Why You Might Want to Rethink Spending Money on Milk Thistle if you have Gilbert’s Syndrome
Milk thistle (Silybum marianum), a member of the Asteraceae family, has long been hailed as a powerful herbal remedy for liver health. Used for over 2,000 years, this plant is celebrated for its supposed benefits, which include antioxidant, anti-inflammatory, and liver-regenerating properties. But do the claims hold up under modern scientific scrutiny? Let’s explore the research to see if milk thistle deserves its reputation—or your money.
What is Milk Thistle?
Milk thistle’s active ingredient, silymarin, is a compound derived from the plant’s seeds. Silymarin is a mixture of three compounds, including silybin (the most potent component), silydianin, and silychristin. These compounds are thought to provide therapeutic effects, particularly for liver-related issues such as:
Alcoholic liver disease
Nonalcoholic fatty liver disease (NAFLD)
Viral hepatitis
Toxin-induced liver injury
The Science Behind the Claims
You may have read about the great benefits of taking Milk Thistle for protecting your liver.
Numerous preclinical studies suggest that silymarin has antioxidant and other benefits. For instance, it has shown promise in animal studies for reducing liver damage caused by substances like acetaminophen, alcohol, and certain toxins. However, when it comes to human clinical trials, the evidence is far less convincing.
A 2018 review concluded that while preclinical data are encouraging, the results from human trials remain inconsistent and inconclusive. In particular, well-designed randomized clinical trials are needed to verify whether milk thistle truly benefits liver diseases.
The Hidden Risks: Enzyme Inhibition
Beyond its questionable efficacy, milk thistle may pose risks due to its interaction with liver enzymes. This affects people with Gilbert’s Syndrome in particular. It’s time to rethink Milk Thistle and Gilbert’s Syndrome!
Research has found that silymarin, particularly silybin, inhibits UDP-glucuronosyltransferase (UGT) enzymes such as UGT1A1. People with Gilbert’s Syndrome have less of this enzyme than other people.
UGT1A1 plays a crucial role in metabolizing drugs and toxins. Inhibiting this enzyme can lead to higher levels of certain medications in the bloodstream, potentially causing adverse effects. For example:
Chemotherapy Drug Interaction: A study on irinotecan, a chemotherapy drug metabolized by UGT1A1, found that milk thistle inhibited the drug’s metabolism. This led to increased drug concentrations, raising concerns about toxicity.
Raloxifene Interaction: Milk thistle compounds were shown to inhibit the metabolism of raloxifene (a drug for breast cancer prevention), potentially amplifying its effects by 4-5 times—a significant risk.
These findings underscore the importance of caution when using milk thistle alongside medications with a narrow therapeutic window (where small differences in dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions). It’s particularly important if you have Gilbert’s Syndrome, as you are already impacted, and this could cause further issues with processing of drugs.
Is Milk Thistle Safe?
Despite these concerns, milk thistle is generally considered safe at therapeutic doses. Studies show that it is well-tolerated even at high doses (up to 700 mg three times daily for 24 weeks), with mild side effects such as nausea or diarrhea reported in some cases. However, the herb’s potential to interact with medications remains a significant issue, especially for people taking drugs metabolized by UGT1A1, CYP3A4, or CYP2C9. And especially if you have Gilbert’s Syndrome.
A Closer Look at the Benefits
While milk thistle is widely marketed as a liver “saviour,” the scientific consensus suggests that’s not the case. The gap between promising laboratory studies and lacklustre clinical results leaves little reason to believe it helps for most liver diseases. Moreover, its enzyme-inhibiting properties can lead to harmful drug interactions.
The Bottom Line
Milk thistle is not the miracle herb it’s often claimed to be. While it may offer some antioxidant and liver-protective effects, the current evidence does not justify its widespread use, especially given its potential to interfere with vital enzymes. If you’re considering milk thistle for liver health or any other condition, consult a healthcare provider to ensure it’s safe and suitable for your needs.
In the end, your liver—and your wallet—may thank you for skipping this overhyped supplement.
Studies show that Calcium-D-glucarate may help fight Gilbert’s Syndrome symptoms. Here I unpack what it is and what it could do for people with Gilbert’s Syndrome.
What is Calcium-D-glucarate?
Calcium-D-glucarate is naturally found in fruits and vegetables. It’s a combination of calcium with glucaric acid, and is similar to glucaric acid which is found in the body. It is commonly used as a dietary supplement due to its potential health benefits.
What does Calcium-D-glucarate do and why does it help fight Gilbert’s Syndrome symptoms?
Some studies show that Calcium-D-glucarate may have a positive effect on liver health and bile metabolism. It is believed that Calcium-D-glucarate may improve the detoxification process in the liver by increasing the excretion of certain toxins. Importantly for people with Gilbert’s Syndrome this includes bilirubin.
