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

Good Nutrition
Exercise
Good Sleep
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

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.
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.
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
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.

July 3, 2020July 6, 2020

Sesame – magic for your liver!

Can you take a moment to help with a survey on caffeine use? It won’t take a minute or two and the information could help us all live better with Gilbert’ Syndrome.

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.

To buy :

For recipes try this : ‘the magic of tahini’
Whilst you’re at The Vegan Kind Supermarket, you can stock up on these store cupboard essentials:

Meridian organic sesame oil
Suma organic sesame seeds
Al Fez tahini

Or from Amazon: Hatton Hill 1kg of sesame seeds

For more resources, food and supplements go here: https://gilbertssyndrome.org.uk/resources/

Sources:

https://www.greenmedinfo.com/blog/sesame-oil-may-heal-liver-damage

https://www.webmd.com/vitamins/ai/ingredientmono-1514/sesame

Sesame seeds may relieve liver damage caused by modern drugs

June 26, 2020June 26, 2020

Protected: Symptom Checker

June 19, 2020March 17, 2023

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, there are additional benefits in trying something like green tea, which has other beneficial effects. Clipper produce an organic and ethically traded tea that you can buy online or in many large supermarkets

Another option is a green coffee bean supplement

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 stress and energy levels and have found my energy more resilient as a result.

This Rhodiola from Viridian has been a daily staple for me for many years

Ashwagandha is a great herb for the end of the day.

plus gotu kola which can provide an extra, but gentle, boost that can help concentration levels when they start to flag

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!

May 21, 2020May 22, 2020

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

Sorting out the health effects of alcohol

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:

May 6, 2020October 14, 2022

COVID-19 and Gilbert’s Syndrome

So you have lots of bits of information about COVID-19, but what do they add up to if you have Gilbert’s Syndrome? Well, there are a number of things I can tell you which should help join the dots and give you the big picture of where you stand when faced with COVID-19, if you have Gilbert’s Syndrome.

First of all, we have to understand what type of virus COVID-19 is.

It’s a virus similar to the flu and colds. Because it’s new no-one had it before and so no-one is immune and can catch it easily. You can catch it the same way you catch any cold or flu – the virus travels in tiny droplets pushed out from the infected person’s nose and mouth when they cough or sneeze. It either goes straight into your mouth or nose, or sits around for a while waiting to catch a ride on your body. The virus hijacks your cells in your nose, throat and lungs and multiplies. Your body then responds with the usual attack mechanisms, and depending on how healthy your immune system is, and how much of the virus you have been exposed to, you can see it off or have a more severe, possibly fatal reaction. The severe reaction is partly because the body’s immune system response goes into overdrive and the lung tissues become blocked because they become inflamed – which is why people have difficulty breathing.

Okay, so far, it’s pretty straightforward – but there are differences in how viruses can affect people. This one is pretty different where children are concerned (see below). Others can also affect the liver more – recently the pandemic of 2009, H1N1, was shown to cause liver damage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941665/

So far, studies show that COVID-19 doesn’t seem to cause permanent liver damage, although there can be some impact on the liver initially, which doesn’t appear related to the medication given to patients, as this extract from The Hindu, and the Lancet journal text extract below show:

Liver damage in mild cases of COVID-19 is often temporary and the organ can return to normal without any special treatment. This could be due to the state of direct infection of liver cells or could as well be due to liver cells getting caught up in the immune war between body’s immune system and the virus with chemicals produced by our body, namely cytokines. The Hindu

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30084-4/fulltext :

‘mild liver test derangement is present at baseline in many patients with COVID-19 before significant medication use. Ie. the liver is impacted before medication is given’

‘It has been proposed that COVID-19 causes direct liver injury via a viral hepatitis, but we believe that there are alternative explanations. First, the derangement of liver function is clearly mild. Second, when liver function tests for patients with different durations of symptoms are examined, there is no evidence that later presentation is associated with greater liver function derangement.’

What’s also great to hear is that: ‘worse outcomes were not seen in the 42 patients with chronic liver disease and COVID-19 who had outcome data’

The greatest problem that people will face when fighting off COVID-19 are underlying health problems which impact the immune system:

https://patient.info/news-and-features/covid-19-coronavirus-what-is-an-underlying-health-condition

In which case you must take special care!

