Gilbert’s Syndrome

Gilbert’s Syndrome (pronounced zhil-bairs) is a condition considered by the medical profession to be a silent genetic disorder. Often when people are diagnosed as having abnormal levels of bilirubin on a routine blood test, they are told they have Gilbert’s but then immediately told not to worry about it, that “it doesn’t really mean anything and won’t impact their health”.


In my practice roughly 20% of my clients have Gilbert’s syndrome or elevated or abnormal bilirubin levels. Unlike mainstream medical, I do consider this to be significant clinical information that may indeed impact an individual’s health.


Bilirubin is a yellowish pigment produced when the body breaks down old red blood cells. Bilirubin travels through the bloodstream to the liver where it is broken down with an enzyme reaction. In people with Gilbert’s syndrome a genetic mutation means that this enzyme reaction cannot happen effectively resulting in higher than normal bilirubin in the blood.


From a clinical perspective, the most important thing to be aware of is that one of the main detoxification pathways of the liver, glucuronidation is adversely affected. This pathway is a vital phase two liver detoxification process and without it functioning optimally, hormones may be impacted as will the ability to detoxify any externally ingested hormones as well as most clinically prescribed medication.


Most of my Gilbert’s clients have learned the hard way that they are more sensitive to any substance that puts pressure on this pathway. They often tell me that they don’t tolerate things like the oral contraceptive pill, too much coffee or simple medications such as Panadol.


If you have Gilbert’s syndrome there is a higher tendency to feel what we naturopath’s call ‘liverish’ – feelings of being ‘off’, slight nausea, fatigue just generally under par. A noticeable side effect when bilirubin is high in the blood is the yellow appearance of the skin and whites of the eyes and this may become particularly obvious when the person is fighting an infection. Low iron stores are also one of the things I ask about when I have Gilbert’s syndrome on my radar.


Most of my Gilberts clients have some level of anxiety that they have learned to live with. Many have a digestive component to their condition that is incredibly hard to pin down.  They may have been misdiagnosed as having irritable bowel syndrome or complex food intolerances. Often my clients with Gilbert’s have just learned to live with their sensitive and complex digestive systems and believe there is nothing they can do because they haven’t been able to identify a pattern or specific thing that causes their GIT distress.


It may be helpful for people to know that there is a definite link between impaired glucuronidation, impaired bilirubin excretion and digestive disturbance.  When this pathway is not working well extra strain will be placed on the system which is under enough duress as it is in modern life!


The following tips are both evidence based and anecdotally tested by many of my Gilbert’s clients and may help to decrease those random digestive disturbances as well as keep bilirubin levels more steady.


  1. Increase fibre in the diet. Some people do well on LSA or chai seeds or some added psyllium or PHGG ( Partially Hydrolysed Guar Gum) which helps optimise the bowel transit time.
  2. Increase bile flow. A simple way to do this is with lemon juice in water 3 x per day. I also often use herbs for the liver/ gallbladder such as dandelion root, globe artichoke, chamomile and foods such as parsley, granny smith apples and olive oil.
  3. Correct fat malabsorptionif this is an issue and check fat soluble vitamins ( your poo may tell you this if it is slimy, fatty or floats).
  4. The use of specific probiotics and prebiotics. For Gilberts clients this is specifically Lactobacillus plantarum. I encourage my clients not to self-prescribe and always be supplementing with probiotics but also looking at prebiotics such as lactulose, inulin, Jerusalem artichokes and all the vegetables with pre biotic fibres.
  5. Use zinc to heal the gut liningby tightening gap junctions. Often zinc is low as well as iron in my Gilbert’s clients.
  6. Increase acidity of the colonby providing more short chain fatty acids. Butyrate is a key SCFA that can be promoted by eating butter, but also all those foods high in insoluble fibres such as nuts soaked with skins and vegetables with their peels still intact.
  7. Extra supplementation where required. Quercetin is particularly helpful supplement for Gilbert’s Syndrome as is broccoli seed sprouts and Calcium D glutarate but talk to a naturopath before you take these things.