Fatigue – or how can I boost my energy?

As many as one in five people feel fatigued at any time. If you’ve been feeling exhausted then you’ll want to know: Why am I so tired all the time; how can I get more energy?

Fatigue – what is it?

Fatigue is a symptom of many health conditions and life circumstances. Technically fatigue is one or more of these:

  • Overwhelming exhaustion that lingers beyond a good night’s sleep
  • Sleepiness and a lack of motivation to move about that doesn’t go away if you rest
  • A limiting lack of energy that prevents you from getting normal tasks done
  • Feeling like your muscles are too heavy and moving about takes energy you don’t have
  • Foggy achy head, finding it difficult to think or concentrate
  • Apathy and disinterest – everything feels too much

If you feel like this for more than a few days, for a reason that’s not clear, then you must see your doctor.

Is fatigue common?

Yes! Numerous studies across different populations show fatigue is common. You can find many studies, such as this one https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557471/ which illustrate that women tend to report fatigue more than men, and those of lower socioeconomic status also experience more fatigue. Across populations it appears above 20% of people report fatigue. 

What causes fatigue?

Excessive tiredness can be caused by simple or serious health conditions. Common deficiencies of vitamins and minerals have tiredness as a symptom. There are many life circumstances which can leave you feeling exhausted. Let’s look at a few in more detail:

Life Stage : A new baby, a new job, grief or a crisis, moving house, caring responsibilities, overwork, stress at home or in the workplace.

Medical conditions: commonly, as you can see on the NHS website, and the Mayo Clinic , conditions causing fatigue include diabetes, depression, cancer, thyroid, coeliac disease, fibromyalgia, liver problems, MS, hormonal changes, heart disease and sleep apnoea, and so many more. This is why it is so important to receive a diagnosis if you experience fatigue which doesn’t let up over time. 

Deficiencies: Iron deficiency (experienced by many women with heavy or prolonged periods), Vitamin D deficiency (common if you live in the northern hemisphere where we aren’t exposed to strong sunlight which generates vitamin D), magnesium (particularly common in women), and an imbalance in good nutrition generally. Some people have metabolic conditions which prevent them from absorbing nutrients well and this can result in multiple deficiencies.

Poor choice of foods which attack energy levels: Food high in sugar or refined carbohydrates provide instant energy. Your body will then have a crash in blood sugar which will make you feel exhausted. Wholegrains, plant based proteins, and wholefoods containing natural sugars will balance your energy levels and make you feel a whole lot better. A high intake of caffeine may also leave you struggling later in the day. (For more about the pro’s and cons of caffeine read this).

A combination of the above!

Unpicking the causes of your fatigue is really important. You must rule out serious health problems, working with your Dr.

Does Gilbert’s Syndrome cause fatigue?

For people with Gilbert’s Syndrome lack of energy is a really commonly reported symptom. I hear all the time from people desperate with debilitating exhaustion, with energy levels that are unpredictable.

There are a number of reasons why people with Gilbert’s Syndrome may feel exhausted. 

  • Reduced liver function. If you eat highly refined carbohydrates such as white bread or sugary things, your blood sugar will rise and fall a lot. This means the enzyme we’re deficient in cannot work as well as it needs blood sugar. The result is your liver won’t do its cleaning job effectively and certain toxins and bilirubin will build up in your body. Typically feelings of exhaustion, jaundice, itching and nausea are reported. You may feel a bit like you have a persistent hangover.  Of course consuming toxins may add to that effect, eg alcohol.
  • Delayed gastric emptying. Food takes longer to leave your stomach if you have Gilbert’s Syndrome. I’m sure many recognise the abdominal discomfort that entails! This has been linked to fatigue .  It is also worth noting that it is also linked to Chronic Fatigue Syndrome. Which itself has often been linked to Gilbert’s Syndrome.
  • Excess serotonin. People with Gilbert’s Syndrome have defective processing of certain neurotransmitters (chemicals that send messages around the brain and nervous system). This can lead to raised levels of Serotonin for example, which is linked to feelings of lethargy and lack of motivation as well as anxiety.

How do I get more energy?

Assuming you don’t have a particular condition or issue that is causing you to feel exhausted, then there are four simple foundations to build your energy on

  1. Good Nutrition
  2. Exercise 
  3. Good Sleep
  4. Mental resilience

The great thing about these four things is that they support each other. 

Eat well and be properly nourished and you’ll exercise better and get better sleep. Better sleep will help you be mentally resilient and give you more muscle energy for exercise. Exercise will help you be more mentally resilient etc etc 

  1. Good Nutrition. A plant based whole food diet has been overwhelmingly shown to provide you with the most sustained energy, lifespan and wellbeing. Eating a variety of plants, legumes, nuts, seeds and wholegrains will ensure you don’t need any vitamin supplements. With all food patterns you need to make sure you aren’t missing anything out. For vegans that means ensuring you get Vitamin B12. Things that will suck your energy and not enhance your wellbeing include refined sugar, other refined and processed foods. If you want the ultimate nutrition facts then dig in here nutritionfacts.org and buy the book ‘How not to die’ . I offer other thoughts on foods to eat here https://gilbertssyndrome.org.uk/the-liver-diet/ https://gilbertssyndrome.org.uk/detox-diets-and-gilberts-syndrome/ https://gilbertssyndrome.org.uk/sesame-magic-for-your-liver/ The How Not to Die cookbook has lots of tasty recipes and you can see from the reviews that many readers report increased energy.
  2. Exercise should ideally be a mix of activities that raise your heart rate and which challenge your posture and muscles both in terms of flexibility and density. Walking briskly combined with pilates (plenty free videos on youtube) are simple cost free and energising. If you aren’t up to a great deal of exercise, then just start with walking a small distance and build up. Even standing up for a while engages muscles. Adding in exercise is something that needs to become a habit or you won’t stick to it. Stand up whilst you are on the phone or watching a favourite programme, take a 20 minute walk at lunchtime, do squats in the shower or whilst brushing your teeth, dance to a favourite song for 5 minutes when you get home from work. Every bit of movement is helping you stay fit and well.
  3. Good quality sleep is vital. Research shows that our circadian rhythm (our body clock) is really important to when we feel awake and when we sleep well. Just making sure your bedroom is really dark can make a big difference to your body clock. Getting plenty of light in the morning will also help you feel alert and awake during the day and sleep better in the morning. There are lots of ways to deal with bad sleep – which I won’t go into here. It’s enough to say that regular sleep hours in a dark room without interruption are fundamental to good quality sleep. There are many books on the subject. Try the popular ‘Sleep Smarter’ by Shawn Stevenson  
  4. Mental resilience is a quality many of us feel we could develop more. It enables you to put the ups and downs of life into perspective. With mental resilience you will better cope when something bad happens in your day or your life, and will worry less about it. That’s not to say that you shouldn’t worry, be upset, grieve or be without feelings. It means you can do those natural things and then move on in time. If you want to understand more about living without anxiety you can buy ‘The Anxiety Solution’ by Chloe Brotheridge or find resources at www.calmer-you.com and Chloe’s podcast. You can also find out more about mental resilience and ‘grit’ here https://positivepsychology.com/5-ways-develop-grit-resilience/ Another great way to build up your mental resilience is through meditation. If it isn’t something you have considered or have found difficult in the past, then you could try these simple and effective tools from Mind Cards:

