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Joey Graziadei's 'Yellow Eyes' Due to Gilbert Syndrome

— Current contestant on 'The Bachelor' was diagnosed with the genetic condition in high school

MedpageToday
A photo of Joey Graziadei on a billboard for The Bachelor in Los Angeles

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After weeks of speculation on social media about his "yellow eyes," Joey Graziadei, the star of the current season of "The Bachelor," revealed he has Gilbert syndrome.

To clear up the concerns expressed by fans of the hit reality show, 28-year-old Graziadei explained in an that he was diagnosed in high school after feeling sick for about a week and a half. Bloodwork revealed high bilirubin levels, and a subsequent liver ultrasound showed no emergent conditions.

Instead, he was diagnosed with a genetic disorder called Gilbert syndrome.

"At the end of the day, I am told that I am healthy. It's something that does affect the whites of my eyes," Graziadei said. "It is worse when I have stress or lack of sleep, which happens on a TV show."

According to the Genetic and Rare Diseases (GARD) Information Center from the NIH, is a mild liver disorder in which the liver doesn't properly break down bilirubin, potentially leading to hyperbilirubinemia. This can lead to signs of mild jaundice -- including yellowing of the eyes and skin -- although most individuals do not present with any symptoms at all.

James S. Park, MD, co-director of the Northwell Center for Liver Disease and Transplantation at the Northwell Health Transplant Institute in New York City, told ֱ that Gilbert syndrome is caused by changes in the UGT1A1 gene, which is autosomal recessive and must be inherited from both parents.

However, the recessive quality does not mean the mutated gene is uncommon, Park said.

"Roughly half of the population is known to carry at least one mutated [UGT1A1] gene," he said. "Different studies have estimated anywhere between 6% to 14% of the U.S. population has Gilbert syndrome."

Most people who have such mutations are unaware they have Gilbert syndrome because they don't experience any symptoms, he added.

"Typically, the scenario is that people find out [they] have slightly elevated unconjugated bilirubin or bilirubin in the blood during routine physical examination," Park said. "They're otherwise healthy."

When people with the condition experience an elevation in bilirubin, as Graziadei recently did, it's "thought to be related to dehydration, prolonged fasting, menstruation in females, physical overexertion, or certain medications," Park said, adding that stress or poor sleep can prompt bilirubin elevations as well.

"It is possible that if the show involves certain stressful events or conditions, such as being overly dehydrated or [increased] physical exertion, then it's possible that he can activate bilirubin elevations, so they can be more noticeable in the body such as in skin color or eye [color]," Park said.

Park added that Gilbert syndrome often "is a diagnosis of exclusion," as doctors must first rule out other conditions such as underlying chronic liver disease or hemolysis. However, genetic testing is available to confirm the diagnosis.

There are no specific treatments for the condition, Park added, but patients should inform all of their doctors about it in order to avoid exacerbations, which can be brought on by certain medications. Patients with Gilbert syndrome are not at higher risk of liver disease in the long term, he added.

Park said liver societies are advocating for regular liver function testing in the U.S., which may eventually lead to more people being diagnosed with Gilbert syndrome. "I do expect them to see more of this problem in the general population as a lot of people are getting [a] liver blood test," he said.

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    Michael DePeau-Wilson is a reporter on ֱ’s enterprise & investigative team. He covers psychiatry, long covid, and infectious diseases, among other relevant U.S. clinical news.