Total Bilirubin

Understanding Bilirubin:

• Mild elevation (20-35 umol/L) with normal liver enzymes → likely Gilbert's syndrome (affects ~5-10% of population, benign)
• Elevation with elevated ALT/AST/GGT → liver stress — address hepatotoxic compounds
• Very high bilirubin (>50 umol/L) with jaundice → urgent medical evaluation required

Supplements:

• NAC -- 600-1200mg/day (supports glutathione and liver detoxification pathways)
• TUDCA -- 500mg/day (if liver-related elevation, improves bile flow)
• Milk Thistle (Silymarin) -- 200-400mg/day (antioxidant liver support)

Lifestyle:

• Stay well hydrated (bilirubin clearance improves with hydration)
• If Gilbert's syndrome: fasting and dehydration worsen elevation — eat before blood draws
• Avoid combining multiple hepatotoxic compounds (oral AAS + alcohol + NSAIDs)
• Monitor trend: stable mild elevation = likely benign; rising trend with enzyme elevation = investigate

References:

• Rushworth, G. F., & Megson, I. L. (2014). Existing and potential therapeutic uses for N-acetylcysteine: The need for conversion to intracellular glutathione for antioxidant benefits. Pharmacology & Therapeutics, 141(2), 150-159. DOI: 10.1016/j.pharmthera.2013.09.006
• Paumgartner, G., & Beuers, U. (2002). Ursodeoxycholic acid in cholestatic liver disease: Mechanisms of action and therapeutic use revisited. Hepatology, 36(3), 525-531. DOI: 10.1053/jhep.2002.36088
• Abenavoli, L., Capasso, R., Milic, N., & Capasso, F. (2010). Milk thistle in liver diseases: Past, present, future. Phytotherapy Research, 24(10), 1423-1432. DOI: 10.1002/ptr.3207