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.

Although 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. “In addition, lifestyle adjustments have the benefit of preventing or combating other medical illnesses that can affect the liver, including metabolic syndrome and cardiovascular disease,” says Mayo Clinic expert and liver specialist Kymberly D. Watt, MD

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 some additional aspects to keep in mind when it comes to managing a healthy diet and supporting liver health.

Your health care team may recommend specific goals or dietary choices depending on the progression of the disease and any other conditions associated with PBC. 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 need a higher protein intake to combat muscle wasting.”

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

Choose anti-inflammatory foods.

Foods with anti-inflammatory properties can benefit people living with chronic inflammatory diseases like PBC, says Dr. Watt. Look for foods high in omega 3 fatty acids, such as salmon, sardines, cod, walnuts, chia seeds and leafy greens. These healthy fats are found in seed oils, such as canola or soybean oils. Research has also shown that fermented foods can reduce inflammatory markers in the body within 10 weeks. Foods like yogurt, kefir, kombucha, kimchi and cottage cheese are included—but to get anti-inflammatory benefits, be sure to buy products with live microbes. Look for packaging that lists live and active cultures.

Focus on vitamins A, D, E and K.

It is not uncommon for people with PBC to experience deficiencies of certain vitamins and minerals, including A, D, E and K. According to Dr. Watt, all of these vitamins require bile for proper absorption into the body, so for people with PBC, it is possible. Maintaining proper levels of these vitamins can be a challenge. While it’s great to get all the vitamins and minerals from a daily serving of fruits and vegetables, Dr. Watt says that people with PBC are often prescribed vitamin supplements to make sure they have the proper nutrients. In some cases, you 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 foods rich in calcium.

People with PBC are at a higher risk of developing osteoporosis, a condition that thins the bones and makes them more susceptible to fractures. Calcium – along with vitamin D, which your body needs to absorb calcium – can help protect your bones. The amount of calcium you need depends on a number of factors including your age and sex, but in general, adults should not have more than 2,500 milligrams per day. Foods rich in calcium 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.

“There are components in coffee other than caffeine that are beneficial for 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 may provide a range of health benefits. These benefits include lowering your risk of some chronic diseases and even some cancers. Research has shown that black coffee, caffeine, in particular, may be beneficial for the liver. “Some evidence suggests that more than three cups of coffee a day is more beneficial than less than three cups a day,” says Dr. Watt. Make sure that the time of drinking coffee does not 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 damage the liver and contribute to a number of chronic liver issues, including steatohepatic 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 talk about your options, talk to 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 good, fit in well with your lifestyle and help support your liver. Remember: It’s probably easier to make small changes than to overhaul your entire diet overnight. Consistency, rather than perfection, is the goal.

If you have been diagnosed with PBC and would like to learn more about your specific nutritional needs or simply improve your eating habits, talk to your healthcare team.

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