Calcium-D-glucarate helps fight Gilbert’s Syndrome symptoms

Studies show that Calcium-D-glucarate may help fight Gilbert’s Syndrome symptoms. Here I unpack what it is and what it could do for people with Gilbert’s Syndrome. 

What is Calcium-D-glucarate?

Calcium-D-glucarate is naturally found in fruits and vegetables. It’s a combination of calcium with glucaric acid, and is similar to glucaric acid which is found in the body. It is commonly used as a dietary supplement due to its potential health benefits. 

What does Calcium-D-glucarate do and why does it help fight Gilbert’s Syndrome symptoms?

Some studies show that Calcium-D-glucarate may have a positive effect on liver health and bile metabolism. It is believed that Calcium-D-glucarate may improve the detoxification process in the liver by increasing the excretion of certain toxins. Importantly for people with Gilbert’s Syndrome this includes bilirubin.

How does Calcium-D-glucarate help fight Gilbert’s Syndrome symptoms?

It’s thought that Calcium-D-glucarate stops an enzyme called beta-glucuronidase. This enzyme is responsible for breaking the bond between glucuronic acid and toxins. This lets them be reabsorbed into the body instead of being eliminated. This means that by stopping beta-glucuronidase from working as well, Calcium-D-glucarate may help prevent the reabsorption of bilirubin and other toxins.

Here’s what happens in your body in medical terms: 

Beta-glucuronidase is an enzyme that plays a role in the breakdown of bilirubin in the intestines. It acts by deconjugating bilirubin, converting it back into its unconjugated form, which is less water-soluble. Normally, bilirubin that has been conjugated by UGT1A1 in the liver is excreted into the intestines, where it is further metabolised and eliminated from the body. However, in individuals with Gilbert’s syndrome, the reduced UGT1A1 activity leads to impaired bilirubin conjugation. The presence of beta-glucuronidase in the intestines can cause an increased release of unconjugated bilirubin.

The increased activity of beta-glucuronidase can contribute to higher levels of unconjugated bilirubin. This makes the symptoms of Gilbert’s syndrome worse.

Here’s what this means in ordinary words-

Calcium-D-glucurate gets in the way of chemicals that increase bilirubin and so you can deal with it more easily, if you have Gilbert’s Syndrome. 

Be cautious!

It is always important to note that the available research on Calcium-D-glucarate’s effect on bilirubin is limited. More studies are needed to establish how well it works in reducing Gilbert’s Syndrome symptoms. 

Is it the right supplement for you?

Don’t forget – everyone responds differently to supplements too. You might have other conditions that mean that Calcium-D-glucarate isn’t right for you. It does other things, such as affect estrogen levels and some suggest its use for hormone related conditions :https://drbrighten.com/benefits-of-calcium-d-glucarate/. Make sure you check with your Doctor before taking it as it could affect other medications. 

You can increase your levels of the glucaric acid element by eating more apples, oranges, broccoli, cauliflower and cabbage. 

You can also decrease the beta-glucuronidase that may be worsening your symptoms by eating a healthy low fat diet, that includes plenty of fresh fruit and veg. Reducing smoking, alcohol and sugar may also help. Want to find out more about how your diet can help you live a happier life with Gilbert’s Syndrome? Check out this post https://gilbertssyndrome.org.uk/the-liver-diet/ You can find out more about food and nutrition to help with Gilbert’s Syndrome in the Posts ‘diet’ category here https://gilbertssyndrome.org.uk/category/diet/

If you decide you want to get a supplement, try this one. It has good reviews, although badged as for women due to its impact on hormones – you don’t have to be a woman to take it of course.

Want more help?

You can work with me as a health coach to support you in managing your Gilbert’s Syndrome symptoms and improving your wellbeing. Find out more here https://wellandgoodlife.co.uk/

You can also take the Gilbert’s Syndrome Essentials course which gives you all the basics on Gilbert’s Syndrome and how to manage the top symptoms. Find out more here https://wellandgoodlife.co.uk/uncategorized/essentials-of-gilberts-syndrome-course/

So, it sounds like Calcium-D-glucarate just might have a positive impact on bilirubin levels by potentially enhancing the liver’s detoxification processes. However, further research is needed to fully understand its effects, and it is advisable to consult a healthcare professional for personalised advice if you plan to take a supplement. 

You can find out more here

https://www.webmd.com/vitamins/ai/ingredientmono-136/calcium-d-glucarate

Master your immunity with Gilbert’s Syndrome.

Disclaimer: Please note that I am not medically qualified and this is not medical advice. The information in this article comes from sources which are referenced /linked to, many of which are published scientific research papers, or secondary sources which reference published research. Please consult your health professional about any health issues or concerns.

What you need to know about immunity

  • Immunity is your body’s power to fight alien invaders that make you sick.
  • You already have many active immune powers – your skin barrier, stomach acid and gut bacteria, mucus, coughs and sneezes, fevers and killer cells in your circulatory system.
  • You can maintain and support your immune powers by eating more plants, exercising, controlling stress and good sleep.
a hand is held up against images of virus cells coming towards it
Image by Bruno /Germany from Pixabay

Why is it important to support your immunity if you have Gilbert’s Syndrome?

Your liver works between your gut and your blood system. It supports both of these and the cells needed to fight disease. 

If you have Gilbert’s Syndrome, you may become jaundiced when fighting infection, and when recovering from a virus. You might feel tired for longer and after the virus has gone it could take a while to get back on your feet. It’s not clear exactly why you may experience these symptoms, but the liver is involved in so many elements of immunity that it works over-time when you are sick. By looking after your immune system you give it the best chance of working well and recovering quickly from any illness.

You can read more detailed information on liver and immunity here : https://www.nature.com/articles/cmi20163 https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.22034 

If you want to know more about your immunity superpowers and how you can master them, read on…

Our immune system is working for all of us all the time – not just during a pandemic. Our clever bodies fight off many threats, not just viruses. We use our immunity to kill bacteria, remove toxins, heal wounds and fight cancer. 

During the Covid19 pandemic scientists around the world worked to understand immunity and the impact of a virus on individuals and society. We have learnt a lot that we can use to build up our long term health and immunity. We could live longer healthier lives as a result. 

What is immunity?

https://medlineplus.gov/ency/article/000821.htm

We all start life with the basics of immunity. Our immune defences include a skin barrier, stomach acid, mucus in our nose and a cough reflex. These are part of how our body responds to harmful invaders. If bacteria or viruses get past our frontline barriers, then other systems kick in, and we may develop a fever or inflammation which also kill invaders.

a person holds their hand in front of their mouth as they cough
Image by mohamed Hassan from Pixabay

Our protective cells

Within our body tissues, and in our circulatory system, we have cells that respond to protect us, such as white blood cells. These produce antibodies (here’s a link to a description of antibodies: https://my.clevelandclinic.org/health/body/22971-antibodies) and cytokines (here’s a link to a description of cytokines: https://www.verywellhealth.com/what-are-cytokines-189894)  which are cells that attack harmful viruses and control how your immune system responds. White blood cells are also attracted to places where our body is damaged, by chemicals such as histamine. When white blood cells collect together the damaged part swells, helping the body to isolate and deal with any harmful substance. 

We are born with some of our immune system in place, but we then develop immunity as our bodies encounter new substances. Vaccines teach our bodies to respond to a harmful virus, in a very small amount,  without experiencing the full virus. 

Because our immune system involves so many parts of the body, from our liver, bone marrow, to spleen and our lymphatic system, as well as individual cell types, overall health is really important. 

There’s so much we DO know and 

much MORE 

we DON’T know about immunity

Some things we’ve learnt from Covid19

Our understanding of immunity has changed a lot in a short period of time. Scientists have had the opportunity to study immunity in many millions of people around the world because of the widespread Covid19 virus. This sort of data gives us much better quality information than the usual research samples of small scale studies in an artificial environment on (usually) young healthy male humans.

Nutrition and existing health problems measurably impact Covid rates and recovery

A study from the UK Biobank of 500,000 participants showed lower rates of COVID in those consuming the most vegetables and coffee, and higher rates in those eating the most processed meats2. (Plant Based Health Professionals fact sheet September 2022 https://plantbasedhealthprofessionals.com/wp-content/uploads/Nutrition-Immunity-and-Covid-19-for-Health-Professionals-060922.pdf )

There’s no doubt that having other chronic health problems impacts how badly you suffer from a virus such as Covid19 or flu. Obesity, hypertension, high cholesterol, and type II diabetes – all of which are widespread in the UK, USA and other westernised countries, leave you with a higher risk of going to hospital when you have a virus. Fortunately these are chronic health problems which can be tackled through changes in diet and lifestyle. 

One study of almost 600,000 UK & US participants, showed a 9% lower risk of contracting COVID, and a 41% lower risk of severe COVID in those eating a healthy plant based diet.(Plant based health professionals fact sheet September 2022 https://plantbasedhealthprofessionals.com/wp-content/uploads/Nutrition-Immunity-and-Covid-19-for-Health-Professionals-060922.pdf )

Of course there are many other conditions, social and economic impacts as well as lifestyle which will influence your immunity. A good healthcare system is another important factor! Some of these can be managed and controlled. This article looks at how to give yourself the best chance of supporting your immune system alongside these challenges. 

Age

Age plays a part in immunity. Usually, young children and older people have less robust immune systems. Covid19 is an unusual virus as it doesn’t affect young people as much as older people or other adults. The best way to protect younger or older people from viruses is to ensure they have a healthy diet, spend time being physically active, and are kept protected from potentially life threatening viruses. For children, vaccines and some exposure support the development of their immune system. 

Gut microbiome

There is a lot of emerging data that shows that the health of your gut bacteria (all the different types of bacteria together are called the microbiome) play an enormous role in your immune health. https://gut.bmj.com/content/70/4/698  . Over at Zoe they have done an incredible amount of research looking at the gut microbiome and health https://joinzoe.com/learn/gut-health-and-immune-system . It now appears that this part of our body is responsible for much of our overall health like a central government ruling a nation. 

The best way to feed the gut is with plants. Lots of different types of plants. A healthy gut will keep down inflammation in your body, reduce auto-immune conditions, help you overcome infection, balance your blood sugar and fat levels in your blood. It will protect you from many chronic and acute health problems. 

a person places their hands over their stomach
Image by Alicia Harper from Pixabay

According to David Heber MD, PhD, Professor emeritus at UCLA 

70% of the immune system is located in the gut, where diverse bacteria is best.” https://connect.uclahealth.org/2021/03/19/want-to-boost-immunity-look-to-the-gut/

“The microbiome and the immune system are critically intertwined,” says Jonathan Jacobs, MD, PhD, a professor of digestive diseases at the David Geffen School of Medicine at UCLA. “What’s present in the gut determines what education immune cells get.”

