The bilirubin test measures total bilirubin, the pigment produced when haem from old red cells is broken down. Practitioners read it for red cell turnover, liver and bile duct function, and Gilbert's syndrome, which explains most isolated mild rises in otherwise well adults. Fasting, illness and haemolysis raise it, while light exposure of the sample can falsely lower it. Practitioners can order it through the Vively practitioner platform.
| Test type | Measured in a blood sample |
|---|---|
| Measurements required | Bilirubin only |
| Sample and collection | Blood draw at a collection centre |
| Preparation | If your practitioner has requested the Baseline Health Check, fast for 8 to 12 hours before a morning collection (water is fine). |
| Turnaround | 3 to 5 business days |
| Available through | Liver Function Tests, part of the Baseline Health Check. Also in: Full Body Health Check, Weight Management Test. |
| Pricing | Included in the $99 Baseline Health Check |
| Results | Returned in the Vively practitioner platform, beside your client's other markers |
What are the Bilirubin reference and optimal ranges?
| Typical lab reference | Vively optimal | |
|---|---|---|
| Adults | 1 to 20 µmol/L | 10 to 20 µmol/L |
Labs differ, so read the client's result against the range on their report (RCPA guidance). The optimal range is a long-term health target, not a diagnostic cut-off.
Check a client's Bilirubin result
Enter the value from your client's lab report to see where it sits against the typical lab range and the Vively optimal range.
A guide only, not a diagnosis. One result is a starting point: read it with symptoms, history and a repeat test. Labs differ, so check the result against the range on your client's report. Nothing you enter is stored or sent.
How do you arrange Bilirubin testing through Vively?
- Get verified. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Choose a panel. Log in to the practitioner platform and pick a panel that includes Bilirubin, or build your own. It is included in the $99 Baseline Health Check.
- Client collects. Your client collects at a partner collection centre, with their request on their phone or printed.
- Review results. Results come back to you in the practitioner platform, beside your client's other markers, ready for the follow-up consult.
Which Vively panels include Bilirubin?
Log in to the practitioner platform to view a panel in full, or build and save your own from 100+ tests and panels.
- Baseline Health Check74 markers across 11 lab groups$99
One fasting blood draw.
Full Blood CountUrea, Electrolytes & CreatinineLiver Function TestsCalcium, Phosphate & MagnesiumLipid StudiesDiabetes & Glycaemic StudiesIron StudiesThyroid Function Tests+3 moreLog in to view this panel - Weight Management Test27 markers · Heart & metabolicPrice on sign-upBilirubinTotal CholesterolLDL CholesterolHDL CholesterolNon-HDL CholesterolTriglyceridesFree testosteroneSHBG+19 moreLog in to view this panel
- Log in to view this panelFull Body Health Check87 markers · Health checksPrice on sign-up
Why does the optimal range sit there?
Our optimal range lifts the floor to 10 µmol/L and keeps the lab ceiling, because mildly higher bilirubin tracks with lower cardiovascular risk.
Bilirubin is a potent antioxidant (Stocker, Science 1987). Schwertner and colleagues (Clinical Chemistry, 1994) linked low serum bilirubin with more coronary artery disease, and several cohorts report lower cardiovascular disease rates in Gilbert's syndrome.
All are associated with lower bilirubin and explain part of the link, so a low-normal value adds some weight to other metabolic findings.
Higher values need a cause identified first.
What should Bilirubin be read with?
- ContextBilirubin 20 to 50 µmol/L, normal liver enzymes and blood count
Most often Gilbert's syndrome, especially if higher after fasting or illness.
- HighRaised bilirubin with low haemoglobin or abnormal red cell indices
Haemolysis; needs GP review.
- HighRaised bilirubin with high ALP and GGT
Cholestasis or bile duct obstruction; prompt GP review.
- HighRaised bilirubin with high ALT and AST
Liver cell injury; GP review.
