Gilbert's Syndrome Treatment Boston MA

Should you worry about your GS? In Gilbert’s syndrome (GS), your liver loses some of its ability to eliminate bilirubin—a yellow pigment that results from the breakdown of red blood cells.

Frederick W Heiss, MD
(718) 744-8743
41 Mall Rd
Burlington, MA
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Lahey Burlington Gastroenterology
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Gastroenterology

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Tony Edward Yusuf, MD
55 Fruit St
Boston, MA
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Gastroenterology
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Medical School: American Univ Of Beirut, Fac Of Med, Beirut, Lebanon
Graduation Year: 1993

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Daniel Stephan Pratt
(617) 726-3313
55 Fruit St
Boston, MA
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Gastroenterology

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Andrew Beryl Leiter, MD
(617) 636-8337
750 Washington St
Boston, MA
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Gastroenterology
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Male
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Medical School: Case Western Reserve Univ Sch Of Med, Cleveland Oh 44106
Graduation Year: 1978

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Won-Seok Jo, MD
(617) 291-0225
55 Fruit St # GRJ-722
Boston, MA
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Gastroenterology
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Male
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Medical School: Univ Of Ca, San Diego, Sch Of Med, La Jolla Ca 92093
Graduation Year: 1999

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Leonard S Gottlieb, MD, MPH
(617) 534-5309
784 Massachusetts Ave
Boston, MA
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Gastroenterology
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Graduation Year: 2007

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Barbara Joyce Nath
(617) 726-3505
55 Fruit St
Boston, MA
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Gastroenterology, Internal Medicine

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Rong J Guan
(617) 482-7555
885 Washington Street
Boston, MA
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Gastroenterology, Internal Medicine

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Douglas Albert Janowski, MD
(617) 636-5623
750 Washington St # 233
Boston, MA
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Gastroenterology
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Male
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Medical School: Univ Of Miami Sch Of Med, Miami Fl 33101
Graduation Year: 1997

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Joseph Anthony Fiore
(617) 636-5000
750 Washington St
Boston, MA
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Gastroenterology

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Ask the Doctor—Living with Gilbert's Syndrome

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By Robert Rountree, MD

Q After finding elevated bilirubin on a routine blood test, my doctor told me I had Gilbert’s syndrome, but it was nothing to worry about. Is that really true?

In Gilbert’s syndrome (GS), your liver loses some of its ability to eliminate bilirubin—a yellow pigment that results from the breakdown of red blood cells. A relatively common genetic condition, GS may affect as much as 10 to 20 percent of the population. Under normal conditions, the liver detoxifies bilirubin by combining it with a type of sugar called glucuronic acid in a process known as conjugation. The liver then releases the “conjugated” bilirubin into the bile ducts from whence it subsequently gets eliminated in the stool. For people with GS, the UGT1A1 enzyme that conjugates bilirubin works at only 20 to 70 percent of normal.

In a person with GS, situations that either increase the breakdown of red blood cells or overload the detoxifying ability of the liver can cause blood levels of “unconjugated” bilirubin to rise so high that the whites of her eyes will turn yellow—a condition called jaundice. This can occur with fasting, prolonged strenuous exercise, fatigue, surgery, infections, excessive alcohol intake, or menstruation.

Up until a few years ago, experts considered GS an innocuous condition, the only significant feature of which was abnormally high levels of unconjugated bilirubin on routine fasting blood tests. As it turns out, GS is not so benign: A significant percentage of people with this genetic abnormality also have an impaired ability to metabolize and excrete certain medications, including the pain-relieving drug acetaminophen (Tylenol) and a cancer chemotherapy agent called irinotecan. That makes them more susceptible to side effects, such as liver toxicity from acetaminophen or a severe drop in white blood cells from irinotecan. More recently, a groundbreaking study at the University of Washington in Seattle has shown that having a sluggish UGT1A1 enzyme can make it more difficult for people with the most severe form of GS to eliminate cancer-causing environmental toxins found in smoke, automotive exhaust, and charbroiled meat.

The study also reports another significant discovery, however: Eating a diet rich in cruciferous vegetables like broccoli, Brussels sprouts, cabbage and watercress can increase the activity of the UGT1A1 enyzme. (Onions, citrus fruits, and legumes also increase activity of the UGT1A1 enzyme, but not quite at the level as crucifers.) This implies that people with GS are particularly susceptible to the beneficial, cancer-preventive properties of broccoli and its edible relatives. Based on this research, I would recommend that you minimize the use of acetaminophen and avoid grilled meats, cigarette smoke, and exhaust fumes from petrochemical fuels as much as possible. In addition, eat at least one full serving of cruciferous vegetables every day. Or, if you aren’t particularly fond of this vegetable family, tr...

Author: Robert Rountree, MD

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