Gilbert’s Syndrome: Causes, Symptoms and Treatment Explained

Gilbert’s syndrome is named after one of two French doctors who first described it in 1901, Dr Nicholas Augustin Gilbert. If you have Gilbert’s syndrome it means you have a slightly higher-than-normal amount of an orange-yellow pigment called bilirubin – a waste substance that’s a normal by-product of the breakdown of old red blood cells – in your blood.

The good news is most cases of Gilbert’s syndrome – also sometimes called unconjugated hyperbilirubinaemia – don’t need any treatment because the condition is considered harmless. You may, however, experience a yellowing of your skin or, more commonly, the whites of your eyes called jaundice if your bilirubin levels become high enough.

These jaundice episodes don’t usually cause any health problems or last very long and shouldn’t be anything to worry about. Your liver won’t be affected and should otherwise work normally.

Gilbert’s syndrome is a common condition that’s thought to affect 5 to 10 per cent of the population of Western Europe, with men more often affected than women (i). It’s most often diagnosed in people who are in their late teens or early 20s and is usually discovered by chance when someone has a routine or unrelated blood test.

However, because many people don’t experience jaundice with Gilbert’s syndrome, it’s thought that the true number of people with the syndrome could be much higher (according to the NHS, around one in three people with Gilbert’s syndrome don’t have any symptoms, so many may not realise they’re affected (ii) ).

Genetic cause

Gilbert’s syndrome is caused by a gene mutation that runs in families, making it a hereditary condition. The gene in question is called the UDP-glucuronosyltransferase gene, and its mutation makes the body produce limited amounts of an enzyme called UGT1A1, which converts (or metabolises) bilirubin into a form that’s more easily excreted (experts believe the mutation reduces the liver’s ability to metabolise bilirubin by 60 - 70 per cent (i) ).

If you have Gilbert’s syndrome, it means you’ve inherited a copy of the abnormal gene from both your parents – when this happens it’s called a recessive disorder. However even if you have two copies of the abnormal gene, it doesn’t necessarily mean you will go on to have Gilbert’s syndrome.

Meanwhile, if you’ve inherited just one copy of the abnormal gene from one parent and a normal gene from your other parent, you will be a carrier for the disease but you usually won’t have any symptoms (iii).

Should you see your GP?

Since Gilbert’s syndrome isn’t harmful, is there any point in going to your GP if you think you may have it?

The only reason you may suspect you have Gilbert’s syndrome is if you have an episode of jaundice. If this happens it’s nevertheless important to see your GP, since jaundice can be a symptoms of some other, sometimes more serious liver problems that your doctor may want to rule out.

These include the following:

• Acute inflammation of the liver (sometimes caused by viral infection, alcohol or having high levels of fat in your liver)

• Crigler-Najjar syndrome (a rare, serious disorder linked to the same gene as Gilbert’s syndrome)

• Dubin-Johnson syndrome (a genetic disorder that causes jaundice usually in teenagers and young adults)

• Cholangitis (inflammation or infection of a bile duct – one of the small tubes that carry fluid called bile from the liver into the small intestine)

• Cholestasis (can be caused by liver diseases such as hepatitis and alcoholic liver disease, as well as pancreatitis and cancer of a bile duct or the pancreas)

• Bile duct obstruction (often caused by gallstones, but can be a symptom of gallbladder, bile duct or pancreatic cancer)

• Haemolytic anaemia (a form of anaemia caused when immune system antibodies damage red blood cells)

If a blood test confirms you have Gilbert’s syndrome, however, it shouldn’t stop you leading a normal life and your life expectancy won’t be affected.
 

Symptoms and triggers

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

• Tiredness and fatigue. Why not read more about tiredness and fatigue here ?

• 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

Despite the fact that the above symptoms are known to affect some people with Gilbert’s syndrome, it’s generally believed they may not be caused by the syndrome itself, as there has yet to be any link found between them and the level of bilirubin in the blood.

Meanwhile, if you do have Gilbert’s 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

• 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)

Avoiding these triggers wherever possible could help reduce your chance of having a jaundice episode.
 

Your liver and bilirubin

The liver is an important organ and is responsible for around 500 bodily functions, including filtering and cleaning the blood and eliminating waste substances. It also produces bile, a fluid that helps to break down food in the gut.

Bilirubin is produced when old red blood cells are broken down in the body. Red blood cells carry oxygen throughout the body and contain a protein called haemoglobin (they also provide the pigment that gives the cells their red colour). These cells, which are made in your bone marrow, usually last around 120 days before they die.

When this happens, the haemoglobin inside the dead cells is broken down into globin – a protein that your body stores for future use – and haem, which is broken down further into a fat-soluble form of bilirubin. This is then transported to the liver, where the enzyme UGT1A1 turns it into a water-soluble form called conjugated bilirubin that can be more easily secreted into bile.

What is bile?

Bile is a fluid made in the liver. Adults produce between 400 and 800ml of this fluid every day (iv). And as well as bilirubin it contains cholesterol and bile acids (or bile salts) as well as water, electrolytes (potassium, sodium and other salts), copper and other metals.

