If you’re living with primary biliary cholangitis (PBC), you might wonder why a condition that affects your liver can lead to seemingly unrelated issues like osteoporosis (weak bones) or low vision at night. You can trace these complications back to vitamin deficiencies, which are common among people living with PBC.

MyPBCTeam members share the challenges they’ve experienced due to vitamin deficiencies caused by PBC, ranging from hair loss to dental concerns. “I lost half the volume of my hair, most likely from a vitamin deficiency,” said one member. “I also have blurry vision from the lack of vitamins A, D, K, and E.” Another said, “I had bleeding gums for a while. I think it is a sign of vitamin deficiency.”

Your healthcare provider can help you determine if unusual symptoms come from a vitamin deficiency, which vitamins might help you, and how to get the amount you need. Read on to learn about four important vitamins to support your liver health with PBC.

Vitamin Deficiencies and PBC

PBC is an autoimmune disease that causes scarring and inflammation in your liver, eventually shutting it down. Your liver plays a few important roles to keep your body running smoothly, including filtering waste from your blood and producing bile, a fluid that helps break down fats in the small intestine.

In PBC, small tubes in the liver called bile ducts are mistakenly attacked by your body’s immune system, which causes bile to build up in the liver. This is harmful to liver cells and slowly causes inflammation and liver scarring, which stops your body from producing enough bile to absorb fat and fat-soluble vitamins. When this happens, you might not get enough fat-soluble vitamins, even if you eat a balanced diet.

Vitamins for Liver Health

As the liver becomes more damaged, disrupted bile flow from PBC directly affects your small intestine’s ability to absorb fat-soluble vitamins. These include vitamins A, D, E, and K. Fat-soluble vitamins are absorbed with fats and oils from your diet. They’re stored in the liver and your body fat.

It’s important to have plenty of these vitamins in your body because they, along with other nutrients, support your:

• Vision
• Bone density
• Immune system
• Nerves and muscles
• Hormonal health

Your body doesn’t create enough of these vitamins on its own, so you need to get them through your diet. If you have a deficiency, your doctor might recommend taking vitamin supplements.

1. Vitamin A

Vitamin A, also called retinol or retinoic acid, plays an important role in the immune system to keep you healthy and helps you see clearly, and in the dark. It’s also critical for your metabolism, reproductive health, and growth. Most people get enough vitamin A in their diets from foods like leafy greens and dairy products. You can also up your vitamin A supply by eating foods rich in beta-carotene, including carrots and cantaloupe, because your body converts beta-carotene to vitamin A.

Importantly, vitamin A also has antioxidant properties. Antioxidants protect your cells from the damaging effects of free radicals, which are molecules your body produces during digestion or when exposed to radiation and smoke. Some research suggests that free radicals contribute to heart disease and cancer, so antioxidants like vitamin A could play an important preventive role.

Signs of a Vitamin A Deficiency

A vitamin A deficiency linked to PBC can lead to several complications you might not link to your PBC at first. A vitamin A deficiency can lead to:

• Vision loss or blindness
• Visible spots, sores, or clouding in your eyes
• Dry eyes
• Trouble seeing in the dark
• Dry or itchy skin
• Frequent colds and other respiratory infections (infections in your chest and throat)

According to Mayo Clinic, the recommended daily amount of vitamin A is 900 micrograms for men and 700 micrograms for women. However, your doctor may want you to take more or less depending on your vitamin A deficiency or if you are pregnant.

2. Vitamin D

Vitamin D supports activity in your nervous system, bones, muscles, and nerves. One of its main roles is supporting bone health by helping you absorb calcium and phosphorus, two chemicals that your bones and tissues need to stay strong. You can get vitamin D from your diet, supplements, or from spending time in the sun. While your diet is your main source of other nutrients, up to 90 percent of the vitamin D you need comes from sun exposure.