- ContextBilirubin below 10 µmol/L with high triglycerides or fasting insulin
Fits a metabolic stress picture; read with the other markers.
What can affect a Bilirubin result?
- Fasting, very low calorie diets, illness and dehydration raise unconjugated bilirubin, most of all in Gilbert's syndrome.
- Haemolysis, in the body or in the sample.
- Light exposure of the sample before analysis can falsely lower it.
- Medicines such as rifampicin and atazanavir raise it.
- Smoking is associated with lower levels.
When should you refer the client to their GP?
- Jaundice, dark urine, pale stools, itch or right upper abdominal pain.
- Bilirubin above about 40 µmol/L (twice the upper limit), or rising on repeat tests.
- Raised bilirubin with abnormal liver enzymes or full blood count.
- Any raised conjugated (direct) bilirubin.
How should a client prepare for a Bilirubin test?
Copy or print this to send to your client.
Preparing for your Bilirubin test
- If your practitioner has requested the Baseline Health Check, fast for 8 to 12 hours before a morning collection (water is fine).
- Don't fast for much longer than 12 hours, as a long fast can raise bilirubin, especially if you have Gilbert's syndrome.
- Take your pathology request to any of 4,000+ collection centres. Bring it printed or on your phone.
- Keep taking prescribed medicines as usual unless your doctor tells you otherwise.
- Results usually take 3 to 5 business days and come to your practitioner. Book your results appointment for after that.
How do practitioners use Bilirubin with clients?
Record known Gilbert's syndrome in the client's notes so future results are not over-read, and steer them away from long fasts before blood tests. For low-normal bilirubin, the useful work sits with the metabolic markers that travel with it: diet quality, alcohol, activity and weight.
Bilirubin FAQs
Can a naturopath, nutritionist or dietitian order bilirubin through Vively?
Yes. Add it to a client panel on the Vively practitioner platform. It is part of Liver Function Tests in the $99 Baseline Health Check, and is also in Full Body Health Check and Weight Management Test. No account yet? Request free access.
How can I tell if a high bilirubin is Gilbert's syndrome?
Look for a mild, mostly unconjugated rise (usually 20 to 50 µmol/L) with normal liver enzymes and a normal full blood count, often higher after fasting or illness. A split into conjugated and unconjugated bilirubin helps, and the client's GP can request it. Formal diagnosis sits with the GP.
Does Gilbert's syndrome matter for supplements or medicines?
It can. Gilbert's reduces activity of the UGT1A1 enzyme, which also clears some medicines, most notably the chemotherapy drug irinotecan. For most supplements there is no established interaction. Ask clients to tell their GP and pharmacist they have it, and avoid prolonged fasting protocols, which push bilirubin higher.
Why does bilirubin rise after fasting or illness?
Fasting, very low calorie diets, illness and dehydration raise unconjugated bilirubin, most of all in Gilbert's syndrome. That is why an isolated mild rise is often higher after a long fast before blood collection. Advising clients to avoid prolonged fasting before the test gives a cleaner result, and recording known Gilbert's syndrome in their notes stops future results being over-read.
When is a raised bilirubin more than Gilbert's syndrome?
Involve the client's GP if bilirubin is above about 40 µmol/L (twice the upper limit), rising on repeat, or any of it is conjugated (direct). The same applies if liver enzymes or the full blood count are abnormal, or the client has jaundice, dark urine, pale stools, itch or right upper abdominal pain. Low haemoglobin alongside a high bilirubin points to haemolysis.
References
- RCPA Manual. Bilirubin.
- Pathology Tests Explained. Bilirubin.
- Stocker R, Yamamoto Y, McDonagh AF, Glazer AN, Ames BN. Bilirubin is an antioxidant of possible physiological importance. Science. 1987.
- Schwertner HA, Jackson WG, Tolan G. Association of low serum concentration of bilirubin with increased risk of coronary artery disease. Clinical Chemistry. 1994.