Primary biliary cholangitis diet: Foods to eat and avoid

Last updated April 8, 2025, by Susie Strachan
Fact-checked by Marta Figueiredo, PhD

Primary biliary cholangitis (PBC) is a chronic liver disease that causes inflammation and damage to the bile ducts, the small channels that carry bile — a digestive fluid — from where it’s made in the liver to the intestines.

As this makes it harder for the body to digest and absorb fats and fat-soluble vitamins, eating a nutritious diet is important.

While there isn’t a specific PBC diet, eating a Mediterranean diet that focuses on plant-based foods and healthy fats can support your liver health by reducing inflammation and providing essential nutrients.

Avoiding alcohol consumption and smoking and limiting foods high in salt, saturated fats, and sugars can also help reduce liver strain and inflammation.

Nutritional goals for people with PBC

The best foods for a healthy liver are generally whole foods that provide nutrition without excess sugar or fat. These foods may help to prevent or lessen your PBC symptoms, such as fatigue, itching, and nutritional deficiencies.

Fatigue can be linked to poor nutrition or insufficient energy intake, so balanced meals can help maintain strength and energy.
Itchiness (pruritus) can occur when bile builds up to toxic levels in the liver, spills into the bloodstream, and accumulates in the skin, where it irritates nerves.
PBC can cause fat malabsorption, increasing the risk of nutrient deficiencies, including vitamin D, a fat-soluble vitamin, and calcium, whose absorption is dependent on vitamin D.
Vitamin D and calcium deficiencies, along with other features of PBC, can affect bone formation, putting you at risk for osteoporosis and broken bones.

Essential nutrients and foods to eat

Part of a balanced diet is ensuring you eat the proper nutrients for your condition. A registered dietitian can help you determine which foods to eat with PBC.

Some foods and nutrients they may recommend include:

unsaturated fats, such as those in olive oil, avocado, and nuts, which can help reduce inflammation and are more easily broken down, meaning that less bile is needed and they can more readily help your body absorb essential fat-soluble vitamins like A, D, E, and K
lean meats, fish, and plant-based protein sources like beans, lentils, and tofu, which can help provide high-quality protein without overloading your liver
sources of fiber such as whole grains (oatmeal, brown rice, whole-grain bread), fruits, and vegetables, which can support a healthy digestive system, reduce the risk of constipation, support the absorption of nutrients, and promote excretion of the fatty molecule cholesterol
antioxidant-rich foods, including berries, leafy greens, broccoli, and green tea, which can help protect liver cells from damage and inflammation
calcium-rich foods such as dairy products, fortified milk alternatives, cooked spinach, and canned fish with bones to help maintain strong bones.

In addition to certain dairy products, you can also try eating vitamin D-fortified foods or taking a supplement if recommended by your healthcare provider to help your body absorb calcium when living with PBC.

However, before adding vitamins or other supplements to your diet, consult your doctor, as too high a dose may cause toxicity and harm your health.

Foods to limit or avoid

Your dietitian may make specific dietary recommendations, including limiting or avoiding eating certain foods, as they have the potential to make your PBC symptoms worse.

High-fat and fried foods can strain your liver, as more bile is needed to break them down; if it doesn’t flow properly to the intestines, it promotes inflammation and damage to the bile ducts and liver.
Processed and sugary foods can lead to fat buildup in the liver, causing further damage, as well as weight gain and insulin resistance (a condition that causes high blood sugar levels). This may increase the risk of other health problems and make it harder for your body to maintain overall health.
High-sodium foods in your diet, such as processed meats and packaged foods, can contribute to swelling and fluid buildup, worsening symptoms of liver disease and increasing blood pressure.
Alcohol, which is metabolized by the liver, can put additional stress on the organ and worsen liver damage, so it’s best to avoid it entirely.
Raw shellfish such as oysters and other shellfish may carry harmful bacteria that can lead to infections, which can be more dangerous for people with liver disease.

Managing fat malabsorption and nutrient deficiencies

Fat malabsorption can occur when your liver can’t digest or absorb fat properly, leading to weight loss, diarrhea, greasy stools, and nutrient deficiencies.

Adding medium-chain triglycerides (MCTs), a type of fatty molecule, into your diet can help you manage the fat malabsorption PBC may cause.

Unlike long-chain fats, MCTs are more easily absorbed and can provide a source of calories without requiring bile for digestion. Coconut oil and MCT oil supplements are common sources of these fats.

Your healthcare provider can run blood tests to determine whether you have malabsorption. Then, a registered dietitian familiar with PBC can help you develop a nutrition plan to manage these deficiencies.

Meal planning and lifestyle tips

When changing your diet to improve your health, remember that this is a marathon, not a sprint. You want to create lifelong habits, not short-term fixes. You can do this by logging your food intake, exercising, and more.

Log your food intake

To give your dietitian a look at your typical diet, you can write out everything you’ve eaten in a week or use a food-tracking app, which can help you understand the nutritional content of the foods you eat.

Instead of radically changing your diet, your dietitian can then advise you on incremental changes to help you build new habits around the foods you put on your plate.

Ask your doctor about supplements

Supplements may help you with certain nutrient deficiencies. However, you must be cautious when considering supplements or herbal remedies, as some may harm your liver. Always consult your healthcare provider before adding new supplements to your routine.

Exercise regularly

Regular exercise can help support liver health by promoting circulation, reducing inflammation, and helping you maintain a healthy weight. Even moderate activities like walking, cycling, or swimming can be beneficial.

Before starting any exercise program, talk with a healthcare professional familiar with liver diseases such as PBC. They can assess your health and offer guidance on how to exercise safely.

Stop smoking

If you smoke, consider quitting, as smoking can negatively affect your liver as it works to remove tobacco’s toxic components from your system.

Smoking is also a known risk factor for more advanced liver diseases such as cirrhosis (irreversible liver scarring) and liver cancer.

You can support the health of your liver by following these tips and consuming nutritious foods, such as lean meats, unsaturated fats, and whole grains.

Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.