Primary biliary cholangitis: Your guide to diet and nutrition

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Diet is an important part of supporting liver health — and that’s especially true for people with chronic liver conditions.

Primary biliary cholangitis (PBC) is a progressive disease that damages the bile ducts of the liver and, over time, can lead to liver damage.

While lifestyle changes may not be able to slow the progression of PBC or treat the underlying disease, they can help manage symptoms and maintain your quality of life. “Additionally, lifestyle adjustments have the benefit of preventing or addressing other medical ailments that can impact the liver, including metabolic syndrome and cardiovascular disease,” says Mayo Clinic expert and liver specialist Kymberly D. Watt, M.D.

Below, Dr. Watt discusses the ins and outs of a PBC-friendly diet.

Tips for a healthy, PBC-friendly diet

By now, most people know that a healthy diet includes a wide variety of foods, including plenty of fruits and vegetables, whole grains, dairy, protein, and healthy fats. For those living with PBC, Dr. Watt says there are a few extra considerations to keep in mind when it comes to managing a healthy diet and supporting liver health.

Your healthcare team may recommend specific goals or diet options depending on the disease progression and any other PBC-related conditions. For those with more-advanced liver scarring, for example, it may be necessary to avoid high-sodium foods to minimize the risk of swelling and fluid retention, according to Dr. Watt. “Meanwhile, people with cirrhosis may require higher protein intake to combat muscle wasting.”

But Dr. Watt says there are a few general guidelines that may be helpful for people with PBC:

Choose anti-inflammatory foods.

Foods with anti-inflammatory properties can have a potential benefit for people living with chronic inflammatory diseases such as PBC, says Dr. Watt. Look for foods with omega 3 fatty acids, such as salmon, sardines, cod, walnuts, chia seeds and leafy greens. Seed oils, such as canola or soybean oils, also contain these healthy fats. Research has also shown that fermented foods can decrease inflammatory markers in the body in as little as 10 weeks. Foods such as yogurt, kefir, kombucha, kimchi and cottage cheese all count — but to receive anti-inflammatory benefits, make sure to purchase products with live microbes. Look for packaging that lists live and active cultures.

Focus on vitamins A, D, E and K.

It’s not uncommon for people with PBC to experience deficiencies of certain vitamins and minerals, including A, D, E and K. According to Dr. Watt, these vitamins all require bile for proper absorption into the body, so for people with PBC, it can be a challenge to maintain proper levels of these vitamins. Although it’s ideal to get all vitamins and minerals from daily servings of fruits and vegetables, Dr. Watt says people with PBC are often prescribed vitamin supplements to ensure they have the proper nutrients. In some cases, you also may need to take calcium, folic acid or iron supplements. Dr. Watt says your healthcare team may recommend routine blood tests to monitor your levels.

Look for calcium-rich foods.

People with PBC are at a higher risk of developing osteoporosis, a condition that causes the bones to thin and become more susceptible to fractures. Calcium — alongside vitamin D, which your body needs to absorb calcium — can help protect your bones. How much calcium you need depends on a number of factors including your age and sex, but in general, adults should have no more than 2,500 milligrams a day. Calcium-rich foods include dairy products, dark leafy greens, and certain fish such as sardines and salmon. However, even if you have a balanced diet, your healthcare team may recommend prescription medications or supplements to help reduce or treat bone loss.

Enjoy your coffee.

“Coffee has components beyond just caffeine that are beneficial to people with chronic liver disease,” says Dr. Watt. Coffee has hundreds of different components — including antioxidants and micronutrients such as magnesium, potassium and vitamin E — that can bring a range of health benefits. These benefits include lowering your risk of a number of chronic diseases and even certain cancers. Research has shown that black, caffeinated coffee can be beneficial, in particular, for the liver. “Some evidence suggests that over three cups of coffee a day is more beneficial than less than three cups a day,” says Dr. Watt. Just be sure that the timing of coffee drinking doesn’t interfere with your ability to fall asleep.

Avoid alcohol.

Finally, Dr. Watt recommends that anyone with an underlying chronic liver disorder avoid alcohol. Excessive alcohol consumption can cause liver damage and contribute to a number of chronic liver issues, including steatotic liver disease and cirrhosis. For people without liver disease, moderate drinking is considered two drinks a day for men and one drink a day for women. If you want to cut down on drinking or simply talk through your options, consult with your healthcare team.

A PBC diet to fit your lifestyle and support your liver

There is no one-size-fits-all diet when it comes to managing your PBC symptoms and risk factors. But a healthy diet should feel satisfying, fit well into your lifestyle and help support your liver. Just remember: Small changes will probably be easier to maintain than overhauling your entire diet overnight. Consistency, rather than perfection, is the goal.

If you have been diagnosed with PBC and want to learn more about your specific nutrition needs or simply improve your eating habits, speak with your healthcare team.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

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