# Nutrition in primary biliary cholangitis
Fat absorption and fat-soluble vitamins
In primary biliary cholangitis (PBC), bile production gradually decreases, which can reduce fat absorption in the small intestine. This can become particularly noticeable as the disease progresses.
Fat-soluble vitamins (A, D, E and K) are normally absorbed with dietary fat. When this process is disrupted, deficiencies can develop.
ProveniIncluded in official guidelines, or approved by EMA or FDA
is that patients with PBC are regularly monitored for levels of these vitamins, especially vitamin D and K. Vitamin D also plays a role in bone strength, which is relevant because patients with PBC more often experience bone loss (osteoporosis).
ResearchediPositive results in clinical studies, not yet standard treatment
is the question of whether additional vitamin D intake can be protective against certain complications. Research suggests that adequate vitamin D levels may contribute to overall wellbeing, but this requires regular monitoring by your doctor or dietitian.
Vitamin K is important for blood clotting. When the liver no longer functions well, the body may have difficulty absorbing and storing K. This is usually monitored by your healthcare provider through blood tests.
Protein intake and liver nutrition
Adequate protein intake helps maintain muscle strength and tissue repair capacity. For people with PBC, this is important because the disease can affect energy metabolism.
ProveniIncluded in official guidelines, or approved by EMA or FDA
is that sufficient protein intake is part of standard supportive care. However, this does not mean you need to eat extremely large amounts of protein — normal amounts from food (meat, fish, eggs, dairy, legumes) are usually sufficient. As liver function further declines, adjustments may be needed, something your healthcare provider will discuss with you.
Salt and fluid intake
In earlier stages of PBC, salt intake restriction is usually not necessary. As the disease may progress and symptoms such as fluid retention develop, salt restriction may become part of the treatment strategy.
ProveniIncluded in official guidelines, or approved by EMA or FDA
is that your healthcare provider will advise you about this when it becomes relevant — not in advance.
Carbohydrates and sugar
There is no specific evidence that patients with PBC must avoid certain types of carbohydrates. A balanced diet with whole grain and fibre-rich products contributes to overall wellbeing, just as it does for everyone.
ResearchediPositive results in clinical studies, not yet standard treatment
is the possible role of certain dietary patterns in preventing additional conditions (such as metabolic syndrome), but there is currently no clear guideline specifically for PBC on this.
Alcohol
Advised againstiProven ineffective or harmful, or dangerous in combination with your treatment
is alcohol consumption in everyone with known liver disease, regardless of the stage. Alcohol can further burden liver function and have harmful interactions with medicines you take. This also applies to people who feel their PBC is still "mild".
Food and medication interactions
Some medicines used in PBC (such as ursodeoxycholic acid) work best when taken at certain times and can be affected by food. Your healthcare provider or pharmacist will give you specific instructions about this, tailored to your own medication schedules.
ProveniIncluded in official guidelines, or approved by EMA or FDA
is that regular consultation between you, your doctor and dietitian is important to ensure that your nutrition aligns with your medicines.
Energy and weight
Fatigue is a frequently reported symptom in PBC. This can be related to altered energy expenditure. Regular, healthy meals can help maintain stable weight and energy.
ResearchediPositive results in clinical studies, not yet standard treatment
is the question of whether certain dietary patterns can relieve fatigue, but there is currently no strong evidence on this.
Tests and appointments with a dietitian
Because nutritional problems can occur (or may not), regular monitoring by your medical team is essential. A dietitian with experience in liver disease can help you understand what you personally need, based on your blood values, symptoms and medicines.
ProveniIncluded in official guidelines, or approved by EMA or FDA
is that nutritional guidance is part of optimal care for patients with PBC.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._