What To Eat To Help Manage Primary Biliary Cholangitis

Your liver cranks up bile production to help your body digest fats in the food you eat. But if that bile can’t get from your liver to where it needs to go … well, that can be a problem.

Primary biliary cholangitis (PBC) is a chronic disease that affects your bile ducts, which typically allow bile to flow from your liver. Inflammation and scarring from PBC can create bile backups that eventually lead to liver failure and other health issues.

But adjusting your diet can help manage PBC and keep your liver healthier. Gastroenterologist Dian Chiang, MD, explains what should (and shouldn’t) be on your plate.

What is a healthy PBC diet?

First things first: There’s no standard or singular “PBC diet,” Dr. Chiang says. Your specific nutritional needs may change as the disease progresses or your symptoms change.

That said, there are some food recommendations that apply to most people with PBC.

Foods that are good for PBC

The pillars of the Mediterranean diet typically work well for most people with PBC, given the anti-inflammatory properties of many of the foods it includes.

That makes sense because, when it comes to using food as a form of preventive medicine, the Mediterranean diet is often considered the gold standard. Research shows the eating plan can help lower your risk of disease and even help you live longer.

Here are some foods to add to your grocery list when you’re living with PBC.

Unsaturated fats

Unsaturated fats are the so-called “good” fats (like omega-3 fatty acids) that can be found in fish and some plant-based foods. They’re especially good for people with PBC because they break down more easily during digestion than food loaded with saturated fats.

“That means your body needs less bile to get the job done, which puts less strain on your liver,” Dr. Chiang explains.

Omega-3 fatty acids also help combat inflammation, which can help keep PBC in check. Look for fish high in omega-3s, like:

• Salmon
• Herring
• Bluefin tuna
• Halibut
• Mackerel
• Anchovies

Not a seafood fan? You can also get omega-3s from plant-based foods, like nuts, seeds, avocados and olives.

Fruits and vegetables

From a nutrient standpoint, it’s tough to top what fruits and vegetables provide. They are:

• Anti-inflammatory
• High in fiber
• Full of important nutrients

When you have PBC, certain fruits and veggies bring something else important to the table, too: They help increase your intake of fat-soluble vitamins. These vitamins are abundant in fattier meats and dairy products, which aren’t ideal for people with PBC. (More on that in a bit.) So, it’s important to get them through plant-based foods instead.

“People with PBC are often at risk of deficiencies in fat-soluble vitamins,” Dr. Chiang notes. “Eating five or more servings of fruits and vegetables every day can help you get what you need.”

Your provider may recommend supplements to help you get enough of the vitamins you need — but don’t take anything without speaking to them first. Your provider gives you guidance that’s specifically tailored to your health needs.

Whole-grain foods

A fiber-rich diet can improve liver function and protect against steatotic (fatty) liver disease and other conditions.

Whole-grain foods are packed with fiber, which makes them excellent mealtime choices for anyone with PBC, says Dr. Chiang. Good options include:

• Oatmeal
• Whole-grain bread
• Brown rice

Whole-grain foods are complex carbohydrates, which can help keep your stomach feeling fuller for longer without taking in as many calories or saturated fats.

Coffee

Your morning cup of coffee might do more than wake you up — it may also give your liver a helpful jolt.

Research shows that coffee may have a protective effect on your liver.

“We don’t have the definitive answer as to why, but the caffeine in coffee may activate a small receptor inside the liver that can slow down the progression of PBC,” Dr. Chiang reports.

Foods to limit with PBC

Certain foods can place extra demand or stress on your liver, and if you have PBC, that’s something you want to avoid. If you’re living with this disease, try to avoid or limit the following.

Saturated fats

Foods that are high in saturated fat put extra pressure on your liver to produce bile, which is an especially bad thing if PBC is keeping bile from flowing efficiently. Saturated fats can also worsen inflammation, which can escalate PBC and further restrict bile flow.

Because of that, it’s best to limit foods like:

• Fatty meats, such as certain cuts of beef and pork
• Deli meats
• Other processed meats, like bacon, sausage and hot dogs
• Higher-fat dairy, like butter, ice cream and other milk-based products

Look for leaner cuts of meat without heavy marbling. And substitute low-fat or fat-free dairy products to reap the nutritional benefits of these foods without the saturated fat.

Sugary foods and drinks

Added sugar can harm your health in a variety of ways. A sweetened-up diet can be bad for your heart, for instance, and has been linked to weight gain, obesity and diabetes.

And as you might suspect, too much sugar isn’t the best for your liver either.

“When your body absorbs these sugars, it can lead to fat building up in the liver,” Dr. Chiang explains. “You may find yourself dealing with fatty liver disease in addition to PBC, which can cause you even more trouble.”

Avoid or significantly limit items like:

• Soda
• Baked goods
• Candy
• Other sweet treats

High-sodium foods

As PBC progresses, your body becomes less able to process and remove sodium from your body. So, it’s best to avoid high-sodium foods.

“Your kidneys regulate the balance of sodium in your system, and advanced liver disease can affect this process,” says Dr. Chiang. “So, we usually recommend a low-sodium diet, particularly as PBC advances.”

More than 70% of the sodium in people’s diets is estimated to come from pre-packaged, processed foods, like cereals, frozen meals, condiments and more. It’s important to learn where sodium is hiding in your pantry so you can make changes as needed.

Alcohol

Your liver’s long list of jobs includes removing alcohol from your blood. But over time, drinking alcohol can lead to a buildup of toxins and fats in your liver, which can contribute to the development of liver disease.

“Alcohol is a definite stressor for your liver,” Dr. Chiang cautions. “So, if you have PBC, less is always better.”

Final thoughts

When it comes to diet and PBC, there is no one-size-fits-all answer. Talk with your healthcare provider — and perhaps a registered dietitian — to create an eating plan that fits your needs.

Diet alone can’t regulate PBC. But it can be an important part of your treatment plan, alongside options like medication, an exercise regimen and regular checkups to monitor your health.

“Right now, there’s no cure for PBC,” Dr. Chiang acknowledges. “But there are things we can do, with diet and treatments, to manage it and slow its progression to a point that it doesn’t affect your quality of life or longevity.”