Living With PBC (Primary Biliary Cholangitis)

Primary biliary cholangitis (PBC) doesn’t just go away. It’s a chronic, progressive condition that damages the small bile ducts in your liver. Without treatment, it can lead to complications over time.

But many people live for years with the disease, says gastroenterologist Dian Chiang, MD, and the daily decisions you make may help you stay healthier for longer.

Dr. Chiang explains how to be proactive in managing PBC.

4 tips to manage PBC

Your liver is a spongy, wedge-shaped organ about the size of a football. It handles hundreds of critical tasks for your body, including creating bile to help you digest food.

But PBC causes inflammation that narrows passageways known as bile ducts, which disrupts the flow of bile from your liver to your digestive system. Bile that can’t get through backs up and damages your liver. That can lead to permanent scarring (cirrhosis) and eventual liver failure, along with other health issues.

Dr. Chiang shares what you can do to slow that process.

1. Eat a healthy diet

Bile helps your body break down fats in the food you eat. But if you have PBC, it’s important to limit foods that need bile for digestion.

“Following the Mediterranean diet typically works well for people with PBC because it focuses on plant-based foods and healthy fats,” Dr. Chiang says.

Foods that fit best into a PBC diet include:

• Fruits and vegetables: The produce aisle is full of nutrient-dense options that are loaded with vitamins A, D, E and K. These fat-soluble vitamins are also found in fattier meats and dairy products that aren’t ideal for people with PBC, so it’s important to get them through produce.
• Whole-grain foods: A fiber-rich diet can boost liver function and guard against fatty liver disease. Whole-grain foods, like oatmeal, whole-grain bread and brown rice, also help keep you feeling fuller for longer, which can help limit snacking.
• Unsaturated fats: Unsaturated fats, like omega-3 fatty acids, are
  “good” fats. They break down more easily during digestion, which puts less demand on your liver to produce bile.

If you have PBC, it’s best to limit or avoid foods that are high in saturated fats, sugar or sodium. Minimize or avoid alcohol, too, which can put extra stress on your liver.

2. Exercise regularly

Research shows that 20% to 45% of people with PBC develop osteoporosis, a gradual weakening of the bone. It’s one of the more common complications of the disease.

“Adopting a fitness regimen early after a PBC diagnosis can guard against the loss of bone density and muscle mass,” Dr. Chiang says. “We recommend both aerobic and resistance [strength] exercise.”

Regular physical activity may also help relieve PBC-related fatigue and improve your energy levels.

3. Focus on fall prevention

If PBC weakens your bones, it increases your risk of serious injury in a fall.

“A fracture from a fall is one of the biggest things that can decrease quality of life in people with PBC as it advances,” notes Dr. Chiang.

Exercise can help you maintain strength and agility to avoid a tumble. Dr. Chiang also recommends taking the following steps to make your home safer:

• Clear walkways of clutter (like shoes) and other hazards (like cords).
• Get rid of throw rugs, or secure them with two-sided tape.
• Install grab bars and add non-slip mats to bathrooms, tubs and showers.
• Add bright lighting to dark areas to improve visibility.

“You can significantly minimize your fall risk by paying attention to your home environment,” he says.

4. Get regular checkups

When you’re living with PBC, it’s important to see a liver specialist (hepatologist) for regular checkups. They’ll want to monitor your condition for signs of progression.

Different medications and treatments are available to address your specific needs, particularly if your PBC symptoms change. Your provider can also test for vitamin deficiencies and recommend diet changes or supplements to manage any nutritional issues.

“There’s no one-size-fits-all approach,” Dr. Chiang clarifies. “There are several medications available for PBC, so talking with your liver doctor is the best way to figure out what will work best for you.”

Bottom line

PBC often progresses slowly. Healthy habits — including eating nutritious foods, exercising regularly and keeping up with your medications — can help slow the disease even further.

“There’s not yet a cure for PBC,” Dr. Chiang acknowledges. “But there are things you can do to keep it from affecting your quality of life.”