All you need to know about bilirubin and its importance

Everything in life has a certain age limit – and so do the red blood cells in our bodies. Once these cells have reached the end of their life, they are broken down into various products including heme, which formed part of the haemoglobin in the red cell. Heme then becomes bilirubin, a yellow-orange compound that makes up bile in our liver. Bile aids in fat digestion and excretion of waste products. It is stored in the gallbladder and expelled into the small intestine through a connecting duct.

Bilirubin exists in different forms, either soluble or insoluble. When heme is turned into Bilirubin, it is transported in our system to the liver in an insoluble, unconjugated (indirect) form. Once in the liver, enzymes convert this indirect bilirubin into a more soluble, conjugated (direct) form. Diseases of the liver, gallbladder and connecting organs can disturb the normal levels of these two types of bilirubin in the blood.

Normal Total (conjugated + unconjugated) Bilirubin Level: 1.2 mg/dL.

Normal Conjugated Bilirubin Level: 0.3 mg/dL

Normal Unconjugated Bilirubin Level: 0.9 mg/dL

How do I know if I have raised bilirubin in my plasma?

Bilirubin tests make an integral part of liver function tests. The amount of bilirubin in a urine and blood test is analysed. Raised bilirubin levels in these tests indicate an underlying disease that is either restricting the excretion of bile, reducing the rate of conjugation of bilirubin, or increasing red blood cell breakdown (haemolysis).

Raised levels of bilirubin often produce classic signs that can easily be identified. Yellowing of the skin and the white of the eye (jaundice) is the most common symptom of abnormal bilirubin levels in the plasma. Other symptoms include dark colored urine and stool, nausea, vomiting, abdominal pain and fatigue.

Apart from the basic blood tests, liver and/or gallbladder pathology can also be recognised on a general physical examination, ultrasound, CT scan, MRI or a biopsy.

What causes abnormal bilirubin levels in the plasma?

The level of bilirubin in your plasma is closely associated with the condition of your liver. Liver pathologies such as hepatitis, cirrhosis, fatty liver and drug reactions can cause bilirubin levels to rise, in particular the level of unconjugated bilirubin (since the conjugating function of the liver may be impaired). Raised bilirubin levels are also observed in cases of hereditary disorders like Gilbert Syndrome or anaemia. One in 20 of us suffer from Gilberts and do not even know it!

In some instances, the level of conjugated bilirubin might also rise. This happens when there is an obstruction in the outflow of bile from the liver to the small intestine via the gall bladder. Usually a stone in the gallbladder or its ducts is a cause of raised conjugated bilirubin and hence, jaundice.

Lifestyle Modifications for Managing Bilirubin Levels

A balanced, healthy diet is key to maintaining proper bilirubin levels in the plasma. Including a diet rich in fruits, vegetables, red meat, whole grain and fish can promote liver health. Fibre is another important food group that helps improve the function of the liver and maintains appropriate bilirubin levels in the blood.

Natural food that is red in color, like tomatoes, are rich in antioxidants and a substance called lycopene that reduces bilirubin levels in the bile. Toxins are also removed by the nutrients contained in barley and radishes.

Along with adding healthy items to the palate, it is equally essential to remove those that can cause untoward consequences. Sugar, fast food, alcohol and sodas all affect the health of the liver and can cause it to become fatty. This can affect the production of bile and the conjugation of bilirubin in the liver cells.

While a healthy diet can help prevent the incidence of jaundice, it does not treat it once the condition has set in. In such cases, you will need professional guidance to help you treat the underlying condition causing raised bilirubin levels in the plasma.

If you’re interested in learning more about bilirubin, how it affects your body and what it indicates about your health, read on more about it in our biomarker post here!

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