“Dietary diversity and microbial diversity go together,’ Dr. Jacobs says. ‘The typical Western diet, which is high in animal proteins, sugar, processed foods and saturated fat, results in less-diverse gut bacteria and promotes inflammation and chronic disorders”, he says.

Fortunately, it appears that Gilbert’s Syndrome itself does not have a negative effect on the gut microbiome, (you can read more in this link: https://www.frontiersin.org/articles/10.3389/fcimb.2021.701109/full ).

4 KEY factors

There are 4 key factors that affect immunity (and the gut) : diet, exercise, stress and sleep. 

Diet

Three little words I offer to everyone who consults me as a health coach are ‘eat more plants.’ If you do nothing more than this, your body will thank you. Your gut and your liver will both work much better the more plants you eat. 

Plants are anti-inflammatory. Although short term inflammation is good for beating alien invaders, in many people it becomes a long term condition which harms the body. This can lead to heart problems, bowel, disease, arthritis and cancer. Plants have chemicals and nutrients that feed your cells and organs – helping them to stay strong and work better. 

If you have Gilbert’s Syndrome you could focus on ‘cruciferous’ veg such as broccoli, brussel sprouts, cabbage and cauliflower as these are great for your liver function. Read more about the liver fortifying diet here: https://gilbertssyndrome.org.uk/the-liver-diet/ 

If you need to build up your veg eating tolerance, you can start with some easy swaps or inclusions eg add more peppers, courgettes and tomatoes (tinned are great!) to a pasta sauce; lots of veg can make a tasty mash – parsnips, carrots and squash, not just potatoes; curries, casserole, stews, soups, tagines, pies, pasties, fajitas, wraps, etc can all have added veg that will enhance texture, flavour and be fabulous for your health. 

Try to eat what’s in season as this will be more affordable. Reducing animal products will also be better for your wallet as well as your health. A health coach can give you lots of support to include nutritious food that works for your situation. 

With the added fibre you’ll feel fuller for longer and your blood sugar will be more stable giving you more energy over time. Your gut bugs LOVE fibre. 

For a more detailed post on a diet for your liver go here https://gilbertssyndrome.org.uk/the-liver-diet/

You can find recipes here https://gilbertssyndrome.org.uk/recipes-for-your-liver/ and a recipe leaflet as well as more advice here https://gilbertssyndrome.org.uk/tips-for-gilberts-syndrome-and-holiday-celebrations/

Exercise

This review of work around Covid looks at exercise and immunity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387807/#:~:text=The%20practice%20of%20physical%20exercises,as%20well%20as%20cell%20recruitment.

Exercise helps your body in lots of ways – keeping your body fat down, supporting healthy muscle tissues and blood vessels and reducing inflammation. All of these contribute to the chemical reactions which ensure your body has the powers it needs to deal with infections.

Image by Julien Tromeur from Pixabay

It’s really important to maintain physical fitness through movement as you age. Recent studies show that you will be less likely to die from all causes if you build muscle strength. 

You can read more about muscle and its relationship with immunity and infection in these two pieces, which cite research material. 

“Muscles produce and release compounds which play an important role in the creation, activation, and distribution of some immune cells. They are also key sources of amino acids used by the body during stress or infection.“ https://timesofindia.indiatimes.com/blogs/voices/impact-of-poor-muscle-health-on-bodys-immunity/ 

“Muscles produce and release compounds which play an important role in the proliferation, activation and distribution of some immune cells.2 And while additional research is needed, data suggests loss of muscle mass is associated with compromised immunity and infections.3,4 “ https://www.nutritionnews.abbott/healthy-living/aging-well/minding-our-muscles-for-immune-health/#:~:text=Muscles%20produce%20and%20release%20compounds,distribution%20of%20some%20immune%20cells.&text=And%20while%20additional%20research%20is,with%20compromised%20immunity%20and%20infections

So what do I mean by exercise?  It really varies depending on your personal situation.

For people with Gilbert’s Syndrome, whose symptoms could be triggered by sudden high intensity exercise, as well as other people who may not be used to exercise – low to moderate intensity exercise is the best place to start. If you have been very unwell or are out of condition then the smallest movement will be a positive step. Lots of conditions affect your ability to exercise, through pain or exhaustion, or feeling sick. You may need help to pace yourself as you achieve greater fitness. 

Ideally you would achieve a good amount of moderate intensity exercise. A brisk walk, heavy cleaning, playing tennis or cycling could be considered moderate intensity. Up to 90 minutes of exercise in one go is optimum, but even half an hour of brisk walking will benefit you.

You can develop your fitness alongside a physiotherapist or coach, who can guide you through appropriate movements for you. 

If you feel able to tackle more exercise yourself you can find more examples of different exercise levels here https://www.hsph.harvard.edu/obesity-prevention-source/moderate-and-vigorous-physical-activity/#:~:text=Moderate%2Dintensity%20activities%20are%20those,burn%20more%20than%206%20METs.

Exercise that supports your cardiovascular system is only one kind that will benefit you. As you get older it’s really important to ensure you have muscle strength as muscle tissue decreases every year as you age. 

Strength exercises play a crucial role in staying healthy and strong. Squats, push ups (even on your knees), roll ups, bicep curls and lunges are the top strength exercises and you don’t need a gym or special equipment to do them. You can find more details on how to do those exercises here https://gethealthyu.com/strength-training-moves-for-women-over-50/ If you aren’t used to them just start with one or two repetitions to get your body used to the idea. It won’t take long before you progress. 

I would add that if you have Gilbert’s Syndrome and you are having a symptom flare up – don’t over do it! Gentle exercise is better than none, but you don’t have to push yourself. You’ll only take longer to recover if you force yourself to exhaustion. Moving around a bit usually helps, unless you are flat out. It’s usually better for your mind and body to have a gentle walk than stay in bed all day.

Stress

Stress is a word that means different things to different people, so let’s take a minute to think about what it is. Stress can be good and bad. If it’s too much stress over a longer period of time  then you will likely experience symptoms such as an impact on your immunity.

Good stress is energising, gives you a buzz and is motivating. Short term acute stress actually temporarily enhances your immune system, as we’ve evolved to deal with and survive sudden attacks.

illustrated outline of a person with words relating to stress and worry written in different colours over the image, a clock is in the background
Image by John Hain from Pixabay

Bad stress, over a period of time, will do the opposite – you may feel paralysed or overwhelmed. You may be running around madly but feel like you are achieving little. Feeling tearful or short tempered a lot of the time are symptoms of too much stress. You may respond differently to a stress such as a deadline or sudden additional life task depending on what else is going on in your life. If you have space and time then it may feel good to focus on those tasks, but if you have an already overwhelming list or lack sleep, or feel ill, then it could feel unachievable. 

This study of 30 years of research https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/ shows how your body’s psychological response to a stress can ‘upregulate’ some of your body systems and ‘downregulate’ others, including your immune system. 

You may have heard of ‘fight or flight’ which is one way your body systems respond to psychological stress. This is a really shorthand way of saying that your nervous system has evolved to respond to threats. These are very physical responses, but the stresses of modern life are not physical – an exam, test, aggressive client or boss, bad driver, rude shop assistant etc. Some of these involve short term reactions – an increase in adrenaline and heart rate. Some of them are long term stressors such as grief or a divorce, the wrong job or caring for a disabled relative 24/7 with no respite. With repeated acute stresses, or longer term stress, your body is continually ‘disregulated’, flooded with stress hormones and altered physiological responses that are bad for your immune system longer term. 

Simply put, your body wants to respond to the stress and move on. When you can’t do that then it can be harmful to your body, mind and immune system. 

A note on trauma. It’s now accepted that traumatic situations that happened earlier in life can have a long lasting effect on your mind and body. In particular events in childhood form the way your body and mind will respond in the future. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143500/ In this research observation in people shows that inflammation is increased in those who experienced trauma when children. Stimulation of the stress response when young also affects how the brain develops. There is so much more to understand in this area and we are just scratching the surface of immunity and stress and trauma in particular. 

But what can you do? You may feel stress is outside of your control, or is something that happened in your past and you can’t now change it. Maybe you feel powerless.

You always have power against stress.

The most important way to deal with stress is to notice it. Don’t get drawn into response, notice you are feeling stressed, overwhelmed, angry, irritable, tired, upset. Say to yourself ‘ I notice I am feeling x’, label it and give yourself a moment of distance. It can be enough to break a spiral downward. 

Regular breathwork and meditation will also manage your body’s responses. Using just your breath will instantly send your body signals that you are calming down. Longer term, meditation will reduce your reactive stress response. 

an outline image of a person sitting in a  meditative pose has a backdrop of words such as 'attend' 'allow' 'pause' 'feel'
Image by John Hain from Pixabay

With trauma or deeper issues it’s important to get help. You may find you are stuck in repeated behaviours or thoughts that you need support to manage. Like getting a plumber to repair or service your heating system, your body and mind are systems that need repair and maintenance too. Sometimes you can get away with DIY, sometimes you need a professional to help you. 

I have lots of resources to help you manage stress and anxiety on the resources page https://gilbertssyndrome.org.uk/resources/ , and in these posts, https://gilbertssyndrome.org.uk/hack-your-liver-to-improve-your-mental-health/ plus the Essentials of Gilbert’s Syndrome course (available from November 2022 https://gilbertssyndrome.org.uk/free-foundation-course-to-understand-gilberts-syndrome/ ).

Sleep

Sleep impacts your immune system, and the reverse is also true! 

Rest is key to your body and mind’s ability to repair and regenerate. But did you know that sleep also influences how effective a vaccine is?  Just one good night of sleep following a vaccination can enhance the antigen activity (https://en.wikipedia.org/wiki/Antigen) https://www.youtube.com/watch?v=qCRwuxDpthY&ab_channel=By%3ARachelTaylor

https://www.sleepfoundation.org/physical-health/how-sleep-affects-immunity

In fact, during sleep parts of our immune system actually ramp up, taking advantage of the down time to get some jobs done whilst you aren’t using your energy to move about. 

There’s also no doubt that poor sleep can add to the likelihood of developing chronic health problems such as diabetes and heart problems. 

