DEAR DR. GOTT: My doctor has told me that I have elevated bilirubin but he has never been overly concerned about it because it has been a factor that shows up every time I have lab work. I turned 65 in January and wonder if this condition will be a problem as I get older. Is it congenital? Can diet make a difference? I am trying to stick to an anti-inflammatory diet and I avoid flour and sugar as much as I can. I also avoid dairy products because they cause gas and mucous problems. I have been diagnosed with osteoarthritis, fibrositis and IBS, all of which seem to run in my family and cause me to lose sleep. Any advice?
DEAR READER: Bilirubin is a yellowish bile pigment. It is formed when the liver breaks down old red blood cells. Elevated levels of bilirubin can cause jaundice, a condition most often associated with newborns.
Jaundice and elevated bilirubin can occur when more red blood cells are broken down than normal. This can be caused by erythroblastosis fetalis (a condition that affects fetuses and newborns), a transfusion reaction, hemolytic anemia (the premature destruction of red blood cells), certain liver or gallbladder problems, and certain medications.
If elevation or jaundice is caused by the liver, it may be due to cirrhosis (liver scarring), hepatitis, or Gilbert’s disease (a genetic condition which typically causes jaundice during periods of stress, infection or exertion and doesn’t require treatment). The gallbladder can cause jaundice or elevated levels due to gallstones, biliary stricture (narrowing of the common bile duct that moves bile from the liver to the small intestine) or pancreatic or gallbladder cancer.
To the best of my knowledge, diet will not affect bilirubin levels. As long as your diet is nutritionally balanced and you are getting the required amounts of vitamins and minerals, you should be fine.
As for your osteoarthritis, irritable bowel syndrome (IBS), and fibrositis (more commonly known as fibromyalgia), I imagine you are on medication for these conditions. If the elevated bilirubin began after beginning a new medication, you may have your answer. If not, further investigation is necessary.
As for your concern about future problems, I cannot say. Without knowing the cause of your elevated bilirubin, there is no way to know if it could or will pose a problem. I urge you to speak with your physician about testing to find the cause and, if necessary, taking steps toward correcting it. Because this situation has been going on for some time and you state that your physician is seemingly unconcerned, you may be better served by requesting a referral to a specialist. In my opinion, your physician has dropped the ball, but if you haven’t thus far expressed your concerns to him, you are somewhat to blame, as well. Patients are just as responsible for their health as are their physicians, if not more so.
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