How does Calcium-D-glucarate help fight Gilbert’s Syndrome symptoms?
It’s thought that Calcium-D-glucarate stops an enzyme called beta-glucuronidase. This enzyme is responsible for breaking the bond between glucuronic acid and toxins. This lets them be reabsorbed into the body instead of being eliminated. This means that by stopping beta-glucuronidase from working as well, Calcium-D-glucarate may help prevent the reabsorption of bilirubin and other toxins.
Here’s what happens in your body in medical terms:
Beta-glucuronidase is an enzyme that plays a role in the breakdown of bilirubin in the intestines. It acts by deconjugating bilirubin, converting it back into its unconjugated form, which is less water-soluble. Normally, bilirubin that has been conjugated by UGT1A1 in the liver is excreted into the intestines, where it is further metabolised and eliminated from the body. However, in individuals with Gilbert’s syndrome, the reduced UGT1A1 activity leads to impaired bilirubin conjugation. The presence of beta-glucuronidase in the intestines can cause an increased release of unconjugated bilirubin.
The increased activity of beta-glucuronidase can contribute to higher levels of unconjugated bilirubin. This makes the symptoms of Gilbert’s syndrome worse.
Here’s what this means in ordinary words-
Calcium-D-glucurate gets in the way of chemicals that increase bilirubin and so you can deal with it more easily, if you have Gilbert’s Syndrome.
Be cautious!
It is always important to note that the available research on Calcium-D-glucarate’s effect on bilirubin is limited. More studies are needed to establish how well it works in reducing Gilbert’s Syndrome symptoms.
Is it the right supplement for you?
Don’t forget – everyone responds differently to supplements too. You might have other conditions that mean that Calcium-D-glucarate isn’t right for you. It does other things, such as affect estrogen levels and some suggest its use for hormone related conditions :https://drbrighten.com/benefits-of-calcium-d-glucarate/. Make sure you check with your Doctor before taking it as it could affect other medications.
You can increase your levels of the glucaric acid element by eating more apples, oranges, broccoli, cauliflower and cabbage.
You can also decrease the beta-glucuronidase that may be worsening your symptoms by eating a healthy low fat diet, that includes plenty of fresh fruit and veg. Reducing smoking, alcohol and sugar may also help. Want to find out more about how your diet can help you live a happier life with Gilbert’s Syndrome? Check out this post https://gilbertssyndrome.org.uk/the-liver-diet/ You can find out more about food and nutrition to help with Gilbert’s Syndrome in the Posts ‘diet’ category here https://gilbertssyndrome.org.uk/category/diet/
If you decide you want to get a supplement, try this one. It has good reviews, although badged as for women due to its impact on hormones – you don’t have to be a woman to take it of course.
So, it sounds like Calcium-D-glucarate just might have a positive impact on bilirubin levels by potentially enhancing the liver’s detoxification processes. However, further research is needed to fully understand its effects, and it is advisable to consult a healthcare professional for personalised advice if you plan to take a supplement.
These small seeds pack a protein punch and produce more oil than most nuts or seeds. They bundle in calcium, manganese, copper, magnesium, phosphorous and Vitamin B1. Sesame seeds have properties that protect the liver, reduce inflammation and pain, level out blood sugar and reduce cholesterol. They are purported to be anti-cancer, anti-aging, and are antioxidant.
‘A 2013 study by researchers from the Tabriz University of Medical Sciences reported that 40 grams of sesame seeds were better than Tylenol when it came to alleviating the pain caused by knee arthritis.’
Wow! With that much going on – why not get the wok out and start stir frying with a dash of sesame seed oil, ginger, garlic and some sliced veg right now!
Studies indicate that sesame could be a ‘hepatoprotectant’ or liver protector.
So what does sesame do?
Your liver faces stresses from toxins all around us: pharmaceuticals, pesticides, fumes and particulates in the environment, additives in food and overindulging in alcohol or other toxic stimulants and relaxants. It seems that sesame could be a much needed support for the liver, struggling with modern toxic impacts.
The technical bit: sesame maintains levels of glutathione (a potent antioxidant), reducing free radicals and inhibiting the oxidation of fats. (Antioxidants fight free radicals which damage the cells of your body. Free radicals are unstable molecules produced because of environmental pressures on your system).
So, in more straightforward terms – sesame helps the good stuff in your body fight off the damage to your body caused by those toxins that we’re swallowing and surrounded by.
Sesame also appears to be safe for you. As sesame can change blood sugar levels and lower blood pressure, then do be careful if you have diabetes or already low blood pressure.