You can read more about the science behind what happens when you sleep in your body that strengthens your immune system here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/

‘Sleep and the circadian system exert a strong regulatory influence on immune functions. Investigations of the normal sleep–wake cycle showed that immune parameters like numbers of undifferentiated naïve T cells and the production of pro-inflammatory cytokines exhibit peaks during early nocturnal sleep whereas circulating numbers of immune cells with immediate effector functions, like cytotoxic natural killer cells, as well as anti-inflammatory cytokine activity peak during daytime wakefulness. ‘

an illustration of a person in a bed with arms outstretched as the sun rises and an alarm clock next to them shows 9am
Image by Tumisu from Pixabay

There are lots of reasons that sleep affects your immunity. Your body has a natural rhythm when hormones rise and fall and which are part of your body’s ability to respond to daily challenges. When these are not synchronised, then your body isn’t equipped to respond effectively to changing energy needs or demands on it. Cytokines – the chemicals/cells that trigger the work of white blood cells that kill invading infections, also ebb and flow with your sleeping patterns. 

There’s much more about sleep and Gilbert’s Syndrome here https://gilbertssyndrome.org.uk/sleep-and-gilberts-syndrome/

Top tips to take away

  • Most of your immune system is in your gut and the best way to support your gut is to eat lots of different types of plants. 
  • Exercise helps your body by improving your muscle to fat balance, your cardiovascular system (circulation of blood, lymph and oxygen) and reducing your inflammation levels. 
  • Managing stress stops longer term damage to your immune system.
  • Sleep helps you heal and your body work well every day. 

There are no shortcuts to a strong immune system. There are so many working parts to it that you can’t do one thing and expect a miracle cure. BUT –

Your body is a wonderful machine and will respond immediately to positive changes.

If you need support to make those changes, you can speak to a health coach. http://wellandgoodlife.co.uk/

Fatigue – or how can I boost my energy?

As many as one in five people feel fatigued at any time. If you’ve been feeling exhausted then you’ll want to know: Why am I so tired all the time; how can I get more energy?

Fatigue – what is it?

Fatigue is a symptom of many health conditions and life circumstances. Technically fatigue is one or more of these:

  • Overwhelming exhaustion that lingers beyond a good night’s sleep
  • Sleepiness and a lack of motivation to move about that doesn’t go away if you rest
  • A limiting lack of energy that prevents you from getting normal tasks done
  • Feeling like your muscles are too heavy and moving about takes energy you don’t have
  • Foggy achy head, finding it difficult to think or concentrate
  • Apathy and disinterest – everything feels too much

If you feel like this for more than a few days, for a reason that’s not clear, then you must see your doctor.

Is fatigue common?

Yes! Numerous studies across different populations show fatigue is common. You can find many studies, such as this one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557471/ which illustrate that women tend to report fatigue more than men, and those of lower socioeconomic status also experience more fatigue. Across populations it appears above 20% of people report fatigue. 

What causes fatigue?

Excessive tiredness can be caused by simple or serious health conditions. Common deficiencies of vitamins and minerals have tiredness as a symptom. There are many life circumstances which can leave you feeling exhausted. Let’s look at a few in more detail:

Life Stage : A new baby, a new job, grief or a crisis, moving house, caring responsibilities, overwork, stress at home or in the workplace.

Medical conditions: commonly, as you can see on the NHS website, and the Mayo Clinic , conditions causing fatigue include diabetes, depression, cancer, thyroid, coeliac disease, fibromyalgia, liver problems, MS, hormonal changes, heart disease and sleep apnoea, and so many more. This is why it is so important to receive a diagnosis if you experience fatigue which doesn’t let up over time. 

Deficiencies: Iron deficiency (experienced by many women with heavy or prolonged periods), Vitamin D deficiency (common if you live in the northern hemisphere where we aren’t exposed to strong sunlight which generates vitamin D), magnesium (particularly common in women), and an imbalance in good nutrition generally. Some people have metabolic conditions which prevent them from absorbing nutrients well and this can result in multiple deficiencies.

Poor choice of foods which attack energy levels: Food high in sugar or refined carbohydrates provide instant energy. Your body will then have a crash in blood sugar which will make you feel exhausted. Wholegrains, plant based proteins, and wholefoods containing natural sugars will balance your energy levels and make you feel a whole lot better. A high intake of caffeine may also leave you struggling later in the day. (For more about the pro’s and cons of caffeine read this).

A combination of the above!

Unpicking the causes of your fatigue is really important. You must rule out serious health problems, working with your Dr.

Does Gilbert’s Syndrome cause fatigue?

For people with Gilbert’s Syndrome lack of energy is a really commonly reported symptom. I hear all the time from people desperate with debilitating exhaustion, with energy levels that are unpredictable.

There are a number of reasons why people with Gilbert’s Syndrome may feel exhausted. 

  • Reduced liver function. If you eat highly refined carbohydrates such as white bread or sugary things, your blood sugar will rise and fall a lot. This means the enzyme we’re deficient in cannot work as well as it needs blood sugar. The result is your liver won’t do its cleaning job effectively and certain toxins and bilirubin will build up in your body. Typically feelings of exhaustion, jaundice, itching and nausea are reported. You may feel a bit like you have a persistent hangover.  Of course consuming toxins may add to that effect, eg alcohol.
  • Delayed gastric emptying. Food takes longer to leave your stomach if you have Gilbert’s Syndrome. I’m sure many recognise the abdominal discomfort that entails! This has been linked to fatigue .  It is also worth noting that it is also linked to Chronic Fatigue Syndrome. Which itself has often been linked to Gilbert’s Syndrome.
  • Excess serotonin. People with Gilbert’s Syndrome have defective processing of certain neurotransmitters (chemicals that send messages around the brain and nervous system). This can lead to raised levels of Serotonin for example, which is linked to feelings of lethargy and lack of motivation as well as anxiety.

How do I get more energy?

Assuming you don’t have a particular condition or issue that is causing you to feel exhausted, then there are four simple foundations to build your energy on

  1. Good Nutrition
  2. Exercise 
  3. Good Sleep
  4. Mental resilience

The great thing about these four things is that they support each other. 

Eat well and be properly nourished and you’ll exercise better and get better sleep. Better sleep will help you be mentally resilient and give you more muscle energy for exercise. Exercise will help you be more mentally resilient etc etc 

  1. Good Nutrition. A plant based whole food diet has been overwhelmingly shown to provide you with the most sustained energy, lifespan and wellbeing. Eating a variety of plants, legumes, nuts, seeds and wholegrains will ensure you don’t need any vitamin supplements. With all food patterns you need to make sure you aren’t missing anything out. For vegans that means ensuring you get Vitamin B12. Things that will suck your energy and not enhance your wellbeing include refined sugar, other refined and processed foods. If you want the ultimate nutrition facts then dig in here nutritionfacts.org and buy the book ‘How not to die’ . I offer other thoughts on foods to eat here https://gilbertssyndrome.org.uk/the-liver-diet/ https://gilbertssyndrome.org.uk/detox-diets-and-gilberts-syndrome/ https://gilbertssyndrome.org.uk/sesame-magic-for-your-liver/ The How Not to Die cookbook has lots of tasty recipes and you can see from the reviews that many readers report increased energy.
  2. Exercise should ideally be a mix of activities that raise your heart rate and which challenge your posture and muscles both in terms of flexibility and density. Walking briskly combined with pilates (plenty free videos on youtube) are simple cost free and energising. If you aren’t up to a great deal of exercise, then just start with walking a small distance and build up. Even standing up for a while engages muscles. Adding in exercise is something that needs to become a habit or you won’t stick to it. Stand up whilst you are on the phone or watching a favourite programme, take a 20 minute walk at lunchtime, do squats in the shower or whilst brushing your teeth, dance to a favourite song for 5 minutes when you get home from work. Every bit of movement is helping you stay fit and well.
  3. Good quality sleep is vital. Research shows that our circadian rhythm (our body clock) is really important to when we feel awake and when we sleep well. Just making sure your bedroom is really dark can make a big difference to your body clock. Getting plenty of light in the morning will also help you feel alert and awake during the day and sleep better in the morning. There are lots of ways to deal with bad sleep – which I won’t go into here. It’s enough to say that regular sleep hours in a dark room without interruption are fundamental to good quality sleep. There are many books on the subject. Try the popular ‘Sleep Smarter’ by Shawn Stevenson  
  4. Mental resilience is a quality many of us feel we could develop more. It enables you to put the ups and downs of life into perspective. With mental resilience you will better cope when something bad happens in your day or your life, and will worry less about it. That’s not to say that you shouldn’t worry, be upset, grieve or be without feelings. It means you can do those natural things and then move on in time. If you want to understand more about living without anxiety you can buy ‘The Anxiety Solution’ by Chloe Brotheridge or find resources at www.calmer-you.com and Chloe’s podcast. You can also find out more about mental resilience and ‘grit’ here https://positivepsychology.com/5-ways-develop-grit-resilience/ Another great way to build up your mental resilience is through meditation. If it isn’t something you have considered or have found difficult in the past, then you could try these simple and effective tools from Mind Cards:

If you are doing the right things and are still feeling fatigued then you really need your doctor’s help to look into underlying medical conditions. 

Your personal biology will need a personalised response so that it works the best way it can for you and your circumstances. 

Sometimes this may mean prescription medication or balancing up other elements of your nutrition, supplements or lifestyle. 

Beating fatigue in Gilbert’s Syndrome

So, let’s take a look at what this might mean if you have Gilbert’s Syndrome. As mentioned, there are specific reasons you’ll feel fatigued. Everyone with Gilbert’s Syndrome will have other things going on for them too – other chronic conditions, lifestyle or life stage issues, hormonal changes etc. This means that some things may work some of the time and you may need to adjust because of what is going on for you right now. 

What you put in is key to what you get out

Many people with Gilbert’s Syndrome steer clear of alcohol as it really messes with their wellbeing and energy levels. You may want to consider this for other chemicals and potential toxins to lighten the load on your liver. This would mean a plant based wholefood diet which avoids processed and refined foods. Ideally organic! Particularly good foods include broccoli, nuts and seeds. https://gilbertssyndrome.org.uk/the-liver-diet/ . Keep it low in refined sugar and make sure to include limited good fats of plant origin. 

Drinking plenty of water will also ensure you stay hydrated and support the removal of toxins from your body. 

Eat little and often. For a couple of reasons. 

1) to maintain stable blood sugar levels 

2) with delayed gastric emptying a large meal will make you feel uncomfortable and make it harder to move about. 

This isn’t an excuse to pack in more food, unless that means eating more vegetables! Look at what you would like to eat over the day or week and portion it out. If you do it ahead of time you won’t have to think about it. 

