The liver cleansing diet

All about Bilirubin

Gilbert's Syndrome Triggered by the Menopause?

Testing for Gilbert's Syndrome

So you’ve over indulged, and you’re feeling tired and sluggish.  Perhaps your liver could do with a spring clean to give it a fresh start.  Here’s some tips for eliminating those toxins.

Cut down on the alcohol, salt, caffeine, tobacco, medication, sugar, and fat and stock up on these goodies.  Your liver will love you.

Essential Vitamins and Minerals
Vitamins C and E and minerals zinc and selenium are ‘antioxidants’ shown to aid liver healing. Sources include carrots, tomatoes, peppers, watercress, citrus fruits, berries, wholegrains seeds and oils.

B vitamins and choline are found in egg yolks, liver, legumes and brewer’s yeast and can help liver function.  Make sure your diet contains plenty of green leafy veg rich in folic acid, wholegrains and shellfish rich in vitamin B6, and vitamin B12 foods such as fortified cereals, seafood and seaweed.

Cruciferous Veg.
Members of the cabbage family have been shown to activate the liver’s cytochrome P450 detoxification process and glutathione conjugation.  In plain English – a process that converts fat-soluble toxins into water-soluble ones, more easy for your body to get rid of.  Try include broccoli, cauliflower, kale, mustard greens, radish, brussel sprouts and cabbage in your diet.

Sulphur rich foods.
Garlic, onions, eggs and legumes are rich in sulphur.  They can enhance the sulphuration detoxification process performed by the liver.

Detoxing superfoods.
You should add red fruits, berries, beetroot, and grapes to your diet, as these all help the liver to detoxify and are high in toxin fighting anthrocyanidines.  Papayas and pineapple contain useful enzymes to improve digestion and lemons have a strong cleansing effect.

Helpful Herbs.
Milk thistle, dandelion, turmeric and liquorice have all been shown to aid liver function.  Ginger is also an excellent cleanser.

Good Protein.
The liver needs protein to repair itself, and a diet high in protein gives some people with Gilbert’s Syndrome more energy.  Choose healthy alternatives to red meat such as fish, nuts, pulses and seeds as they are easier to break down and place less of a burden on your liver.

Water.
Once your liver has removed the toxins from your body, you must flush them out of your body.  The only way to do this is to drink lots of water.  Three pints or eight glasses a day minimum!  Although you may find this no problem as some sufferers have expressed how thirsty they seem these days
 

All about Bilirubin

If you’ve been diagnosed with Gilbert’s Syndrome, then you’ve most probably been told that your bilirubin levels were high.  It’s one of the most common ways of determining that a patient has GS, and usually happens after general blood tests.

But what is Bilirubin, what does it do and will it harm us?

Bilirubin comes from the blood when blood cells become old, and die.  Hemaglobin, the substance in blood that carries oxygen, is broken down to heme and globin and is passed onto the liver. Bilirubin is formed from the heme part of hemaglobin, and is a bright greenish yellow colour.

The bilirubin is not water soluble when it gets to the liver, and needs an enzyme to become so, then it can be easily passed out of the body.  The water soluble substance now passes through the gall bladder as bile and into the small intestine where it continues to be processed by bacteria in the intestines, and is passed out through the faeces and urination.

This enzyme that makes the bilirubin water soluble is called glucuronyl transferease, known as UGT for short, and is what people with GS are genetically lacking.  This means that the bilirubin is not ‘conjugated’ or converted so that it can easily leave the body.

The enzyme also uses blood sugar to help in processing bilirubin, which is one reason why missing meals can affect you.  It’s best to ensure you have regular small meals, and cut down on unrefined sugar and carbohydrates like white bread and pasta, so that the amount of enzyme you have can always have a stable supply of blood sugar to do its job.

There is always some bilirubin that is in the blood but this is chemically different from the ‘conjugated’ bilirubin.  GS sufferers however, have a lot more of this ‘unconjugated’ bilirubin because it hasn’t been disposed of as it should through the usual process. It’s the difference between the 2 types that tips off those conducting the lab tests on your blood that you have GS.

When bilirubin builds up in the blood at more than around 2.5mg/dl, then the skin and eyes become discoloured with yellow, otherwise know as jaundice. There are a number of reasons bilirubin builds up in the blood other than the lack of the enzyme, and it’s important to rule those out before diagnosing Gilbert’s Syndrome.  For example the patient’s bile duct could be blocked, or they could have a type of anaemia, or hepatitis.

Drugs can also affect the measurements of bilirubin, and many can increase it such as  steroids, some antibiotics, antimalarials, codeine, diuretics, MAO inhibitors, nicotinic acid, oral contraceptives, and others.  Drugs that decrease bilirubin measurements include barbiturates, caffeine, penicillin and high dose salicylates.