Paracetamol, ibuprofen and COVID-19 – originally it was thought that ibuprofen might cause problems for people with COVID-19, and for those of us with Gilbert’s Syndrome this was bad news. Paracetamol has been shown to impact the liver more in people with Gilbert’s Syndrome (it makes me feel VERY ill),https://www.ncbi.nlm.nih.gov/pubmed/10412886 , so ibuprofen might by your painkiller of choice. Fortunately the WHO and governments have given it the all clear https://www.gov.uk/government/news/commission-on-human-medicines-advice-on-ibuprofen-and-coronavirus-covid-19

So, you should not worry more if you have Gilbert’s Syndrome as COVID-19 doesn’t appear to have an especial impact on the liver. However, just on flu and colds generally – the stress on your body can make you feel really unwell and trigger your Gilbert’s Syndrome symptoms. This is important to tell clinicians if they are treating you so that they can understand what’s happening to your body and why.

Check out this leaflet from an NHS trust and its recommendations to get the flu vaccine if you have a liver disease, including GIlbert’s Syndrome. https://psnc.org.uk/avon-lpc/wp-content/uploads/sites/23/2015/07/Liver-Disease-and-Flu-Vaccine-Importance.pdf

There may be other questions that we can’t answer such as – is there a link between low white blood cell counts, Gilbert’s Syndrome and fighting infection; what if some of the medication used in the treatment of COVID-19 is processed in the pathways of the liver affected by our enzyme deficiency. As it appears there is a link between high levels of bilirubin and reduced white cell count https://journals.sagepub.com/doi/10.1177/0004563214541969 (topic for another post!), you could potentially hypothesize that this is a good thing – as the overproduction of white cells is part of the excessive inflammatory response I talked about that can actually harm not heal. As mentioned above – do let your clinicians know you have Gilbert’s Syndrome and that some medication, processed in the Phase II pathways, isn’t dealt with as well.

If you want to know more about how COVID-19 virus works and how the body responds (knowledge is power after all), check out this video from Yale: https://www.youtube.com/watch?v=vvKhT9tAhig

And if you’d just like to feel like you know a bit more about how the liver works check this out: https://www.healthline.com/health/what-does-the-liver-do

But wait – why doesn’t it affect children more, like other flu and colds? How is it different?

https://time.com/5816239/children-coronavirus/

Why are children less affected when their immune system is still developing? It’s theorized it is BECAUSE their immune system is developing that the life threatening response to COVID doesn’t occur as much in children – the adult body’s immune response includes a ‘cytokine storm’ which results in an inflammatory response in the lungs, making it hard for adults to breathe. Children’s bodies don’t yet respond as aggressively to the virus.

https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2014.3085

As age advances, the immune system undergoes profound remodelling and decline, with major impact on health and survival [81,82]. This immune senescence predisposes older adults to a higher risk of acute viral and bacterial infections. Moreover, the mortality rates of these infections are three times higher among elderly patients compared with younger adult patients [83]. Infectious diseases are still the fourth most common cause of death among the elderly in the developed world. Furthermore, aberrant immune responses in the aged can exacerbate inflammation, possibly contributing to other scourges of old age: cancer, cardiovascular disease, stroke, Alzheimer’s disease and dementia [84]. During a regular influenza season, about 90% of the excess deaths occur in people aged over 65.

I hope this information helps you live better with Gilbert’s Syndrome!

April 7, 2013May 15, 2020

Breast Cancer and Gilbert’s Syndrome?

So little is known, and much is speculated about Gilbert’s Syndrome! Please beware before reading this that this cited article notes that the information they discuss results in their speculation that people with Gilbert’s Syndrome may be more likely to get breast cancer. This is not proven, and is an association only. However, in the interests of offering new information to people with Gilbert’s Syndrome I am sharing this article.

Med Hypotheses. 2011 Aug;77(2):162-4. doi: 10.1016/j.mehy.2011.03.047. Epub 2011 Jun 1.

Is Gilbert syndrome a new risk factor for breast cancer?

Astolfi RH, Bugano DD, Francisco AA, de Souza MM, Ono-Nita SK, Baracat EC.