Antidepressants in the form of SSRI’s (Selective Serotonin Reuptake Inhibitors) can help for some people. If you feel your anxiety or low mood are overwhelming then you must speak to your doctor and get their advice and diagnosis. These are also prescribed for IBS (again, something that people with Gilbert’s Syndrome have a high rate of) and may be a useful treatment option to consider – in dialogue with your doctor. This may improve your sleep, mental resilience and energy levels. However, as some people with Gilbert’s Syndrome may have raised levels of serotonin, as mentioned above, then you need to be cautious of side effects. Some brands may work better than others.

Supplements. Extra ingredients that can give you a boost or added support to your system are basically just plants in powdered form in a capsule. Some of the supplements offering additional energy balancing and support include types of ginseng, rhodiola rosea, ashwagandha etc available at Approved Vitamins and have been used safely for thousands of years. I list some supplements you can try in the Resources section. https://gilbertssyndrome.org.uk/resources/

I use rhodiola rosea and ashwagandha and have seen an impressive improvement in my ability to function. I occasionally add in gotu kola towards the end of the week or if I’ve not had a great night’s sleep, or have extra physical or mental demands. It works like a really gentle caffeine that doesn’t have the come-down effects.

Some people find caffeine works well at the right points of the day – find out more about caffeine here and let us know how it makes you feel https://gilbertssyndrome.org.uk/gilberts-syndrome-and-caffeine/

Sleep appears to be a really important factor in feeling well, when you have Gilbert’s Syndrome. A good 8 hours can make a world of difference. Some of the supplements I mention above can help sleep. Follow the suggestions in the four foundations section above. Resist the temptation to lie in bed and doze or rest without sleep. This won’t help you sleep later. Keep bed for specific night time hours if you can, and keep your sleep routine and hours regular. Being active during the day will help you sleep better later.

Anxiety can stop you sleeping and suck your energy whilst awake. If it’s overwhelming then seek help from your Dr. I mention Chloe Brotheridge’s work above, but also Mind and other websites have many pointers for help. Mindfulness is a well founded technique for calming your mind and should guarantee better sleep and more energy. You can find some free apps here. As mentioned above, these are also a really simple and effective tool to help try mediation:

I’d really like to hear what your experience is. If you follow the lifestyle above has it changed your energy levels? I found becoming vegan, eating plant based, adding in supplements and building mental resilience transformed my energy levels. What’s worked for you? Please comment. 

Remember – many people feel fatigued. There are basic principles to seize more energy. Plus – there’s the magic ingredient of you and your physiology to consider. Get medical support where needed, and understand your health conditions. You’ll then be in control of your energy and your life. 

Sesame – magic for your liver!

Can you take a moment to help with a survey on caffeine use? It won’t take a minute or two and the information could help us all live better with Gilbert’ Syndrome.

These small seeds pack a protein punch and produce more oil than most nuts or seeds. They bundle in calcium, manganese, copper, magnesium, phosphorous and Vitamin B1. Sesame seeds have properties that protect the liver, reduce inflammation and pain, level out blood sugar and reduce cholesterol. They are purported to be anti-cancer, anti-aging, and are antioxidant. 

A 2013 study by researchers from the Tabriz University of Medical Sciences reported that 40 grams of sesame seeds were better than Tylenol when it came to alleviating the pain caused by knee arthritis.’

Wow! With that much going on – why not get the wok out and start stir frying with a dash of sesame seed oil, ginger, garlic and some sliced veg right now! 

Studies indicate that sesame could be a ‘hepatoprotectant’ or liver protector. 

So what does sesame do?

Your liver faces stresses from toxins all around us: pharmaceuticals, pesticides, fumes and particulates in the environment, additives in food and overindulging in alcohol or other toxic stimulants and relaxants. It seems that sesame could be a much needed support for the liver, struggling with modern toxic impacts.

The technical bit: sesame maintains levels of glutathione (a potent antioxidant), reducing free radicals and inhibiting the oxidation of fats. (Antioxidants fight free radicals which damage the cells of your body. Free radicals are unstable molecules produced because of environmental pressures on your system). 

So, in more straightforward terms – sesame helps the good stuff in your body fight off the damage to your body caused by those toxins that we’re swallowing and surrounded by. 

Sesame also appears to be safe for you. As sesame can change blood sugar levels and lower blood pressure, then do be careful if you have diabetes or already low blood pressure. 

If you want to protect your liver, boost your immune system, lower your blood pressure, lower your cholesterol, reduce cancer risk and boost vital nutrients, then adding sesame into your diet is a great choice. Tahini (sesame seed paste) and sesame seed oil, as well as the seeds themselves, are available in all supermarkets, and can be used in cooking, spread on toast, added to dressings, used to make hummus, stir frys and so much more. 

To buy :

For recipes try this : ‘the magic of tahini’
Whilst you’re at The Vegan Kind Supermarket, you can stock up on these store cupboard essentials:

Meridian organic sesame oil 
Suma organic sesame seeds 
Al Fez tahini

Or from Amazon: Hatton Hill 1kg of sesame seeds

For more resources, food and supplements go here: https://gilbertssyndrome.org.uk/resources/

Sources:

https://www.greenmedinfo.com/blog/sesame-oil-may-heal-liver-damage

https://www.webmd.com/vitamins/ai/ingredientmono-1514/sesame

Gilbert’s Syndrome and Caffeine

What does caffeine do for the liver, and what is the relationship between Gilbert’s Syndrome and caffeine? Many studies now combine to illustrate the positive effects of caffeine on a number of aspects of health and wellbeing.

You can help reveal the impact of caffeine on people with Gilbert’s Syndrome. Get a free download here and answer a handful of questions – it will take less than 5 minutes, and you could help us all live better with Gilbert’s Syndrome. Thank you!

Naturally, it’s not a simple picture.  Everyone has a different genetic and metabolic profile (we’re all made differently!). Each individual has a unique way of processing any chemical or food. This can also be impacted by your lifestyle, age and even time of the month. My goal is to help you personalise your nutrition so that you can take the research, advice and your experience and see what works best for you.  

I’ve been through the research and summarize and link to it below. This post also gives you the benefit of looking through the science as it relates to Gilbert’s Syndrome, but ultimately – I am not a doctor, I am not YOUR doctor, and the best expert on you – is YOU. 

That said, let’s look at liver health and caffeine, and particularly Gilbert’s Syndrome and caffeine

As Professor Graeme Alexander President, British Association for the Study of the Liver Consultant Hepatologist at Cambridge University Hospitals and The Royal Free Hospital, London said, in a study published by the British Liver Trust in 2016, “At last, liver physicians have found a lifestyle habit that is good for your liver!’

The report pulls together studies that look at liver diseases which are developed or acquired, not genetic conditions that impact the liver, like Gilbert’s Syndrome. However, it’s worth looking at the conclusions and the basis of the studies to see what we can draw from those. 

The bottom line is that it appears caffeine can slow disease progression, help prevent liver cancer and support the anti-viral functions of the liver. 

Other conditions also show a beneficial impact, such as diabetes and stroke. 

‘eighteen studies involving almost half a million people that show overall that coffee, decaffeinated coffee and tea do slightly reduce risk of diabetes.’

One stunning assertion from a study in the report showed that :

‘Coffee appears to have a significant effect on all-cause mortality. The National Institutes of HealthAmerican Association of Retired Persons Diet and Health Study involving 229,119 men and 173,141 women demonstrated an inverse relationship between coffee consumption and mortality. In other words, coffee drinkers had a reduction in mortality compared with non-coffee drinkers.’

Any old caffeine? 

Some of the questions raised include the benefits of tea (or other caffeinated beverages) versus coffee. It appears that coffee itself contains beneficial compounds (particularly those found in the green beans) that other caffeinated drinks do not. And that decaffeinated coffee can have some benefits associated with coffee drinking. 

How much should I drink?

Rightly cautious advice about drinking too much coffee or consuming too much caffeine is flagged. Too much caffeine can have an adverse effect on other conditions, from pregnancy to conditions where medication might be impacted. The difference between men and women is only really significant if you are taking hormonal supplements or, as mentioned, you are pregnant. A moderate 2 to 3 cups a day is suggested by the report authors. 

One factoid of interest – caffeine metabolisation is twice as fast in smokers as non-smokers.

Coffee Caution

Everybody reacts differently to substances and caffeine is itself quite a powerful stimulant. If you have anxiety or depression then do NOT suddenly start drinking lots of coffee! It raises levels of stress hormones adrenaline and cortisol. Plus, it can raise blood pressure. 

Although coffee can enhance energy and alertness, it can also trigger certain conditions, and decaffeinated coffee might provide some benefits without the downsides for people who react strongly to caffeine. However, as noted in Medical News Today In 2013, a study published in World Journal of Biological Psychiatry suggested that drinking between 2–4 cups of coffee a day may reduce suicide risk in adults.

Caffeine is in fact a psychoactive substance and should not be overused. Most studies suggest that more than 400mg of caffeine a day could have adverse effects (probably more than 4 cups of coffee). Plus, as well as the caution for pregnant women, there is a lack of information about how it can impact the growing, changing and susceptible brains of children and adolescents. 

If you would like to read the studies and explore the associated articles on this, then do read the report. https://britishlivertrust.org.uk/wp-content/uploads/The-health-benefits-of-coffee-BLT-report-June-2016.pdf

You can also watch this video from Dr Greger at nutrition facts (buy his excellent book ‘How Not to Die’ which looks at many health conditions and how to optimise your diet to live longer and better).

Dr Greger rightly raises the fact that people metabolise coffee / caffeine very differently. This different metabolisation can result in very different responses, harms and benefits. 

Gilbert’s Syndrome and Caffeine

In the catchily titled piece of scientific research: Caffeine Clearance in Subjects With Constitutional Unconjugated Hyperbilirubinemia

The abstract concludes: ‘CAF altered kinetics in 27% of GS cases may suggest multiple deficits in the hepatocellular metabolism, thus confirming the heterogeneity of this syndrome.’

Ie. caffeine altered the reaction rates in 27% of Gilbert’s Syndrome cases, suggesting that the liver wasn’t processing as well, demonstrating (once again) that Gilbert’s Syndrome has different elements or characteristics. 

(It didn’t seem to impact bilirubin levels or bile acids, though.)

As with many studies into Gilbert’s Syndrome, the conclusions note that there are in fact differences in how our livers process things. But, as is so often the case, this is not taken further, to examine just what that means to the lifestyle management for someone with Gilbert’s Syndrome. 

