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.
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.
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:
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.
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.
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.
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.
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.
Last updated on July 12th, 2022 at 12:54 pm