A Functional Medicine Approach to Jaundice

Jaundice occurs when the skin, mucus membranes, and whites of the eyes (sclera) turn yellow due to elevated levels of bilirubin in the body. It can also be accompanied by darkening of the urine and lighter than normal stool color. This hyperbilirubinemia can occur due to increased production or impaired excretion of this waste product. 

Jaundice is common in newborn babies, occurring in around 60 percent of term and 80 percent of preterm babies during the first week of life. Adult jaundice is much less common but is often a sign of a more serious underlying disease.

A functional medicine approach to jaundice focuses on discovering the underlying causes and devising a holistic treatment plan tailored to the individual.

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What is Jaundice?

Bilirubin is a metabolite of heme (ferroprotoporphyrin IX) which helps to bind iron in various proteins like hemoglobin inside red blood cells. The majority (80%) of bilirubin is made by breaking down hemoglobin from red blood cells and destroying erythroid cells in the bone marrow. The rest of the bilirubin in your body is derived from breaking down other heme-containing proteins like myoglobin, cytochromes, catalase, peroxidase, and tryptophan pyrrolase found in the muscles and liver. 

Since bilirubin is toxic, your liver filters your blood to pull out waste products like bilirubin which is formed from breaking down red blood cells and combines these and other wastes with bile salts for safe detoxification and excretion. The conjugated bile is normally sent to the gallbladder and secreted into the intestines to help break down fats and be excreted from the body. Since bilirubin has a yellow-orange color, it contributes to the distinctive yellow color of bile, stool, and urine.

Bilirubin is made up of unconjugated (indirect) and conjugated (direct) components. Elevation of either of these components can result in jaundice and the ratio varies depending on if the cause is pre-hepatic, hepatic, or post-hepatic.

The earliest sign that bilirubin is starting to become somewhat elevated is the yellowing of the whites of the eyes (scleral icterus) due to their high elastin content which has an affinity for bilirubin. If levels of bilirubin continue to rise, the skin and mucous membranes can progressively become bright yellow. If the issue persists and is long-standing, the tissues may take on a more apple-green color due to biliverdin. 

What Causes Jaundice?

Bilirubin can start to deposit in body tissues due to processes that increase the production of bilirubin and/or issues with the liver processing and/or excreting this waste product like cirrhosis, hepatitis, primary biliary cholangitis, tumors, and gallstones.

Jaundice is classified into three different categories based on what is causing the elevation of bilirubin including pre-hepatic, intra-hepatic, or post-hepatic (obstructive) jaundice. 

When jaundice occurs due to increased production of bilirubin that exceeds the liver’s ability to conjugate the bilirubin and excrete it into the gut this is classified as pre-hepatic jaundice and is predominantly unconjugated hyperbilirubinemia. The most common cause of this type of jaundice is hemolytic anemia where red blood cells are destroyed resulting in excess heme breakdown and it can also occur with malaria and reabsorbed hematomas.

Intra-hepatic issues can cause jaundice during the production of bilirubin in the liver due to diseases that cause an inability to either conjugate or excrete bilirubin. These include hepatitis A and C, Epstein-Barr virus (infectious mononucleosis), alcohol, genetic metabolic disorders, autoimmune hepatitis, and medicine such as acetaminophen (Tylenol), penicillins, oral contraceptives, chlorpromazine (Thorazine®) and estrogenic or anabolic steroids.  

Jaundice due to post-hepatic causes occurs because there is obstruction of the bile ducts by gallstones, inflammation such as occurs with pancreatitis, parasites, or cancer blocking already produced bilirubin. 

Functional Medicine Perspective on Jaundice

Early recognition and diagnosis of contributing factors to jaundice in older children and adults are important to allow for interventions that improve physiologic functioning and help prevent complications. Functional medicine seeks to identify the root causes of jaundice, rather than just treating symptoms. 

Infant jaundice is worked up by pediatricians and is routinely screened for after birth. Bilirubin levels usually peak between the third and seventh day after birth, so babies should be examined for jaundice during this time. The guidelines presented in this article are focused on jaundice in older children and adults.

A functional medicine approach to jaundice in older children and adults approaches individual factors contributing to health from many aspects. This personalized, root-cause-oriented approach to jaundice looks at the patient’s overall health and addresses her as a whole person. 

This includes listening to the patient and taking a thorough personal and family history. It also includes evaluating aspects that can contribute to conditions that lead to jaundice like diet, genetics, hormonal changes, and lifestyle elements. In addition, a complete physical examination can uncover signs of liver disease such as bruising, spider angiomas (abnormal collection of blood vessels near the surface of the skin), palmar erythema (red coloration of the palms and fingertips), or fluid in the abdomen (ascites) that may give clues to the causes of jaundice.