The implication here is that people with Gilbert’s Syndrome might find coffee or caffeine impacts them negatively, and I’ve written elsewhere how coffee or caffeine can impact energy levels in a way that you may find unhelpful. Stable energy levels and blood sugar are important for the liver enzymes we are deficient in to work properly. We can also experience anxiety as a symptom. These both suggest we would need to be careful around our coffee / caffeine consumption. 

Of course, energy levels can also be an issue if you have Gilbert’s Syndrome. Fatigue is a common symptom of Gilbert’s Syndrome. It would be great to be able to reach for caffeine as a pick me up, to break through that brain fog and boost your concentration!

What caffeine to try when you have Gilbert’s Syndrome

If you want to try caffeine in a different format to coffee, there are additional benefits in trying something like green tea, which has other beneficial effects. Clipper produce an organic and ethically traded tea that you can buy online or in many large supermarkets

Another option is a green coffee bean supplement

If you want to explore alternatives to coffee then there are other natural stimulants which are more gentle which may help with your energy levels. I take adaptogens to balance my stress and energy levels and have found my energy more resilient as a result.

This Rhodiola from Viridian has been a daily staple for me for many years

Ashwagandha is a great herb for the end of the day.

plus gotu kola which can provide an extra, but gentle, boost that can help concentration levels when they start to flag

I personally find coffee or caffeine makes me feel quite unwell. I don’t seem to metabolise it comfortably and it leaves me feeling frazzled and sick. I’d love to hear more about whether you find coffee or caffeine helps you, and what your experiences are with it. Please do comment and share your story here. 

This website is dedicated to helping people like you live better with Gilbert’s Syndrome, I hope you find the information interesting and useful – if you do, please consider donating to keep it going. Because so many people struggle to find help and support to live with Gilbert’s Syndrome, please donate today – THANK YOU!

Hack your liver to improve your mental health

We’re all talking more about mental health and that’s really important for people with liver conditions. Liver condition or not – looking after your liver and your mental health will lead to a happier healthier life. 

There’s a ton of evidence that liver disease relates to mental health:

These are serious clinical problems, but whether or not you have a liver condition,  if you aren’t looking after the organ that cleans all the rubbish out of your system (yes, that’s your liver), then you will feel like the bottom of a well used cat litter tray!

This is a two-sided coin – look after one and the other improves. Great! That means you’ve twice the opportunity to feel better. 

There are signs that your liver is stressed, and you should always go to your doctor if you experience jaundice, aches and pains, digestive problems, fatigues, darker urine, mood swings, weight loss, etc https://pharmeasy.in/blog/7-signs-you-suffer-from-liver-stress/

I’m not a doctor and this is not medical advice, this information is from research I’ve linked to (if you want to dig deeper) and curated with additional resources from well regarded books by scientists, doctors and other reputable authors. Links to those books will give me a small commission if you choose to make a purchase – just so we’re clear 😊

Diet

Everything you eat or drink passes through your liver – so let’s start there. 

Alcohol is a well known liver toxin. It’s also an emotional crutch and widely abused. You feel bad so you drink more, it harms your liver, you feel worse, you drink more – it’s a vicious downward spiral. Any alcohol will stress the liver, and if you have a liver condition it will do so even more. If you want to save your liver, and your mental health, save the alcohol for never if you have a liver condition, or in moderation if you are otherwise healthy. Here’s more on that:

https://www.healthline.com/nutrition/alcohol-good-or-bad#section15

Good food feels great! There are tons of wonderful foods that will help your liver and you feel great! Eat more of the good things and you will also keep a healthy weight which will prevent you from getting a fatty liver too.

Some of the foods that work best for supporting the liver include broccoli (and other ‘cruciferous’ veg such as cabbage, cauliflower and radishes), avocados, tomatoes, carrots, beetroot, fruits (apples, lemons, grapefruits) and nuts (Nuts are a good source of glutathione, omega-3 fatty acids that help the liver evacuate ammonia, the substance responsible for certain diseases. They also promote blood oxygenation https://www.myliverexam.com/en/detoxification-some-food-to-cleanse-your-liver/), garlic and turmeric. If you eat healthy food I guarantee you’ll feel better all round. I’m vegan and totally advocate for a completely plant based diet if you want to feel great, full of energy and bright-eyed (yup, helps with the jaundice). You can find out more about food and diets in the books below. 

Sugar – sorry, but it really does make you feel rubbish. Especially if you have a liver condition, such as Gilbert’s Syndrome, your liver will work better if you have a steady blood sugar level https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390583/. This is because the chemicals used by liver processes need steady blood sugar levels to be able to work. Plus, your liver does the hard work in managing your blood sugar levels when they’re high or you need to draw on energy for your muscles http://www.diabetesforecast.org/2012/feb/the-liver-s-role-how-it-processes-fats-and-carbs.html Too much sugar means your liver bgins to store it as fat and ultimately damages the liver. Keeping steady blood sugar levels can be achieved by  eating little and often, and not going long periods without food, plus not relying on high sugar snacks when you feel lethargic. For those of us with liver conditions who have trained their body to love good food just looking at a piece of cake can make me feel sick. If it’s a real treat for you though, don’t deny yourself completely, just don’t make it a daily crutch that keeps you on the uphill treadmill of feeling knackered and rough. 

Read this :

Oh my gosh – Dr Greger is just the most-evidenced expert in nutrition I have ever come across. Honestly, this should be your bible for living a healthy life and feeling great. It’s so persuasive you will be completely convinced and so much more likely to stick to a healthy way of eating: How Not To Die: Discover the foods scientifically proven to prevent and reverse disease by Dr Michael Greger

The Dalai Lama and Daily Mail both think Dr Greger is on the money!

This book may help those who are susceptible to illnesses that can be prevented with proper nutrition. — His Holiness the Dalai Lama

Dr Michael Greger reveals the foods that will help you live longer, Daily Mail

Get the cookbook to go with it: The How Not To Die Cookbook: Over 100 Recipes to Help Prevent and Reverse Disease

#BOSH! Healthy Vegan: Over 80 brand-new recipes with less fat, less sugar and more taste. As seen on ITV’s ‘Living on the Veg’ by Henry Firth, Ian Theasby

Healing Through Nutrition: The Essential Guide to 50 Plant-Based Nutritional Sources by Eliza Savage

Mental wellbeing

There are so many resources that can help your mental health. The less stressed you are the better your liver will work too. ‘Growing scientific evidence has demonstrated the detrimental effects of psychosocial stress on liver diseases in humans and animals ’http://www.ijcem.com/files/ijcem0089076.pdf https://pubmed.ncbi.nlm.nih.gov/16460474/

You can get pretty much instant results from some simple activities, and longer term calm through regular practice. 

Breathing deeply and slowly has a powerful impact on your nervous system. You feel calm instantly! https://www.nhs.uk/conditions/stress-anxiety-depression/ways-relieve-stress/

Be kind – just do one kind thing, and your brain actually produces happy hormones! https://greatergood.berkeley.edu/article/item/kindness_makes_you_happy_and_happiness_makes_you_kind

Meditation has been clinically proven to alter your brain for the better, https://www.healthline.com/health/meditation-for-depression#how-to-try-it

Exercise – a total liver/brain/body hack. Fortunately you don’t have to be a gym bunny or have an olympian body to do this one. Just get outside for a half hour stroll every day for starters. Yes, you WILL feel better. 

Here are some resources to check out to explore this one further. Find what works for you and your lifestyle:

Read this :

The 4 Pillar Plan: How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life Dr Rangan Chatterjee

Chloe Brotheridge is trained in so many disciplines and has a hungry mind for finding ways to live more calmly and confidently. Check out her website and podcasts, at calmer-you.com and buy her book The Anxiety Solution: A Quieter Mind, a Calmer You

These are books by scientists who use proven methods to improve your mental wellbeing –

Mindfulness: A Practical Guide to Finding Peace in a Frantic World (Includes Free CD with Guided Meditations) by Professor Mark Williams, and Dr Danny Penman

The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive by Dr Kristin Neff, a world leading expert in this field

Other resources:

https://www.mind.org.uk/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/self-care-for-anxiety/

https://www.beyondblue.org.au/the-facts/anxiety/treatments-for-anxiety/anxiety-management-strategies

Meditation and mindfulness websites https://www.calm.com/ / https://www.headspace.com/

For young people https://youngminds.org.uk/

For men https://www.thecalmzone.net/

If you need more help, then you can try these helplines and websites

https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/

Extra Science bit for people with Gilbert’s Syndrome

People with Gilbert’s Syndrome may experience anxiety and IBS / gut symptoms. Findings that may explain this are the relationship between serotonin levels in the blood and your brain / gut. There’s a tendency for people with Gilbert’s Syndrome to have too much serotonin in the blood – something called hyperserotoninaemia http://www.hormones.gr/759/article/non-tumoral-hyperserotoninaemia-responsive-to-octreotide%E2%80%A6.html

Anxiety is a common reported symptom of Gilbert’s Syndrome.At the molecular level, recently emerging data have established the increased frequency of dual genetic polymorphisms in UDP glucuronosyl-transferases 1A1 and 1A6 in approximately 87% of patients with Gilbert’s syndrome, leading to defective glucuronidation not only of bilirubin but of several other endogenous and exogenous substrates, such as serotonin, coumarin and dopamine derivatives.7,8

Increased serotonin levels have been reported in patients with Gilbert’s syndrome, suggesting a possible explanation for the nonspecific symptoms described in these patients that are commonly attributed to anxiety.9,10’

There are also studies showing that this and ‘unconjugated bilirubin’ (associated with Gilbert’s Syndrome) may be more evident in people with bi-polar disorder, autism and schizophrenia. In fact people with those conditions are also more likely to have Gilbert’s Syndrome. https://pubmed.ncbi.nlm.nih.gov/16736395/ https://questioning-answers.blogspot.com/2014/05/neonatal-jaundice-and-risk-of-autism.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924810/

So, if you’re more likely to have problems with your mental health, then it’s really important to look after yourself. Following the advice above and keeping to a healthy diet, exercise and mental wellbeing routine will absolutely help you lead a better life with Gilbert’s Syndrome.