The bile acids in bile are important for the digestion and absorption of fats and fat-soluble vitamins. Meanwhile bile is also important for the elimination of bilirubin and other waste materials, which travel in the fluid through the gall bladder and into the small intestine where they are converted into other substances and eventually flushed out of the body in urine and faeces.

People with Gilbert’s syndrome, however, lack sufficient amounts of the UGT1A1 enzyme, which means the bilirubin produced during the breakdown of haemoglobin cannot be converted into a water-soluble form (conjugated) at the normal rate. This means much of the unconjugated bilirubin builds up in the bloodstream because it cannot be secreted into bile and disposed of effectively.

And when levels of unconjugated bilirubin become high, it can trigger an episode of jaundice.

Ways to keep your liver healthy

There’s no way to prevent Gilbert’s syndrome since the only cause is a genetic one. But if you’re one of those affected there are a few things you could try to do to help stop your bilirubin level becoming too high. These include steering clear of some of the triggers that can make an episode of jaundice more likely – though some of these triggers aren’t always avoidable. Whenever possible, try to avoid the following:

• Fasting, going on very low-calorie diets or waiting too long before eating

• Not drinking enough fluids

• Stress and anxiety

• Infections

• Vigorous exercise that wears you out

• Not getting enough sleep

Meanwhile, there’s no evidence that any particular diet may be helpful for those with Gilbert’s syndrome, but the British Liver Trust recommends eating regularly and healthily, drinking plenty of water and avoiding fatty or sugary foods (iii).

Alcohol and your liver

It may also be a good idea to cut down on alcohol if you have any type of condition that involves your liver. Drinking too much alcohol can cause serious and lasting liver damage, so try to stick to the government’s recommendations for safe drinking, which include not drinking more than 14 units of alcohol a week.

Examples of how many units are in different alcoholic drinks include:

• Single shot of spirit (ABV 40%): 1 unit

• Large (250ml) glass of wine (ABV 12%): 3 units

• Pint of beer or lager (ABV 4%): 2.3 units

• Standard bottle of lager/beer/cider (ABV 5%): 1.7 units

According to the British Liver Trust’s Love Your Liver campaign, it’s worth considering taking a minimum of two days off alcohol in a row every week to give your liver a chance to repair itself, and not saving up several days’ allowance so you can drink it all at the same time (v).

Nutrition support for your liver

As well as following the lifestyle advice above, you could consider taking the following supplements that may help support liver health in general:

Multivitamin and mineral

A range of vitamins and nutrients are important for liver health, which you can normally get by following a healthy, nutritious diet. If your diet isn’t always as healthy as it should be, you may want to consider taking a good-quality multivitamin and mineral supplement to make sure your liver – as well as the rest of you – is being supported effectively. If, however, you have a liver condition, speak to a health professional before taking any supplements, as high doses of some nutrients may be harmful in your situation.

Artichoke

Artichokes have antioxidant properties and have been used as digestive aids since ancient Greek and Roman times. Indeed, even today artichoke leaf extract is often taken before large, fatty meals, as its thought to help break up fats in food. In Germany it’s currently authorised officially for ‘dyspeptic problems’ (vi). There is also some evidence to suggest it may help support the liver (vii).

N-acetyl-cystine

NAC is the form of the amino acid L-cysteine found in nutritional supplements and is needed for the production of one of the body’s most potent antioxidants, glutathione (viii). It’s often recommended as a supplement for liver support, as it’s thought to have an important role in the body’s detoxification process – for instance, it’s often used to treat liver damage caused by paracetamol (acetaminophen) overdose (viii). Thanks to its role in the production of glutathione NAC is also frequently used for the treatment of other liver disorders (viii).

L-cysteine-rich foods include chicken, turkey, yoghurt, cheese, eggs, sunflower seeds, legumes and oat bran. However, because L-cysteine is only found in food in small amounts, some may want to consider taking a NAC supplement.

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References:

1. Available online: https://patient.info/doctor/gilberts-syndrome-pro

2. Available online: https://www.nhs.uk/conditions/gilberts-syndrome

3. Available online: https://rarediseases.org/rare-diseases/gilbert-syndrome/

4. Available online: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/bile.html

5. Available online: https://britishlivertrust.org.uk/information-and-support/liver-health-2/love-your-liver/looking-after-your-liver/

6. Blumenthal. M. The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications. (1998)..84.

7. Ben Salem. M., et al. Pharmacological Studies of Artichoke Leaf Extract and Their Health Benefits. Plant Foods Hum Nutr, (2015 Dec).;70(4):441-53. Available online: https://link.springer.com/article/10.1007%2Fs11130-015-0503-8

8. Mokhtari. V., Afsharian. P., Shahhoseini. M., Kalantar. S.M., Moini. A. (2017). A Review on Various Uses of N-Acetyl Cysteine. Cell Journal (Yakhteh). 19(1), 11–17. Available online: https://celljournal.org/journal/article/abstract/4872

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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