If you want to protect your liver, boost your immune system, lower your blood pressure, lower your cholesterol, reduce cancer risk and boost vital nutrients, then adding sesame into your diet is a great choice. Tahini (sesame seed paste) and sesame seed oil, as well as the seeds themselves, are available in all supermarkets, and can be used in cooking, spread on toast, added to dressings, used to make hummus, stir frys and so much more.
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:
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
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.pdfhttps://pubmed.ncbi.nlm.nih.gov/16460474/
You can get pretty much instant results from some simple activities, and longer term calm through regular practice.
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:
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 –
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’
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:
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.
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.
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.
Boil lentils in stock until just cooked, about 15 mins. Drain, then tip into a large bowl.
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.
Mix together the dressing ingredients with some seasoning.
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.
In a large frying pan, heat the oil. Add the onion and garlic, and cook for 5 mins.
Add the spices, vinegar and honey. Cook for 2 mins more.
Add the beans and some salt / pepper, and heat through.
Remove from the heat and mash the beans gently with the back of your spoon to a chunky purée.
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.
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!
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.
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.
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.
A recent article from Net Doctor has food for thought for those of us on long term medication. Please don’t take initiatives with your medication – talk to your Doctor or Pharmacist first! :
Patients are putting themselves at risk of serious harm by believing it is beneficial to occasionally stop taking long-term medicines in order to given their body a ‘detox’, experts have warned.
Research by the National Pharmacy Association (NPA) suggests that one in five people believe a so-called ‘medicines detox’ is beneficial.
However, the NPA warned that this could be seriously harmful for patients with conditions such as diabetes, asthma or depression, as they could lose control of their illness.
The survey also revealed that nearly one in three people believe it is safe to take non-prescription medicines that have been recommended for other people.
And some wrongly assume it is okay for a child to take an adult’s medication, as long as the dosage is reduced.
NPA head of information Leyla Hannbeck said: ‘There is a lot of misunderstanding about how medicines work in your body.
‘It’s important to get the right treatment and the right advice – which you can get from your local pharmacy, often without an appointment.’
Pharmacies provide a wealth of services in addition to dispensing medicines.
These include the disposal of unwanted medicines, promotion of healthy lifestyles and support for self-care.
Pharmacists can also provide personalised advice on medicines, smoking cessation support and guidance on sexual health.
Glucuronidation
The UGT enzyme (that people with Gilbert’s Syndrome don’t have so much of) works in one particular part of your liver and is responsible for the part (or pathway) of your liver’s processing called ‘glucuronidation’. Glucuronidation happens when toxins are bound to glucuronic acid which is produced by the liver. Chemicals processed by glucuronidation include common opiate based drugs used in pain relief or during surgery (Liston, H.; Markowitz, J.; Devane, C. (2001). “Drug glucuronidation in clinical psychopharmacology”. Journal of clinical psychopharmacology). Other things that affect glucuronidation include smoking, obesity, age and gender.
Some herbal supplements may help glucuronidation (Effects of herbal supplements on drug glucuronidation. Review of clinical, animal, and in vitro studies. March 2011 Mohamed ME, Frye RF.Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida 32610, USA.)The use of herbal supplements has increased steadily over the last decade. Recent surveys show that many people who take herbal supplements also take prescription and nonprescription drugs, increasing the risk for potential herb-drug interactions. In vitro and animal studies indicate that cranberry, gingko biloba, grape seed, green tea, hawthorn, milk thistle, noni, soy, St. John’s wort, and valerian are rich in phytochemicals that can modulate UGT enzymes. However, the IN VIVO consequences of these interactions are not well understood. Only three clinical studies have investigated the effects of herbal supplements on drugs cleared primarily through UGT enzymes. The need for further research to determine the clinical consequences of the described interactions is highlighted.
Essential for Glucuronidation are the nutrients L-glutamine, aspartic acid, iron, magnesium, B3 (niacin) and B6. Thyroid should also be adequate. Cruciferous vegetables (cauliflower, cabbage, cress, bok choy, broccoli and similar green leaf vegetables) are helpful. Glucuronidation efficiency can be improved by calcium-d-glucarate. However, you have to start very gradually with the calcium-d-glucarate, and be very consistent.
People with Gilbert’s Syndrome can experience unpleasant reactions when they drink alcohol, although it doesn’t bother some people at all. Here is what happens in the body when you drink:
Alcohol is metabolized extremely quickly by the body – absorbed and metabolized before most other nutrients. About 20% is absorbed directly across the walls of an empty stomach and can reach the brain within one minute.
Once alcohol reaches the stomach, it begins to break down with the alcohol dehydrogenase enzyme. This process reduces the amount of alcohol entering the blood by approximately 20%. (Women produce less of this enzyme, which may help explain why women become more intoxicated than men).