Because your support helps keep this research and website alive, please donate today:

links and notes that might help people with Gilbert’s Syndrome

Find out more about how Milk Thistle works. The effective ingredient is sylmarin, and you need enough of a dose for it to have an impact. Read more here: http://www.nlm.nih.gov/medlineplus/druginfo/natural/138.html

Diet plays a really important part in managing your health and wellbeing, and especially in helping your liver. However, there is an industry out there just waiting to push the latest ‘superfood’ your way. NHS ‘Choices’ gives the latest lowdown on the claims and offers the evidence to counter / support them here

Find ordinary household paints make you feel unwell? I’ve been using these for years and they are brilliant! www.ecosorganicpaints.co.uk Odourless, solvent free, totally non-toxic.

Liver help – the basics

The liver is the body’s largest solid organ. It responsible for detoxifying many of the potentially harmful substances that can pollute the body.

The liver also plays a critical role in many other body processes including energy production, digestion, and nutrient storage.

What will help my liver?

The cornerstone of any liver-friendly programme is a diet that makes it easier for your liver to work. Lots of fruits and vegetables will help you and your liver work better.

Not only do these foods tend not to tax and stress the liver, they also contain an lots of nutrients such as vitamin C and carotenoids (e.g. beta-carotene) which can support liver function.

Organic produce is best as this is relatively free of potentially toxic herbicides, pesticides and fungicides.

Drinking plenty of water (about one and-a-half to two litres a day) really helps your body and your liver work well.

What won’t help my liver?

Foods that contain artificial additives such as sweeteners, colourings, flavourings and preservatives might cause your liver more problems.

People with Gilbert’s Syndrome often find that drinking alcohol gives them symptoms such as fatigue, brain fog and jaundice. Alcohol is hard for your liver to process and the less you drink the less stressed your liver will be. Watch out for hidden alcohol! You might find some herbal tinctures or food contains alcohol – worth avoiding if you are particularly sensitive.

You might also find fatty food makes you feel sick, and carbohydrates like sugar and white bread or pasta leave you drained and feeling rough. In Gilbert’s Syndrome you need to keep balanced blood sugar levels to help your enzymes work as well as possible (check out ‘What is Gilbert’s Syndrome’ for an explanation), so refined carbs are best avoided.

Recipes for your liver

BETTER than a sandwich!

For a quick boost try the following super tasty liver loving lunch:

Quick pitta lunch

Wholemeal pitta bread, sliced open, spread with humous or tahini, add slices of avocado, a handful of watercress and spinach, and season with a dash of lemon juice, salt and black pepper. For extra nutrition and yumminess add sesame seeds or pine nuts or sunflower seeds. Scrumptious.

Wow! Tasty, quick POWER salad.

Puy lentil salad with soy beans, sugar snap peas & broccoli

Serves 4

Ingredients

  • 200.0g Puy lentils
  • 1.0l hot vegetable stock
  • 200.0g tenderstem broccoli
  • 140.0g frozen soya beans , thawed
  • 140.0g sugarsnap peas
  • 1 red chilli , deseeded and sliced

Dressing

  • 2 tbsp sesame oil
  • juice 1 lemon
  • 1 garlic clove , chopped
  • 40.0ml reduced-salt soy sauce
  • 3cm piece fresh root ginger , finely grated
  • 1 tbsp clear honey

 Boil lentils in stock until just cooked, about 15 mins. Drain, then tip into a large bowl.

  1. Bring a saucepan of salted water to the boil, throw in the broccoli for 1 min, add the beans and peas for 1 min more. Drain, then cool under cold water. Pat dry, then add to the bowl with the lentils.
  2. Mix together the dressing ingredients with some seasoning.
  3. Pour over the lentils and veg, then mix in well with the chopped chilli. Pile onto a serving platter or divide between 4 plates and serve.

Per serving

302 kcalories, protein 22.0g, carbohydrate 42.0g, fat 7.0 g, saturated fat 1.0g, fibre 8.0g, sugar 9.0g, salt 1.41 g

Recipe from Good Food magazine.

Day or night, alone or with friends – tasty goodness.

Avocado and black bean wraps

Serves 4 for a filling meal, or halve the quantities and serve with a leafy salad for a lighter lunch.

Ingredients

  • 8 wholemeal wraps (in world food isle with Mexican stuff, or in bakery section)
  • 1 tbsp olive oil
  • 1 onion , chopped
  • 3 garlic cloves , chopped
  • 1 tbsp paprika
  • 1 tbsp ground cumin
  • 5 tbsp cider vinegar
  • 3 tbsp clear honey
  • 3 x 400g cans black beans , rinsed and drained
  • choose a few toppings-  diced avocado, salsa, sliced jalapeño peppers
  • crème fraîche / yoghurt or Tabasco / hot pepper sauce, to serve

Serve with green salad, sliced tomatoes, or green beans and sweetcorn.

  1. In a large frying pan, heat the oil. Add the onion and garlic, and cook for 5 mins.
  2. Add the spices, vinegar and honey. Cook for 2 mins more.
  3. Add the beans and some salt / pepper, and heat through.
  4. Remove from the heat and mash the beans gently with the back of your spoon to a chunky purée.
  5. Spread some beans over wraps, scatter with your choice of toppings and add a spoonful of crème fraîche / yoghurt to cool down, or a splash of Tabasco / hot pepper sauce to spice it up.
  6. Roll up and YUM!

Sin free sinning!

This wonderful recipe is from a very good friend:

Fat free fudgy wudgy brownies

Preheat the oven to 180C

Dry ingredients:

¾ cup of wholemeal flour

¼ cup cocoa powder

½ cup white flour

1 tsp baking powder

½ cup Demerara sugar (or brown sugar)

¾ cup broken walnuts (optional)

Handful dark chocolate chips (optional)

Mix the dry ingredients together in a bowl.

Wet ingredients:

1 ½ cups black beans (one tin drained and rinsed well)

1 cup pitted medjool dates (this can be anywhere from 7-10 dates depending on their size, or just use ordinary dried dates if you don’t want to fork out for medjool)

¼ cup maple syrup (or date syrup, which is particularly tasty, or indeed any other kind of syrup)

Whiz the wet ingredients together in a food processor until completely smooth.

Then add:

1 TB balsamic vinegar (or cider vinegar)

3 tsp instant coffee (optional but enhances the flavour)

1 tsp vanilla essence

2 TB flax meal (ground flax seeds) or other ground seeds such as hemp powder

1 cup water

Whiz that all up until it is smooth, then mix in with the dry ingredients.

Spoon into a greased 9×12 or 9×13 pan.

Bake for 14 minutes then take the pan out and rotate it and put it back in for another 14 minutes. Test with a toothpick to see if it comes out clean. If not put it in for 2 more minutes.

Let cool before you slice. Slice it into 16 brownies-4 by 4.

Store in an airtight tin. I think they taste better the next day. Yum!

 

Detox diets and Gilbert’s Syndrome

I’ve been monitoring the ‘de-tox diet’ phenomenon for many years, and each year my scepticism grows. Avid marketers have spotted a desire for many people to find a solution to the modern malaise of feeling tired and sluggish, and there is a proliferation of products – powders / pills / soups /  excercises / regimes / books / websites / treatments etc that claim to help powerfully cleanse the body and leave you lighter, fresher, and generally bright eyed and bushy tailed.

However, on the one hand many run of the mill Doctors will tell you that the liver does a perfectly good job of dealing with toxins. On the other hand many people feel generally under par much of the time. Although I agree that the liver generally does an excellent job, some of us may need a wee bit more help for our liver to do the job we want it to.  Given the disadvantage that those with Gilbert’s Syndrome experience, with a reduced capacity to process certain toxins, it makes sense to me to look after my diet so that I can help my liver. But I don’t want to burden my body with the shock of suddenly changing my diet to all fruit or liquid or pureed broccoli or whatever. My message would be to make a lifestyle choice to ensure you feel better EVERY day.

So, what can we all agree on?  Well, water is good for you. Drink plenty of it. Alcohol may be ok in small quantities, but personally it makes me feel awful so I avoid it. Caffeine can mess up your blood sugar levels and so reduce your ability to maintain consistent energy, particularly because those with Gilbert’s Syndrome are lacking in an enzyme that needs stable blood sugar levels for it to work properly. Eat little and often to keep your energy up, but make sure you stick to wholefoods such as brown rice, wholemeal bread, crackers, jacket potatoes etc and plenty of vegetables and fruit and not high fat food. This will help you maintain a steady weight, not experience hunger pangs, as well as avoiding over burdening your liver with fat processing. Protein is supposed to help with extra energy. I avoid eating animals and animal products for environmental reasons as well as health and compassionate reasons, so my sources of protein tend to be marmite (full of an awesome range of vitamins), and nut butters, such as peanut butter and cashew butter (high in fat but replace margarine and used as my only source of fat– don’t rule it out completely as your body does need fat), avocado, hemp powder added to soups and dressings, plus lots of soya milk.

Star liver foods include: broccoli, garlic, turmeric, avocado, beetroot, apples, lemons, walnuts.

If you need caffeine then try swapping to green tea which is better at cleansing the liver, and more gentle to your system than coffee.

Don’t forget a little naughty treat is ok. But use it as a reward for staying generally more liver conscious and once a week rather than every day. I like the 80 / 20 rule – stay 80% within a good diet, then the other 20% ain’t so bad.

Helping your liver deal better with toxins

Good news! The detox process of the liver which won’t work as well for people with Gilbert’s Syndrome is called Glucuronidation and this process can be helped with Calcium D-Glucarate, glycine, magnesium, and b vitamins.

  • Calcium D Glucarate can be taken as tablets or capsules, but is also available in apples, brussels sprouts, broccoli, cabbage and bean sprouts.
  • Glycine is an amino acid and in high-protein foods, such as fish, meat, beans, milk, and cheese. Glycine is also available in capsule and powder forms, and as part of many combination amino acid supplements.
  • Spices, nuts, cereals, coffee, cocoa, tea, and vegetables are rich sources of magnesium. Green leafy vegetables such as spinach are also rich in magnesium as they contain chlorophyll. Magnesium supplements are widely available and often with calcium and vitamin c which help its absorption. The best absorbed types of magnesium are citrate and malate, rather than the cheaper form of oxide.
  • B vitamins are available in many different foods (see the NHS website), but the easiest ways of accessing them are through yeast extracts such as Marmite, and fortified cereals.

So why not help yourself and make sure your diet contains a good balance of foods that may help your liver to work better.

Pharmacist survey finds ‘Medicines detox’ puts people at risk

A recent article from Net Doctor has food for thought for those of us on long term medication. Please don’t take initiatives with your medication – talk to your Doctor or Pharmacist first! :

Patients are putting themselves at risk of serious harm by believing it is beneficial to occasionally stop taking long-term medicines in order to given their body a ‘detox’, experts have warned.