Source

Medical School, Universidade de São Paulo, Brazil. rafael.astolfi95@gmail.com

Abstract

Patients with Gilbert syndrome have an impaired function of the enzyme UGT1A1, responsible for the degradation of 4-OH-estrogens. These elements are produced by the degradation of estrogens and are well-known carcinogens. In theory, patients with Gilbert syndrome accumulate 4-OH-estrogens and, therefore, might have a higher risk for breast cancer, especially when exposed to higher levels of estrogens. If this theory is true, a new risk group for breast cancer would be described, producing new insights in breast carcinogenesis.

December 31, 2012May 15, 2020

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.

January 20, 2012May 15, 2020

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.

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!

January 20, 2012May 15, 2020

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.

December 19, 2011May 15, 2020

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.

November 9, 2011May 15, 2020

Pharmacist survey finds ‘Medicines detox’ puts people at risk

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. ADNFCR-554-ID-800789373-ADNFCR

November 7, 2011

General anesthesia in a patient with Gilbert’s syndrome.

Having had an operation this year, with a very understanding anesthesiologist, I know that this is an area of poor knowledge in the health service, and that all the advice you as a patient can offer is helpful, and will of course help yourself. We decided that morphine would be avoided and took an approach that would mean using as few drugs as possible. This also meant I would come out of the procedure more alert and able to get going.

There has been some recent research in India which follows the clinical experience I have personally had – namely that the best outcomes are if the drugs used avoid using the enzyme that people with Gilbert’s Syndrome are deficient in:

Source

Department of Anaesthesiology and Critical Care, Tata Main Hospital (TMH), Jamshedpur, India. Nag DS, Sinha N, Samaddar DP, Mahanty PR.

Abstract

Gilbert’s syndrome, caused by relative deficiency of glucuronyl transferase is the commonest cause of congenital hyperbilirubinemia. We report anesthetic management in a case of Gilbert’s syndrome for laparoscopic cholecystectomy under general anesthesia. Avoiding drugs which use this enzyme for its metabolisim or excretion, and minimizing the stress during the perioperative period allows safe conduct of anesthesia for these patients.

October 14, 2011September 28, 2022

The Liver Diet

The great news is that you can easily help your body work better by choosing tasty food that gives you the best nourishment.

The more plants you eat the healthier you will be. Your gut bacteria, immunity, liver function, skin, eyes, cholesterol, blood sugar, energy levels and more will thrive if you add in plants. By plants, I mean everything from herbs and spices to grains such as rice and wheat, as well as nuts, seeds, and fruit – not just salad!

There are lots of tips in this article. Take what works for you. You don’t have to do it all at once! If you need support to change your lifestyle then you could try a health coach.

There are recipes on the site and more information about nutrition that could help you find what works. Explore further, and share your ideas in the comments.

Think Raw
Eat lots of raw fruits and vegetables, especially dark green leafy vegetables and orange, yellow, purple and red coloured fruits and vegetables. Try to eat some raw fruits or vegetables a few times a day as they contain living enzymes, vitamin C, natural antibiotic substances and anti-cancer phytonutrients. Snack on a carrot, have an apple after breakfast, add berries to your dessert, add a tomato to your sandwich, squeeze lemon juice on a salad, garnish a curry with fresh coriander…

Oil but Don’t Grease Your Body
If your liver needs some help then I recommend avoiding all animal milks and substituting them with oat, rice, almond or soymilks. Avoid the fats that make life hard for the liver and gall bladder. These are full-cream dairy products, margarines, processed vegetable oils (hydrogenated fats), deep fried foods, foods that are not fresh and contain rancid fats, preserved meats, animal skins and fatty meats.

Eat the “good fats” which contain essential fatty acids in their natural unprocessed form. These are found in cold pressed vegetable and seed oils, avocados, algae oil, raw fresh nuts, raw fresh seeds such as flaxseeds (linseeds), sunflower seeds, safflower seeds, sesame seeds, hemp seeds, alfalfa seeds, pumpkin seeds and legumes (beans, peas and lentils).

Seeds such as flaxseeds can be ground freshly everyday (in a regular coffee grinder or food processor) or bought ready ground, and can be added to cereals, smoothies, fruit salads and vegetables.

Spirulina, evening primrose oil, black currant seed oil, borage oil and lecithin also contain healthy oils to help the liver.