Although the relationship between your liver and vitamin D isn’t fully understood, vitamin D deficiency is common in people with chronic (long-term) liver diseases, including PBC. Low vitamin D levels are associated with poor liver function in people with PBC, so you should work with your doctor to monitor your levels to avoid deficiency.

For vitamin D to do its job, it must bind to vitamin D receptors in your body. Some research suggests that ursodeoxycholic acid (UDCA), a bile acid that helps reduce liver damage and is the main treatment for PBC, uses these same receptors to work. Combining UDCA with vitamin D supplements might make the treatment more effective.

Signs of a Vitamin D Deficiency

Your doctor will want to monitor you for signs of low vitamin D and may recommend tests for a deficiency. An untreated vitamin D deficiency can lead to:

• Osteoporosis — Weak bones that break easily
• Bone pain in your back, pelvis, arms, or legs
• Muscle weakness, aches, or cramps
• Depression or other mood changes

You might not notice any signs of a vitamin D deficiency.

The recommended daily dose of vitamin D is 600 international units (IU) for people between the ages of 1 and 70 and 800 IU for people older than 70. Your doctor may want you to take more or less, depending on your vitamin D deficiency.

3. Vitamin E

Vitamin E helps you see clearly and preserves the health of your skin, brain, and blood.

Like vitamin A, vitamin E has antioxidant properties and can help protect your cells and organs from damage. This includes the cells in your liver. Some research suggests that vitamin E can improve symptoms of liver diseases.

Your doctor may recommend testing for a vitamin E deficiency if you have PBC. If you have a deficiency, they might suggest eating more vitamin E-rich foods like vegetable oils, meats, leafy greens, or dairy, or taking supplements.

Signs of a Vitamin E Deficiency

Vitamin E deficiency is rare, but it can develop if you have PBC or other liver diseases in advanced stages. A vitamin E deficiency can lead to:

• Neuropathy — Nerve damage leading to pain, burning, tingling, or numbness
• Retinopathy — Damage to your retina (the light-sensitive part of your eye) that can cause vision loss

The recommended daily dose for vitamin E for adults is 15 milligrams per day. Your doctor may want you to take more or less, depending on your vitamin E deficiency.

4. Vitamin K

Like other fat-soluble vitamins, vitamin K keeps your bones strong and healthy. It also plays a key role in helping your blood clot, which is an important early step in healing injuries. Vitamin K helps your liver produce clotting factors (proteins that your blood uses to clot).

Most people get enough vitamin K in their diets from sources like leafy greens, Brussels sprouts, and cauliflower. Meat sources like liver offer smaller amounts. Your lower intestinal tract also produces some. But, as with other fat-soluble vitamins, PBC can lead to a vitamin K deficiency.

Signs of a Vitamin K Deficiency

A vitamin K deficiency from PBC can lead to increased bleeding and bruising.

The recommended daily dose for vitamin K for adults is 90 to 120 micrograms per day. Be sure to talk to your doctor about supplementing with vitamin K, as it can interact with some medications, like blood thinners.

Talk to Your Doctor

If you’re concerned about vitamin deficiencies with PBC, talk to your doctor. Your primary care provider or hepatologist (liver doctor) can recommend healthy changes to your diet to make sure you get the vitamins your liver needs. They might suggest testing for vitamin deficiencies.

In some cases, taking supplements of these vitamins or other nutrients like calcium can prevent osteoporosis and other complications.

It’s important to talk to your doctor before taking any supplements because taking too high a dose can cause toxicity, leading to side effects like nausea. It’s also possible for vitamin supplements to interact with medications you take, which in some cases may worsen liver damage. Long-term, taking high doses of vitamins A or K can cause more liver damage instead of supporting your liver health.

Talk With Others Who Understand

MyPBCTeam is the social network for people with primary biliary cholangitis and their loved ones. On MyPBCTeam, members come together to ask questions, give advice, and share their stories with others who understand life with primary biliary cholangitis.

Have you taken vitamins to manage PBC? Which vitamins have made a difference? Share your experience in the comments below, or start a conversation by posting on your Activities page.