Research by the National Pharmacy Association (NPA) suggests that one in five people believe a so-called ‘medicines detox’ is beneficial.

However, the NPA warned that this could be seriously harmful for patients with conditions such as diabetes, asthma or depression, as they could lose control of their illness.

The survey also revealed that nearly one in three people believe it is safe to take non-prescription medicines that have been recommended for other people.

And some wrongly assume it is okay for a child to take an adult’s medication, as long as the dosage is reduced.

NPA head of information Leyla Hannbeck said: ‘There is a lot of misunderstanding about how medicines work in your body.

‘It’s important to get the right treatment and the right advice – which you can get from your local pharmacy, often without an appointment.’

Pharmacies provide a wealth of services in addition to dispensing medicines.

These include the disposal of unwanted medicines, promotion of healthy lifestyles and support for self-care.

Pharmacists can also provide personalised advice on medicines, smoking cessation support and guidance on sexual health.ADNFCR-554-ID-800789373-ADNFCR

General anesthesia in a patient with Gilbert’s syndrome.

Having had an operation this year, with a very understanding anesthesiologist, I know that this is an area of poor knowledge in the health service, and that all the advice you as a patient can offer is helpful, and will of course help yourself. We decided that morphine would be avoided and took an approach that would mean using as few drugs as possible. This also meant I would come out of the procedure more alert and able to get going.

There has been some recent research in India which follows the clinical experience I have personally had – namely that the best outcomes are if the drugs used avoid using the enzyme that people with Gilbert’s Syndrome are deficient in:

Source

Department of Anaesthesiology and Critical Care, Tata Main Hospital (TMH), Jamshedpur, India. Nag DS, Sinha N, Samaddar DP, Mahanty PR.

Abstract

Gilbert’s syndrome, caused by relative deficiency of glucuronyl transferase is the commonest cause of congenital hyperbilirubinemia. We report anesthetic management in a case of Gilbert’s syndrome for laparoscopic cholecystectomy under general anesthesia. Avoiding drugs which use this enzyme for its metabolisim or excretion, and minimizing the stress during the perioperative period allows safe conduct of anesthesia for these patients.

The Liver Diet

The great news is that you can easily help your body work better by choosing tasty food that gives you the best nourishment.

The more plants you eat the healthier you will be. Your gut bacteria, immunity, liver function, skin, eyes, cholesterol, blood sugar, energy levels and more will thrive if you add in plants. By plants, I mean everything from herbs and spices to grains such as rice and wheat, as well as nuts, seeds, and fruit – not just salad!

There are lots of tips in this article. Take what works for you. You don’t have to do it all at once! If you need support to change your lifestyle then you could try a health coach.

There are recipes on the site and more information about nutrition that could help you find what works. Explore further, and share your ideas in the comments.

Think Raw
Eat lots of raw fruits and vegetables, especially dark green leafy vegetables and orange, yellow, purple and red coloured fruits and vegetables. Try to eat some raw fruits or vegetables a few times a day as they contain living enzymes, vitamin C, natural antibiotic substances and anti-cancer phytonutrients. Snack on a carrot, have an apple after breakfast, add berries to your dessert, add a tomato to your sandwich, squeeze lemon juice on a salad, garnish a curry with fresh coriander…

Oil but Don’t Grease Your Body
If your liver needs some help then I recommend avoiding all animal milks and substituting them with oat, rice, almond or soymilks. Avoid the fats that make life hard for the liver and gall bladder. These are full-cream dairy products, margarines, processed vegetable oils (hydrogenated fats), deep fried foods, foods that are not fresh and contain rancid fats, preserved meats, animal skins and fatty meats.

Eat the “good fats” which contain essential fatty acids in their natural unprocessed form. These are found in cold pressed vegetable and seed oils, avocados, algae oil, raw fresh nuts, raw fresh seeds such as flaxseeds (linseeds), sunflower seeds, safflower seeds, sesame seeds, hemp seeds, alfalfa seeds, pumpkin seeds and legumes (beans, peas and lentils).

Seeds such as flaxseeds can be ground freshly everyday (in a regular coffee grinder or food processor) or bought ready ground, and can be added to cereals, smoothies, fruit salads and vegetables.

Spirulina, evening primrose oil, black currant seed oil, borage oil and lecithin also contain healthy oils to help the liver.

Do not use butter and/or margarine on your breads and crackers. There are so many tasty replacement options with added nutrients that are great for you. Replace them with tahini, humus, pesto, tomato paste or relish, freshly minced garlic and cold pressed oil (chilli or other natural spices can be added if enjoyed), nut-spreads, fresh avocado, cold pressed olive oil or yeast extract.

Good fats are essential to build healthy cell membranes around the liver cells. We need to “oil” our bodies and not “grease” our bodies.

Think Natural
Avoid artificial chemicals and toxins such as insecticides, pesticides, and artificial sweeteners and colourings, flavourings and preservatives. The easiest way to do this is to prepare meals from plants yourself. It doesn’t have to be complicated or time consuming, or cost a lot of money. In fact, if you eat seasonal food it can be much cheaper than including more expensive animal products and pre-prepared packets in your shop.

Just google ‘easy plant based recipes’ for tons of ideas. You can start here

Be Diverse
Consume a diverse range of proteins from grains, raw nuts, seeds, legumes (lentils and every type of bean) and soya products such as tofu. It is both safe and healthy to be a vegan, so long as you are eating a diverse range of plants, however you may need to take supplements of vitamin B 12 and be sure to eat healthy essential fatty acids perhaps in the form of an algae oil supplement (walnuts, flaxseed and other nuts and seeds also help keep up the protein and essential fatty acid levels).

Let Food Be Your Medicine
Many diseases can be overcome by eating healing foods that contain powerful medicinal properties. Optimal health and the prevention of disease is only possible by including these healing foods regularly in the diet.

The healing substances found in certain foods or therapeutically active chemicals are known as phytochemicals. The culinary habits of different cultures have been recognised for decades as being influential in the incidence of diseases. Mediterranean countries have a lower prevalence of cardiovascular diseases because of the protective effect of traditional Mediterranean foods, such as olive oil, tomatoes and legumes.

Broccoli and other vegetables in the cruciferous family are known to reduce the risk of bowel cancer, but it is only recently that scientists have isolated the phytochemicals which confer this protection. Broccoli has been found to contain a phytochemical called sulphoraphane, which enhances the phase two-detoxification pathway in the liver.

Tomatoes contain a powerful antioxidant called lycopene, which according to a paper published in the American Journal of Clinical Nutrition (1997:66:116-22), is the most powerful of all the dietary carotenoids. The researchers found that the dietary intake of lycopene was linked to a lower risk of prostate problems. They also found that higher levels of lycopene in the blood lowered the risk of cell proliferation, which would theoretically exert a powerful anti-cancer effect. Cooking or chopping tomatoes increases the absorption of lycopene into the body. Cooking tomatoes in oil increases the availability of the lycopene to the body, which is another reason that Mediterranean cuisine confers health benefits.

Beetroot is a beautiful deep purple colour because it contains the antioxidant anthocyanidin. Constituents of beetroot have been shown to exert anti-viral and anti-tumour effects in animal studies. Other foods, which have these properties, although to a lesser degree, are red and green peppers, red onion skins, paprika and cranberry. These foods contain healing phytonutrients such as carotenoids, capsanthin and anthocyanins.

Certain foods have high concentrations of plant hormones, which are known as phytoestrogens. Examples of these are the isoflavones genistein and daidzein (found in soya beans and red clover), and lignans (found in flaxseed).

Asian communities consume a high intake of soy (approximately 25 – 50 grams daily), and have a significantly lower incidence of hormone dependent cancers of the prostate, uterus and breast. All legumes such as beans, peas and lentils contain beneficial phytoestrogens.

A study published in the British Medical Journal in 1990, looked at a group of postmenopausal women who were given 45 grams of soy flour for 2 weeks, followed by 25 grams of flaxseed meal for 2 weeks, and then 10 grams of red clover sprouts. This produced improvements in various blood hormone levels and menopausal symptoms.

Asian and Mediterranean cuisines are now integrating themselves into the old fashioned Western diet consisting of meat, bread and a limited range of vegetables. This culinary multiculturalism has enormous and proven benefits for our health and also for our enjoyment. We all know that variety is the spice of life, and Asian and Mediterranean foods can add spice to our often-bland ways of eating.

A wide range of Asian foods is now available from supermarkets and greengrocers as well as Chinese grocery stores. Typical Asian foods and vegetables such as ginger root, chilli, garlic, Chinese water spinach, bok choy, lemongrass, coconut, tumeric, curry, Chinese mushrooms and many others can be experimented with, and gradually introduced into the diet if you want to expand the horizons of your taste buds.

Watch That Sweet Tooth
Use natural sugars from fresh fruits and juices, dried fruits, molasses, fruit sorbets, fruit cakes, fruit jams, carob, date sugar, maple sugar or syrup or rice syrup. Avoid refined white sugar and candies, fizzy drinks, cakes and biscuits made with refined sugars.

Pre diabetes and Type II diabetes are spreading like wildfire thanks to western style diets high in processed sugar and fat.

Balanced blood sugar helps your liver work better and supports your energy levels. Fresh fruit and vegetables and natural sources of sugar will help you from see-sawing blood sugar.

Rehydrate Your Body
Drink large amounts of fluids such as water, raw juices and teas (green tea, herbal and regular weak tea is fine). Aim for 2 litres of fluid daily and this will avoid constipation problems and help your kidneys to eliminate the toxins that the liver has broken down.

The liver is the major organ involved in detoxification, however it is still important to support the other body organs of elimination. The skin and the kidneys eliminate toxins through sweating and urine and this is why some people suggest that saunas and a high intake of filtered water can reduce symptoms of toxic overload.

Some people think it’s important to have a water filter, and depending on what is in your water where you are, this may help you.

Go Organic
Although it is ideal to be able to buy organically grown food it’s not always possible. Don’t worry if you can’t manage to include organic food in your life, it’s important to do what you can, and not stress about what you can’t. It’s much more important to focus on the right types of food.

Not many people want to eat fruits and vegetables that have been sprayed repeatedly with insecticides and fungicides, ripened with ethylene gas and perhaps waxed with an insect secretion. Livestock animals may have been fed antibiotics and the ground-up remains of thousands of dead animals, and had potent sex hormones implanted to accelerate growth.

Organic food is sometimes called biodynamic food and should be produced without synthetic herbicides, insecticides, fertilisers, post-harvest fungicides, antibiotic growth-promoters, or size enhancing hormones. Foods certified as organic must be grown on farms that are inspected and fully certified according to a stringent set of standards.

