Primary Biliary Cholangitis (PBC) Diet Guide

Your liver cranks up bile production to help your body digest fats in the food you eat. It’s pretty responsive, too, making up to 34 ounces (1,000 milliliters) of bile daily to keep your digestive system humming along.

But if that bile can’t get from your liver to where it needs to go … well, that can be problematic.

If you have primary biliary cholangitis (PBC), limiting that call for bile is essential. The disease affects the ducts allowing 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.

Adjusting your diet is one of the things you can do to help manage PBC and keep your liver (and you) healthier. So, what should or shouldn’t be on your plate? Let’s set a menu with the help of gastroenterologist Dian Chiang, MD.

What is a healthy PBC diet?

First things first: There’s no standard PBC diet or single approach, says Dr. Chiang. Your specific nutritional needs may change as the disease progresses, for instance, or as different symptoms present.

But there are food recommendations that apply to most people with PBC.

Foods good for PBC

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 reduce your risk of disease and add years to your life.

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

Consider adding more of these items to your grocery list.

Fruits and vegetables

From a nutrient standpoint, it’s tough to top what fruits and vegetables bring to the table. “They have an abundance of vitamins that our bodies need,” notes Dr. Chiang.

That includes vitamins A, D, E and K, which are known as fat-soluble vitamins. These nutrients are abundant in fattier meats and dairy products that aren’t ideal to eat if you have PBC. (More on that in a bit.)

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

Whole-grain foods

A fiber-rich diet can improve liver function and protect against steatotic (fatty) liver disease and other conditions, says Dr. Chiang. That makes whole-grain foods like oatmeal, whole-grain bread or brown rice excellent mealtime choices for anyone with PBC.

(It should be noted that fruits and vegetables are high in fiber, too. Talk about a win-win on that front!)

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

Unsaturated fats

Dietary fats sound negative, right? Well, it turns out there are some good fats out there waiting to be plated. They’re called unsaturated fats, and they can be found in fish and plant-based foods.

Foods high in unsaturated fat (such as omega-3 fatty acids) break down easier during digestion than food loaded with saturated fats. That means you need less bile to get the job done, which puts less strain on your liver, explains Dr. Chiang.

Omega-3 fatty acids also can combat inflammation, which can help keep PBC in check.

Fish high in omega-3s include salmon, herring, Bluefin tuna, halibut, mackerel and anchovy. If you’re not a seafood fan, you can also get omega-3s from walnuts, flax seeds and chia seeds.

Other plant-based foods that serve as good sources of unsaturated fat include:

• Avocados.
• Nuts such as almonds, cashews and pecans.
• Olives and olive oil.
• Peanut and peanut products.
• Seeds such as pumpkin seeds, sesame seeds and sunflower seeds (ideally unsalted).

Coffee

A morning cup of coffee might give your liver a helpful jolt while also waking you up.

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,” notes Dr. Chiang.

Foods to limit with PBC

Certain foods can place extra demand or stress on your liver, something you want to avoid if you have PBC. That’s why you should try to avoid or limit the following in your diet if you have the disease.

Saturated fats

No surprise here given what we said above, right? Foods high in saturated fat put extra pressure on your liver to produce bile. If that bile can’t efficiently get through due to PBC, your liver will suffer the consequences.

Saturated fats can also worsen inflammation, escalating PBC further to restrict flow through your liver’s bile ducts.

So, given all that, it’s best to limit the consumption of fattier meats, like certain cuts of beef and pork. (If your beef is heavily marbled, it’s on the fatty side.) Try to stay away from deli meats, bacon and sausage, too.

Higher-fat dairy — such as butter, ice cream and other milk-based products — should also be kept to a minimum. (Substituting low-fat or fat-free dairy products can help you gain the nutritional benefits of the foods without the saturated fat.)

Sugary items

Foods loaded with added sugars aren’t good for 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 from sodas, baked goods, candy and other treats isn’t the best for your liver either.

“When we absorb these sugars, it can lead to fat building up in the liver,” Dr. Chiang adds. “Then, all of a sudden, you’re dealing with fatty liver disease in addition to PBC, which can cause you even more trouble.”

High-sodium foods

As PBC progresses, your body’s ability to process sodium and remove it from your body declines.

“The balance of sodium in our system is regulated by the kidneys, which is affected by advanced liver disease,” says Dr. Chiang. “Therefore, we usually recommend a low-sodium diet, particularly as PBC advances.”

Processed foods are typically high in sodium. In fact, more than 70% of the sodium in people’s diets usually comes from these pre-packaged food items, ranging from cereals to frozen meals to condiments. (Learn more about where sodium is hiding in your pantry.)

Alcohol

Your liver’s long list of jobs includes removing alcohol from your blood after you tip back an adult beverage. Over time, this can lead to a buildup of toxins and fats in your liver and the development of liver disease.

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

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 build a daily menu that works for you.

Diet alone can’t control PBC either. But it can be an important part of a treatment plan that also includes medication, an exercise regimen and regular checkups to monitor the progression of the disease.

“PBC is not a disease we can cure at this moment,” says Dr. Chiang. “But there are things we can do with diet and treatments to control it and slow the progression to a point that will not affect your quality of life or longevity.”