Gilbert's syndrome

Gilbert's syndrome, often shortened to the acronym GS, is a genetic disorderof bilirubinmetabolism, found in about 5% of the population. The main symptom is elevated bilirubin (hyperbilirubinemia) leading to otherwise harmless mild jaundice. Alternative, less common names for this disorder are as follows:

• Familial Benign Unconjugated Hyperbilirubinaemia
• Constitutional Liver Dysfunction
• Familial Non-Hemolytic-Non-Obstructive Jaundice
• Icterus Intermittens Juvenilis
• Low-Grade Chronic Hyperbilirubinemia
• Unconjugated Benign Bilirubinemia

Signs and symptoms

The Gilbert's syndrome produces an elevated level of unconjugated bilirubin in the bloodstreambut normally has no other effect. Rarely, mild jaundicemay appear.

Some patients report fatigueand "brain fog" during episodes of high bilirubin levels. There is some evidence that Gilbert's syndrome also reduces the liver's ability to detoxifycertain chemicals; it may be wise to avoid drugs that tax liver function, such as paracetamol.

Diagnosis

While this syndrome is considered harmless, it is clinically important because it may be confused with much more dangerous liver conditions. However, these will show other indicators of liver dysfunction. Haemolysiscan be excluded by a full blood count and lactate dehydrogenaselevels. Liverbiopsyis rarely necessary. The onset of GS is often in childhood or early adulthood.

Normal levels of Total Bilirubin (conjugated and unconjugated) are under 20 mmol/dl.Patients with GS show only elevated unconjugated bilirubin, while conjugated is in normal ranges and forms less that 20% of the total. Levels of bilirubin in GS patients should be between 20 mmol/dl and 80 mmol/dl. It is proven that GS patients have a 30% slower Gluconuitril transferase rate than normal.

The level of Total Bilirubin is often increased if the blood sample is taken whilst fasted.

Gilbert's syndrome causes a 31% slower than normal rate of glucuronidationin the Phase II detoxification pathway of the liver. The phase II detoxification pathway of the liver deals with conjugationrather than the oxidation, reduction and hydrolysis of the phase I pathway.

More severe types of gluconitril transferase disorders like GS are Criggler-Najjar Syndrome Type Iand Criggler-Najjar Syndrome Type II. Patients with type I disorder show no bilirubin detoxification and suffer from brain damage due to exessive bilirubin levels(both conjugated and unconjugated bilirubin are elevated). Infants with this disorder live not more than one year. There are cases of Criggler-Najjar Type Ipatients living twenty or thirty years.

It is arguable that GS is benign, due to many reported symptoms by GS patients.

Controversial Dietary Recommendations

Many persons with GS report more severe symptoms during periods of high bilirubin levels, including persistent or meal-related fatigue, dizziness, tremors, nausea, abdominal pain, and "brain fog". While some argue that these symptoms are attributable to mild hypochondria, others claim to find relief through certain dietary habits.

The following lists are a combination of these dietary recommendations, compiled from related web sites:

First Aid:

• From a man with GS: "First aid for a GS episode is 500 mg. of vitamin C, every 6 hours. It reduces the blood level of bilirubin by oxidation."

Potentially Jaundice-Causing Foods:

• Fatty foods - meats such as bacon, fried foods such as french friesor potato chips, and non-skim milk products such as cheeseand butter.
• Cooking oils such as vegetable oil, sunflower oil, coconut oil, olive oiland palm oilas well as oil-rich condiments such as margarine, mayonaise, most commercial pasta sauses, most salad dressings, and non-dairy whipped topping.
• Pickled foods.

Substances That Tax Phase II Liver Function

• Acetaminophen/ Paracetamol
• Aromatic and heterocyclic amines
• Aromatic hydrocarbons
• Clofibrate
• Estrogen
• Fluoride
• Menthol
• Tolbutamide/ Orinase
• Quinolones (fluoroquinolones) antibotics
• Steroid hormones
• T4 thyroid hormones

Otherwise Problematic Foods for people who have Gilbert's Syndrome:

• Alcohol.
• Artificial sweeteners.
• Sugary foods and refined carbohydrates.
• Extracts such as peppermint, and vanilla.

Recommended Foods:

• Protein - fish, chicken, lean beef, kidney beans.
• Fresh vegetables and fruit - most are good but often broccoli, blueberries, cabbage, carrots, beetrootand cauliflowerare recommended highest.
• Nuts (in moderation) - walnuts, almonds.
• Tea, coffee, mineral water.
• Milk thistleis the supplement most often used amongst those with GS, with the claim that it supports liver function. Other supplements are used, such as Vitamin B complex, Vitamin C, iron, glycine, glutamic acid, cysteine, taurine, turmeric, methionine(in the form of S-adenosylmethionine (SAM)), and royal jelly.
• 6 to 8 glasses of water / day.

In addition, as with any illness, various stressors such as anxiety, depression, poor sleep, poor work-life balance and lack of regular exercisecan worsen the symptoms of Gilbert's syndrome.

History

Gilbert's syndrome is thought to be caused by a deficiency in the enzymeglucuronosyltransferase. It was first described by French gastroenterologistAugustin Nicolas Gilbertand co-workers in 1900.

External links

• Action on Gilbert's Syndrome- the UK organisation helping people with Gilbert's Syndrome
• Gilbert's web- patient forum

References

• Extract from "Total Wellness" by Dr. Joseph Pizzorno
• Gilbert's Syndrome Fact Sheet at AllRefer Health
• Gilbert's Web Food Recommendations
• Liver Detoxification Pathway from Liver Doctor Websitede:Morbus Meulengracht

es: Síndrome de Gilbert nl:Syndroom van Gilbert sl:Gilbertov sindrom sv:Gilberts syndrom

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Gilbert%27s+syndrome Wikipedia article Gilbert's syndrome.