A holistic approach to jaundice appreciates the role that lifestyle factors like diet and alcohol use can play in the development of conditions that cause jaundice and addresses these elements as part of a comprehensive plan to manage disease can be used to adopt a whole-person approach. Diet, supplementation, lifestyle, and integrative therapies can be used to help prevent progression and reduce inflammation.

Not only does this help to address the underlying causes of jaundice such as improving liver function, reducing inflammation, and calming autoimmunity, but it also helps the entire body come into better balance and improves quality of life overall. 

Diagnostic Testing in Functional Medicine

The causes of jaundice can be assessed using diagnostic testing. Tests used in functional medicine including liver function tests, bilirubin tests, and imaging studies can help to establish the root cause(s) of jaundice. Utilizing these tests can help with understanding the underlying mechanisms causing hyperbilirubinemia and guide treatment.

Tests of liver function can help establish any hepatic dysfunction. This includes measuring levels of enzymes that reflect liver damage such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) as well as testing to measure protein levels and blood clotting abilities. The Hepatic Function Panel by Access Med Labs analyzes a variety of important liver health markers to investigate overall hepatic function and look at levels of both direct and indirect bilirubin. 

Normal serum levels of bilirubin are less than 1 milligram per deciliter (mg/dL) with jaundice appearing first as scleral icterus when levels exceed 3 mg/dl. The ratio of direct (or conjugated) bilirubin and indirect (unconjugated) bilirubin can help narrow down the causes of jaundice. For example, post-hepatic jaundice caused by obstruction of the bile ducts will have primarily direct or conjugated elevated bilirubin with the direct bilirubin accounting for more than 50% of the total bilirubin and may also show elevated alkaline phosphatase. Unconjugated bilirubin usually dominates with pre-hepatic causes of jaundice like hemolytic anemias, autoimmune disorders, drugs, and defects in hemoglobin structure such as sickle cell disease and the thalassemias as well as from some intrahepatic causes that impair enzyme metabolism and the ability for the liver to carry out the conjugation process.

Bilirubin can also be detected in the urine. A urinalysis that is positive for bilirubin indicates that the patient has conjugated jaundice.

Comprehensive stool testing can be a valuable part of functional medicine assessments for jaundice. The GI-MAP + Zonulin from Diagnostic Solutions can be used to evaluate many of the underlying contributors of inflammation and autoimmunity that can impact the liver and bile ducts, including microbial imbalances, digestion, and immune function.

Imaging studies like ultrasound, CT scan, and MRI scan can be utilized to further investigate the structure of the biliary system and liver.

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Dietary and Nutritional Interventions

Dietary and nutritional interventions are an important part of a holistic approach to managing jaundice and supporting liver health. Dietary choices can aid in detoxification and support healthy liver function. This involves emphasizing foods that are rich in antioxidants and support the liver’s functioning and avoiding substances that add burden to the work of the liver.

An anti-inflammatory diet that emphasizes nutrient-dense foods like whole fresh fruits and vegetables, fatty fish, and olive oil like the Mediterranean diet provides a wide variety of micronutrients that the liver needs for optimal detoxification and functioning. Consuming a range of colorful produce helps you eat antioxidants like polyphenols. These phytonutrients provide powerful anti-inflammatory benefits, support a healthy microbiome, and have a potent antioxidant capacity that allows them to combat harmful free radicals and prevent damage to cells from oxidative damage, protecting liver health. 

This way of eating avoids processed meats, refined sugars and sugary beverages, ultra-processed foods, inflammatory fats like trans fats, and refined grains to reduce inflammation, nourish the microbiome, and improve liver health. 

Incorporating foods rich in natural probiotics like kimchi and sauerkraut into your diet can also help support liver health while boosting a diverse microbiome. Probiotic-rich foods and supplementation can help to heal the intestinal barrier, reduce inflammation, and decrease bacterial toxins such as lipopolysaccharides (LPS) that can pass from the gut to the liver and add to its toxic burden.

Herbal and Natural Remedies

Natural treatments for liver health support liver function and help to address jaundice. Herbal remedies for jaundice include milk thistle, dandelion root, turmeric, and many traditional herbal preparations. Because these treatments can have potential interactions and side effects, it is important to always consult with healthcare professionals before using these remedies to tailor a plan of care that works for your unique needs.Herbal remedies are part of many traditional healing modalities and offer treatment options for some types of jaundice. 

