Living with primary biliary cholangitis (PBC) may mean that you face challenges during activities that were previously simple, like deciding what to eat. Some people find they need to change their diet to manage their PBC symptoms. Although there’s no official diet for PBC, eating certain foods may help support better health with a compromised liver.

The body relies on the liver for digestion and metabolism. Some of the liver’s many responsibilities include breaking down fat, storing iron and sugar, producing cholesterol, and detoxifying the blood.

However, in people with PBC, the liver becomes damaged and less efficient at keeping up with all these tasks. Since the liver plays a key role in fat absorption, people with PBC may not absorb essential fatty acids as well. They’re also more prone to certain health issues related to malabsorption, like weight loss and osteoporosis (a condition that causes bones to become weak and brittle).

Read on to discover which foods and beverages you may want to add to your diet and which you might consider avoiding.

5 Foods To Eat With PBC

Fortunately, you can eat plenty of tasty foods to give your body the nutrition it needs. You might want to meet with a registered dietitian nutritionist for individualized recommendations. In the meantime, here are five nutritious options to consider adding to your diet.

1. Fatty Fish

Digesting fat isn’t as easy when your liver isn’t working at full capacity. But healthy fats like the omega-3 fatty acids in fish reduce inflammation and benefit your health. Include a couple of servings of fatty fish like salmon or sardines in your weekly menu to improve your diet.

If you’re concerned about the cost of seafood, look for sales on canned items with no added salt. Mix them with low-fat mayonnaise or mashed avocado to make a sandwich filling similar to tuna salad. Fish cakes are another tasty dish that you can whip up in no time with some eggs, whole-grain bread crumbs, and salt-free seasonings.

2. Raw Walnuts

If you’re following a plant-based diet or just don’t like seafood, you can still get plenty of healthy fats in your diet by adding a small handful of walnuts and other nuts and seeds to your meals.

Add raw nuts and seeds on salads, yogurt parfaits, or homemade trail mix for a nutritional boost and satisfying crunch.

3. Kefir

Kefir is a fermented yogurt drink that provides probiotics (good bacteria) to support a healthy gut flora. These good bacteria help with various body functions, including digestion and immunity. However, antibiotics sometimes kill both the “bad bacteria” and the good. People with PBC can benefit from fermented foods like kefir, especially to help replenish their good bacteria after a round of antibiotics.

Kefir can also be a good source of calcium and vitamin D, essential for strong bones. Look for low-fat, low-sugar varieties in the refrigerated section of your grocery store and enjoy kefir regularly as a quick snack or with meals.

4. Oatmeal

PBC can raise your risk for high cholesterol, potentially leading to heart damage. Although many people require medication to get their cholesterol under control, you may reduce your cholesterol by five percent to eight percent with a daily bowl of oatmeal.

The soluble fiber in oatmeal helps the body excrete more cholesterol, keeping blood levels down. Enjoy your oatmeal with fruit, nuts, cinnamon, or chia seeds for added taste, texture, and health benefits.

5. Cooked Spinach

Cooked spinach is a nutritional powerhouse loaded with potassium, calcium, folic acid, and fiber. The nutrients in spinach can help people with liver diseases like PBC ward off common concerns like osteoporosis, high blood pressure, high cholesterol, and anemia. Researchers have also found that a higher intake of spinach is associated with a lower odds of developing fatty liver disease.

It’s easy to sneak spinach into a range of popular dishes, like soups, pasta meals, casseroles, and smoothies. Increasing your intake of nutrient-dense foods like spinach may help reduce the need for certain dietary supplements. Buy spinach frozen or fresh, and make an effort to include it frequently as part of a balanced diet.

5 Foods and Drinks To Avoid With PBC

People with PBC can continue to enjoy a variety of foods and beverages. There’s no need to have a highly restrictive diet with PBC, but reducing your intake of these items can help reduce complications and protect your long-term health.

1. Processed Meats

Eating too much sodium can cause fluid buildup in people with PBC. You may notice swelling if your rings are suddenly too tight on your fingers or the number on the scale goes up significantly over the course of the day. While most people think that the salt shaker is the main source of sodium, there’s a lot of sodium hidden in foods like deli meats.

In addition, processed meats like bacon and sausage can be high in saturated and trans fats, which promote inflammation, raise cholesterol, and can be difficult for people with PBC to digest. Cooking fresh or frozen lean meats is a better bet for your health.

2. Full-Fat Dairy Products

Dairy products can be a great source of bone-building protein and calcium, but they can be high in saturated fat. This can be problematic for people with PBC: The condition can cause a person to have less bile, which makes it more difficult for their bodies to absorb the fats from foods like dairy products. In light of these potential issues, the American Liver Foundation recommends that people with PBC avoid eating saturated fats.

When it comes to dairy, you can get the same nutritional benefits without the hazards of saturated fat by choosing low-fat or fat-free products. Check the label on milk, cottage cheese, yogurt, and even ice cream to find lower-fat varieties that you enjoy.

Keep in mind that sometimes food manufacturers add sugar to make up for the taste difference in lower-fat products, so be mindful of sugar content as well. Adding fresh or frozen fruit to dairy is a healthier way to boost the flavor.

3. Sugary Drinks

Consuming concentrated sources of sugar, like soda, can lead to the buildup of fatty deposits in the liver. After a while, you may develop a fatty liver that further impairs liver function and health. Cutting back on sugary drinks can be a challenge if they’ve been part of your routine for a while.

Remember, any progress is good. You can reduce your intake by replacing sodas with naturally flavored seltzer water or juice spritzers with a splash of fruit juice diluted with plain club soda. If the sugar in your coffee or tea is a must, try reducing your usual amount by half and give it a week to allow your taste buds to get used to a morning beverage that’s not as sweet.

4. Raw Seafood

Raw shellfish and oysters can put anyone at risk for food poisoning. But when you have liver disease, a foodborne illness can put your health in serious jeopardy. Avoid this risk by choosing fully cooked seafood only. If you’re a fan of sushi, choose vegetarian rolls or those with cooked seafood, like shrimp.

5. Alcohol

Any alcohol you consume must be processed by the liver. It’s best not to put your liver under any unnecessary stress by including alcohol in your diet with PBC.

Only your health care provider can assess your liver condition to determine whether alcohol or other dietary choices are appropriate for you. If you don’t plan to quit drinking, it’s crucial to make every effort to work on cutting back. Discuss your diet and lifestyle with a health professional for support and guidance when making changes.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with primary biliary cholangitis.

Do you have any strategies for a healthy, low-sodium diet? How do you get enough fat-soluble vitamins in your diet? Share your experience in the comments below, or start a conversation by posting on your Activities page.