To help keep your liver healthy and working well, you’ll need to eat a balanced diet that packs the right nutrients and enough calories. Eating foods that are rich in vitamin D and calcium can help boost deficiencies that happen when your body doesn’t make enough bile to absorb fats. Your doctor might suggest supplements for special forms of vitamins A, D, E, and K that your body can more easily absorb. 

This popular nutrition plan helps curb inflammation, which can help support diseases like PBC. The Mediterranean diet features:

• Unsaturated fats – think salmon, extra virgin olive oil, and foods with Omega-3s.
• Plenty of fruits and veggies
• Complex carbs, which your body digests slowly, letting sugar gradually into your bloodstream. They’re in foods such as whole-grain breads, rice, pasta, and cereal.
• Lean meats in moderation

Your doctor might advise you to steer clear of these foods if you have PBC:

• Unpasteurized milk, which can harbor bacteria. Ditto for undercooked or raw fish, shellfish, or meat.
• Saturated fats. Found in butter, cream, and fatty meats, they’re hard to digest.
• Sugary foods and drinks. Foods with natural sugar, like fruits, are a good choice, though.
• High-sodium foods. Spice up meals with non-salty seasonings.
   

Some medical experts advise people with PBC to limit alcohol to no more than one glass a day. Others say it’s best to avoid it altogether. Alcohol can tax your liver, which must process it. Check in with your doctor to see how much, if any, alcohol is OK for you to drink. Most experts say water – and plenty of it – is better to reach for instead.

Fatigue is a main symptom of PBC. While more than half of people with PBC will have some degree of tiredness, 1 in 5 have a severe lack of energy. One way to manage is to use your stamina when you need it most. For example, you might schedule key things you need to get done in the morning, since fatigue usually sets in as the day goes on.

PBC can affect how your body processes some drugs. You may need to steer clear of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which can further damage your liver. Other substances and treatments that can clash with PBC include:

• Large doses of vitamin A, which can be toxic
• Iron supplements. People with liver disease often have more than enough iron in their systems. 
• Estrogen therapy, which can make itching worse
   

Your doctor might prescribe an anti-itching med, such as cholestyramine, for pruritus (the medical term for itching). But you also can help ease itching in other ways, too:

• Use moisturizers to keep your skin from getting too dry.
• Bathe in lukewarm water.
• Apply ice packs.
• Wear loose-fitting clothing.
• Try oatmeal extract, or colloidal oatmeal. It comes in forms that include creams, bath treatments, and cleansing bars.
   

Antioxidant-rich coffee – and the caffeine in it – have been shown to improve liver health. It may help ease swelling and slow tissue scarring, and even stave off liver cancer. Check with your doctor first, but it’s likely you can enjoy a cup of joe or even two. Hold the cream and sugar, though. 

Most any type of exercise can do your liver good if you stick with it. Physical activity can help:

• Lessen swelling in your liver
• Reduce fat in your liver as well as your whole body
• Boost blood flow to your liver

Smoking is especially bad for you when you have PBC. An Indian study found that smoking cigarettes when you have the disease raises the chances that you’ll get advanced liver fibrosis, or thickening and scarring of tissue. How long and how much you’ve smoked figure in, too. Studies are ongoing, but so far, the smoking link hasn’t been noted in other autoimmune liver diseases.