Living with primary biliary cholangitis (PBC) can make it harder for your body to absorb key nutrients. Because of this, some people with PBC look into dietary supplements like omega-3 fatty acids, milk thistle, or fish oil to support their health. These are often said to reduce inflammation and have antioxidant properties — but do they actually help people with PBC? Here’s what the research shows and what to keep in mind before adding them to your routine.

Why Nutrition and Supplements Matter for PBC

PBC affects how the liver makes and moves bile. Bile helps your body digest fats and absorb vitamins A, D, E, and K. Without enough bile, people with PBC may not get enough of these important nutrients. An unhealthy diet can make PBC symptoms worse and cause the liver to get weaker over time.

Here are some ways nutrition and supplements may support people with PBC:

• Reduce inflammation — Inflammation can speed up liver scarring and damage.
• Restore lost nutrients — PBC-related bile duct damage makes it harder to absorb key vitamins and minerals.
• Support liver function — Certain supplements may help liver cells recover from oxidative stress, which is a form of cell damage.

Check with your healthcare provider before making changes to your diet or adding supplements. They can give advice based on your health and connect you with a dietitian or other professionals for extra support.

Omega-3 Fatty Acids and Liver Health

Omega-3 fatty acids are healthy fats found in foods like fatty fish (salmon, sardines, mackerel), walnuts, chia seeds, and flaxseeds. They’re known for fighting inflammation and improving heart and brain health.

Research on Omega-3s for PBC

There are many studies on omega-3s and liver disease in general but not much that focuses on PBC. Some trials show that omega-3s may help reduce liver fat and inflammation in people with metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called nonalcoholic fatty liver disease (NAFLD). However, we still need stronger research that looks at omega-3s in people with PBC. Even so, omega-3s have many health benefits and can be a helpful part of a PBC-friendly diet.

Food vs. Supplementing Omega-3s

Foods with omega-3s also give you other important nutrients and are easy to add to meals. If you don’t eat much seafood, supplements like fish oil or algae-based omega-3s might help. If your doctor says it’s OK, choose a high-quality supplement that’s been tested by a third party. This means an outside company (not the one that makes or sells the product) checks to make sure it is safe and pure and contains what the label says.

Milk Thistle and Liver Health

Milk thistle is a flowering plant that contains silymarin, a natural compound believed to protect the liver from harmful substances. People have used silymarin in traditional medicine for hundreds of years, and it’s a popular supplement for liver health today. Possible benefits of milk thistle include:

• Antioxidant properties — May protect liver cells from oxidative damage, which is when harmful molecules damage cells and, in PBC, can make liver problems worse
• Anti-inflammatory effects — Could help reduce liver inflammation
• Liver support — May help the liver heal from ongoing damage

Research on Milk Thistle for PBC

There’s no evidence that milk thistle can help PBC. Some small studies show that milk thistle might lower liver enzymes, which can signal reduced inflammation. But there’s not enough evidence to say it’s effective for PBC. Also, milk thistle may interact with medications, so you’ll need to ask your doctor or pharmacist before trying it.

Are Milk Thistle and Omega-3 Safe Together?

There’s no known interaction between milk thistle and omega-3 supplements. Taking them together may offer combined benefits for inflammation and liver health. Still, always get professional advice before mixing supplements, especially if you have an autoimmune condition like PBC.

Fish Oil and PBC

Fish oil is one of the most common supplements that contains omega-3s, as well as other healthy fats from fish. It contains EPA and DHA, two types of omega-3s shown to benefit heart and brain health. Fish oil might help:

• Lower triglycerides — This is especially important for people with PBC who have abnormal cholesterol levels.
• Reduce liver inflammation — The anti-inflammatory effects can potentially slow down liver damage.
• Complement your diet — It can be useful for people who don’t eat fatty fish regularly.

Research on Fish Oil for PBC

Fish oil may help with some chronic conditions, but specific studies on fish oil and PBC are limited. There’s currently no evidence that it would help PBC or its symptoms. Fish oil supplements are considered generally safe, but you should talk to your doctor before trying them if you have PBC.

Choosing a Safe Fish Oil Supplement

When choosing a fish oil supplement, look for one that’s free of heavy metals and tested for signs of oxidation, which is when the oil starts to break down and lose its effectiveness. Sticking to the recommended dose is also key, as high doses can lead to stomach upset and interact with medications.

Risks and Considerations

All supplements come with some risks:

• Omega-3s can thin the blood and increase bleeding risk, especially if you’re on blood thinners.
• Milk thistle may cause an upset stomach or interfere with drugs for cholesterol, diabetes, or liver disease.
• Fish oil can cause burping, nausea, or loose stools.
• High doses of any supplement could strain your liver or interact with medications.

Introduce supplements slowly, and always consult your healthcare team.

Important Nutrients for People With PBC

Because of problems with fat absorption, people with PBC often need extra nutrients:

• Vitamin D helps support bone health.
• Vitamins A, E, and K may need to be replaced with supplements.
• Calcium is essential for strong bones, especially if your vitamin D is low.
• Probiotics support gut health and help your body absorb nutrients.

Talk to Your Healthcare Provider

Supplements like omega-3, milk thistle, and fish oil may support liver health, but there’s no strong evidence that they help PBC directly. However, when used as part of a healthy lifestyle, they may help your symptoms or protect liver function.

If you’re thinking about trying supplements for PBC, talk to your doctor. Always get personalized guidance from your healthcare team before starting any new supplement. Eating a balanced diet is also important, as food is still the best source of nutrition with PBC. Maintaining an exercise routine and stress management plan can also help reduce inflammation and protect your liver.

With a well-rounded approach to managing your symptoms, including proper nutrition and cautious supplement use, you can support your health and well-being while managing PBC.

Find Your Team

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 PBC.

Have you wondered about taking any of these supplements with PBC? Share your experience in the comments below, or start a conversation by posting on your Activities page.