If you are doing the right things and are still feeling fatigued then you really need your doctor’s help to look into underlying medical conditions. 

Your personal biology will need a personalised response so that it works the best way it can for you and your circumstances. 

Sometimes this may mean prescription medication or balancing up other elements of your nutrition, supplements or lifestyle. 

Beating fatigue in Gilbert’s Syndrome

So, let’s take a look at what this might mean if you have Gilbert’s Syndrome. As mentioned, there are specific reasons you’ll feel fatigued. Everyone with Gilbert’s Syndrome will have other things going on for them too – other chronic conditions, lifestyle or life stage issues, hormonal changes etc. This means that some things may work some of the time and you may need to adjust because of what is going on for you right now. 

What you put in is key to what you get out

Many people with Gilbert’s Syndrome steer clear of alcohol as it really messes with their wellbeing and energy levels. You may want to consider this for other chemicals and potential toxins to lighten the load on your liver. This would mean a plant based wholefood diet which avoids processed and refined foods. Ideally organic! Particularly good foods include broccoli, nuts and seeds. https://gilbertssyndrome.org.uk/the-liver-diet/ . Keep it low in refined sugar and make sure to include limited good fats of plant origin. 

Drinking plenty of water will also ensure you stay hydrated and support the removal of toxins from your body. 

Eat little and often. For a couple of reasons. 

1) to maintain stable blood sugar levels 

2) with delayed gastric emptying a large meal will make you feel uncomfortable and make it harder to move about. 

This isn’t an excuse to pack in more food, unless that means eating more vegetables! Look at what you would like to eat over the day or week and portion it out. If you do it ahead of time you won’t have to think about it. 

Antidepressants in the form of SSRI’s (Selective Serotonin Reuptake Inhibitors) can help for some people. If you feel your anxiety or low mood are overwhelming then you must speak to your doctor and get their advice and diagnosis. These are also prescribed for IBS (again, something that people with Gilbert’s Syndrome have a high rate of) and may be a useful treatment option to consider – in dialogue with your doctor. This may improve your sleep, mental resilience and energy levels. However, as some people with Gilbert’s Syndrome may have raised levels of serotonin, as mentioned above, then you need to be cautious of side effects. Some brands may work better than others.

Supplements. Extra ingredients that can give you a boost or added support to your system are basically just plants in powdered form in a capsule. Some of the supplements offering additional energy balancing and support include types of ginseng, rhodiola rosea, ashwagandha etc available at Approved Vitamins and have been used safely for thousands of years. I list some supplements you can try in the Resources section. https://gilbertssyndrome.org.uk/resources/

I use rhodiola rosea and ashwagandha and have seen an impressive improvement in my ability to function. I occasionally add in gotu kola towards the end of the week or if I’ve not had a great night’s sleep, or have extra physical or mental demands. It works like a really gentle caffeine that doesn’t have the come-down effects.

Some people find caffeine works well at the right points of the day – find out more about caffeine here and let us know how it makes you feel https://gilbertssyndrome.org.uk/gilberts-syndrome-and-caffeine/

Sleep appears to be a really important factor in feeling well, when you have Gilbert’s Syndrome. A good 8 hours can make a world of difference. Some of the supplements I mention above can help sleep. Follow the suggestions in the four foundations section above. Resist the temptation to lie in bed and doze or rest without sleep. This won’t help you sleep later. Keep bed for specific night time hours if you can, and keep your sleep routine and hours regular. Being active during the day will help you sleep better later.

Anxiety can stop you sleeping and suck your energy whilst awake. If it’s overwhelming then seek help from your Dr. I mention Chloe Brotheridge’s work above, but also Mind and other websites have many pointers for help. Mindfulness is a well founded technique for calming your mind and should guarantee better sleep and more energy. You can find some free apps here. As mentioned above, these are also a really simple and effective tool to help try mediation:

I’d really like to hear what your experience is. If you follow the lifestyle above has it changed your energy levels? I found becoming vegan, eating plant based, adding in supplements and building mental resilience transformed my energy levels. What’s worked for you? Please comment. 

Remember – many people feel fatigued. There are basic principles to seize more energy. Plus – there’s the magic ingredient of you and your physiology to consider. Get medical support where needed, and understand your health conditions. You’ll then be in control of your energy and your life. 

Gilbert’s Syndrome and Caffeine

What does caffeine do for the liver, and what is the relationship between Gilbert’s Syndrome and caffeine? Many studies now combine to illustrate the positive effects of caffeine on a number of aspects of health and wellbeing.

You can help reveal the impact of caffeine on people with Gilbert’s Syndrome. Get a free download here and answer a handful of questions – it will take less than 5 minutes, and you could help us all live better with Gilbert’s Syndrome. Thank you!

Naturally, it’s not a simple picture.  Everyone has a different genetic and metabolic profile (we’re all made differently!). Each individual has a unique way of processing any chemical or food. This can also be impacted by your lifestyle, age and even time of the month. My goal is to help you personalise your nutrition so that you can take the research, advice and your experience and see what works best for you.  

I’ve been through the research and summarize and link to it below. This post also gives you the benefit of looking through the science as it relates to Gilbert’s Syndrome, but ultimately – I am not a doctor, I am not YOUR doctor, and the best expert on you – is YOU. 