Do not use butter and/or margarine on your breads and crackers. There are so many tasty replacement options with added nutrients that are great for you. Replace them with tahini, humus, pesto, tomato paste or relish, freshly minced garlic and cold pressed oil (chilli or other natural spices can be added if enjoyed), nut-spreads, fresh avocado, cold pressed olive oil or yeast extract.

Good fats are essential to build healthy cell membranes around the liver cells. We need to “oil” our bodies and not “grease” our bodies.

Think Natural
Avoid artificial chemicals and toxins such as insecticides, pesticides, and artificial sweeteners and colourings, flavourings and preservatives. The easiest way to do this is to prepare meals from plants yourself. It doesn’t have to be complicated or time consuming, or cost a lot of money. In fact, if you eat seasonal food it can be much cheaper than including more expensive animal products and pre-prepared packets in your shop.

Just google ‘easy plant based recipes’ for tons of ideas. You can start here

Be Diverse
Consume a diverse range of proteins from grains, raw nuts, seeds, legumes (lentils and every type of bean) and soya products such as tofu. It is both safe and healthy to be a vegan, so long as you are eating a diverse range of plants, however you may need to take supplements of vitamin B 12 and be sure to eat healthy essential fatty acids perhaps in the form of an algae oil supplement (walnuts, flaxseed and other nuts and seeds also help keep up the protein and essential fatty acid levels).

Let Food Be Your Medicine
Many diseases can be overcome by eating healing foods that contain powerful medicinal properties. Optimal health and the prevention of disease is only possible by including these healing foods regularly in the diet.

The healing substances found in certain foods or therapeutically active chemicals are known as phytochemicals. The culinary habits of different cultures have been recognised for decades as being influential in the incidence of diseases. Mediterranean countries have a lower prevalence of cardiovascular diseases because of the protective effect of traditional Mediterranean foods, such as olive oil, tomatoes and legumes.

Broccoli and other vegetables in the cruciferous family are known to reduce the risk of bowel cancer, but it is only recently that scientists have isolated the phytochemicals which confer this protection. Broccoli has been found to contain a phytochemical called sulphoraphane, which enhances the phase two-detoxification pathway in the liver.

Tomatoes contain a powerful antioxidant called lycopene, which according to a paper published in the American Journal of Clinical Nutrition (1997:66:116-22), is the most powerful of all the dietary carotenoids. The researchers found that the dietary intake of lycopene was linked to a lower risk of prostate problems. They also found that higher levels of lycopene in the blood lowered the risk of cell proliferation, which would theoretically exert a powerful anti-cancer effect. Cooking or chopping tomatoes increases the absorption of lycopene into the body. Cooking tomatoes in oil increases the availability of the lycopene to the body, which is another reason that Mediterranean cuisine confers health benefits.

Beetroot is a beautiful deep purple colour because it contains the antioxidant anthocyanidin. Constituents of beetroot have been shown to exert anti-viral and anti-tumour effects in animal studies. Other foods, which have these properties, although to a lesser degree, are red and green peppers, red onion skins, paprika and cranberry. These foods contain healing phytonutrients such as carotenoids, capsanthin and anthocyanins.

Certain foods have high concentrations of plant hormones, which are known as phytoestrogens. Examples of these are the isoflavones genistein and daidzein (found in soya beans and red clover), and lignans (found in flaxseed).

Asian communities consume a high intake of soy (approximately 25 – 50 grams daily), and have a significantly lower incidence of hormone dependent cancers of the prostate, uterus and breast. All legumes such as beans, peas and lentils contain beneficial phytoestrogens.

A study published in the British Medical Journal in 1990, looked at a group of postmenopausal women who were given 45 grams of soy flour for 2 weeks, followed by 25 grams of flaxseed meal for 2 weeks, and then 10 grams of red clover sprouts. This produced improvements in various blood hormone levels and menopausal symptoms.

Asian and Mediterranean cuisines are now integrating themselves into the old fashioned Western diet consisting of meat, bread and a limited range of vegetables. This culinary multiculturalism has enormous and proven benefits for our health and also for our enjoyment. We all know that variety is the spice of life, and Asian and Mediterranean foods can add spice to our often-bland ways of eating.

