Are people With Gilbert's Syndrome more susceptible to certain things?

Susceptability

Susceptability

Susceptability

Susceptability

Even though Gilbert’s Syndrome is technically said to “not cause symptoms or make you more susceptible to other conditions 🤓☝🏼,” I personally believe it can. This doesn’t mean everyone with GS will definitely experience all of these, but I do think it makes you more likely. I’ll do my best to explain why—but from talking to and interviewing a BUNCHHH of people with GS, I’ve noticed many share these same experiences.

BILE SLUDGE and GALLSTONES/ PIGMENT STONES

individuals with Gilbert's Syndrome (GS) may have an increased tendency to develop biliary sludge (which can be a precursor to gallstones) due to a number of factors related to how the body processes bile components.

Key Factors That May Affect Bile Flow:

• Potential for Imbalanced Bile Components: GS is associated with a naturally altered ratio of bile components. Specifically, a higher level of less-soluble unconjugated bilirubin relative to bile salts and cholesterol may contribute to the bile becoming less fluid. This change in balance can promote the clumping together of solids, which may lead to sludge formation.

• Slower Detoxification Pathways: GS is linked to a partially reduced function of the UGT1A1 enzyme. This enzyme is crucial for glucuronidation—the process that makes bilirubin soluble for excretion. When this process is slower, more unconjugated bilirubin enters the bile, which, in turn, may reduce overall bile solubility and cause it to thicken or flow sluggishly.

• Hormonal Influence (Estrogen): Hormones like Estrogen may increase the risk of bile becoming sluggish, particularly in individuals with hormonal fluctuations. Estrogen is suggested to promote the secretion of cholesterol into the bile. This extra cholesterol, when combined with the underlying GS-related bile imbalance, may heighten the chance of bile supersaturation and stasis (sluggish flow).

• May Affect Bile Recycling Efficiency: GS may subtly impact the efficiency of the enterohepatic circulation—the vital process of recycling bile acids between the liver and the intestine. If this recycling is less efficient, it could alter the total pool of soluble bile acids, further compromising the bile's ability to remain liquid and flow freely.

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SIBO and Microbiome Dysbiosis

-Slower gastric emptying

• Clinical studies — along with tons of patient reports — show that people with Gilbert’s Syndrome often have slower gastric emptying, about 1.5x slower than average.

• When the stomach empties more slowly, it creates a perfect breeding ground for bacteria.

• For most people, this isn’t a problem. But if someone is taking PPIs (proton pump inhibitors), which reduce stomach acid, bacterial overgrowth risk can increase even further.

-Sluggish bile and microbiome changes

• Less efficient bile flow can make the small intestine more hospitable to certain bacteria.

• Some bacteria are bile-tolerant, meaning they can survive and even thrive when bile is present. Examples include:

  • Clostridium species

  • Bacteroides species (linked to SIBO)

  • Bilophila wadsworthia

• When bile flow is irregular, these bile-tolerant bacteria gain a competitive edge, while beneficial bacteria like Bifidobacterium and Lactobacillus may shrink.

• Additionally, bilirubin itself can feed certain gut bacteria, including E. coli, Bacteroides, and some Clostridium species, potentially supporting bacterial overgrowth.

Hormonal issues [Estrogen Dominance]

If you have Gilbert’s Syndrome, your hormones and liver can have a tricky relationship. Because your liver already has to work harder to process bilirubin, it may also struggle a bit with other compounds cleared through the same pathway — like estrogen.

Many people with GS notice bilirubin spikes around their period. This happens because right before menstruation, estrogen and progesterone levels fluctuate sharply. These changes can temporarily reduce the activity of UGT1A1, the liver enzyme responsible for clearing bilirubin. Since GS already lowers UGT1A1 activity, it’s easy to see why premenstrual “flares” happen.

High estrogen levels — whether from natural cycles, medications, or synthetic sources like the pill — can add extra load to the liver. When the liver is handling both bilirubin and extra estrogen, clearance can slow, making bilirubin more likely to rise.

Your gut bacteria can play a role too. Certain bacteria produce beta-glucuronidase, which can reactivate estrogen in the intestines. This reabsorbed estrogen puts even more stress on the liver, potentially amplifying bilirubin fluctuations and contributing to estrogen dominance symptoms.

In short, people with GS often experience hormonal flares or imbalances not just because of hormones themselves, but because the liver’s limited capacity to process bilirubin can make it harder to keep everything else in balance. Everyone experiences it differently, but this pattern is widely observed both clinically and in real life.

For example here is MY beta-glucuronidase in a GI test [ this DOSENT mean that everyone with GS will have this, i have pretty bad SIBO which is causing it!}