That said, let’s look at liver health and caffeine, and particularly Gilbert’s Syndrome and caffeine

As Professor Graeme Alexander President, British Association for the Study of the Liver Consultant Hepatologist at Cambridge University Hospitals and The Royal Free Hospital, London said, in a study published by the British Liver Trust in 2016, “At last, liver physicians have found a lifestyle habit that is good for your liver!’

The report pulls together studies that look at liver diseases which are developed or acquired, not genetic conditions that impact the liver, like Gilbert’s Syndrome. However, it’s worth looking at the conclusions and the basis of the studies to see what we can draw from those. 

The bottom line is that it appears caffeine can slow disease progression, help prevent liver cancer and support the anti-viral functions of the liver. 

Other conditions also show a beneficial impact, such as diabetes and stroke. 

‘eighteen studies involving almost half a million people that show overall that coffee, decaffeinated coffee and tea do slightly reduce risk of diabetes.’

One stunning assertion from a study in the report showed that :

‘Coffee appears to have a significant effect on all-cause mortality. The National Institutes of HealthAmerican Association of Retired Persons Diet and Health Study involving 229,119 men and 173,141 women demonstrated an inverse relationship between coffee consumption and mortality. In other words, coffee drinkers had a reduction in mortality compared with non-coffee drinkers.’

Any old caffeine? 

Some of the questions raised include the benefits of tea (or other caffeinated beverages) versus coffee. It appears that coffee itself contains beneficial compounds (particularly those found in the green beans) that other caffeinated drinks do not. And that decaffeinated coffee can have some benefits associated with coffee drinking. 

How much should I drink?

Rightly cautious advice about drinking too much coffee or consuming too much caffeine is flagged. Too much caffeine can have an adverse effect on other conditions, from pregnancy to conditions where medication might be impacted. The difference between men and women is only really significant if you are taking hormonal supplements or, as mentioned, you are pregnant. A moderate 2 to 3 cups a day is suggested by the report authors. 

One factoid of interest – caffeine metabolisation is twice as fast in smokers as non-smokers.

Coffee Caution

Everybody reacts differently to substances and caffeine is itself quite a powerful stimulant. If you have anxiety or depression then do NOT suddenly start drinking lots of coffee! It raises levels of stress hormones adrenaline and cortisol. Plus, it can raise blood pressure. 

Although coffee can enhance energy and alertness, it can also trigger certain conditions, and decaffeinated coffee might provide some benefits without the downsides for people who react strongly to caffeine. However, as noted in Medical News Today In 2013, a study published in World Journal of Biological Psychiatry suggested that drinking between 2–4 cups of coffee a day may reduce suicide risk in adults.

Caffeine is in fact a psychoactive substance and should not be overused. Most studies suggest that more than 400mg of caffeine a day could have adverse effects (probably more than 4 cups of coffee). Plus, as well as the caution for pregnant women, there is a lack of information about how it can impact the growing, changing and susceptible brains of children and adolescents. 

If you would like to read the studies and explore the associated articles on this, then do read the report. https://britishlivertrust.org.uk/wp-content/uploads/The-health-benefits-of-coffee-BLT-report-June-2016.pdf

You can also watch this video from Dr Greger at nutrition facts (buy his excellent book ‘How Not to Die’ which looks at many health conditions and how to optimise your diet to live longer and better).

Dr Greger rightly raises the fact that people metabolise coffee / caffeine very differently. This different metabolisation can result in very different responses, harms and benefits. 

Gilbert’s Syndrome and Caffeine

In the catchily titled piece of scientific research: Caffeine Clearance in Subjects With Constitutional Unconjugated Hyperbilirubinemia

The abstract concludes: ‘CAF altered kinetics in 27% of GS cases may suggest multiple deficits in the hepatocellular metabolism, thus confirming the heterogeneity of this syndrome.’

Ie. caffeine altered the reaction rates in 27% of Gilbert’s Syndrome cases, suggesting that the liver wasn’t processing as well, demonstrating (once again) that Gilbert’s Syndrome has different elements or characteristics. 

(It didn’t seem to impact bilirubin levels or bile acids, though.)

As with many studies into Gilbert’s Syndrome, the conclusions note that there are in fact differences in how our livers process things. But, as is so often the case, this is not taken further, to examine just what that means to the lifestyle management for someone with Gilbert’s Syndrome. 

The implication here is that people with Gilbert’s Syndrome might find coffee or caffeine impacts them negatively, and I’ve written elsewhere how coffee or caffeine can impact energy levels in a way that you may find unhelpful. Stable energy levels and blood sugar are important for the liver enzymes we are deficient in to work properly. We can also experience anxiety as a symptom. These both suggest we would need to be careful around our coffee / caffeine consumption. 

Of course, energy levels can also be an issue if you have Gilbert’s Syndrome. Fatigue is a common symptom of Gilbert’s Syndrome. It would be great to be able to reach for caffeine as a pick me up, to break through that brain fog and boost your concentration!

What caffeine to try when you have Gilbert’s Syndrome

If you want to try caffeine in a different format to coffee, this myprotein drink includes caffeine plus protein and vitamin B6 which can help supplement energy levels too.

Another option is a green coffee bean supplement, this one has additional ingredients to add to the energy boost.

If you don’t want the caffeine, but want the protective elements of green coffee beans (which appear to have the most beneficial compounds), then try this decaffeineated version.

If you want to explore alternatives to coffee then there are other natural stimulants which are more gentle which may help with your energy levels. I take adaptogens to balance my energy levels, you can find a range of supplements here at Approved Vitamins , such as Ashwagandha and Rhodiola (I only use Viridian Maximum Potency Rhodiola ), plus gotu kola which can provide an extra, but gentle, boost that can help concentration levels when they start to flag. I recently tried this one and it works a treat for giving me a gentle pick me up:

Nature’s Answer, Gotu Kola, 950 mg, 90 Vegetarian Capsules

I personally find coffee or caffeine makes me feel quite unwell. I don’t seem to metabolise it comfortably and it leaves me feeling frazzled and sick. I’d love to hear more about whether you find coffee or caffeine helps you, and what your experiences are with it. Please do comment and share your story here. 