A wide range of Asian foods is now available from supermarkets and greengrocers as well as Chinese grocery stores. Typical Asian foods and vegetables such as ginger root, chilli, garlic, Chinese water spinach, bok choy, lemongrass, coconut, tumeric, curry, Chinese mushrooms and many others can be experimented with, and gradually introduced into the diet if you want to expand the horizons of your taste buds.

Watch That Sweet Tooth
Use natural sugars from fresh fruits and juices, dried fruits, molasses, fruit sorbets, fruit cakes, fruit jams, carob, date sugar, maple sugar or syrup or rice syrup. Avoid refined white sugar and candies, fizzy drinks, cakes and biscuits made with refined sugars.

Pre diabetes and Type II diabetes are spreading like wildfire thanks to western style diets high in processed sugar and fat.

Balanced blood sugar helps your liver work better and supports your energy levels. Fresh fruit and vegetables and natural sources of sugar will help you from see-sawing blood sugar.

Rehydrate Your Body
Drink large amounts of fluids such as water, raw juices and teas (green tea, herbal and regular weak tea is fine). Aim for 2 litres of fluid daily and this will avoid constipation problems and help your kidneys to eliminate the toxins that the liver has broken down.

The liver is the major organ involved in detoxification, however it is still important to support the other body organs of elimination. The skin and the kidneys eliminate toxins through sweating and urine and this is why some people suggest that saunas and a high intake of filtered water can reduce symptoms of toxic overload.

Some people think it’s important to have a water filter, and depending on what is in your water where you are, this may help you.

Go Organic
Although it is ideal to be able to buy organically grown food it’s not always possible. Don’t worry if you can’t manage to include organic food in your life, it’s important to do what you can, and not stress about what you can’t. It’s much more important to focus on the right types of food.

Not many people want to eat fruits and vegetables that have been sprayed repeatedly with insecticides and fungicides, ripened with ethylene gas and perhaps waxed with an insect secretion. Livestock animals may have been fed antibiotics and the ground-up remains of thousands of dead animals, and had potent sex hormones implanted to accelerate growth.

Organic food is sometimes called biodynamic food and should be produced without synthetic herbicides, insecticides, fertilisers, post-harvest fungicides, antibiotic growth-promoters, or size enhancing hormones. Foods certified as organic must be grown on farms that are inspected and fully certified according to a stringent set of standards.

It’s a positive choice if you can make it, and it protects the environment. You could also try growing your own with a packet of courgette seeds in a window box!

Pamper Your Liver
Eat foods to increase nutrients beneficial to liver function. Here are some more tips:

Vitamin K – green leafy vegetables and alfalfa sprouts.
Arginine – this helps the liver to detoxify ammonia, which is a toxic waste product of protein metabolism. Arginine is found in legumes (beans, peas, and lentils), carob, oats, walnuts, wheatgerm and seeds.
Antioxidants – found in fresh raw juices such as carrot, celery, beetroot, dandelion, apple, pear and green drinks like wheatgrass and barley-grass juice, and fresh fruits, particularly citrus and kiwi fruit.
Selenium – sources of the antioxidant selenium are brazil nuts, brewers yeast, designer yeast powders (very good source), kelp, brown rice, molasses, seafood, wheatgerm, whole-grains, garlic and onions.
Methionine – is essential for detoxification. Is found in legumes, garlic, onions and seeds
Essential fatty acids – Fresh avocado, fresh raw nuts and seeds, legumes (beans, peas, lentils), wholegrain, wheatgerm, green vegetables such as spinach, green peas and green beans, eggplant/ aubergine, cold pressed fresh vegetable and seed oils, freshly ground seeds, especially flaxseeds (linseed), evening primrose oil, black-currant seed oil, star flower oil. Essential fatty acids are required for healthy membranes in every cell of the body and plentiful amounts are required for healthy liver function. This is why strict low fat diets are not beneficial for general health, weight control or liver function.
Natural sulphur compounds – are found in garlic, onions, leeks, shallots and cruciferous vegetables such as broccoli, cauliflower, cabbage and brussel sprouts.

So – the take away here is ‘eat a diverse range of plants’. Just add more plants and you will feel and be healthier. You can focus on areas where you need to bring in more nutrients – such as cruciferous veg and essential fatty acids, or reducing processed sugar and fats. If you need support then you can work with a health coach. If you have particular questions then do post in the comment!