It’s a positive choice if you can make it, and it protects the environment. You could also try growing your own with a packet of courgette seeds in a window box!

Pamper Your Liver
Eat foods to increase nutrients beneficial to liver function. Here are some more tips:

  • Vitamin K – green leafy vegetables and alfalfa sprouts.
  • Arginine – this helps the liver to detoxify ammonia, which is a toxic waste product of protein metabolism. Arginine is found in legumes (beans, peas, and lentils), carob, oats, walnuts, wheatgerm and seeds.
  • Antioxidants – found in fresh raw juices such as carrot, celery, beetroot, dandelion, apple, pear and green drinks like wheatgrass and barley-grass juice, and fresh fruits, particularly citrus and kiwi fruit.
  • Selenium – sources of the antioxidant selenium are brazil nuts, brewers yeast, designer yeast powders (very good source), kelp, brown rice, molasses, seafood, wheatgerm, whole-grains, garlic and onions.
  • Methionine – is essential for detoxification. Is found in legumes, garlic, onions and seeds
  • Essential fatty acids – Fresh avocado, fresh raw nuts and seeds, legumes (beans, peas, lentils), wholegrain, wheatgerm, green vegetables such as spinach, green peas and green beans, eggplant/ aubergine, cold pressed fresh vegetable and seed oils, freshly ground seeds, especially flaxseeds (linseed), evening primrose oil, black-currant seed oil, star flower oil. Essential fatty acids are required for healthy membranes in every cell of the body and plentiful amounts are required for healthy liver function. This is why strict low fat diets are not beneficial for general health, weight control or liver function.
  • Natural sulphur compounds – are found in garlic, onions, leeks, shallots and cruciferous vegetables such as broccoli, cauliflower, cabbage and brussel sprouts.

So – the take away here is ‘eat a diverse range of plants’. Just add more plants and you will feel and be healthier. You can focus on areas where you need to bring in more nutrients – such as cruciferous veg and essential fatty acids, or reducing processed sugar and fats. If you need support then you can work with a health coach. If you have particular questions then do post in the comment!

Jaundice

WHAT IS JAUNDICE?

The word “jaundice” comes from the French word jaune, which means yellow.

Jaundice is a yellowish staining of the skin, the whites of the eyes, and mucous membranes by bilirubin, a yellow-orange bile pigment. Bilirubin (read more about it here!) comes mainly from the breakdown of red blood cells, and is basically a waste product that your liver gets rid of.

Jaundice usually appears when the bilirubin in your blood is more than 3 mg per dL (51.3 µmol per L). The classic definition of jaundice is a serum bilirubin level greater than 2.5 to 3 mg per dL (42.8 to 51.3 µmol per L) as well as having yellow skin and eyes.

Your body processes bilirubin in 3 phases: prehepatic (before it gets to the liver), intrahepatic(whilst in the liver), and posthepatic(after leaving the liver). If any of these aren’t working properly you can become jaundiced.

PREHEPATIC

The human body produces about 4 mg per kg of bilirubin per day, from the breakdown of blood cells. Bilirubin is then transported from to the liver for conjugation (where it needs to link up with other enzymes and chemicals so that it can be removed from the body) .

INTRAHEPATIC

Unconjugated bilirubin (the bilirubin that hasn’t been removed by linking up with an enzyme) doesn’t dissolve in water but is soluble in fats. That means it can easily cross the blood-brain barrier or enter the placenta. The unconjugated bilirubin is conjugated (linked up with) with a sugar via the enzyme glucuronosyltransferase (the enzyme that people with GS don’t have enough of) and is then soluble in the bile.

POSTHEPATIC

Once soluble in bile, bilirubin is transported through to the gallbladder, where it is stored, or passed on to the duodenam. Inside the intestines, some bilirubin is excreted in the stool, while the rest is dealt with by the bacteria in your gut.

JAUNDICE AND OTHER SYMPTOMS

Some people with jaundice have no symptoms at all.  But some may have an acute illness, which is frequently caused by infection, may seek medical care because of fever, chills, abdominal pain, and flu-like symptoms. For these patients, the change in skin color may not be their greatest concern!

Patients with noninfectious jaundice may complain of weight loss or itching / skin discomfort. Abdominal pain is the most common symptom in patients with pancreatic or biliary tract cancers.Even something as nonspecific as depression may be a symptom in patients with chronic infectious hepatitis and in those with a history of alcoholism.

‘False’ jaundice can happen if you eat foods rich in beta-carotene (e.g., squash, melons, and carrots). Unlike true jaundice, you don’t get yellow eyes, or changes in bilirubin level.

CAUSES OF JAUNDICE:

PREHEPATIC CAUSES

Unconjugated hyperbilirubinemia (this is when you’ve too much bilirubin in your bloodstream because it’s not been processed in the liver, as in Gilbert’s Syndrome) might happen before bilirubin has entered the liver cells or within the liver cell. If you’ve had an unusual breakdown in your red blood cells then there may be too much of the waste product, bilirubin, for your liver to process as normal.

This will usually result in mild bilirubin elevation, to about 5 mg per dL (85.5 µmol per L), with or without clinical jaundice. The blood might be breaking down because of a number of causes in the blood cells or your enzymes which mean your red cells have stayed alive longer than normal, and built up.  Other causes include autoimmune disorders, drugs, and defects in hemoglobin structure such as sickle cell disease and the thalassemias.

INTRAHEPATIC CAUSES

Un-Conjugated Hyperbilirubinemia Gilbert syndrome is a common, benign, hereditary disorder that affects approximately 5 percent of the U.S. population. It usually results in a mild decrease in the activity of the enzyme glucuronosyltransferase. Gilbert syndrome is typically an incidental finding on routine liver function tests, when the bilirubin level is slightly increased and all other liver function values are within normal limits. Jaundice and further elevation of the bilirubin level may occur during periods of stress, fasting, or illness.

Conjugated Hyperbilirubinemia. Main causes are when there’s a blockage preventing bilirubin from moving into the intestines. Viruses, alcohol, and autoimmune disorders are the most common causes of hepatitis. Inflammation also disrupts transport of the bilirubin and causes jaundice.

Hepatitis A can cause acute onset of jaundice. Hepatitis B and C infections often do not cause jaundice straight away, but can lead to jaundice when chronic infection has led to liver cirrhosis. Epstein-Barr virus infection occasionally causes hepatitis and jaundice that resolve as the illness clears.

Alcohol has been shown to affect bile acid uptake and secretion, stopping the normal flow through the liver. Chronic alcohol use may result in fatty liver (steatosis), hepatitis, and cirrhosis, with varying levels of jaundice. Fatty liver, the most common liver problem, usually results in mild symptoms without jaundice but occasionally progresses to cirrhosis. Hepatitis secondary to alcohol use typically presents with acute onset of jaundice and more severe symptoms.

More rare conditions that can cause jaundice: Autoimmune hepatitis traditionally has been considered a disease that affects younger persons, especially women. Two serious autoimmune diseases that directly affect the biliary system without causing much hepatitis are primary biliary cirrhosis and primary sclerosing cholangitis. Primary biliary cirrhosis is a rare progressive liver disease that typically presents in middle-aged women. Fatigue and itching / skin discomfort are common initial complaints, while jaundice happens later. Primary sclerosing cholangitis, which is also rare, is more common in men; nearly 70 percent of patients also have inflammatory bowel disease. Dubin-Johnson syndrome and Rotor’s syndrome are rare hereditary metabolic defects that disrupt transport of conjugated bilirubin.

Common drugs can also cause problems, such as acetaminophen, penicillins, oral contraceptives, anti-psychotic medication, and steroids. Cholestasis can develop during the first few months of oral contraceptive use and may result in jaundice.

POSTHEPATIC CAUSES

Gallstones in the gallbladder are fairly common in adults. Obstruction within the biliary duct system can inflame the gallbladder, and can lead to infection. Cholangitis is diagnosed clinically by the classic symptoms of fever, pain, and jaundice, known as Charcot’s triad. Cholangitis most commonly occurs because of an impacted gallstone, which might then be removed.

Biliary tract tumors are uncommon but serious causes of posthepatic jaundice. Gallbladder cancer classically presents with jaundice, enlarged liver, and a mass in the right upper quadrant (Courvoisier’s sign). Another biliary system cancer, cholangiocarcinoma, typically manifests as jaundice, itching / skin discomfort, weight loss, and abdominal pain. It accounts for roughly 25 percent of hepatobiliary cancers.

Jaundice also may arise with pancreatitis. The most common causes of pancreatitis are gallstones and alcohol use. Gallstones are responsible for more than one half of cases of acute pancreatitis, which is caused by obstruction of the duct that drains the biliary and pancreatic systems.

Evaluation

The initial work-up of the patient with jaundice depends on whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect). A urine anlysis that is positive for bilirubin indicates the presence of conjugated bilirubinemia. Conjugated bilirubin is water soluble and so passed through urine.

SO IF YOU’RE JAUNDICED WHAT DO THEY DO TO WORK OUT WHAT’S CAUSING IT? Here’s the clinical information :

BLOOD TESTING

First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase, and alkaline phosphatase levels.

Depending on the results of the initial tests, further serum tests or imaging studies may be warranted. The second-line serum investigations may include tests for hepatitis A IgM antibody, hepatitis B surface antigen and core antibody, hepatitis C antibody, and autoimmune markers such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. An elevated amylase level would corroborate the presence of pancreatitis when this condition is suspected based on the history or physical examination.

IMAGING

Ultrasonography and computed tomographic (CT) scanning are useful in distinguishing an obstructing lesion from hepatocellular disease in the evaluation of a jaundiced patient. Ultrasonography is typically the first test ordered, because of its lower cost, wide availability, and lack of radiation exposure, which may be particularly important in pregnant patients. While ultrasonography is the most sensitive imaging technique for detecting biliary stones, CT scanning can provide more information about liver and pancreatic parenchymal disease. Neither is good at finding stones inside the ducts.

Further imaging that may be done by a gastroenterologist or interventional radiologist includes endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

LIVER BIOPSY

A liver biopsy provides information on the architecture of the liver and is used mostly for determining prognosis. It also may be useful for diagnosis if serum and imaging studies do not lead to a firm diagnosis. Liver biopsy can be particularly helpful in diagnosing autoimmune hepatitis or biliary tract disorders (e.g., primary biliary cirrhosis, primary sclerosing cholangitis).