This website is dedicated to helping people like you live better with Gilbert’s Syndrome, I hope you find the information interesting and useful – if you do, please consider donating to keep it going. Because so many people struggle to find help and support to live with Gilbert’s Syndrome, please donate today – THANK YOU!

Hack your liver to improve your mental health

We’re all talking more about mental health and that’s really important for people with liver conditions. Liver condition or not – looking after your liver and your mental health will lead to a happier healthier life. 

There’s a ton of evidence that liver disease relates to mental health:

These are serious clinical problems, but whether or not you have a liver condition,  if you aren’t looking after the organ that cleans all the rubbish out of your system (yes, that’s your liver), then you will feel like the bottom of a well used cat litter tray!

This is a two-sided coin – look after one and the other improves. Great! That means you’ve twice the opportunity to feel better. 

There are signs that your liver is stressed, and you should always go to your doctor if you experience jaundice, aches and pains, digestive problems, fatigues, darker urine, mood swings, weight loss, etc https://pharmeasy.in/blog/7-signs-you-suffer-from-liver-stress/

I’m not a doctor and this is not medical advice, this information is from research I’ve linked to (if you want to dig deeper) and curated with additional resources from well regarded books by scientists, doctors and other reputable authors. Links to those books will give me a small commission if you choose to make a purchase – just so we’re clear 😊

Diet

Everything you eat or drink passes through your liver – so let’s start there. 

Alcohol is a well known liver toxin. It’s also an emotional crutch and widely abused. You feel bad so you drink more, it harms your liver, you feel worse, you drink more – it’s a vicious downward spiral. Any alcohol will stress the liver, and if you have a liver condition it will do so even more. If you want to save your liver, and your mental health, save the alcohol for never if you have a liver condition, or in moderation if you are otherwise healthy. Here’s more on that:

https://www.healthline.com/nutrition/alcohol-good-or-bad#section15

Good food feels great! There are tons of wonderful foods that will help your liver and you feel great! Eat more of the good things and you will also keep a healthy weight which will prevent you from getting a fatty liver too.

Some of the foods that work best for supporting the liver include broccoli (and other ‘cruciferous’ veg such as cabbage, cauliflower and radishes), avocados, tomatoes, carrots, beetroot, fruits (apples, lemons, grapefruits) and nuts (Nuts are a good source of glutathione, omega-3 fatty acids that help the liver evacuate ammonia, the substance responsible for certain diseases. They also promote blood oxygenation https://www.myliverexam.com/en/detoxification-some-food-to-cleanse-your-liver/), garlic and turmeric. If you eat healthy food I guarantee you’ll feel better all round. I’m vegan and totally advocate for a completely plant based diet if you want to feel great, full of energy and bright-eyed (yup, helps with the jaundice). You can find out more about food and diets in the books below. 

Sugar – sorry, but it really does make you feel rubbish. Especially if you have a liver condition, such as Gilbert’s Syndrome, your liver will work better if you have a steady blood sugar level https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390583/. This is because the chemicals used by liver processes need steady blood sugar levels to be able to work. Plus, your liver does the hard work in managing your blood sugar levels when they’re high or you need to draw on energy for your muscles http://www.diabetesforecast.org/2012/feb/the-liver-s-role-how-it-processes-fats-and-carbs.html Too much sugar means your liver bgins to store it as fat and ultimately damages the liver. Keeping steady blood sugar levels can be achieved by  eating little and often, and not going long periods without food, plus not relying on high sugar snacks when you feel lethargic. For those of us with liver conditions who have trained their body to love good food just looking at a piece of cake can make me feel sick. If it’s a real treat for you though, don’t deny yourself completely, just don’t make it a daily crutch that keeps you on the uphill treadmill of feeling knackered and rough. 

Read this :

Oh my gosh – Dr Greger is just the most-evidenced expert in nutrition I have ever come across. Honestly, this should be your bible for living a healthy life and feeling great. It’s so persuasive you will be completely convinced and so much more likely to stick to a healthy way of eating: How Not To Die: Discover the foods scientifically proven to prevent and reverse disease by Dr Michael Greger

The Dalai Lama and Daily Mail both think Dr Greger is on the money!

This book may help those who are susceptible to illnesses that can be prevented with proper nutrition. — His Holiness the Dalai Lama

Dr Michael Greger reveals the foods that will help you live longer, Daily Mail

Get the cookbook to go with it: The How Not To Die Cookbook: Over 100 Recipes to Help Prevent and Reverse Disease

#BOSH! Healthy Vegan: Over 80 brand-new recipes with less fat, less sugar and more taste. As seen on ITV’s ‘Living on the Veg’ by Henry Firth, Ian Theasby

Healing Through Nutrition: The Essential Guide to 50 Plant-Based Nutritional Sources by Eliza Savage

Mental wellbeing

There are so many resources that can help your mental health. The less stressed you are the better your liver will work too. ‘Growing scientific evidence has demonstrated the detrimental effects of psychosocial stress on liver diseases in humans and animals ’http://www.ijcem.com/files/ijcem0089076.pdf https://pubmed.ncbi.nlm.nih.gov/16460474/

You can get pretty much instant results from some simple activities, and longer term calm through regular practice. 

Breathing deeply and slowly has a powerful impact on your nervous system. You feel calm instantly! https://www.nhs.uk/conditions/stress-anxiety-depression/ways-relieve-stress/

Be kind – just do one kind thing, and your brain actually produces happy hormones! https://greatergood.berkeley.edu/article/item/kindness_makes_you_happy_and_happiness_makes_you_kind

Meditation has been clinically proven to alter your brain for the better, https://www.healthline.com/health/meditation-for-depression#how-to-try-it

Exercise – a total liver/brain/body hack. Fortunately you don’t have to be a gym bunny or have an olympian body to do this one. Just get outside for a half hour stroll every day for starters. Yes, you WILL feel better. 

