If you’re living with primary biliary cholangitis (PBC), formerly called primary biliary cirrhosis, you likely know that fatigue is a common and challenging symptom. Many factors can influence energy levels when you live with PBC, but making small lifestyle changes alongside your prescribed treatment plan can help support both your energy levels and liver health.

Working with your healthcare team and a registered dietitian can help you better understand which symptoms or nutrient deficiencies may be contributing to your fatigue and how to safely add foods to your diet that will improve your energy levels and overall health.

Common PBC Symptoms That Affect Energy

PBC happens when there is ongoing inflammation and damage to the bile ducts, which carry bile to the liver. According to Cleveland Clinic, PBC is more common in women, affecting about 60 in 100,000 women and 15 in 100,000 men. Over time, PBC can lead to scarring of the liver, called cirrhosis. It has different stages that can get worse over time. If left unmanaged, PBC can lead to advanced liver disease, liver failure, and the need for a liver transplant. Thankfully, some medications can help slow this progression, and some foods can help support liver health and symptoms.

These are some of the most common symptoms of PBC, but their severity can vary depending on a person’s medical history.

Fatigue

Fatigue is the most common symptom of PBC. About 50 percent of people with PBC experience it. Fatigue can affect both the mind and the muscles, making everyday tasks harder to complete. At this time, there isn’t a proven treatment for PBC-related fatigue, and more research is needed.

Portal Hypertension

As PBC progresses, it can cause portal hypertension, which is high blood pressure in the veins of the liver. This can lead to physical problems such as decreased immunity, visible blood vessels under the skin, and bloating or fluid buildup in the belly or lower body. If bile waste builds up in the body, it can also affect the brain and cause symptoms like confusion.

Fat Malabsorption

Another symptom that can be linked to nutrition and energy levels is fat malabsorption. This means your body can’t properly absorb and digest fat. It happens when your digestive system can’t access the bile, which is needed to break down fat.

Fat malabsorption can lead to nutrition-related symptoms such as high blood cholesterol, weight loss, potential deficiencies of fat-soluble vitamins (vitamins A, D, E, K), and osteoporosis. Because fat is an important source of caloric energy, not absorbing it well can also cause fatigue and low energy.

Dietary Tips for Primary Biliary Cholangitis

PBC can affect digestion, making it harder to eat enough to keep energy levels steady through the day. When possible, choose more natural foods versus processed ones, which are often high in sugar, salt, and unhealthy fats, and lower in nutrients. Focus on whole foods such as fruits, vegetables, whole grains, nuts, seeds, lean proteins, and beans.

If you have trouble digesting foods or don’t feel hungry, try simple, easy-to-digest foods like homemade soups or smoothies. Eating smaller meals more often, instead of large meals, may also make digestion easier.

Key Nutrients for Primary Biliary Cholangitis

In addition to fat-soluble vitamins (A, D, E, K), people with PBC may be low in certain nutrients that are linked to fatigue. For example, when the liver isn’t working well, it can interfere with how the body absorbs B vitamins, including folate and vitamin B12. Iron is another important nutrient because it helps carry oxygen through the body, which supports energy. However, too much iron can be dangerous for people with liver disease. This is why it’s important to check with your doctor before taking vitamins.

The best and safest way to get nutrients is through the foods you eat. In some cases, your doctor may recommend that you take vitamins. Here are some food sources you can include in your daily diet to help prevent common nutrient deficiencies:

5 Foods To Improve Energy Levels

A healthy diet includes a variety of natural, whole grains, dairy, lean protein, healthy fats, fruits, and vegetables. Living with PBC increases the risk of nutrient deficiencies, and specific recommendations can vary depending on the stage of your condition and your overall health. In general, a healthy PBC diet focuses on anti-inflammatory foods that support stable blood sugar and prevent energy crashes.

1. Fatty Fish

Fatty fish such as salmon, trout, and sardines are rich in omega-3 fatty acids, which have anti-inflammatory effects that are helpful for people with PBC. Omega-3 fats in fish can help calm inflammation and support both liver and heart health. Fish is also a good source of lean protein, which is important in moderate amounts for a PBC-balanced diet. Salmon and sardines are also rich in calcium, which is important for strong bones.

2. Whole Grains

Whole-grain foods like whole-grain bread, brown rice, and oats are recommended for people with PBC. These foods are rich in fiber, which may help improve liver health and reduce the risk of fatty liver disease and related conditions. Fiber also helps you feel full, supports steady energy levels, and can help lower cholesterol and blood pressure. Whole grains, which are complex carbohydrates, can also increase satiety without as many calories and saturated fats.

3. Leafy Greens

Leafy green vegetables include spinach, kale, cabbage, bok choy, and collard greens. They are rich in nutrients that are important for PBC, such as vitamin K and folate. Leafy greens are also a non-dairy rich source of calcium, which helps protect bone health and prevent osteoporosis. Aim for at least five servings of fruits and vegetables, like leafy greens, per day.

4. Nuts

Nuts such as cashews, almonds, and walnuts are rich in unsaturated fats, which may be easier to digest. Nuts contain vitamin E, which helps protect your cells and support immune function. Walnuts also contain omega-3 fatty acids, offering plant-based anti-inflammatory benefits.

5. Dairy Products

People with PBC are at a higher risk of deficiencies in fat-soluble vitamins. Dairy products are a good source of fat-soluble vitamins. Choose low-fat or nonfat options with little to no added sugar. High-fat dairy contains saturated fats, which can worsen inflammation, and diets high in added sugar may also increase inflammation. If you tolerate dairy well, options such as nonfat or low-fat dairy products like yogurt, milk, mozzarella cheese, and cottage cheese can be part of a balanced diet.

Small Changes Can Make a Difference

Healthy habits shouldn’t feel overwhelming. The key is to gain more energy and feel the best you can with PBC. For instance, maybe just start by adding a handful of greens to your eggs in the morning. Or topping your low-fat Greek yogurt with nuts. Make small, consistent steps, with the guidance of your doctor and a registered dietitian, and talk to others who understand.

Join the Conversation

On myPBCTeam, people share their experiences with primary biliary cholangitis, get advice, and find support from others who understand.

Which foods give you energy and improve your PBC fatigue? Let others know in the comments below.