Gilbert's Syndrome

An overlooked cause of digestive and mood problems.

Gut problems and mood issues: Do you feel as if you were born with them?

If so, your genes may hold the answer. A genetic mutation that affects up to 13% of Americans could account for your symptoms if you have:

  • Constipation or diarrhea that seems to defy explanation
  • Nausea
  • Bloating
  • Abdominal pain
  • Depression
  • Anxiety
  • Gallstones
  • Poor tolerance of alcohol
  • Negative reaction to fasting
  • Sleep disturbances
  • Yellow tint to skin and whites of eyes
  • Low energy level

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.

Have Gilbert's Syndrome? You probably have dysbiosis.

The Gut Wellness Program at the Global Wellness Lab is a 10 week program designed to address all three types of dysbiosis at once. 

If you or your practitioner think you have Gilbert’s Syndrome, Leaky Gut Syndrome, and/or dysbiosis, this comprehensive strategy can help you restore the balance in your microbiome and your body as a whole. 

Gilbert's Syndrome Supplements:

Whether you’ve had your gallbladder removed or whether it’s simply challenged due to Gilbert’s Syndrome, these supplements can help take up the slack. Always consult with your healthcare professional about nutritional supplements.

Digestive Complete:

Proteins, carbohydrates, and fats all require specific enzymes to help break them down in the digestive tract, and this formula contains all three kinds. It contains ox bile as well, which is similar to human bile. Herbal extracts like dandelion, gentian, and fennel that aid digestion are also included to round out this general-purpose digestive aid that should be taken before each meal.

Calcium D-Glucarate Plus:

Since proper glucuronidation is impaired in Gilbert’s Syndrome, calcium-D-Glucarate is especially important. Research shows that taking this calcium salt as a supplement inhibits beta-glucuronidase, a Phase II liver detoxification enzyme. High beta-glucuronidase activity has been linked to increased cancer risk, especially hormone-related cancers like breast, prostate, and colon cancers. Whether you’re male or female, irregular levels of estrogen in your body can lead to irritability, poor immune function, and risk of cancer. Calcium D-Glucarate helps clear the body of a variety of toxins, including toxic forms of estrogen.

Cortisol Pro:

Levels of cortisol, the stress hormone, rise and fall with our circadian rhythms. In order for levels to drop properly at night so you can wind down, the day’s cortisol should be processed and eliminated through the liver. With the impaired glucuronidation in Gilbert’s syndrome, cortisol levels can remain too high at night, so you may feel as if your brain won’t shut down. Cortisol Pro contains several herbs that calm the body’s stress response and limit excess cortisol secretion. These adaptogenic herbs include Ashwagandha leaf and root, rhodiola, phellodendron, and maral root. Other natural ingredients that support a healthy stress response are l-theanine, an amino acid, and phosphatidylserine, a phospholipid.

Lipo-Flow:

This product supports the breakdown and metabolism of fat by the liver with ingredients that are choleretic (increase bile production) and cholagogue agents (increase flow of bile from the liver and/or gallbladder to the intestines). Compounds that have established effects on liver health—methionine, inositol, and choline—are combined with herbal ingredients like dandelion, artichoke, and beet root, which support the liver while providing antioxidant and anti-inflammatory benefits.

ATP Energy:

With or without a gallbladder, your body still produces bile; the gallbladder only stores this important digestive fluid. Keeping bile flowing is important for proper digestion of fats. Magnesium and malic acid have been used traditionally to thin the bile. By supporting muscle function, the ATP energy cycle, and digestion, this product can help you feel more energetic.