Here are some resources to check out to explore this one further. Find what works for you and your lifestyle:

Read this :

The 4 Pillar Plan: How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life Dr Rangan Chatterjee

Chloe Brotheridge is trained in so many disciplines and has a hungry mind for finding ways to live more calmly and confidently. Check out her website and podcasts, at calmer-you.com and buy her book The Anxiety Solution: A Quieter Mind, a Calmer You

These are books by scientists who use proven methods to improve your mental wellbeing –

Mindfulness: A Practical Guide to Finding Peace in a Frantic World (Includes Free CD with Guided Meditations) by Professor Mark Williams, and Dr Danny Penman

The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive by Dr Kristin Neff, a world leading expert in this field

Other resources:

https://www.mind.org.uk/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/self-care-for-anxiety/

https://www.beyondblue.org.au/the-facts/anxiety/treatments-for-anxiety/anxiety-management-strategies

Meditation and mindfulness websites https://www.calm.com/ / https://www.headspace.com/

For young people https://youngminds.org.uk/

For men https://www.thecalmzone.net/

If you need more help, then you can try these helplines and websites

https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/

Extra Science bit for people with Gilbert’s Syndrome

People with Gilbert’s Syndrome may experience anxiety and IBS / gut symptoms. Findings that may explain this are the relationship between serotonin levels in the blood and your brain / gut. There’s a tendency for people with Gilbert’s Syndrome to have too much serotonin in the blood – something called hyperserotoninaemia http://www.hormones.gr/759/article/non-tumoral-hyperserotoninaemia-responsive-to-octreotide%E2%80%A6.html

Anxiety is a common reported symptom of Gilbert’s Syndrome.At the molecular level, recently emerging data have established the increased frequency of dual genetic polymorphisms in UDP glucuronosyl-transferases 1A1 and 1A6 in approximately 87% of patients with Gilbert’s syndrome, leading to defective glucuronidation not only of bilirubin but of several other endogenous and exogenous substrates, such as serotonin, coumarin and dopamine derivatives.7,8

Increased serotonin levels have been reported in patients with Gilbert’s syndrome, suggesting a possible explanation for the nonspecific symptoms described in these patients that are commonly attributed to anxiety.9,10’

There are also studies showing that this and ‘unconjugated bilirubin’ (associated with Gilbert’s Syndrome) may be more evident in people with bi-polar disorder, autism and schizophrenia. In fact people with those conditions are also more likely to have Gilbert’s Syndrome. https://pubmed.ncbi.nlm.nih.gov/16736395/ https://questioning-answers.blogspot.com/2014/05/neonatal-jaundice-and-risk-of-autism.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924810/

So, if you’re more likely to have problems with your mental health, then it’s really important to look after yourself. Following the advice above and keeping to a healthy diet, exercise and mental wellbeing routine will absolutely help you lead a better life with Gilbert’s Syndrome.

Because your support helps keep this research and website alive, please donate today:

links and notes that might help people with Gilbert’s Syndrome

Find out more about how Milk Thistle works. The effective ingredient is sylmarin, and you need enough of a dose for it to have an impact. Read more here: http://www.nlm.nih.gov/medlineplus/druginfo/natural/138.html

Diet plays a really important part in managing your health and wellbeing, and especially in helping your liver. However, there is an industry out there just waiting to push the latest ‘superfood’ your way. NHS ‘Choices’ gives the latest lowdown on the claims and offers the evidence to counter / support them here

Find ordinary household paints make you feel unwell? I’ve been using these for years and they are brilliant! www.ecosorganicpaints.co.uk Odourless, solvent free, totally non-toxic.

Liver help – the basics

The liver is the body’s largest solid organ. It responsible for detoxifying many of the potentially harmful substances that can pollute the body.

The liver also plays a critical role in many other body processes including energy production, digestion, and nutrient storage.

What will help my liver?

The cornerstone of any liver-friendly programme is a diet that makes it easier for your liver to work. Lots of fruits and vegetables will help you and your liver work better.

Not only do these foods tend not to tax and stress the liver, they also contain an lots of nutrients such as vitamin C and carotenoids (e.g. beta-carotene) which can support liver function.

Organic produce is best as this is relatively free of potentially toxic herbicides, pesticides and fungicides.

Drinking plenty of water (about one and-a-half to two litres a day) really helps your body and your liver work well.

What won’t help my liver?

Foods that contain artificial additives such as sweeteners, colourings, flavourings and preservatives might cause your liver more problems.

People with Gilbert’s Syndrome often find that drinking alcohol gives them symptoms such as fatigue, brain fog and jaundice. Alcohol is hard for your liver to process and the less you drink the less stressed your liver will be. Watch out for hidden alcohol! You might find some herbal tinctures or food contains alcohol – worth avoiding if you are particularly sensitive.

You might also find fatty food makes you feel sick, and carbohydrates like sugar and white bread or pasta leave you drained and feeling rough. In Gilbert’s Syndrome you need to keep balanced blood sugar levels to help your enzymes work as well as possible (check out ‘What is Gilbert’s Syndrome’ for an explanation), so refined carbs are best avoided.

Recipes for your liver

BETTER than a sandwich!

For a quick boost try the following super tasty liver loving lunch:

Quick pitta lunch

Wholemeal pitta bread, sliced open, spread with humous or tahini, add slices of avocado, a handful of watercress and spinach, and season with a dash of lemon juice, salt and black pepper. For extra nutrition and yumminess add sesame seeds or pine nuts or sunflower seeds. Scrumptious.

Wow! Tasty, quick POWER salad.

Puy lentil salad with soy beans, sugar snap peas & broccoli

Serves 4

Ingredients

  • 200.0g Puy lentils
  • 1.0l hot vegetable stock
  • 200.0g tenderstem broccoli
  • 140.0g frozen soya beans , thawed
  • 140.0g sugarsnap peas
  • 1 red chilli , deseeded and sliced

Dressing

  • 2 tbsp sesame oil
  • juice 1 lemon
  • 1 garlic clove , chopped
  • 40.0ml reduced-salt soy sauce
  • 3cm piece fresh root ginger , finely grated
  • 1 tbsp clear honey

 Boil lentils in stock until just cooked, about 15 mins. Drain, then tip into a large bowl.

  1. Bring a saucepan of salted water to the boil, throw in the broccoli for 1 min, add the beans and peas for 1 min more. Drain, then cool under cold water. Pat dry, then add to the bowl with the lentils.
  2. Mix together the dressing ingredients with some seasoning.
  3. Pour over the lentils and veg, then mix in well with the chopped chilli. Pile onto a serving platter or divide between 4 plates and serve.

