Gilbert’s Syndrome is an often overlooked condition caused by a mutation in the UGT1A1 gene. This mutation results in decreased production of an important enzyme, bilirubin-UGT.

Bilirubin is a by-product of the breakdown of red blood cells. You’ve probably heard of newborn jaundice, which occurs when a baby’s skin and eyes turn yellow shortly after birth due to the liver’s inability to quickly expel bilirubin. That condition is temporary, usually resolving a few days or weeks after birth.

But adults with the UGT1A1 mutation have excess bilirubin throughout their lives because they don’t make enough of the enzyme that breaks it down. 

You may receive a diagnosis of Gilbert’s Syndrome after a physician notices elevated bilirubin on routine blood work. If your practitioner suspects Gilbert’s Syndrome, they will rule out other conditions, such as liver disease, that can cause increased bilirubin levels. 

But if your practitioner doesn’t order a gene analysis, you can order a test on your own to confirm that you have the mutation.

Glucuronidation — that’s a mouthful. And perhaps a word you’ve never heard. 

Your body can’t do a good job of getting rid of harmful unwanted substances through the liver without glucuronidation during Phase 2 liver detoxification.

Let’s back up. During Phase 1, the liver metabolizes toxins from outside sources (like drugs, pesticides, and pollutants) or internal sources (like neurotransmitters and hormones). 

During Phase 2, those breakdown products bind with other molecules in a process called conjugation that makes them water soluble, allowing them to be excreted in urine or stool. Among the most important conjugation substances are glucuronidation enzymes—exactly the enzymes that people with Gilbert’s don’t produce enough of.

The result? 

Toxins that should be quickly excreted hang around in the body longer and produce side effects in the gut and brain.

Intestinal motility is key to digestive health. The contents of the digestive tract should move along smoothly and steadily, producing a bowel transit time of 12 – 24 hours. But when you have a weak link in the liver due to a shortage of glucuronidation enzymes, the entire process can slow down. Yes that means CONSTIPATION. 

Constipation (slow motility) predisposes you to dysbiosis, an imbalance of gut bacteria, and SIBO, or small intestine bacterial overgrowth.

Symptoms of SIBO include:

• Diarrhea and/or constipation
• Painful abdominal bloating or cramping, especially after eating fruits or simple carbohydrates
• Food intolerances
• Reflux
• Skin rashes
• Joint pain
• Depressed mood

SIBO, dysbiosis, and high bilirubin levels can lead to leaky gut syndrome, where molecules that should be kept out of the bloodstream pass through the compromised intestinal lining, effectively poisoning your entire body. This can be one cause of the anxiety, panic attacks, depression, mood swings, poor concentration, and brain fog that can accompany Gilbert’s.

These symptoms can overlap with and be indistinguishable from Irritable Bowel Syndrome. The only difference is that the person with Gilbert’s has a genetic polymorphism as the root cause.

You can measure and manage your level of constipation (transit time) by following this guide. 

Gilbert’s Syndrome has VERY long tentacles. Since our body systems are so interrelated, the problem of reduced enzymes in the liver can have wide-ranging repercussions in the body. 

Here are some surprising effects that can arise from Gilbert’s Syndrome.

Gallstones and gallbladder issues: Pain in the upper left abdomen, especially after eating a fatty meal, could signal a gallbladder problem. Normally, the main route for bilirubin excretion is through the gallbladder, but without enough enzymes to break down the bilirubin, it builds up in the gallbladder, creating sludge or even gallstones.

Inability to fast: Fasting results in reduced intestinal motility because there’s not enough digesting food in the GI tract keep things moving . If you have Gilbert’s, this exacerbates your digestive issues and causes more toxins to build up. On top of that, more bilirubin is released during fasting. That’s why mood swings and detox effects may get worse when you skip meals.

Drug reactions: Because glucuronidation detoxifies drugs, you can experience toxicity effects at lower doses than other people do.

Sensitivity to alcohol: Alcohol, like drugs, must be detoxified by the liver. After you drink, you may suffer through a several-day hangover because of your liver’s decreased ability to detoxify alcohol.

Estrogen dominance: If you can’t efficiently rid the body of estrogen by-products, you may experience symptoms of estrogen toxicity. These include migraines, headaches, heavy menstrual flow, endometriosis, fibroids, fibrocystic breasts, and even breast cancer.

Poor stress tolerance: Increased toxicity, digestive problems, and mood imbalances contribute to heightened feelings of stress. Since the body gets rid of cortisol (the stress hormone) via glucuronidation, it may feel like your mind can’t shut off and you can’t relax. Fasting—whether planned or inadvertent—can make matters worse.

Sleep disturbances: Impaired bilirubin detoxification can cause a build-up in the brain of high levels of glutamate, which has been correlated with fewer hours of sleep.

Most general articles about Gilbert’s Syndrome state that it isn’t harmful and doesn’t require treatment. 

While it’s true that Gilbert’s itself isn’t degenerative or progressive, its effects can dramatically reduce your quality of life. At this point, you can’t simply take a pill that will restore the missing enzymes. But you can take steps to ease the symptoms you experience and support healthy detoxification.

Here are key actions that can help.

1. Avoid fasting.
2. Control your stress.
3. Limit alcohol consumption.
4. Exercise caution with medications; lower doses may be indicated.
5. Drink plenty of water.
6. Eat smaller meals, eat more frequently, and balance fats, carbohydrates, and proteins at each meal.
7. Try vagal therapy–like exercises and chiropractic or osteopathic treatments that stimulate the vagus nerve–which can improve digestion and interrupt the stress cycle.  
8. If you have a lot of digestive complaints, follow our recommendations for Irritable Bowel Syndrome.
9. Take supplements, including those shown below, plus formulas that promote Phase 2 liver detoxification and estrogen metabolism.

Finally, you can take steps to resolve one of the most common (and impactful) conditions that arises out of Gilbert’s Syndrome, dysbiosis. You can read more about dysbiosis here. 

You can’t reprogram the genetic mutation that causes Gilbert’s syndrome, but with a wise strategy, you can feel better and enjoy life more.