So I had to look all the way back in the UU30 back catalogue to 2013 to find my original Gilbert’s Girls recording talking about this common polymorphism and how it might present in your practice but I haven’t exactly been quiet on this one since then. In the last 5 years, I’ve continued the theme, predominantly focusing on the mental health links but now it’s time to tackle the myriad, murky and mercurial aspects of their digestive problems. You see, a survey of patients with this so-called ‘benign hyperbilirubinemia’ found that < 10% were genuinely asymptomatic – and the main two areas of their health complaints could be categorised as psychiatric and digestive. The problem for doctors, gastroenterologists and us alike is that that’s where the ability to categorise, classify or ideally diagnose comes to an abrupt end. Here’s a few lines from a few of mine to illustrate what I mean:
“I don’t know how to describe it – I just feel ‘off’, yeah I guess, maybe queasy, it changes in intensity but it’s been there as long as I remember”
“Something’s wrong but no one can tell me what. My stools are always different, sometimes pale, sometimes dark, floating, explosive and there’s no pattern with what I eat. I can eat the same thing every day but never get 2 stools the same. I’ve had loads of tests – they can’t find anything”
“It’s weird, I can’t say I get hungry. I just feel full like really quickly and it stays for most of the day. Sometimes I can even burp in the morning and it tastes like last night’s dinner!”
” All they’ve found is ‘biliary sludge’ but they say it can’t explain all my symptoms- makes no sense, right? I’m only 20, I’m male, I’m vego…and no one in my family has ever had gall bladder issues!”
For patients with GIlbert’s Syndrome, the problem is even bigger – they live with these day to day digestive ‘oddities’, where their guts don’t appear to play by the same rules as everyone else, and worse still no one can explain it. But we should be able to. When you appreciate the major excretory pathway for bilirubin is the GIT and the whole digestive tract represents essentially an obstacle course for bilirubin excretion, complete with ‘helpful’ bacteria, ‘unhelpful’ bacteria, pH sensitive enzymes etc etc …one that we must complete or we end up with too much…well it starts to become patently clear why individuals with too much bilirubin already, especially unconjugated bilirubin (UCB), would fail this obstacle course and end up with a whole bunch of digestive issues along the way. But it doesn’t have to be like this.
Understanding the steps and machinations of bilirubin detoxification and GIT handling enables us to find some very core naturopathic approaches to optimising not only their gut health but also assisting with lowering their elevated UCB which is a win-win. So if you’ve got some Gilbert’s Gals (and boys…I never mean to be genderist it just doesn’t have the same twang!) or patients you suspect because of ‘high normal’ serum bilirubin levels (remember anyone with a consistent pattern of >15 ummol/L, i the absence of liver damage or haemolysis, is a tad suspicious) and you want to really understand the nexus between bilirubin and GIT function check out this article by Vitek &Carney 2012 for a good review to start with. And yes..spoiler alert (!), gall stones and sludge are more common in Gilbert Syndrome.
Want to hear about the 7 key treatment objectives for Gilberts’ Guts? And a summary of what the proven and unproven but sensible digestive interventions are? Well I just happen to have one I whipped up earlier…Gilberts’ Guts, our latest Update in Under 30 offering. Oh and if you’re wondering whether coffee enemas might help this bile related issue…well you might want to catch next month when I do an UU30 number on them as well! Hope it helps 🙂
Gilbert’s syndrome presents in many different shapes and forms in our patients & frequently with a ‘digestive component’ that is incredibly hard to pin down. Often dismissed as IBS by medicos or misattributed to complex food reactions by patients, the true cause often eludes patients. In this recording, we summarise the links between impaired glucuronidation, impaired bilirubin excretion and digestive disturbance, from one end of the GIT to the other, and outline the 7 core treatment objectives and the best interventions to Get the Gilbert Gut Good!
Hear all about it by listening by my latest Update in Under 30: Gilbert’s Guts.
For all Update in Under 30 Subscribers, it’s now available in your online account and if you are not a subscriber you can purchase this individually here.