Gilbert syndrome, thalassemia and gallstone formation

October 10, 2018 - 1:06pm

       DEAR DR. ROACH: I am blessed to be a very healthy 63-year-old woman. I am a vegetarian who eats fish occasionally. I take 600 mg of calcium a day, along with 1 mg folic acid for thalassemia minor. I exercise every day. I sleep well. I feel great and full of energy.
       I have diverticulosis due to pockets in my colon, but I have never had an attack. The doctor told me to start taking a fiber supplement. All my doctors also told me what foods to avoid. I do that now.  I also found out that, based on my bilirubin numbers and an ultrasound, I have Gilbert syndrome.
       I have asked my doctors over the years, if there is anything else I need to do to stay healthy. They normally say, "Keep doing what you are doing!" Any additional advice, Dr. Roach? Regarding the Gilbert syndrome, are there certain foods I should avoid, and could I end up with gallbladder problems? -- S.M.
       ANSWER: Gilbert syndrome is a genetic defect in the metabolism of bilirubin, a bile salt. It normally has no symptoms, and is detected due to abnormally high levels of bilirubin in the blood. People with this condition are at higher risk for developing gallstones.
       This is particularly an issue for you, since you also have thalassemia minor. The thalassemias are a group of diseases related to abnormalities in the hemoglobin protein. Alpha thalassemia minor affects the alpha hemoglobin chain, and beta thalassemia minor, naturally enough, affects the beta chain. Alpha thalassemia minor is a mild disease, usually noted by abnormal blood counts but may occasionally have symptoms of mild anemia, whereas beta thalassemia minor normally has no symptoms at all. However, the blood cells of people with even these minor abnormalities are more likely to break apart, which causes the body to break down hemoglobin, one result of which is increased bilirubin. So, you have two reasons for high bilirubin and a higher likelihood of gallstones than someone with either condition.
       There are other risks for gallstones. Being overweight is a risk, but so is rapid weight loss.
       Your diet choices have protected you. Only meat products contain cholesterol, which also increases risk for gallstones. Not eating cholesterol is protective. High dietary fat is also bad for gallstones, but most vegetarians eat relatively little fat. I suspect this is a reason you haven't had any problems in your first 63 years. Fiber, which is certainly good for people with diverticulosis, is also good for preventing gallstones. So, I echo your previous doctors: Keep doing what you're doing.
       DEAR DR. ROACH: My problem is expelling gas, which is most embarrassing. I don't know what is causing it or how to prevent it. I know that anyone near me can hear it. Could it be my medications? Can you help? -- Anon.
       ANSWER: Most people who have this concern are experiencing normal human physiology. On average, humans pass gas 10-20 times daily. One unusual medical possibility is malabsorption -- that is, not being able to properly digest food, which usually has other symptoms, such as weight loss, diarrhea or abdominal discomfort.
       People who eat more nondigestible starches in fruits, vegetables and legumes are likely to have more gas. Some foods are well-known to cause excess gas: cabbage, beans, broccoli, onions and others. Medications are rarely the issue. Identifying and limiting foods that cause gas is the best treatment. A registered dietician nutritionist can give you more information about a diet low in the substances that can cause gas. These are: fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). A low FODMAP diet may be of benefit.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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