangerous (even with natural products!) or you may not be able to get a significant shift in your symptoms. So please, do get a qualified and experienced naturopath onto your case. They should be able to help you evaluate your pathology and your full case history to work out what may be contributing to the severity of your symptoms and address the underlying factors present for you.

Your naturopath may like to use a combination of specific probiotics, prebiotics, herbs, and nutraceuticals to help you manage your Gilbert’s syndrome. These may include herbs such as Dandelion Root, Globe Artichoke, Rosemary, and St Mary’s Thistle. Prebiotics such as inulin, GOS, and PHGG. Zinc to support gap junctions in your gut. Calcium-D-Glucarate and DIMs to support excess estrogen clearance. Quercetin and broccoli seed sprouts may be helpful too in certain cases. And there is more!

AUTHOR: Talitha

I specialise in mental health (depression, stress, and anxiety), gut health (IBS), and women's health (preconception, fertility). I am a degree- qualified naturopath who LOVES helping people transform their health stories!!