Primary Biliary Cholangitis (PBC)
Primary biliary cholangitis (PBC), formerly known as Primary Biliary Cirrhosis, is an inflammatory condition of the bile ducts resulting in narrowing and distortion of the bile ducts; this can eventually cause damage to the surrounding liver cells. The disease more commonly affects middle-aged women. The onset of symptoms is gradual, most commonly with fatigue and itching skin as the first symptoms. If obstruction to the flow of bile occurs, this can lead to liver cirrhosis. This disease is an autoimmune disease where the patient's own immune system attacks their bile ducts.
PBC has many similarities to the autoimmune disease called sclerosing cholangitis; thus, essentially the dietary and supplement program is the same for both diseases. As with sclerosing cholangitis, excellent results and long term control of this disease can usually be achieved with integrative and nutritional medicine.
If you have any questions or concerns, you may contact my naturopath, Christine, at 623-334-3232 or send an email to [email protected].
What are the symptoms of PBC?
The symptoms may include:
- itching
- jaundice
- enlarged liver
- abdominal pain
- fatty deposits under the skin
- soft yellow fatty spots on the eyelids (xanthelasma)
- fatty pale stools
Tests
Liver function tests, an ultrasound scan and a fibroscan should be done. Some doctors will want to do a liver biopsy for a definitive diagnosis. Blood tests for mitochondrial antibodies will be positive in about 95% of cases. Blood tests for Vitamin A, Vitamin K, and Vitamin D can be done as without adequate bile flow the absorption of fat soluble vitamins is compromised.
Recommended books
Treatment and general recommendations
- You must avoid ALL gluten. This is essential for all autoimmune diseases and in order to heal leaky gut.
- Avoid ALL margarines and dairy products.
- Avoid deep fried foods and hydrogenated vegetable oils.
- Limit red meat and poultry that is not free range or grass fed. Some people have found that a vegan diet has helped them - but no matter what you choose you must avoid gluten and processed food.
- Avoid alcohol.
- Avoid excess sugar and sugary foods; choose fresh fruit or dried fruits instead.
- Drink 2 liters of water or herbal tea each day. You may drink good quality coffee and black tea but do not add cow's milk to it.
- Avoid artificial sweeteners (see www.dorway.com).
Diet
Follow the principles of eating in the book 'Healing Autoimmune Disease'. Make these principles a way of life. Eat plenty of avocados, as these contain high amounts of vitamin E which reduces liver scarring.
Orthodox medicine
Cholestyramine (or colestipol) may reduce the itching; this drug works by reducing blood levels of bile acids and improving the clearance of bile acids in the skin.
Ursodeoxycholilc acid (or actigall) may also improve clearance of bile from the bloodstream.
See your doctor every 3 to 4 months for check up and liver function tests.
Recommended supplements for primary biliary cirrhosis
- Livatone Plus Capsules
Take 2 capsules with food twice daily - This will stimulate the phase 1 and 2 detox pathways in the liver, improve liver function and reduce inflammation. - MSM Plus Vitamin C
Take 1 teaspoon once or twice daily in water or raw vegetable juice - MSM is an organic sulfur food powder. Sulfur may assist in preventing further scar tissue. - Vitamin D
Take 2000 to 5000 I.U. daily. Vitamin D helps to reduce inflammation. - N-Acetyl-Cysteine (NAC)
Take one to two capsules twice daily, 15 minutes before food.
The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.
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Like all of the people on here I too have PBC. I was diagnosed about 3 yrs ago. I currently take URSO twice daily. I have started ox bile and berberine also should I be taking ox bile along with the URSO or not? To support my insulin resistance and reduce my cholesterol I take berberine along with an insoluble and soluble fiber supplement. I am lost as to what I should and should not be taking? Do you have a better supplement regime that I should consider? Thank you for all your wonderful advice to give to everyone daily.
Sincerely
Jacqueline
Our first advice is to obtain a copy of Dr Cabot’s Autoimmune Book and undertake the detox and then follow the dietary protocol.
Gut inflammation is usually involved, so diet is very important.
Another factor that is rarely mentioned is that of stress. Autoimmune conditions tend to flare when stress levels are high.
Stress is something that is difficult to avoid so we recommend taking Magnesium powder or tablets – 200 mg twice daily.
URSO is a conjugated form of bile, which makes it more bio available and is very necessary for fat absorption. There is no reason why you can’t take both Ox Bile and URSO.
PBC and insulin resistance are not good for your liver, because insulin resistance leads to diabetes if unchecked, and there are few diabetics without Fatty Liver.
Berberine hastens the reversal of insulin resistance much faster, when accompanied by a low carbohydrate diet.
Glicemic Balance – 1 to 2 capsules 10 to 15 minutes before meals are most helpful to reduce cravings for high carb and high sugar foods.
Troublesome cholesterol is a result of raised blood sugar.
