Bilirubin and Physical Activity: Understanding Urinary Levels and How to Regulate Them

What is Bilirubin?

Bilirubin is a yellow pigment that is formed when the body breaks down red blood cells. Normally, bilirubin is processed by the liver and excreted in bile, which is then eliminated from the body through the stool. However, in certain circumstances, bilirubin may appear in the urine.

High levels of bilirubin in urine during sports can be the result of several factors:

Hemolysis of exertion

During intense or prolonged exercise, particularly endurance sports or high-impact activities, red blood cells can rupture at an increased rate. Physical stress (repeated muscle contractions, shocks or vibrations to the body, equipment poorly adapted to physical activity, running on hard ground, etc.) imposed on the body during exercise can induce this phenomenon called "exertional hemolysis". When red blood cells rupture, they release bilirubin into the blood which is then excreted in the urine.

Physical impact and muscle contractions 

Sports activities that involve repetitive or sudden movements can also contribute to hemolysis. Also, the breakdown of muscles can release myoglobin (a protein found in muscle tissue) into the blood, and allow the production of bilirubin as it breaks down. The release of bilirubin will be increased into the blood and therefore into the urine.

Extreme temperatures 

When you expose yourself to excessive heat, your body may experience additional stress, which can increase the breakdown of red blood cells (hemolysis). Increased hemolysis can lead to increased release of bilirubin into the blood, resulting in higher levels of bilirubin in the urine. Very cold temperatures can also affect these levels, particularly when vasoconstriction (narrowing of blood vessels) occurs in certain parts of the body to increase blood pressure and reduce body heat loss.

Dehydration

Inadequate hydration during exercise can concentrate urine and increase bilirubin levels. Dehydration can increase the risk of hemolysis.

Use of medications 

Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of hemolysis and high bilirubin levels in the urine when taken before or during exercise.

It is essential to carefully monitor urinary bilirubin levels, especially during and after exercise. In general, maintaining adequate hydration, adjusting exercise intensity, and limiting prolonged exposure to extreme heat or cold can help prevent elevated urinary bilirubin levels during athletic activity.

To help maintain optimal levels of bilirubin in your urine, you may want to consider the following strategies:

Stay hydrated 

Make sure to stay well hydrated before, during and after training .

Proper warm-up and cool-down 

Performing a proper warm-up before training to prepare your body for physical activity helps reduce muscle breakdown. After training, allow yourself plenty of time to recover, which can help reduce stress on the body and maintain optimal bilirubin levels in your urine.

Progressive training 

Adopt a progressive approach in your training program to allow your body to gradually adapt to physical activity, both in terms of the intensity, duration and frequency of training, as well as the training conditions (cold or intense heat).

Avoid extreme environmental conditions 

Be careful when exercising in extreme temperatures, as heat or cold stress, combined with dehydration, can increase the risk of hemolysis. Stay hydrated and take breaks as needed to avoid overheating or overexerting your body.

Use of adapted equipment 

Use appropriate equipment for your sport or activity that helps reduce impacts, shocks or vibrations on the body, and thus prevent premature degradation of red blood cells.

Balanced diet 

A balanced diet rich in antioxidants, fiber, essential vitamins and minerals helps prevent bilirubin levels in the body. The following foods can be incorporated:

After intense physical activity, it is normal to find bilirubin levels in the body mainly coming from muscle breakdown and exertional hemolysis. Combining several of the techniques mentioned above will allow you to reduce these levels in the days that follow and help with physical preparation and recovery.