INTRODUCTION: Bilirubin is a potent endogenous antioxidant and immunomodulating substance, implicated also involved in cell signalization and various metabolic pathways. Mild elevation of its systemic concentrations provides substantial protection against numerous oxidative stress and inflammation-mediated diseases. Rare reports in the literature suggest that serum bilirubin might also be relevant to physical performance. The aim of the current study was to evaluate serum bilirubin concentrations and prevalence of Gilbert syndrome in elite athletes. METHODS: The study was carried out in 536 consecutive healthy elite athletes and in 2,594 individuals of the Czech post-MONICA study randomly selected from the Czech general population. Serum bilirubin concentrations, prevalence of benign hyperbilirubinemia >17 umol/L (1 mg/dL, a phenotypic sign of Gilbert syndrome, GS), and variant of the UGT1A1 promoter gene (rs81753472) were evaluated in study subjects. RESULTS: As compared to Czech general population, significantly higher serum bilirubin concentrations were found in elite athletes (9.6 vs. 11.6 umol/L, p<0.001), and this difference was observed in both men (11.3 vs. 12.6 umol/L, p<0.001) and women (8.3 vs. 10.5 umol/L, p<0.001). In addition, also the prevalence of a phenotypic GS was significantly higher in elite athletes (9.6 vs. 22%, p<0.001). Serum bilirubin concentrations in elite athletes were positively correlated with serum total antioxidant status (p<0.05). CONCLUSION: Elite athletes have significantly higher serum concentrations of serum bilirubin, the most potent endogenous antioxidant substance. Simultaneously, also the prevalence of GS syndrome is much higher in elite athletes, suggesting that mild elevation of serum bilirubin might predispose to better physical performance.
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