Supplements to assist your liver are Livatone Plus – 2 capsules twice daily, and NAC – 2 capsules twice daily with a large glass of water to avoid temporary stomach irritation.
Kind regards
Victoria
Naturopath for Dr Sandra Cabot MD
I have started ox bile every other day with other liver supporting life style and supplements. I have orange/red urine the day I have ox bile. Is it normal? Also sometimes itching.
What does it mean if you have high ALT?
Thanks
From your symptoms it seems that your autoimmune condition is now full blown and requires more considered lifestyle and supplement considerations.
Itching is a significant sign of liver dysfunction and orange/red urine is never considered normal.
There may have been many causes for your PBC so it is very important to establish diet, lifestyle and supplements that are appropriate for all likely causes of your liver dysfunction.
A Keto Diet is very low in most inflammogens, daily exercise invigorates the body’s processes and water consumption is to be at least 2 liters daily.
In addition to Ox Bile, Livatone Plus and NAC support liver health and function.
If your symptoms do not improve after implementing all our recommendations strictly for 3 months we strongly suggest an appointment with your doctor.
Kind regards
Victoria
Naturopath for Dr Sandra Cabot MD
PBC patients are usually prescribed an ursodiol medication to improve the supply of bile to the liver. If you do not have this, we recommend Ox Bile capsules – 1 - 2 capsules during each meal to replace the bile that can no longer transport metabolites to your gallbladder from your liver. Do you have gallstones?
Supplementation is very important to reduce inflammation, so please begin taking
Livatone Plus – 1 to 2 capsules twice daily, to improve liver function.
N-Acetyl-Cysteine (NAC 600mg) – 1 to 2 capsules twice daily well away from food with a large glass of water, to avoid stomach upset. This supplement is the precursor nutrient of glutathione; the body’s strongest anti-oxidant and most potent detoxifier.
MSM + Vitamin C – ½ to 1 teaspoon twice daily in vegetable juice or water to reduce oxidation, inflammation and boost liver health.
Vitamin D 5,000iu – 1 capsule daily. Please have a Vitamin D blood test to ensure this dose is sufficient.
Magnesium Ultrapotent – ½ teaspoon in water twice daily, to reduce the acidity of the metabolites being deposited through your skin and also to reduce stress levels which often makes PBC flares far worse.
We expect you would have considerable gut inflammation which will be well treated with Dr Cabot’s Ultimate Gut Health – this supplement is to keep your intestines as healthy as possible. Designed to soothe, heal and restore the gut lining, you will find your intestines love this powder. Dr Cabot Ultimate Gut Health supports better digestion and favorable and healthy gut bacteria. Helpful for acidity, reflux, bloating, sensitive gut, sluggish bowels and leaky gut. One scoopful once to twice daily away from food. Just before bed is a very good time to take second dose.
As well as removing gluten from your vegan diet we also strongly suggest that all legumes are to be removed to reduce gut inflammation.
Kind regards
Victoria
Life can put these stumbling blocks in our path to force us onto the straight and narrow, and you are doing extremely well and with these strategies you are very unlikely to get a third strike.
We strongly recommend you obtain a copy of Dr Cabot's ground-breaking book ‘Healing Autoimmune Disease – A plan to help your immune system and reduce inflammation’ and follow the protocol to help reduce your antibodies and symptoms.https://shop.cabothealth.com.au/healing-autoimmune-disease
As you will see in this book, all gluten and dairy must be avoided, and legumes are also highly inflammatory so are best avoided.
Anyone with a liver disorder really needs to treat their liver very kindly and as you have Livatone Plus 2 capsules twice daily we recommend you couple it with NAC and take 2 capsules twice daily with a large glass of water to avoid gastric upset.https://www.liverdoctor.com/nac-n-acetyl-l-cysteine-600mg-90-capsules.html
Kind regards
Victoria
I am doing a clean Keto plan, taking manuka honey 1 tsp daily, and weight training 5 times a week. It has helped me so much- I lost 35 pounds in 6 weeks, I have never felt better, my itch and fatigue are gone- and my liver and Vit D number on much better.
Note if i have one gluten thing i end up in alot of whole body pain/fatigue and can't sleep. This way of living has helped me so much. I am stage 2 as well.
The PBC article has all the advice and supplements required for good management of PBC, except that stress often exacerbates autoimmune symptoms and for this we recommend either 1/2 teaspoon twice daily of Magnesium Ultrapotenthttps://www.liverdoctor.com/magnesium-ultra-potent-powder-210-grams.html or 2 tablets twice daily of Magnesium Complete .https://www.liverdoctor.com/magnesium-complete-100-tablets.html. to reduce the effects of your life stresses.
With Fatty Liver you may have insulin resistance at the moment and for this we find Berberinehttps://www.liverdoctor.com/products/supplements/weight-loss/berberine-500mg-60ct.html very effective in lowering cholesterol and lowering blood glucose levels.
Kind regards
Victoria