About 10% of the alcohol is expelled in the breath and urine.
Alcohol is rapidly absorbed in the upper portion of the small intestine. The alcohol-laden blood then travels to the liver via the veins and capillaries of the digestive tract, which affects nearly every liver cell. The liver cells are the only cells in our body that can produce enough of the enzyme alcohol dehydrogenase to oxidize alcohol at an appreciable rate.
Though alcohol affects every organ of the body, it’s most dramatic impact is upon the liver. The liver cells normally prefer fatty acids as fuel, and package excess fatty acids as triglycerides, which they then route to other tissues of the body. However, when alcohol is present, the liver cells are forced to first metabolize the alcohol, letting the fatty acids accumulate, sometimes in huge amounts. Alcohol metabolism permanently changes liver cell structure, impairing the liver’s ability to metabolize fats. This is why heavy drinkers develop fatty livers.
The liver can deal with about ½ ounce of ethanol per hour (about one drink, depending on a person’s body size, food intake, etc.). If more alcohol arrives in the liver than the enzymes can handle, the excess alcohol travels to all parts of the body, circulating until the liver enzymes are finally able to process it.
If you are looking after your liver, then it pays to not drink alcohol!
For people with Gilbert’s Syndrome alcohol will likely raise bilirubin levels, and can result in a hangover that’s pretty quick to appear and may last for days.
OK, this is quite technical, but quite handy to know as background to how your liver works:
The liver is one of the most important organs in the body when it comes to detoxifying or getting rid of foreign substances or toxins. The liver neutralizes a wide range of toxic chemicals, both those produced by your own body and those from the environment.
One of the liver’s primary functions is filtering the blood. Almost 2 quarts of blood pass through the liver every minute for detoxification. Filtration of toxins is absolutely critical as the blood from the intestines contains high levels of bacteria, and various other toxic substances. When working properly, the liver clears 99% of the bacteria and other toxins during the first pass.
Bile Excretion
The liver’s second detoxification process involves the synthesis and secretion of bile. Each day the liver manufactures approximately 1 quart of bile, which serves as a carrier in which many toxic substances are dumped into the intestines. In the intestines, the bile and its toxic load are absorbed by fibre and excreted. However, a diet low in fibre results in inadequate binding and reabsorption of the toxins.
Phase I and Phase II Detoxification
The liver’s third role in detoxification involves a two-step process, Phase 1 and Phase 2. If the phases are out of balance, as in Gilbert’s Syndrome where Phase 2 is impaired, then you are more sensitive to toxins. These toxins not only include drugs, pesticides, and toxins from the gut, but also normal body chemicals such as hormones and inflammatory chemicals (e.g. histamine) which become toxic if allowed to build up.
Phase I enzymes directly neutralize some chemicals, but most are converted to intermediate forms that are then processed by phase II enzymes. These intermediate forms are much more chemically active and therefore more toxic.
Phase II detoxification typically involves ‘conjugation’. Conjugation is where various enzymes in the liver attach small chemicals to the toxin. This conjugation (or binding together) reaction either neutralizes the toxin or makes the toxin more easily excreted through the urine or bile. Phase II enzymes act on some toxins directly, while others must first be activated by the phase I enzymes. There are essentially six phase II detoxification pathways:
· Glutathione conjugation, Amino acid conjugation, Methylation, Sulfation, Acetylation and , Glucuronidation – this last one is impaired in GS sufferers.
Glucuronidation
Glucuronidation, the combining of glucuronic acid with toxins, requires the enzyme UDP-glucuronyl transferase (UDPGT). Many of the commonly prescribed drugs are detoxified through this pathway. It also helps to detoxify aspirin, menthol, vanillin (synthetic vanilla), food additives such as benzoates, and some hormones. Glucuronidation appears to work well, except for those with Gilbert’s syndrome.
The activity of UDPGT is increased by foods rich in the monoterpene limonene (citris peel, dill weed oil, and caraway oil). Methionine, administered as SAM, has been shown to be quite beneficial in treating Gilbert’s syndrome.
Nutrients needed by phase II detoxification enzymes
Glutathione conjugation: Glutathione, vitamin B6
Amino acid conjugation: Glycine
Methylation: S-adenosyl-methionine
Sulfation: Cysteine, methionine, molybdenum
Acetylation: Acetyl-CoA
Glucuronidation: Glucuronic acid
phase II detoxification enzymes can be encouraged by :
Recently evidence suggests that people with Gilbert’s syndrome may show increased toxicity compared to unaffected individuals following use of medications which are metabolised by glucuronidation in the liver. This has been reported with some anti-cancer agents and also with paracetamol, where they may be more prone to toxicity after paracetamol overdose.
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.