The Physics of Nutrition in PBC
By Mary Anne Simpson, ADN
One of the first questions asked by newly diagnosed PBC
patients is what to do about their diet. They want to know what to eat to
help improve the condition and what not to eat that might
aggravate the condition. You must know how PBC effects the
digestive system to understand the nutritional needs a PBC
patient requires.
In PBC the back up of bile from inflammation and scarring of
the bile ducts causes decreased absorption of fat in the
intestines due to diminished excretion of bile from the ducts.
Ductopenia results when the bile ducts in
the liver are destroyed, thwarting bile transport to the large
bile duct of the intestine, thus causing the diminished
secretion of bile into the small intestine. Because of the
decrease in bile secretion, absorption of fat and fat soluble
vitamins is impeded. The retention of bile in the liver
literally burns the bile ducts and causes scarring.
This causes a decrease in the amount of fat and fat soluble vitamins a
PBC patient can absorb (A, D, E and K). Some patients will
lose weight and develop diarrhea before being diagnosed due to
the inability to absorb fat. Therefore taking a
good multivitamin without iron is important to obtain as much nutrition as
possible. It makes sense to limit the amount of fat
in the diet if you are having problems with fat absorption. So
the statement that "we can't eat all the things we used to eat"
is correct. PBC patients must limit fat, cholesterol, sugar and sodium.
It's best to eat a moderate amount of protein and I feel Dr.
Atkins diet would be overdoing it for a PBC liver with fat and
cholesterol intake. In my humble opinion, the Atkins diet is not for
anyone especially
patients with PBC. As far as alternative medicine, AKA
herbs, toxic reactions have been reported with herbal
supplements that were made in Asia. A number of herbal
supplements have been proven to be clearly toxic. These include
germander chaparral, Kava, precursor androgens, and ephedra-containing
products. Consult with your physician before taking any type of
herbal supplement.
PBC patients need extra calcium because Vitamin D is a fat
soluble
vitamin and we need Vita. D to absorb Calcium. Did you know that
10
minutes in the sun everyday gives you all the Vita. D you need.
PBC patients have trouble synthesizing the vitamin due to
mal-absorption in the gut. That is why taking the drug URSO is important.
This drug assists with metabolizing fats and fat soluble
vitamins to enhance a PBC patient's total nutritional status.
Many PBC patients have high cholesterol readings. Controlling
the saturated fats and cholesterol of food in the diet can
improve these values in some patients.
Personally I feel the best diet for PBC consists of the
adhering to the
following guidelines: a low fat, low salt, (in later stages PBC
patients retain fluid),
moderate HBV protein, limited sugar, generous in whole grains (B
Vitamin source), with 4-6 servings of
vegetables or fruits daily and copious amounts of calcium rich foods
every day. Dr. Lewitz,
PBC GI Specialist in San Antonio suggests patients take at least
1000mg of Calcium a day. Dr. Lewitz advises that Calcium
Citrate is better to take than oyster shell calcium as its absorbed better in the gut.
Also recommended is 500mg Vitamin D per day, 50,000U per
day of
Vitamin A and 800U per day of Vitamin E as these are fat
soluble. Don't overdo the vitamin A as it can be detrimental and
cause blood abnormalities. Some GI doctors will obtain
baseline labs for the fat soluble vitamins and add
supplementally as indicated.
Vitamin K helps with blood clotting so keeping this at a
normal level is important. If you are having trouble
with free bleeding (cuts bleed excessively, nosebleeds), tell your
physician he may want to check your
Vitamin K level. (Bleeding from the stomach or rectum
should be reported immediately as this is from another problem
related to PBC and not within the scope of this article.) Patients with low levels can be placed on
Vitamin K injections to bring the value back to normal limits. Since Vitamin D aids in
Calcium absorption many PBC patients have low calcium levels and
develop osteoporosis. It's important to get a yearly Bone
Scan to assess the condition of your bones. Medications such as Fosamax,
will be ordered if osteoporosis is detected.
Many dietitians feel that coffee, nuts, and other bile acid
inducing foods should be avoided. Theoretically this makes
sense, if you eat foods that do not require as much bile to
metabolize your liver won't work as hard trying to produce bile
for digestion. They suggest PBC
patients drink 4-6 8oz glasses of water daily. Remember
the solution to pollution is dilution, keep your body well
hydrated for the best health. |
