The reciprocal relation between caloric intake and the degree of hyperbilirubinemia in Gilbert's syndrome.

Abstract A reciprocal relation between caloric intake and the level of serum bilirubin was observed in 12 diet studies in seven patients with Gilbert's syndrome. An abrupt rise in serum unconjugated bilirubin always occurred within 24 hours after the beginning of a brief period of fasting. Twelve to 48 hours after resumption of a high caloric intake, the serum bilirubin was significantly reduced. In one patient the starvation-induced hyperbilirubinemia was prevented by high doses of phenobarbital. Only small increases in serum bilirubin occurred during fasting in eight normal control subjects. In three of six nonicteric relatives of one patient, a 48-hour fast resulted in distinct elevations in serum bilirubin. This relation between caloric intake and hyperbilirubinemia may explain the commonly observed fluctuations in serum bilirubin in Gilbert's syndrome.