Gilbert’s Syndrome
Gilbert’s Syndrome is considered a benign condition of the liver that requires little or no
treatment and in most cases manifests few symptoms according to the majority of research
available. This is a boring subject at first glance compared to the myriad of conditions available
to our modern day western culture. When considering this from an integrated lens it becomes
more interesting and relevant for individuals diagnosed. Gilbert’s Syndrome is a genetic liver
condition occurring in a small percentage of the human population due to an inherited mutation
in the production of the enzyme responsible for detoxification of bilirubin. Characterized as an
asymptomatic, benign condition, with intermittent jaundice and hyperbilirubinemia (serum
bilirubin level 1.2-3.0 mg/dL). The pathway of detoxification of bilirubin occurs during
glucuronidation, one pathway of phase II detoxification in the liver. Typically there is no
treatment for Gilbert’s Syndome. The treatment for this “benign” liver condition should be to
educate patients suspected of Gilbert’s Syndrome that they are at a higher risk of toxic overload.
Stress, fasting, fatigue, alcohol, anesthesia, surgery, acetaminophen among other offenders can
all exacerbate symptoms Gilbert’s Syndrome which may lead to jaundice, nausea, right
hypochondriac pain or abdominal pain in severe cases.(1) The only significant risk factor for
Gilbert’s Syndrome, a genetic disorder, is having both parent carriers of the abnormal gene, and
it is more common in men than women.
To understand how Gilbert’s Syndrome manifests it is important to know the mechanism
of action within the glucuronidation pathway. Glucuronidation combines glucuronic acid, an
acid formed by the oxidation of glucose, with toxins. Gilbert’s syndrome may be caused by a
compromise in the glucuronidation pathway due to an enzyme deficiency leading to a build up of
toxins that otherwise would be excreted by urine or bile. There are two main enzymes to focus
on in this process, beta-glucuronidase and UDP-glucuronyl transferase. Beta-glucuronidase is not
affected by Gilbert’s Syndrome, but does affect the glucuronidation pathway by inhibiting
glucuronic acids conjugation capability. The main targeted enzyme of Gilbert’s Syndrome is a
deficiency in glucuronyl transferase. The balance between these enzymes is key to the function
and elimination of certain toxins from the liver.
Western differential diagnosis may be difficult because there are generally no symptoms
and a mildly impaired functioning of the liver. Other conditions that may impair liver function
should be considered. Liver diseases such as hepatitis, cirrhosis, or liver cancer can affect levels
of serum bilirubin, but Gilbert’s Syndrome is a moderate elevation in levels and doesn’t have the
severity of these other diagnoses. Drug toxicity or chemical exposure can adversely load phase II
detoxification. An article on decreased glucuronidation and increased bioactivation of
acetaminophen reported a 31% lower acetaminophen glucuronide formation in subjects with
Gilbert’s Syndrome compared to normal controls.(2) Many hormones and metabolic byproducts
are excreted through Phase I/II liver detoxification. Without the ability to detox these chemicals,
an accumulation of toxins may lead to a wide range of signs and symptoms aside from the
moderately high level of bilirubin leading signs of jaundice. This is where an integrated approach
starts to come into action.
Where Traditional Chinese Medicine shines is in the differential diagnosis of syndromes
based on thousands of years of observation and clinical experience. Western medicine is brilliant
but if we cannot show on our lab report the hard evidence of symptomatic manifestation patients
are often left without an option for care. The diagnosis itself is not precise. Blood work needs to
show a normal liver function test and moderate levels of unconjugated bilirubin. One interesting
resource created for individuals diagnosed with Gilbert’s Syndrome shows signs and symptoms
based on self-reports categorized as emotional, mental, energy level, and digestive problems and
adverse reactions to environmental and endogenous toxins.(3) It must be noted the findings are
not based on scientific studies, only patient reports, and therefor cannot be considered as
diagnostically relevant. Considering a medical establishment that recognizes patient reports
without scientific data it would be noteworthy that symptoms include but are not limited to
chronic fatigue, stress, depression, headache, insomnia, mood swings, difficulty in concentration,
poor appetite, nausea, vomiting, irritable bowel, hypochondriac pain, jaundice, gallstones, heart
palpitations, chest pain, light sensitivity, and on and on.
Gilbert’s Syndrome may be treated from a TCM perspective according to an article
written by Valerie Cameron, a practicing medical acupuncturist with 26 years of experience and
a background in biochemistry. She cites The Treatment of Modern Western Diseases with
Chinese Medicine, “According to the theory of Traditional Chinese Medicine, the mild
hyperbilirubinemia of Gilbert’s Syndrome can be generally understood as an imbalance of Liver
qi” (Flaws & Sionneau, 2001). Conditions of Liver Qi imbalance can be broadly categorized into
excess or deficiency patterns. Excess patterns manifest as signs and symptoms of stagnation or
rebellion and deficiency patterns of qi, yang, blood or yin.(4)
The TCM diagnosis for Gilbert’s Syndrome is dependent on the individual and the
manifestation of the symptoms. The treatment protocol would generally focus on the
harmonizing of Liver qi and blood.
In general, if diagnosed with Gilbert’s Syndrome or trying to improve overall health,
laugh and sweat every day. Exercise to move the stagnant Liver qi. Eat mindfully, an organic
whole foods diet that supports both Phases I and II detoxification and adequate fluid intake.
Don’t fast or skip meals. Employ a practice of Tai Chi, loving kindness meditation and/or yoga
with breathing emphasis. According to Traditional Chinese Medicine in order to support
digestion and absorption it is recommended that food is cooked and ingested warm. Oranges,
apples, grapefruit and cruciferous vegetables contain calcium-D glucarate and glucaric acid. This
supports detoxification by inhibition of beta-glucuronidase. Beta-glucuronidase minimizes the
detoxification process where glucuronic acid is conjugated with numerous drugs, hormones,
bilirubin, pollutants and bile acids.(5) Some common substances detoxified through the
glucuronidation pathway include but are not limited to aspirin, menthol, synthetic vanilla,
acetaminophen, morphine, diazepam, digitalis, benzoates, and some hormones.(3) With modern
day exposure to environmental and endogenous toxins being so high in our medicated, polluted,
GMO-exposed, high stress culture, this is a disease that deserves at least some attention.
References:
1. General anesthesia in a patient with Gilbert's syndrome
Deb Sanjay Nag, Niraj Sinha,1 Devi Prasad Samaddar, and Pratap Rudra Mahanty
Author information ► Copyright and License information ►
2. acetaminophen article Feb;102(2):577-86.
Decreased glucuronidation and increased bioactivation of acetaminophen in Gilbert's syndrome.
de Morais SM, Uetrecht JP, Wells PG.
Source
Faculty of Pharmacy, University of Toronto, Ontario, Canada.
3. www.gilbertssyndrome.com
4. Valerie Cameron article
http://www.acupunctureherballismore.com.au/index.php?option=com_content&view=article&id=13:gilbertssyndrome-an-introduction-to-traditional-chinese-medicines-approach-to-relatedsymptoms&catid=7:valerie&Itemid=8
5. http://www.vrp.com/detoxification/phase-I-and-II-detox-pathways