Milk thistle (Silybum marianum) has traditionally been used to address liver conditions in many practices. This herb has immunomodulatory, antioxidant, and antifibrotic effects that make it protective of the liver. Studies suggest that this herb can benefit liver function in alcohol-related liver disease, toxin-induced liver disease, viral liver disease, and primary biliary cholangitis at a dose of 140 mg three times daily.

Curcuma longa is a plant-based medicine derived from turmeric that can support the liver due to its anti-inflammatory properties. It may be especially helpful in cases of jaundice due to bile duct injury and biliary fibrosis. 

Another herbal remedy that can benefit liver health is dandelion root (Taraxacum officinale). The phytochemicals in this plant are protective of the liver and help reduce oxidative stress that can lead to liver damage and jaundice. Dandelion is also a bitter herb that can increase bile flow.

Yin Zhi Huang is an herbal preparation of Artemisia capillaris and three other herbs that are traditionally used in Traditional Chinese Medicine (TCM) to prevent and treat neonatal jaundice by facilitating the clearance of bilirubin. 

The ancient Indian medicine of Ayurveda also addresses jaundice with plant-based medicines. Ayurveda describes jaundice as “Pandu-roga” meaning yellowish pale, or white disease in Sanskrit. Within this tradition, various methods like emesis, evacuation of the bowels, medicated ghee, a diet rich in rice, wheat, barley, and broth of Mung leaves, and various herbs are used to restore the body to balance. Plants such as ginger, curcumin/turmeric, and Picrorhiza kurroa are used to treat jaundice.

Lifestyle Modifications

Lifestyle factors can have a significant impact on jaundice and liver health. Lifestyle changes for jaundice include stress management, exercise, and avoiding alcohol and toxins.

The health of the gut is closely linked with the health of the liver via the liver-gut axis. This bidirectional communication network is influenced by lifestyle, dietary, and environmental factors. The balance of microbes in the gut influences inflammation and toxin levels in the blood and modulates how the liver functions. 

Lifestyle factors like stress and sleep have significant impacts on the microbiome and the integrity of the intestinal barrier. Having a leaky gut increases inflammation and the chance of autoimmunity which are involved in many cases of jaundice. 

Incorporate a meaningful stress management practice to support your liver health. Mind-body approaches such as yoga, meditation, prayer, time in nature, and breathwork help to activate your parasympathetic nervous system and shift you into a rest-and-digest mode. Aim for a regular sleep schedule that allows for at least 7-9 hours a night.

Regular moderate exercise is also important for supporting liver health. Moving regularly helps to decrease excess inflammation and can improve intestinal permeability and gut health.

It is also important to avoid drinking alcohol or smoking to reduce the burden on your liver.

Integrating Conventional and Functional Treatments

Since the most effective treatment of jaundice in adults depends on understanding the underlying cause, functional medicine approaches are a valuable part of an integrated approach. Integrating treatments for jaundice that combine conventional medical treatments with functional medicine approaches provides a comprehensive management plan.

This type of holistic and collaborative healthcare approach is more likely to accurately pinpoint underlying factors. For example, a functional medicine history looks at nutrition factors and diet carefully. This can help uncover cases where carotenoderma from excessive consumption of carotene-rich foods like carrots, leafy greens, and tomatoes can cause yellowing of the skin that may look similar to jaundice but spares the whites of the eyes. 

This collaborative approach also supports the implementation of important lifestyle changes such as avoiding alcohol to support liver health and treat jaundice. This is key in cases of jaundice caused by alcoholic hepatitis and other liver disease where the individual must first stop drinking alcohol for the jaundice to be appropriately treated. In addition, certain medications may cause drug-induced liver disease including acetaminophen, penicillins, oral contraceptives, chlorpromazine (Thorazine), and estrogenic or anabolic steroids, so functional medicine can help offer alternatives.

In cases where surgery is needed, functional medicine can complement the conventional treatment by supporting the patient with post-operative recovery. This approach emphasizes nutrients that promote healing and encourages integrative methods for pain management and recovery.

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A Functional Medicine Approach to Jaundice

Jaundice or hyperbilirubinemia leads to yellow discoloration of body tissues including the sclera, skin, and mucus membranes due to a buildup of excess bilirubin. Functional medicine offers a comprehensive approach to figuring out the underlying causes of jaundice utilizing a careful history and physical examination along with functional medicine testing. This allows for a personalized plan of care to address the individual’s unique needs and rebalance her physiology. 

A multidisciplinary team of care integrating conventional with functional medicine approaches provides a multifaceted approach to effective jaundice management. This holistic management of jaundice incorporates strategies like diet, lifestyle, supplementation, and integrative medicine therapies to address each individual’s unique needs. This approach offers strategies to restore and maintain liver health to address jaundice.