For Patients Caregiver Tips and Advice For Medical Professionals

25 OCTOBER 2018

The PBC Diet: What to Eat, What to Avoid

If you have PBC and go online to look for advice about diets, you’ll find lots of contradictory information and impassioned opinions.  To help sort out what to eat, we consulted Megan Gutierrez, Advanced Dietitian at the Kovler Transplant Center at Northwestern Memorial Hospital in Chicago.  She has extensive experience providing nutrition counseling to people with PBC and other liver diseases.



First, are there dietary guidelines that apply to everyone with PBC?

There isn’t a “one-size-fits all” diet for everyone with PBC. Nutritional needs can change as the symptoms arise and the disease progresses. A patient may need a very low-sodium diet if they have fluid overload from advanced ascites or edema. Later on – especially if the person is a liver transplant candidate – the focus might be to gain weight. People with advanced liver disease can experience nausea and loss of appetite, resulting in significant weight loss.

So everyone’s journey is different.  That’s why it’s important to see a registered dietician who can help tailor a diet to your individual needs. But there are still dietary recommendations that apply to most PBC patients.



So what’s a healthy diet for most people with PBC? What should they eat?

I typically recommended a Mediterranean diet modified for individual needs. PBC is an inflammatory disease, and this is a diet that fights inflammation. Here are my five suggestions:

  1. Eat lots of fruits and vegetables. If you can, go for five servings every day.  If you eat more, that’s even better!
  2. Opt for moderate amounts of lean meats. The recommended amounts will vary.
  3. Go for unsaturated fats like Omega 3s, extra virgin olive oil, nuts and fatty fish like salmon.
  4. Choose whole grains and complex carbohydrates.  Whether it’s cereal, crackers, breads or rice, always choose the whole grain variety.
  5. Drink coffee if it agrees with you, because there is evidence that it can help to that it can help to reduce the risk of liver cancer.  But try not to add cream or sugar.


What foods should PBCers reduce or eliminate?

  1. Avoid saturated fats like cream and butter and cut back or eliminate beef and pork with visible fat, sausages, bacon and deli meats.Always remember: fats are part of a balanced diet and should not be avoided completely. It’s true that people with PBC often have problems absorbing fats and fat-soluble vitamins because they have less bile.  The undigested fats can cause diarrhea, weight loss and other complications.  As a result, sometimes PBC patients think they should drastically reduce all fats.  That’s a mistake.  The key is to eat healthy fats.
  2. Stay away from foods high in sugar, especially sugar-sweetened beverages such as sodas, fruit drinks, and high fructose corn syrup.Here’s why: when the liver is forced to absorb too much sugar, it leads to fatty deposits that can eventually build up and result in fatty liver disease. On the other hand, don’t refrain from the naturally occurring sugar in fruits, which are great for people with PBC.
  3. Reduce sodium. If you have edema or ascites, cutting back on sodium is extremely important. But even if you don’t have those symptoms, you should get your sodium intake under control.Start by avoiding the salt shaker at the dinner table.  Cook with seasonings that do not contain any sodium such as salt-free blends (e.g, Mrs. Dash). I don’t want to suggest a specific amount of sodium, as diets will vary and there are variations in low- and moderate-sodium diets.


What about drinking alcohol?

People with PBC should either eliminate alcohol or drink very moderate amounts of it (no more than one glass of alcohol per day.  Drinking a lot of alcohol is not a good idea for anyone and it’s an especially bad idea people with liver diseases, including PBC.  But I don’t want to over-generalize about this: you absolutely need to consult with your physician to determine how much, if any, alcohol to drink.



What’s your view of nutritional supplements?

You should always try to meet nutritional needs from natural food sources before you turn to supplements.  But sometimes that’s not possible.

For example, people with PBC are at-risk for deficiencies in fat-soluble vitamins, such as A, D E and K. If you have these deficiencies, especially Vitamin D, it’s really hard to get all the extra vitamins you need from foods you eat.

If you’re concerned about your vitamin or mineral levels, you should first speak to a physician or dietitian about appropriate supplementation before taking anything over the counter.

As for other supplements, some people with PBC and other liver diseases swear by milk thistle. Another one I hear a lot about is dandelion.  There is no reliable evidence that either of these help people with PBC.

In general, one big problem with supplements is that they are regulated by the FDA as food, not drugs. So no regulatory agency makes sure that the labels match what’s in the bottles, and you can’t be sure what you’re getting when you take these pills.  That’s another reason I’d be very cautious about taking advice from “Doctor Google” about nutritional supplements.



What about probiotics? Do you recommend them?

Probiotics are the “good bacteria” that change the composition of the bacteria in the gut. Doctors often recommend them to people taking antibiotics or for other reasons. You can usually get more than enough probiotics from active cultures of bacteria in fermented foods. Low fat kefir or yogurts would be my choice for most PBC patients because they are lower in sodium than other fermented foods.



Some people in the PBC community rave about specific diets like gluten-free or non-dairy?  What would you advise them?

I’ve seen some PBCers who’ve felt symptom relief from avoiding certain foods. It could be related to true food sensitivities and it also could be a placebo-effect. I don’t dismiss trying them if you want.  But you need to be very careful if you try to eliminate major food groups from your diet, and I wouldn’t advise making any drastic changes before consulting with a physician and registered dietitian.



We wish you could consult with everyone who has PBC!  Since you can’t, please tell us how to find a nutritionist who’s qualified to help.

I’d recommend checking out eatright.org, the website of the Academy of Nutrition and Dietetics.  Click on “Find an Expert” in the top right hand corner. In most cases, you should be able to find registered dietitians located nearby.  Or I suggest asking your physician to recommend someone.

 

Megan Gutierrez is a Registered Dietitian Nutritionist and Board Certified Specialist in Renal Nutrition working with solid organ (liver, kidney, pancreas) transplant recipients and donors in Chicago. Interests include lifestyle interventions, gastrointestinal health, behavior change, and performing arts.


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