Per serving

302 kcalories, protein 22.0g, carbohydrate 42.0g, fat 7.0 g, saturated fat 1.0g, fibre 8.0g, sugar 9.0g, salt 1.41 g

Recipe from Good Food magazine.

Day or night, alone or with friends – tasty goodness.

Avocado and black bean wraps

Serves 4 for a filling meal, or halve the quantities and serve with a leafy salad for a lighter lunch.

Ingredients

  • 8 wholemeal wraps (in world food isle with Mexican stuff, or in bakery section)
  • 1 tbsp olive oil
  • 1 onion , chopped
  • 3 garlic cloves , chopped
  • 1 tbsp paprika
  • 1 tbsp ground cumin
  • 5 tbsp cider vinegar
  • 3 tbsp clear honey
  • 3 x 400g cans black beans , rinsed and drained
  • choose a few toppings-  diced avocado, salsa, sliced jalapeño peppers
  • crème fraîche / yoghurt or Tabasco / hot pepper sauce, to serve

Serve with green salad, sliced tomatoes, or green beans and sweetcorn.

  1. In a large frying pan, heat the oil. Add the onion and garlic, and cook for 5 mins.
  2. Add the spices, vinegar and honey. Cook for 2 mins more.
  3. Add the beans and some salt / pepper, and heat through.
  4. Remove from the heat and mash the beans gently with the back of your spoon to a chunky purée.
  5. Spread some beans over wraps, scatter with your choice of toppings and add a spoonful of crème fraîche / yoghurt to cool down, or a splash of Tabasco / hot pepper sauce to spice it up.
  6. Roll up and YUM!

Sin free sinning!

This wonderful recipe is from a very good friend:

Fat free fudgy wudgy brownies

Preheat the oven to 180C

Dry ingredients:

¾ cup of wholemeal flour

¼ cup cocoa powder

½ cup white flour

1 tsp baking powder

½ cup Demerara sugar (or brown sugar)

¾ cup broken walnuts (optional)

Handful dark chocolate chips (optional)

Mix the dry ingredients together in a bowl.

Wet ingredients:

1 ½ cups black beans (one tin drained and rinsed well)

1 cup pitted medjool dates (this can be anywhere from 7-10 dates depending on their size, or just use ordinary dried dates if you don’t want to fork out for medjool)

¼ cup maple syrup (or date syrup, which is particularly tasty, or indeed any other kind of syrup)

Whiz the wet ingredients together in a food processor until completely smooth.

Then add:

1 TB balsamic vinegar (or cider vinegar)

3 tsp instant coffee (optional but enhances the flavour)

1 tsp vanilla essence

2 TB flax meal (ground flax seeds) or other ground seeds such as hemp powder

1 cup water

Whiz that all up until it is smooth, then mix in with the dry ingredients.

Spoon into a greased 9×12 or 9×13 pan.

Bake for 14 minutes then take the pan out and rotate it and put it back in for another 14 minutes. Test with a toothpick to see if it comes out clean. If not put it in for 2 more minutes.

Let cool before you slice. Slice it into 16 brownies-4 by 4.

Store in an airtight tin. I think they taste better the next day. Yum!

 

Detox diets and Gilbert’s Syndrome

I’ve been monitoring the ‘de-tox diet’ phenomenon for many years, and each year my scepticism grows. Avid marketers have spotted a desire for many people to find a solution to the modern malaise of feeling tired and sluggish, and there is a proliferation of products – powders / pills / soups /  excercises / regimes / books / websites / treatments etc that claim to help powerfully cleanse the body and leave you lighter, fresher, and generally bright eyed and bushy tailed.

However, on the one hand many run of the mill Doctors will tell you that the liver does a perfectly good job of dealing with toxins. On the other hand many people feel generally under par much of the time. Although I agree that the liver generally does an excellent job, some of us may need a wee bit more help for our liver to do the job we want it to.  Given the disadvantage that those with Gilbert’s Syndrome experience, with a reduced capacity to process certain toxins, it makes sense to me to look after my diet so that I can help my liver. But I don’t want to burden my body with the shock of suddenly changing my diet to all fruit or liquid or pureed broccoli or whatever. My message would be to make a lifestyle choice to ensure you feel better EVERY day.

So, what can we all agree on?  Well, water is good for you. Drink plenty of it. Alcohol may be ok in small quantities, but personally it makes me feel awful so I avoid it. Caffeine can mess up your blood sugar levels and so reduce your ability to maintain consistent energy, particularly because those with Gilbert’s Syndrome are lacking in an enzyme that needs stable blood sugar levels for it to work properly. Eat little and often to keep your energy up, but make sure you stick to wholefoods such as brown rice, wholemeal bread, crackers, jacket potatoes etc and plenty of vegetables and fruit and not high fat food. This will help you maintain a steady weight, not experience hunger pangs, as well as avoiding over burdening your liver with fat processing. Protein is supposed to help with extra energy. I avoid eating animals and animal products for environmental reasons as well as health and compassionate reasons, so my sources of protein tend to be marmite (full of an awesome range of vitamins), and nut butters, such as peanut butter and cashew butter (high in fat but replace margarine and used as my only source of fat– don’t rule it out completely as your body does need fat), avocado, hemp powder added to soups and dressings, plus lots of soya milk.

Star liver foods include: broccoli, garlic, turmeric, avocado, beetroot, apples, lemons, walnuts.

If you need caffeine then try swapping to green tea which is better at cleansing the liver, and more gentle to your system than coffee.

Don’t forget a little naughty treat is ok. But use it as a reward for staying generally more liver conscious and once a week rather than every day. I like the 80 / 20 rule – stay 80% within a good diet, then the other 20% ain’t so bad.

Helping your liver deal better with toxins

Good news! The detox process of the liver which won’t work as well for people with Gilbert’s Syndrome is called Glucuronidation and this process can be helped with Calcium D-Glucarate, glycine, magnesium, and b vitamins.

