Complete Testing & Optimization Guide
Optimal ranges, provider comparison, and strategies to improve your Bilirubin (Total) levels
Included in 9 of 10 major testing providers
Liver Function
bile duct obstruction
Abnormal Bilirubin (Total) levels can indicate underlying health issues that may go undetected without proper testing. Regular monitoring helps catch problems early when they're most treatable.
Understanding your Bilirubin (Total) levels enables targeted interventions, tracks treatment effectiveness, and helps optimize your overall health and performance.
Bilirubin is a yellow-orange pigment produced when red blood cells break down at the end of their 120-day lifespan. The spleen and liver process about 250-400 mg of bilirubin daily from old red blood cells. This bilirubin travels to the liver where it is processed (conjugated) and excreted into bile, eventually leaving the body through stool (giving stool its brown color).
Total bilirubin consists of two forms:indirect (unconjugated) bilirubin, which has not yet been processed by the liver, and direct (conjugated) bilirubin, which has been processed and is ready for excretion. When bilirubin accumulates in the blood above 2-3 mg/dL, it causes jaundice—yellowing of the skin and whites of the eyes. The pattern of elevation (direct vs indirect) helps diagnose the underlying cause.
While elevated bilirubin typically indicates liver disease, bile duct obstruction, or excessive red blood cell breakdown, mildly elevated indirect bilirubin can be beneficial. Gilbert's syndrome, a benign genetic condition causing mild bilirubin elevation, is associated with increased longevity and reduced cardiovascular disease, likely due to bilirubin's potent antioxidant properties. However, significantly elevated bilirubin requires medical evaluation.
Bottom line: TSH and Free T4 alone miss people with conversion problems. Free T3 is the only way to know if you have enough active thyroid hormone at the tissue level.
| Range Type | Level | Clinical Significance |
|---|---|---|
| Optimal | 0.3-1.0 mg/dL | Normal bilirubin metabolism with healthy liver function and normal red blood cell turnover. Values in this range indicate efficient bilirubin processing and excretion. Most people fall in this range. |
| Mildly Elevated (Often Gilbert's) | 1.0-3.0 mg/dL | Often due to Gilbert's syndrome, a benign genetic condition affecting 3-7% of population. If indirect bilirubin is elevated with normal liver enzymes, no jaundice, and normal hemolysis markers, this is typically Gilbert's and requires no treatment. May actually be protective. If direct bilirubin elevated or liver enzymes abnormal, investigate further. |
| Moderately Elevated | 3.0-10.0 mg/dL | Causes visible jaundice and indicates significant pathology. Requires urgent investigation. If direct bilirubin elevated:Evaluate for bile duct obstruction (gallstones, tumor, stricture), cholestatic liver disease, or hepatocellular damage. Order liver enzymes, imaging (ultrasound/MRCP). If indirect bilirubin elevated:Investigate hemolysis (check LDH, haptoglobin, reticulocytes) or liver processing defect. |
| Severely Elevated | >10.0 mg/dL | Indicates severe liver dysfunction, complete biliary obstruction, or massive hemolysis. Requires immediate medical attention. Levels >15-20 mg/dL suggest acute liver failure, complete bile duct obstruction, or severe hemolytic crisis. Order urgent comprehensive workup including hepatitis panel, autoimmune markers, toxicology screen, imaging, and consider ICU-level care. May require ERCP for obstruction or emergency interventions. |
Standard lab range:bile duct obstruction
Gallstone management:If obstruction from gallstones, may require ERCP to remove stones or cholecystectomy (gallbladder removal)
Tumor evaluation:Pancreatic head tumors, cholangiocarcinoma, or metastases may require surgery, stenting, or oncologic therapy
Primary sclerosing cholangitis:If chronic bile duct inflammation, ursodeoxycholic acid (UDCA) 13-15 mg/kg daily improves bile flow
Drug-induced cholestasis:Discontinue offending medications (antibiotics, anabolic steroids, oral contraceptives)
Supportive care:Cholestyramine 4g twice daily for severe itching if cholestasis present
Treat underlying cause:Alcohol cessation, antiviral therapy for hepatitis B/C, immunosuppression for autoimmune hepatitis
N-acetylcysteine (NAC):600-1200 mg daily supports glutathione synthesis and liver detoxification
Milk thistle (silymarin):140-280 mg 2-3x daily supports liver regeneration
Avoid hepatotoxins:Eliminate alcohol, minimize acetaminophen (<2000 mg/day), avoid unnecessary medications
Nutritional support:Adequate protein (1.2-1.5 g/kg), vitamins A/D/E/K supplementation if cholestasis present (fat-soluble vitamin malabsorption)
Identify cause:Autoimmune hemolytic anemia, hemoglobinopathies (sickle cell, G6PD deficiency), mechanical hemolysis (prosthetic valves), medications
Corticosteroids:Prednisone 0.5-1 mg/kg daily for autoimmune hemolytic anemia
Folic acid:1-5 mg daily if chronic hemolysis (supports red blood cell production)
Avoid triggers:If G6PD deficiency, avoid fava beans, certain medications (sulfa drugs, antimalarials)
Blood transfusions:If severe anemia from hemolysis causing symptoms
Splenectomy:Consider if refractory autoimmune hemolysis
No treatment needed:Gilbert's is benign and actually associated with health benefits (lower CV risk)
Avoid fasting:Prolonged fasting (>12 hours) or caloric restriction can temporarily increase bilirubin
Adequate hydration:Dehydration can increase bilirubin concentration
Reduce stress:Physical or emotional stress can trigger transient increases
Inform providers:Let doctors know about Gilbert's to avoid unnecessary testing during illnesses (infections often transiently increase bilirubin in Gilbert's)
Consider it protective:Mild antioxidant benefit may reduce cardiovascular disease and cancer risk
Hydration:Adequate fluid intake (2-3 liters daily) supports bilirubin excretion
Fiber intake:25-35g daily fiber binds bile acids and supports elimination
Probiotics:Lactobacillus and Bifidobacterium may help prevent deconjugation of bilirubin in gut
Avoid alcohol:Completely abstain if liver disease present or bilirubin elevated
Monitor for worsening:Track symptoms (jaundice intensity, dark urine, pale stools, itching) and seek care if worsening
Vitamin supplementation:If cholestasis, supplement fat-soluble vitamins A, D, E, K
Note: Low bilirubin requires no treatment and is not associated with adverse health outcomes.
