Diet choices help Gilbert syndrome

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. DEAR READER >> 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.

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.