No, I can’t leave it alone. I’ve been gabbing on about Gilbert’s Syndrome for about 15 years now and it’s not going to stop anytime soon! This is not because I think it’s the most common condition we encounter but, rather because it is not uncommon. It is also not because this diagnosis explains everything for the individual who has, not just the genotype but the phenotype, with only 1/3 of the phase II glucuronidation capacity the rest of us have, but it does explain much of what they’ve sought an understanding for and some assistance with, often to no avail. And all the evidence tells us that Gilbert’s Syndrome continues to suffer from ‘poor visibility’ in general practice – meaning that more often than not it goes unrecognised and undiagnosed. But we can do better…
New research has helped us hone our diagnostic detective skills, refining (actually, redefining) our reference ranges – dramatically lowering our threshold for suspicion of this condition.
While other studies have torn down old notions of: ‘just a tendency to jaundice’, detailing clearly the real health narrative Gilbert’s Guys ‘n’ Gals will present with, including an increased number of self-diagnosed ‘food reactions’, fatigue, greater mental distress, menstrual issues, poor tolerance of certain meds & alcohol etc
But just as SIBO, Mast-cell-activation, Ehlers Danlos Syndrome or [insert…other on-trend-‘explain-all’-in-spite-of-no-1-definitive-result-diagnosis], the Gilbert Syndrome ‘call’, can be completely on the money for some clients, and a complete misdirection for others. These are big calls to make in our clients: ‘Here’s your why and here’s a 12 week, 12 month, lifelong management plan to address this!’ So we need to be absolutely thorough in our consideration of all things that mimic or overlap with certain aspects & features, so we don’t misdiagnose and, simultaneously, miss the real underpinning cause! When it comes to looking at labs and asking, Well, Is It Gilbert’s? – this means being across all the other explanations for high-normal or high bilirubin and following a methodical process excluding all others, to answer in the affirmative & with confidence.
I get Google ‘Gilbert’ alerts daily so I have no life and am reading the latest research all the time, refining my own processes and certainly the way I teach others about this.
Cue my latest Update in Under 30 episode, which is really 15 years in the making. That’s 15 years of reading research, seeing patients, educating and answering the questions of thousands of other practitioners, in order to be able to see where we are getting it right and wrong, to produce a clear 5 step process you can follow to ensure your Gilbert Syndrome call is on the money, not a misdirection and therefore going to be a game-changer in their life – not a time and money waster.
Well, Is It Gilbert’s Syndrome?
Many of us are now alert to this common but still under-recognised polymorphism that has pervasive effects on health. But if you were to base your diagnosis of Gilbert Syndrome on your patient having above reference range bilirubin levels, you will both miss some who have this condition, and misdiagnose others who don’t. Because of this, we need to be competent & confident in our process of identifying the real reason for greater than expected bilirubin levels, which include liver and biliary disease, abundant precursors, dyserythropoiesis esp B12 deficiency and several other genetic hyperbilirubinemias. This recording and the amazingly helpful desktop reference we’ve created to go with it, provide a clear process to follow, with concrete cut-offs for parameter values. Together these ensure you won’t miss a Gilbert’s Syndrome diagnosis but you won’t misdiagnose someone with it, either.