What is Gilbert's Syndrome? Gilbert’s Syndrome is caused by reduced activity of the UGT1A1 enzyme, the key pathway responsible for conjugating (detoxifying) bilirubin so it can be safely excreted from the body. Most patients have a promoter variant that decreases enzyme efficiency by up to 70%. This lower enzyme activity doesn’t just affect bilirubin. UGT1A1—and the glucuronidation pathway in general—also processes: Hormones (especially estrogen) Medications Environmental toxins Gut-derived metabolites Histamine Certain dietary compounds Endogenous stress molecules Mould When this pathway works slowly, biochemistry becomes bottlenecked—especially under physical or emotional stress. Why it's not 'benign' The Hidden Burden of Gilbert’s Syndrome: Why It’s More Than “Just Benign” For decades, people diagnosed with Gilbert’s Syndrome have been told the same thing: “It’s harmless. It doesn’t cause symptoms. You can ignore it. It's benign.” But for many
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