You’re likely to be diagnosed between the age of 10 and 30.  There’s no particular racial difference in how likely you are to have GS, but males are affected more than females.  Many people will not even notice they have it.

Once diagnosed you can be reassured that you’ll have a normal life expectancy.  You may get jaundice, nausea, fatigue, and abdominal pain especially after fevers or flu, exercise or alcohol, stress or missing meals.

One of the major roles of the liver is to process hormones.  It is therefore not irrational to suppose that the menopause may have some effect on a woman’s experience of GS (and vice versa) due to the enormous hormonal changes and fluctuations that cause it.

During the menopause the ovaries are less able than before to respond to the pituitary hormones follicle stimulating hormone (FSH) and luteinising hormone (LH), and so less oestrogen is produced.  Due to the reduction of oestrogen production some androgens that are still produced by the adrenal glands, such as testosterone, are not overridden as they were before the onset of the menopause.

This means there is a major shift in the balance of hormones in the body, with an increase of FSH, LH and androgens for the liver to process.
 

Gilbert's Syndrome Triggered by the Menopause?

Scouring the recently published scientific research I could not find any article that had investigated the effects of these changes on people with liver conditions.  Common sense suggests that these changes would be an immense shock to the liver (we only have to look at all the other effects on the body to understand that this is a huge physical change).  As the liver metabolises hormones and deactivates them when they are no longer useful, it has an increased workload with the excess FSH, LH and androgens.  It seems highly possible that this extra strain on the liver of a GS sufferer would bring to the fore GS symptoms that had not previously been recognised when the liver was used to the hormonal balance of the body.

Many symptoms of the menopause and of GS are very similar and thus these symptoms may be enhanced in the GS sufferer.  For example, the insomnia or disrupted sleep caused by other menopause symptoms, such as hot flushes, can lead to fatigue and generalised aches and pains, common symptoms of GS.  Other symptoms common to both include dizziness and difficulty with cognitive tasks, such as concentration and memory.

Finally, a word about medication.  The most commonly used treatment to ease the effects of the menopause is HRT.  As yet, we are not fully aware of the exact effects many medications have in relation to GS.  We know some medications are processed differently by GS sufferers and so anyone taking any medication who has GS should be aware of this.  There is evidence that HRT can affect bile composition (http://hcd2.bupa.co.uk), which may have implications for GS sufferers.  It may, therefore, be worth being aware of these scant facts when consulting the GP, in order for them to give the best possible advice for the individual.

Unfortunately, as yet, there are no answers to the dual problem of the menopause with GS, apart from the advice AGS passes on to all GS sufferers: to do everything in our power to reduce the workload of our liver.

Testing for Gilbert's syndrome

Copyright Action on Gilbert's Syndrome, June 2005.  Author Adina Farmaner.

I am often asked if there is a test for Gilbert's syndrome.  There are a number of means of diagnosis, but a specific test does not exist.

The most common mechanism for diagnosing Gilbert's syndrome in the UK is as the result of a routine blood test which establishes bilirubin levels outside the normal range.  If other liver conditions have been ruled out, then the health professional will usually diagnose Gilbert's syndrome.  However, a diagnosis by exclusion can be both lengthy and not absolute.
Typically Gilbert’s syndrome presents via a mild elevation of bilirubin in a set of liver function tests ordered for another purpose. The bilirubin typically fluctuates in the range of 20 – 40 mmol/L although normal values may occur, and results as high as 80 mmol/L may be seen in patients who have not consumed food for several days.
A more specific route by which Gilbert's syndrome can be diagnosed is via a blood test taken after a 48 hour reduced calorie intake. A blood test is taken on the first morning, and followed with a further blood test after reduced calorie intake after 48 hours In patients with Gilbert's syndrome an approximate twofold increase in bilirubin levels is usually observed.

As a genetic disorder, you would've thought Gilbert's syndrome could be diagnosed through a genetic test.  There has been research into such diagnostic procedures, however, at present it is not recommended as a routine test.  This is because the prevalence of some of the elements that are involved have not yet been established, and this test would not rule out other liver problems or diseases.

So at present, diagnosis of Gilbert's syndrome must be undertaken after evidence of symptoms combined with exclusion of other conditions.
 
 

This website is produced by a small but friendly organisation working solely for people experiencing Gilbert’s Syndrome.  The information has been painstakingly gathered from years of searching, and some is necessarily anecdotal.  It’s not meant to be a definitive guide to how to deal with Gilbert’s Syndrome, because one of the problems we are set up to overcome is the lack of information and support on this subject.