Gilbert’s Syndrome
Gilbert’s syndrome is a mild, inherited liver condition that affects how the body processes bilirubin—a yellow pigment formed during the breakdown of red blood cells. People with Gilbert’s syndrome have elevated levels of unconjugated (indirect) bilirubin in their bloodstream, which can occasionally cause a slight yellowing of the skin or eyes, known as jaundice. Despite its effect on bilirubin levels, the condition is harmless and usually requires no treatment.
Gilbert’s syndrome is often discovered incidentally during routine blood tests for unrelated health concerns. While it may cause temporary episodes of jaundice, particularly during periods of stress, fasting, illness, or intense exercise, it does not damage the liver or other organs. Understanding the condition helps reduce unnecessary anxiety and prevents misdiagnosis of more serious liver diseases.
How Gilbert’s Syndrome Affects the Body
Bilirubin is a waste product resulting from the normal breakdown of haemoglobin in ageing red blood cells. Normally, bilirubin travels through the bloodstream to the liver, where it is processed by an enzyme called UGT1A1 (uridine diphosphate-glucuronosyltransferase). This enzyme converts bilirubin into a water-soluble form so it can be excreted in bile.
In people with Gilbert’s syndrome, a genetic mutation leads to reduced activity of the UGT1A1 enzyme. As a result:
Unconjugated bilirubin builds up in the blood
The liver still functions normally but clears bilirubin more slowly
During physical or emotional stress, bilirubin levels can temporarily rise further
This process is benign, but the intermittent appearance of jaundice can be confusing, especially without a clear diagnosis.
Who Gets Gilbert’s Syndrome?
Gilbert’s syndrome is one of the most common inherited liver conditions. It affects up to 5–10% of the population worldwide, though many people remain undiagnosed due to the lack of noticeable symptoms.
Key demographic features include:
Both sexes are affected, though mild jaundice is more noticeable in males due to higher haemoglobin turnover
Often identified during late adolescence or early adulthood
Runs in families, as it is inherited in an autosomal recessive manner
A person must inherit the faulty gene from both parents to develop the condition. Carriers—those with only one copy of the gene—do not usually show symptoms.
Common Signs and Symptoms
Most individuals with Gilbert’s syndrome experience no symptoms. However, some may notice:
Mild yellowing of the whites of the eyes (scleral icterus)
Occasional yellowing of the skin, particularly during episodes of raised bilirubin
Episodes triggered by:
Fasting or skipping meals
Physical exertion
Illness, such as viral infections
Stress or lack of sleep
Dehydration
Other reported symptoms, though not always linked definitively to Gilbert’s syndrome, include:
Fatigue or low energy
Mild abdominal discomfort
Nausea or digestive irregularities
These symptoms are often vague and can result from unrelated issues. However, in some individuals, they may coincide with bilirubin fluctuations.
Is It Dangerous?
Gilbert’s syndrome is not dangerous. It does not:
Damage the liver
Lead to liver failure or cirrhosis
Increase the risk of hepatitis or other liver diseases
Require lifelong medication
The key concern with the condition is mistaken diagnosis, particularly when jaundice appears suddenly. This may prompt unnecessary investigations unless a proper diagnosis has already been made.
How It’s Diagnosed
Gilbert’s syndrome is usually discovered when:
Routine blood tests show elevated unconjugated bilirubin levels
Liver enzymes (ALT, AST, ALP) and other liver function tests are completely normal
There are no signs of liver damage or other abnormalities
Doctors may confirm the diagnosis through:
Repeat fasting bilirubin tests
Genetic testing (to confirm UGT1A1 mutation), although this is not always necessary
Ruling out more serious causes of jaundice, such as hepatitis, haemolytic anaemia, or gallbladder disease
Once diagnosed, no further testing is usually needed unless new symptoms arise.
Emotional and Social Impact
While the condition is medically benign, some people experience emotional distress when symptoms first appear—especially the sudden onset of jaundice. Common concerns include:
Fear of having liver disease or cancer
Embarrassment about visible jaundice
Anxiety during exams or work stress that may trigger symptoms
Clear explanation, reassurance, and confirmation of the benign nature of the condition are crucial in helping individuals adjust.
Living with Gilbert’s Syndrome
Most people live completely normal lives. Management focuses on avoiding known triggers, such as:
Skipping meals or prolonged fasting
Dehydration
Overexertion without recovery
Poor sleep or high stress
Dietary and lifestyle tips may help reduce the likelihood of bilirubin spikes:
Eat regular meals with balanced nutrients
Stay well hydrated
Get sufficient sleep and rest
Manage stress with exercise, mindfulness, or relaxation techniques
There is no need to follow a special liver diet unless recommended for another condition.
Medications and Gilbert’s Syndrome
Certain medications may be processed differently in people with Gilbert’s syndrome. These include:
Irinotecan, a chemotherapy drug—higher risk of side effects due to reduced metabolism
Paracetamol (acetaminophen)—generally safe in normal doses, but caution advised if used excessively
Statins and antivirals—usually safe, but liver monitoring may be recommended
It’s important to inform healthcare providers about the condition, especially before starting any new medication.
Conclusion | Gilbert’s Syndrome
Gilbert’s syndrome is a harmless but often misunderstood condition. By recognising the signs, understanding the underlying mechanism, and avoiding unnecessary worry or invasive testing, people with this condition can lead full, healthy lives without limitations.
