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Updated: Mar 15

What is Bilirubin?

Bilirubin is a yellow pigment produced during the body’s breakdown of red blood cells. Under normal circumstances, the liver processes bilirubin, excreting it in bile, which is subsequently expelled from the body in the feces. However, in certain circumstances, bilirubin may appear in urine.

How can levels be affected?

High levels of bilirubin in urine during physical activity can be the result of various factors:

  1. Exercise-induced haemolysis: During intense or prolonged exercise, particularly endurance sports or high-impact activities, red blood cells can break down at an abnormally increased rate. The physical stress (repeated muscular contractions, shocks or vibrations to the body, equipment unsuitable for physical activity, running on hard ground, etc...) exerted on the body during exercise can induce this phenomenon known as "exercise-induced haemolysis". When red blood cells break down, they release bilirubin into the blood, which is then excreted in urine.

  2. Physical impact and muscle contractions: Sports activities involving repetitive or sudden movements can also contribute to haemolysis. Also, muscle breakdown can release myoglobin (a protein present in muscle tissue) into the bloodstream, allowing bilirubin to be produced as it breaks down. The release of bilirubin into the blood, and consequently into the urine, will be elevated.

  3. Extreme temperatures: When you are exposed to excessive heat, your body may experience additional stress, which can increase the breakdown of red blood cells (haemolysis). Increased haemolysis can lead to an 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 the blood vessels) occurs in certain parts of the body to increase blood pressure and reduce body heat loss.

  4. Dehydration: Insufficient hydration during exercise can concentrate urine and increase bilirubin levels. Dehydration can increase the risk of haemolysis.

  5. Use of medicines: Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), can increase the risk of haemolysis and elevated bilirubin levels in the urine when taken before or during exercise.


Careful monitoring of urinary bilirubin levels is essential, particularly during and after exercise. In general, maintaining adequate hydration, adjusting the intensity of exercise and limiting prolonged exposure to extreme heat or cold can help prevent elevated levels of urinary bilirubin during sporting activity.

How can I maintain an optimal rate?

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

  • Stay well hydrated: Make sure you 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 enough time to recover, which can help reduce stress on the body and maintain optimal levels of urinary bilirubin.

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

  • Avoid extreme environmental conditions: Be mindful when exercising in extreme temperatures, as exposure to extreme heat or cold, when coupled with dehydration, can increase the risk of haemolysis. Stay hydrated and take breaks if necessary to avoid overheating or overexerting your body.

  • Use of suitable equipment: Use suitable equipment for your sport or activity that reduces the impact, shock or vibration on the body, thus avoiding premature damage to red blood cells.

  • Balanced diet: A balanced diet rich in antioxidants, fibre, vitamins and essential minerals can help to prevent elevated bilirubin levels in the body. The following foods can be incorporated:

Green leaf vegetables




- Spinach

- Kale

- Rocket

- Beet leaves

- Mustard greens

- Turnip greens

- Collard greens

- ...

- Oranges

- Mandarins

- Grapefruit

- Lemons

- Limes

- ...

- Strawberries

- Blueberries

- Raspberries

- Blackberries

- Goji berries

- Acai berries

- ...

- Walnuts

- Almonds

- Cashew nuts

- Hazelnuts

- Chia seeds

- Linseed

- Sunflower seeds

- Pumpkin seeds

- ...

  • Be mindful when using medicines: Use medications responsibly and as directed by your healthcare provider. Avoid unnecessary use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin, as they can potentially contribute to haemolysis.

After intense physical activity, it is normal to find bilirubin levels in the body, mainly due to muscle breakdown and haemolysis during exercise. Combining several of the above techniques will enable you to reduce these levels in the days that follow and help with physical preparation and recovery.

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