October 3, 2011May 15, 2020

Jaundice

WHAT IS JAUNDICE?

The word “jaundice” comes from the French word jaune, which means yellow.

Jaundice is a yellowish staining of the skin, the whites of the eyes, and mucous membranes by bilirubin, a yellow-orange bile pigment. Bilirubin (read more about it here!) comes mainly from the breakdown of red blood cells, and is basically a waste product that your liver gets rid of.

Jaundice usually appears when the bilirubin in your blood is more than 3 mg per dL (51.3 µmol per L). The classic definition of jaundice is a serum bilirubin level greater than 2.5 to 3 mg per dL (42.8 to 51.3 µmol per L) as well as having yellow skin and eyes.

Your body processes bilirubin in 3 phases: prehepatic (before it gets to the liver), intrahepatic(whilst in the liver), and posthepatic(after leaving the liver). If any of these aren’t working properly you can become jaundiced.

PREHEPATIC

The human body produces about 4 mg per kg of bilirubin per day, from the breakdown of blood cells. Bilirubin is then transported from to the liver for conjugation (where it needs to link up with other enzymes and chemicals so that it can be removed from the body) .

INTRAHEPATIC

Unconjugated bilirubin (the bilirubin that hasn’t been removed by linking up with an enzyme) doesn’t dissolve in water but is soluble in fats. That means it can easily cross the blood-brain barrier or enter the placenta. The unconjugated bilirubin is conjugated (linked up with) with a sugar via the enzyme glucuronosyltransferase (the enzyme that people with GS don’t have enough of) and is then soluble in the bile.

POSTHEPATIC

Once soluble in bile, bilirubin is transported through to the gallbladder, where it is stored, or passed on to the duodenam. Inside the intestines, some bilirubin is excreted in the stool, while the rest is dealt with by the bacteria in your gut.

JAUNDICE AND OTHER SYMPTOMS

Some people with jaundice have no symptoms at all. But some may have an acute illness, which is frequently caused by infection, may seek medical care because of fever, chills, abdominal pain, and flu-like symptoms. For these patients, the change in skin color may not be their greatest concern!

Patients with noninfectious jaundice may complain of weight loss or itching / skin discomfort. Abdominal pain is the most common symptom in patients with pancreatic or biliary tract cancers.Even something as nonspecific as depression may be a symptom in patients with chronic infectious hepatitis and in those with a history of alcoholism.

‘False’ jaundice can happen if you eat foods rich in beta-carotene (e.g., squash, melons, and carrots). Unlike true jaundice, you don’t get yellow eyes, or changes in bilirubin level.

CAUSES OF JAUNDICE:

PREHEPATIC CAUSES

Unconjugated hyperbilirubinemia (this is when you’ve too much bilirubin in your bloodstream because it’s not been processed in the liver, as in Gilbert’s Syndrome) might happen before bilirubin has entered the liver cells or within the liver cell. If you’ve had an unusual breakdown in your red blood cells then there may be too much of the waste product, bilirubin, for your liver to process as normal.

This will usually result in mild bilirubin elevation, to about 5 mg per dL (85.5 µmol per L), with or without clinical jaundice. The blood might be breaking down because of a number of causes in the blood cells or your enzymes which mean your red cells have stayed alive longer than normal, and built up. Other causes include autoimmune disorders, drugs, and defects in hemoglobin structure such as sickle cell disease and the thalassemias.

INTRAHEPATIC CAUSES

Un-Conjugated Hyperbilirubinemia Gilbert syndrome is a common, benign, hereditary disorder that affects approximately 5 percent of the U.S. population. It usually results in a mild decrease in the activity of the enzyme glucuronosyltransferase. Gilbert syndrome is typically an incidental finding on routine liver function tests, when the bilirubin level is slightly increased and all other liver function values are within normal limits. Jaundice and further elevation of the bilirubin level may occur during periods of stress, fasting, or illness.

Conjugated Hyperbilirubinemia. Main causes are when there’s a blockage preventing bilirubin from moving into the intestines. Viruses, alcohol, and autoimmune disorders are the most common causes of hepatitis. Inflammation also disrupts transport of the bilirubin and causes jaundice.

