Bilirubin (total)

What Is Bilirubin?

Bilirubin is a waste product which is produced in the liver when red blood cells are broken down. Bilirubin is yellow-orange in colour.

Which tests include this marker?

What Role Does It Play in The Body?

Within the red blood cells, there is a protein called haemoglobin which is responsible for transporting oxygen around the body. Red blood cells have a lifespan of around 120 days and are removed from circulation by special immune cells called macrophages in the spleen and the liver. Haemoglobin is split into two parts: haem and globin. The haem part contains iron which can be removed and conserved to make new molecules of haemoglobin. The globin part can be recycled or broken down further. When haem is broken down, it is converted into the yellow-orange pigment called bilirubin. Another protein present in the blood, albumin, attaches to the bilirubin and takes it to the liver where it is secreted into bile and helps to give faeces their colour. [1]

Too much bilirubin or a failure to clear bilirubin, however, can cause jaundice. A condition where the whites of your eyes and skin become yellow. Jaundice can be a sign of a serious medical condition such as liver disease. [2]

How Does Bilirubin Affect My Wellbeing?

If there is a bilirubin build-up in your body which results in jaundice, then there can be several consequences for your health. As the colour of the skin will turn yellow this can influence your overall self-esteem and can damage your confidence. Some of the underlying causes of too much bilirubin or jaundice can also be painful. Gallstones can obstruct the flow of bile resulting in jaundice and if one blocks a bile duct, then this can cause severe stomach pain.

An inherited disease called Gilbert’s syndrome causes slightly raised levels of bilirubin in the blood. This is because there is a faulty gene which causes the liver to have trouble removing the bilirubin from the blood. The disorder can cause symptoms such as fatigue, stomach pain, nausea, dizziness and irritable bowel syndrome (IBS). [3]

How Can I Improve My Result?

Alcohol can have a role in increased bilirubin levels, particularly because of the damage it can do to the liver. [4] Therefore, you should try to keep your alcohol intake as low as possible and within the guidelines of no more than 14 units per week.


Research has shown that in the case of Gilbert’s Syndrome, the symptoms of too much bilirubin can be reversed with the Palaeolithic Ketogenic diet. The diet is based on animal fat, meat, eggs and offal as well as fruit and vegetables. However, you should talk through any extreme change to your diet with your GP.

Instead, consuming a healthy, balanced diet rich in natural food sources rather than processed fast food will help to keep your body in equilibrium.


Increased participation in physical activity, as well as weight loss, has been shown to improve many biomarkers including bilirubin levels. [6] You should aim for around 150 minutes of aerobic physical activity per week such as swimming, walking or cycling. However, you should consult your GP before beginning any new training or exercise regime.

Tests that include this marker

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[1] Dean L. (2005). Chapter 1, Blood and the cells it contains. In: Bethesda (MD) ed: Blood Groups and Red Cell Antigens. National Center for Biotechnology Information (US); Available from:

[2] National Health Service. (2018). Jaundice. Available at:

[3] National Health Service. (2015). Gilbert’s Syndrome. Available at:

[4] Mathurin, P., Abdelnour, M., Ramond, M, J et al., (2003). Early Change in Bilirubin Levels Is an Important Prognostic Factor in Severe Alcoholic Hepatitis Treated with Prednisolone. Hepatology: 38(6), pp 1363-1369.

[5] Tóth, C and Clemens, Z. (2015). Gilbert’s Syndrome Successfully Treated with the Paleolithic Ketogenic Diet. American Journal of Medical Case Reports: 3(4), pp 117-120.

[6] Hickman, I, J., Jonsson, J, R., Prins, J, B., Ash, S., Purdie, D, M., Clouston, A, D and Powell, E, E. (2003). Modest Weight Loss and Physical Activity in Overweight Patients with Chronic Liver Disease Results in Sustained Improvements in Alanine Aminotransferase, Fasting Insulin, and Quality of Life. Gut: 53, pp 413-419.

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