Gilbert’s Syndrome
A common, harmless inherited quirk where the liver processes bilirubin a little slowly, so blood levels run slightly high. Most people never notice. Some get a faint yellow tinge to the whites of the eyes when they’re ill, fasting or run-down.
Quick answer: Gilbert’s syndrome is a common, harmless inherited condition where the liver clears bilirubin more slowly, so blood levels run slightly high. Most people have no symptoms; some notice mild yellowing of the eyes during illness, fasting or stress. It doesn’t damage the liver, needs no treatment and doesn’t shorten life.
How common. Very common: estimates range from about 3 to 10 in 100 people. It’s more often found in males and usually picked up in the teens or 20s, often by chance on a blood test done for something else.
Causes. A small change in the UGT1A1 gene means the liver makes less of the enzyme that processes bilirubin, the yellow pigment made when old red blood cells are recycled. You usually inherit the change from both parents.
Triggers. Bilirubin rises, and yellowing may show, with fasting or skipping meals, illness or infection, dehydration, poor sleep, stress, hard exercise, periods and alcohol.
Symptoms. Usually none. Some people get mild jaundice, best seen in the whites of the eyes, that comes and goes. It doesn’t cause itching, dark urine or pale poo, so those point to something else. Some people report tiredness or tummy discomfort during episodes, but it isn’t clear these are caused by Gilbert’s.
Look-alikes. Red blood cells breaking down too fast (haemolysis), hepatitis and other liver diseases, a blocked bile duct (for example from gallstones), and some medicines.
How it’s diagnosed. With blood tests: raised ‘unconjugated’ (indirect) bilirubin, with the other liver tests and full blood count normal and no sign of red cells breaking down. The tests are often repeated, sometimes after fasting. A genetic test is rarely needed.
Living with Gilbert’s
No treatment is needed. These are simple ways to keep episodes rare.
- Eat regular meals and avoid long fasts or crash diets.
- Drink enough fluids, especially when unwell or exercising hard.
- Get enough sleep and keep alcohol within health guidelines.
- Tell any doctor, dentist or pharmacist you have Gilbert’s before starting new medicines. Most common medicines at normal doses are fine.
- Keep a copy of your blood results so future doctors know your bilirubin runs high.
Medicines to mention. The same enzyme handles some drugs. The best-known is irinotecan, a chemotherapy medicine, which can cause more side effects. The HIV medicine atazanavir raises bilirubin further. Your doctor may also monitor more closely with some other medicines.
A silver lining?. Bilirubin acts as an antioxidant, and some observational studies link Gilbert’s with a lower risk of heart disease. That’s an association, not proof, but it’s one of the few conditions with a possible upside.
See your GP if
- You notice yellow skin or eyes and haven’t been diagnosed with Gilbert’s (ask for an urgent appointment)
- Yellowing comes with dark urine, pale poo, itching, tummy pain or fever
- An episode is worse than usual or lasts more than a few days
- A baby or child looks yellow
Get urgent help for jaundice with severe tummy pain, high fever, confusion or drowsiness, or vomiting blood: call 000 (Australia) or your local emergency number.
Outlook. Excellent. Gilbert’s doesn’t damage the liver, cause liver disease or shorten life. It may slightly raise the chance of gallstones.
Common questions
Is Gilbert’s syndrome serious?
No. It’s a harmless genetic variation, not a liver disease. It doesn’t damage the liver or shorten life, and it needs no treatment.
What triggers a Gilbert’s syndrome flare?
Fasting or skipping meals, illness, dehydration, poor sleep, stress, hard exercise, periods and alcohol can all raise bilirubin and bring on mild yellowing of the eyes.
Does Gilbert’s syndrome cause tiredness?
Some people report tiredness during episodes, but studies haven’t shown that Gilbert’s itself causes it. If you’re often exhausted, ask your GP to look for other causes.
Can I drink alcohol with Gilbert’s syndrome?
Gilbert’s doesn’t mean you need to avoid alcohol completely. Alcohol can bring on yellowing in some people, so stay within health guidelines.
Is Gilbert’s syndrome inherited?
Yes. It comes from a change in the UGT1A1 gene, usually inherited from both parents. Brothers and sisters may have it too.
Can I take paracetamol with Gilbert’s syndrome?
Normal doses of common medicines are generally fine, but always tell your doctor or pharmacist you have Gilbert’s, as a few medicines (such as the chemotherapy drug irinotecan) need extra care.
Evidence and more information
- NHS: Gilbert’s syndrome
- healthdirect: Gilbert’s syndrome
- MedlinePlus Genetics (US National Library of Medicine): Gilbert syndrome
maladywise.com/gilbert-syndrome/