Hepatitis A can cause acute onset of jaundice. Hepatitis B and C infections often do not cause jaundice straight away, but can lead to jaundice when chronic infection has led to liver cirrhosis. Epstein-Barr virus infection occasionally causes hepatitis and jaundice that resolve as the illness clears.

Alcohol has been shown to affect bile acid uptake and secretion, stopping the normal flow through the liver. Chronic alcohol use may result in fatty liver (steatosis), hepatitis, and cirrhosis, with varying levels of jaundice. Fatty liver, the most common liver problem, usually results in mild symptoms without jaundice but occasionally progresses to cirrhosis. Hepatitis secondary to alcohol use typically presents with acute onset of jaundice and more severe symptoms.

More rare conditions that can cause jaundice: Autoimmune hepatitis traditionally has been considered a disease that affects younger persons, especially women. Two serious autoimmune diseases that directly affect the biliary system without causing much hepatitis are primary biliary cirrhosis and primary sclerosing cholangitis. Primary biliary cirrhosis is a rare progressive liver disease that typically presents in middle-aged women. Fatigue and itching / skin discomfort are common initial complaints, while jaundice happens later. Primary sclerosing cholangitis, which is also rare, is more common in men; nearly 70 percent of patients also have inflammatory bowel disease. Dubin-Johnson syndrome and Rotor’s syndrome are rare hereditary metabolic defects that disrupt transport of conjugated bilirubin.

Common drugs can also cause problems, such as acetaminophen, penicillins, oral contraceptives, anti-psychotic medication, and steroids. Cholestasis can develop during the first few months of oral contraceptive use and may result in jaundice.

POSTHEPATIC CAUSES

Gallstones in the gallbladder are fairly common in adults. Obstruction within the biliary duct system can inflame the gallbladder, and can lead to infection. Cholangitis is diagnosed clinically by the classic symptoms of fever, pain, and jaundice, known as Charcot’s triad. Cholangitis most commonly occurs because of an impacted gallstone, which might then be removed.

Biliary tract tumors are uncommon but serious causes of posthepatic jaundice. Gallbladder cancer classically presents with jaundice, enlarged liver, and a mass in the right upper quadrant (Courvoisier’s sign). Another biliary system cancer, cholangiocarcinoma, typically manifests as jaundice, itching / skin discomfort, weight loss, and abdominal pain. It accounts for roughly 25 percent of hepatobiliary cancers.

Jaundice also may arise with pancreatitis. The most common causes of pancreatitis are gallstones and alcohol use. Gallstones are responsible for more than one half of cases of acute pancreatitis, which is caused by obstruction of the duct that drains the biliary and pancreatic systems.

Evaluation

The initial work-up of the patient with jaundice depends on whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect). A urine anlysis that is positive for bilirubin indicates the presence of conjugated bilirubinemia. Conjugated bilirubin is water soluble and so passed through urine.

SO IF YOU’RE JAUNDICED WHAT DO THEY DO TO WORK OUT WHAT’S CAUSING IT? Here’s the clinical information :

BLOOD TESTING

First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase, and alkaline phosphatase levels.

Depending on the results of the initial tests, further serum tests or imaging studies may be warranted. The second-line serum investigations may include tests for hepatitis A IgM antibody, hepatitis B surface antigen and core antibody, hepatitis C antibody, and autoimmune markers such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. An elevated amylase level would corroborate the presence of pancreatitis when this condition is suspected based on the history or physical examination.

IMAGING

Ultrasonography and computed tomographic (CT) scanning are useful in distinguishing an obstructing lesion from hepatocellular disease in the evaluation of a jaundiced patient. Ultrasonography is typically the first test ordered, because of its lower cost, wide availability, and lack of radiation exposure, which may be particularly important in pregnant patients. While ultrasonography is the most sensitive imaging technique for detecting biliary stones, CT scanning can provide more information about liver and pancreatic parenchymal disease. Neither is good at finding stones inside the ducts.

Further imaging that may be done by a gastroenterologist or interventional radiologist includes endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

LIVER BIOPSY

A liver biopsy provides information on the architecture of the liver and is used mostly for determining prognosis. It also may be useful for diagnosis if serum and imaging studies do not lead to a firm diagnosis. Liver biopsy can be particularly helpful in diagnosing autoimmune hepatitis or biliary tract disorders (e.g., primary biliary cirrhosis, primary sclerosing cholangitis).