  • Calcium D Glucarate can be taken as tablets or capsules, but is also available in apples, brussels sprouts, broccoli, cabbage and bean sprouts.
  • Glycine is an amino acid and in high-protein foods, such as fish, meat, beans, milk, and cheese. Glycine is also available in capsule and powder forms, and as part of many combination amino acid supplements.
  • Spices, nuts, cereals, coffee, cocoa, tea, and vegetables are rich sources of magnesium. Green leafy vegetables such as spinach are also rich in magnesium as they contain chlorophyll. Magnesium supplements are widely available and often with calcium and vitamin c which help its absorption. The best absorbed types of magnesium are citrate and malate, rather than the cheaper form of oxide.
  • B vitamins are available in many different foods (see the NHS website), but the easiest ways of accessing them are through yeast extracts such as Marmite, and fortified cereals.

So why not help yourself and make sure your diet contains a good balance of foods that may help your liver to work better.

Milk Thistle (Sylbum marianum )

The medicinal use of milk thistle can be traced back to ancient Greece and Rome.  Today researchers around the world have completed more than 300 scientific studies that attest to the benefits of this herb, particularly in the treatment of liver ailments.

Common uses:

  •        Protects liver from toxins, including drugs, poisons and chemicals.
  •        Treats liver disorders such as cirrhosis and hepatitis
  •        Reduces liver damage from excessive alcohol.
  •        Aids in the treatment and prevention of gallstones
  •        Helps to clear psoriasis.

Forms : capsule, tablet, tincture.

What it is.

Know by its botanical name, Silybum marianum, as well as by its main active ingredient, sylmarin, milk thistle is a member of the sunflower family, with purple flowers and milky white leaf veins.  The herb blooms from June to August, and the shiny black seeds used for medicinal purposes are collected at the end of the summer.

What it does.

Milk thistle is one of the most extensively studied and document herbs in use today.  Scientific research continues to validate its healing powers, particularly for the treatment of liver-related disorders.  Most of its effectiveness stems from a complex of three liver-protecting compounds, collectively know as silymarin, which constitutes 4% to 6% of the ripe seeds.

Major benefits.

Among the benefits of milk thistle is its ability to fortify the liver, one of the body’s most important organs.  The liver processes nutrients, including fats and other foods.  In addition it neutralises, or detoxifies many drugs, chemical pollutants and alcohol.  Milk thistle helps to enhance and strengthen the liver by preventing the depletion of glutathione, an amino acid-like compound that is essential to the detoxifying process.  Moreover, studies have shown that it can increase glutathione concentration by up to 35%.  Milk thistle is an effective gatekeeper, limiting the number of toxins which the liver processes at any given time.  The herb is also a powerful antioxidant.  Even more potent than vitamins C and E, it helps to prevent damage from highly reactive free-radical molecules.  It promotes the regeneration of new liver cells which replace old and damaged one.  Milk thistle eases a range of serious liver ailments, including viral infections (hepatitis) and scarring of the liver (cirrhosis).  The herb is so potent that it is sometimes given in an injectable form in hospital resuscitation rooms to combat the life-threatening, liver-obliterating effects of poisonous mushrooms.  In addition, because excessive alcohol depletes glutathione, milk thistle can aid in protecting the livers of alcoholics or those recovering from alcohol abuse.

 Additional benefits.

In cancer patients, milk thistle limits the potential for drug-induced damage to the liver after chemotherapy, and it speeds recovery by hastening the removal of toxic substances that can accumulate in the body.  The herb also reduces the inflammation and may slow the skin-cell proliferation associated with psoriasis.  It may be useful for endometriosis (the most common cause of infertility in women) because it helps the liver to process the hormone oestrogen, which at high levels can make pain and other symptoms worse.  Finally, milk thistle can be beneficial in preventing or treating gallstones by improving the flow of bile, the cholesterol-laden digestive juice that travels from the liver through the gall bladder and into the intestine, where it helps to digest fats.

How to take it.

Dosage :  The recommended dose for milk thistle is up to 200mg of standardised extract (containing 70% to 80% silymarin) three times a day; lower doses are often very effective.  It is often combined with other herbs and nutrients, such as dandelion, choline, methionine and inositol.  This combination may be labelled ‘liver complex’ or ‘lipotropic factors’.  For proper dosage follow the instructions on the packet.

Guidelines for use : Milk thistle extract seems most effective when taken between meals.  However, if you want to take the herb itself, a tablespoon of ground milk thistle can be sprinkled over breakfast cereal once daily.  Milk thistle’s benefits may be noticeable within a week or two.  The herb appears to be safe, even for pregnant and breastfeeding women.  No interactions with other medications have been noted.

Possible side effects : Virtually no side effects have been attributed to the use of milk thistle which is considered one of the safest herbs on the market.  However in some people it may have a slight laxative effect for a day or two.

Buying guide.

To ensure you are getting the right dose buy products made from standardised extracts that contain 70% to 80% silymarin, milk thistle’s active ingredient. Studies show that preparations containing milk thistle bound to phosphatidylcholine, a constituent of the natural fatty compound lecithin, may be better absorbed than ordinary milk thistle.

When taking milk thistle to alleviate liver damage from excessive alcohol, avoid alcohol based tinctures as they can weaken the resolve to break the addiction.

Recent Findings.

Milk thistle may be a weapon in the fight against skin cancer.  Researchers at Case Western Reserve University in Cleveland, Ohio, found that when the active ingredient, silymarin, was applied to the skin of mice, 75% fewer skin tumours resulted after the mice were exposed to ultra violet radiation.  More studies are needed to see if it has a similar effect in humans.

Final fact.

The components of milk thistle are not soluble in water, so teas made from the seeds usually contain few of the herb’s liver-protecting ingredients.

Gilbert’s Syndrome in Young People

It is possible that the reason for the syptoms of Gilbert’s Syndrome becoming obvious at puberty could be similar to the reason they can become more obvious at  the onset of the menopause – hormones.  One of the major roles of the liver is to process and metabolise hormones.

At the onset of puberty the hypothalamus (part of the brain) produces gonadotrophin-releasing hormone.  This stimulates the pituitary gland (also in the brain) to emit follicle stimulating hormone and luteinising hormone.  In boys, when these hormones arrive at the testes they trigger production of testosterone.  This travels round the body and initiates puberty.  In girls when the follicle stimulating hormone and luteinising hormone reach the ovaries they trigger the release of oestrogen and progesterone.  The oestrogen initiates puberty whilst the progesterone prepares the body for pregnancy.  This means there is a major shift in the balance of hormones in the body, which the liver has to process.

