What is Total Bilirubin?
Total bilirubin reflects how much bilirubin — a yellow-colored pigment associated with red blood cell health and liver function — is circulating in your blood.
Every day, your body replaces billions of red blood cells.1 Bilirubin is produced when the liver processes hemoglobin from aging red blood cells.
A total bilirubin test measures two forms of bilrubin:
- Unconjugated bilirubin, which circulates in the bloodstream before reaching the liver
- Conjugated bilirubin, which is processed by the liver, so it can be excreted in bile.
Balanced bilirubin levels are associated with better metabolic and cardiovascular health. Mildly elevated bilirubin may act as an antioxidant, reducing oxidative stress.2
Why Does Total Bilirubin Matter?
- Protects cells from damage by neutralizing reactive oxygen species (ROS)
- Regulate inflammation by suppressing certain immune responses
- Promote fat burning by activating pathways involved in fat metabolism
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How to Interpret Total Bilirubin
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity. Optimal ranges are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Benefits of Optimizing Total Bilirubin
- Reduced fat accumulation and lower body mass index3
- Improved cardiovascular health and reduced heart disease risk4
- Lower risk of metabolic disease5
- Anti-inflammatory protection6
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Low Total Bilirubin Levels
Low bilirubin levels are typically a sign of a healthy, functioning liver, though extremely low levels can be caused by certain medications, consuming coffee or fasting before your blood test, or an underlying condition such as chronic kidney disease or an autoimmune disease.
High Total Bilirubin Levels (Hyperbilirubinemia)
Symptoms:
- Abdominal pain and swelling
- Fever
- Weakness
- Fatigue and lightheadedness
- Nausea and/or vomiting
- Chills
- Dark urine
- Jaundice
Causes:
- Temporary stressors (e.g., new medication; high consumption of alcohol)
- Gallstones
- Gilbert’s syndrome (genetic liver condition)
- Acute or chronic liver disease
- Hepatitis
- Bile duct obstruction
Healthspan impacts:
How Hone Treats Out of Range Total Bilirubin
Your Hone physician will evaluate total bilirubin levels as part of a comprehensive metabolic or liver panel alongside markers including albumin, globulin, liver enzymes, kidney markers and hydration status.
- Antiviral medications* – to treat hepatitis
- Endoscopic surgery* – to remove gallstones or bile duct blockages
- Treatments that address underlying conditions* such as liver dysfunction or viral infections
*Your Hone Physician does not prescribe these treatments but will recommend further evaluation and help coordinate care with your primary care provider when medical treatment is indicated.
- Avoid alcohol
- Reduce over-the-counter medication use
- Eat a liver-friendly, fiber-rich diet with lots of fruits and vegetables, whole grains, nuts, and beans
- Reduce sugar and processed foods
- Stay hydrated
- Avoid fasting or extreme dieting when bilirubin is elevated unless medically supervised
Muckenthaler MU, et al (2017). A Red Carpet for Iron Metabolism. Cell.
↑Vítek, L., & Tiribelli, C. (2021). Bilirubin: The yellow hormone? Journal of Hepatology.
↑Adin, C. A. (2021). Bilirubin as a Therapeutic Molecule: Challenges and Opportunities. Antioxidants.
↑Li, C., et al. (2022). The Nonlinear Relationship Between Total Bilirubin and Coronary Heart Disease: A Dose-Response Meta-Analysis. Frontiers in Cardiovascular Medicine.
↑Vitek, L., Stec, D. E., & Tiribelli, C. (2023). The physiology of bilirubin: Health and disease equilibrium. Trends in Molecular Medicine.
↑Adin, C.A. (2021). Bilirubin as a Therapeutic Molecule: Challenges and Opportunities. Antioxidants.
↑Zuvarox T, Goosenberg E, Belletieri C.(2025). Malabsorption Syndromes. National Library of Medicine.
↑Andrès, E., et al. (2024). Fat-Soluble Vitamins A, D, E, and K: Review of the Literature and Points of Interest for the Clinician. Journal of Clinical Medicine.
↑Chen, Z., et al. (2021). Association of Total Bilirubin With All-Cause and Cardiovascular Mortality in the General Population. Frontiers in Cardiovascular Medicine.
↑Yang, Z. X., et al. (2021). Serum Total Bilirubin Level Is Associated With Hospital Mortality Rate in Adult Critically Ill Patients: A Retrospective Study. Frontiers in Medicine.
↑Ramírez-Mejía, M. M., et al. (2024). The Multifaceted Role of Bilirubin in Liver Disease: A Literature Review. Journal of Clinical and Translational Hepatology.
↑Ramachandran, G., et al. (2023). Effect of probiotics on nutritional status, biochemical parameters, and disease severity in cirrhotic patients referred for liver transplantation–A randomised double blind, placebo-controlled trial. Clinical Nutrition ESPEN.
↑El-Serafi, I., et al. (2018). The effect of N-acetyl-l-cysteine (NAC) on liver toxicity and clinical outcome after hematopoietic stem cell transplantation. Scientific Reports.
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Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