Note: Severity of symptoms correlates with bilirubin level. Mild elevation (1-3 mg/dL) often asymptomatic. Moderate elevation (3-10 mg/dL) causes noticeable jaundice. Severe elevation (>10 mg/dL) indicates serious disease requiring urgent care.
Multiple studies show individuals with Gilbert's syndrome (mild unconjugated hyperbilirubinemia) have 30-50% lower risk of cardiovascular disease and all-cause mortality. Bilirubin acts as a potent antioxidant, reducing LDL oxidation and inflammation. Higher bilirubin within normal range is also associated with reduced CV risk in general population.
Source:Vítek L, et al. Gilbert syndrome and ischemic heart disease:a protective effect of elevated bilirubin. Atherosclerosis. 2002;160(2):449-456.
In cirrhotic patients, serum bilirubin is a key component of the MELD score (Model for End-Stage Liver Disease), which predicts mortality and prioritizes liver transplant allocation. Rising bilirubin in cirrhosis indicates worsening hepatic function and warrants transplant evaluation when bilirubin exceeds 3-5 mg/dL persistently.
Source:Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-470.
Fractionation of bilirubin into direct and indirect components is diagnostically crucial. Direct bilirubin >50% of total indicates cholestasis or hepatocellular damage. Indirect bilirubin >80% of total suggests hemolysis or Gilbert's syndrome. This simple test directs further workup and differentiates numerous causes of jaundice.
Source:Roche SP, et al. Jaundice in the adult patient. Am Fam Physician. 2004;69(2):299-304.
Many medications cause cholestatic liver injury with marked elevation of direct bilirubin and ALP. Common culprits include amoxicillin-clavulanate, fluoroquinolones, anabolic steroids, and chlorpromazine. Withdrawal of the offending agent usually leads to improvement within 2-8 weeks, though some cases progress to chronic cholestasis.
Source:Björnsson ES, et al. Drug-induced liver injury:an overview. Clin Liver Dis. 2013;17(4):507-524.
Bilirubin is a powerful endogenous antioxidant, comparable to vitamin E in potency. It scavenges peroxyl radicals and inhibits lipid peroxidation. Mildly elevated bilirubin (as in Gilbert's) provides antioxidant protection without toxicity. This explains the cardiovascular and cancer risk reduction seen in Gilbert's syndrome.
Source:Stocker R, et al. Bilirubin is an antioxidant of possible physiological importance. Science. 1987;235(4792):1043-1046.
| Provider | Includes Test | Annual Cost | Total Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $468 | 83 | |
| ✓ | $798 | 100+ | |
 InsideTracker | — | $680 | 48 |
 Function Health | ✓ | $499 | 100+ |
| ✓ | $900 | 70+ | |
| ✓ | $1150 | 110 | |
| — | $Varies | 75+ |
Choose from 9 providers that include this biomarker in their panels
Bilirubin (Total) is a liver function biomarker that Waste product from breakdown of red blood cells The normal reference range is bile duct obstruction. Regular testing helps track changes and identify potential health issues early.
9 out of 10 major blood testing providers include Bilirubin (Total) in their standard panels. These include Superpower, Blueprint, Mito Health and others.
For most people, testing Bilirubin (Total) 2-4 times per year is recommended to establish baseline levels and track trends. If you have abnormal results or are actively working to optimize this biomarker, more frequent testing (quarterly) may be beneficial. Always consult with your healthcare provider for personalized testing frequency recommendations.
The standard laboratory reference range for Bilirubin (Total) is bile duct obstruction. However, many functional medicine practitioners recommend tighter "optimal" ranges for peak health and performance. Your ideal range may vary based on your age, sex, health goals, and other individual factors. Work with a healthcare provider familiar with optimal ranges to determine your target levels.
Most direct-to-consumer blood testing services that include Bilirubin (Total) provide the physician order as part of their service. However, some states have restrictions on direct-to-consumer testing. Check with your chosen provider about availability in your state and whether they provide the necessary physician authorization.
Elevated levels cause jaundice (yellowing of skin). Indicates liver disease
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs and before making decisions about blood testing.