These hormonal changes have a huge effect on the whole person, from changes in the appearance of the body to mood swings, and also the emotional aspect of dealing with sudden bodily changes.  With the hormones having such a massive affect on anyone going through puberty it is not difficult to imagine that the changes stress the liver as well, making Gilbert’s Syndrome symptoms more obvious and harder to deal with along with everything else that is happening at this time.

For children and teenagers with Gilbert’s Syndrome it is an unfortunate reality that they have to be emotionally mature more quickly than others.  The key to controlling Gilbert’s Syndrome is to be sensible, which isn’t really what being a child or a teenager is all about, and young people’s brains aren’t wired to be careful. It is possible to carry on with activities and sports but this may have to be balanced off against other things.  The best way to do this and ensure that the symptoms of Gilbert’s Syndrome are not suffered, is not to stress the liver in any way.  The more you take charge of your lifestyle the more choices you have for what activities you want to do.

This responsibility will fall to parents in the case of younger children and may involve having to deny treats, in the form of sugary and refined food/drink and making sure the children get lots of sleep.  Having said all that there is no major harm in occasional treats or late nights as long as it is understood and acknowledged that it may have an effect on energy.  More planning may be required as to when treats are given.

In some ways the earlier the diagnosis of Gilbert’s Syndrome the better the position to cope with it long term compared to someone who has lived in ignorance for years and has a lot of bad work to undo.  It may be useful to give the child as much information as they can  understand and explain that they are a bit different to peers in some ways, but its quite painlessly controlable compared to other differences (most children know someone with epilepsy/diabetes etc).

Here are some practical suggestions for older children or teenagers that I have found beneficial:-sleeping teenager

  • On school nights go to bed early but record any programmes you want to watch.  Then set aside Sunday afternoon to watch them– ensures early nights without missing out on anything and ensures a rest at the weekend.  Also, weekend omnibuses are a cracker!
  • do your homework as soon as you get in from school, maybe after a healthy snack, that way the hard stuff is done before you get too study when your energy levels are highesttired (meaning it’s done more quickly and to a better standard too) then whatever energy is left can be spent with friends or watching TV, whatever you enjoy doing, whilst ensuring there is no pressing reason not to have an early night.
  • Priorities – when I was at secondary school, even though we didn’t know about the Gilbert’s Syndrome, my parents felt my priority was my school work, as did I, and so I wasn’t expected to do anything around the house as long as I was working hard at school.  I also had my weekends and holidays to myself to relax and have fun.  Every child/teen’s priorities are different but if they are agreed, maybe concessions could be made in other areas.
  • During A levels (still undiagnosed with Gilbert’s Syndrome) I had a lot of time off 6th form, this may have been avoided had I known that, staying up late to get academic work done, whilst chugging gallons of coffee through the day and evening to try and keep me going, along with sugar hits here and there were actually making me less able to cope because I was majorly stresing my liver (and going clubbing and drinking at the weekends wasn’t helping either!).  If I had been aware of Gilbert’s Syndrome I could have done more work in free periods at school while I was still alert, had early nights, eaten healthily, gone out maybe every other weekend and avioded alcohol and sugary drinks.  This may have resulted in less time off school and better health.

I hope this article hasn’t made life with Gilbert’s Syndrome sound too difficult to deal with, everyone finds their own balance and in my own experience it’s worth the initial effort to change to a very healthy diet and think more about balancing activities and rest in order to feel more alive.

(by contributor Nicola Southworth)

The Liver Fortifying Diet

The liver fortifying diet:

Cut down on the alcohol, salt, caffeine, tobacco, medication, sugar, and fat and stock up on these goodies.  Your liver will love you.

Essential Vitamins and Minerals

Vitamins C and E and minerals zinc and selenium are ‘antioxidants’ shown to aid liver healing. Sources include carrots, tomatoes, peppers, watercress, citrus fruits, berries, wholegrains seeds and oils.

B vitamins and choline are found in egg yolks, liver, legumes and brewer’s yeast and can help liver function.  Make sure your diet contains plenty of green leafy veg rich in folic acid, wholegrains and shellfish rich in vitamin B6, and vitamin B12 foods such as fortified cereals, seafood and seaweed.

 Cruciferous Veg.

Members of the cabbage family have been shown to activate the liver’s cytochrome P450 detoxification process and glutathione conjugation.  In plain English – a process that converts fat-soluble toxins into water-soluble ones, more easy for your body to get rid of.

broccoli cauliflower cabbage
food good for Gilbert's Syndrome

Try include broccoli, cauliflower, kale, mustard greens, radish, brussel sprouts and cabbage in your diet.

Sulphur rich foods.

Garlic, onions, eggs and legumes are rich in sulphur.  They can enhance the sulphuration detoxification process performed by the liver.

Detoxing superfoods.

You should add red fruits, berries, beetroot, and grapes to your diet, as these all help the liver to detoxify and are high in toxin fighting anthrocyanidines.  Papayas and pineapple contain useful enzymes to improve digestion and lemons have a strong cleansing effect.

Helpful Herbs.

Milk thistle, dandelion, turmeric and liquorice have all been shown to aid liver function.  Ginger is also an excellent cleanser.

Good Protein.

The liver needs protein to repair itself, and a diet high in protein gives some people with Gilbert’s Syndrome more energy.  Choose healthy alternatives to red meat such as fish, nuts, pulses and seeds as they are easier to break down and place less of a burden on your liver.

Water.

Once your liver has removed the toxins from your body, you must flush them out of your body.  The only way to do this is to drink lots of water.  Three pints or eight glasses a day minimum!  Although you may find this no problem as some sufferers have expressed how thirsty they seem these days.

itchy skin

Do you find a side of effect of your GS is itchy skin?  A lot of us experience it.  One suggestion why this might happen is that your skin, as the bodies 2nd largest detoxification organ after your liver, is trying to help your ailing liver in the detox process.  Here’s a couple of tips that might help – 1) Skin brushing before your morning shower or bath helps to stimulate circulation and encourage detoxification.  Brush towards your heart using firm strokes. 2) If you’ve over indulged and your liver is struggling, swapping your morning-after coffee with a cup of nettle or dandelion tea will replace lost minerals and support your liver’s detoxification process.