Primary Biliary Cholangitis (PBC)

Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is an inflammatory condition of the bile ducts resulting in narrowing and distortion of the bile ducts; this can eventually cause damage to the surrounding liver cells. The disease more commonly affects middle-aged women. The onset of symptoms is gradual, most commonly with fatigue and itching skin as the first symptoms. If obstruction to the flow of bile occurs, this can lead to liver cholangitis. This disease is an autoimmune disease where the patient’s own immune system attacks their bile ducts.

PBC has many similarities to the autoimmune disease called sclerosing cholangitis; thus, essentially the dietary and supplement program is the same for both diseases. As with sclerosing cholangitis, excellent results and long-term control of this disease can usually be achieved with integrative and nutritional medicine.

What are the symptoms of PBC?

The symptoms may include:

  • itching
  • jaundice
  • enlarged liver
  • abdominal pain
  • fatty deposits under the skin
  • soft yellow fatty spots on the eyelids (xanthelasma)
  • fatty pale stools


Liver function tests, an ultrasound scan and a fibroscan should be done. Some doctors will want to do a liver biopsy for a definitive diagnosis. Blood tests for mitochondrial antibodies will be positive in about 95% of cases. Blood tests for Vitamin A, Vitamin K, and Vitamin D can be done as without adequate bile flow the absorption of fat soluble vitamins is compromised.

Recommended books

Treatment and general recommendations

  • You must avoid ALL gluten. This is essential for all autoimmune diseases and in order to heal leaky gut.
  • Avoid ALL margarines and dairy products.
  • Avoid deep fried foods and hydrogenated vegetable oils.
  • Limit red meat and poultry that is not free range or grass fed. Some people have found that a vegan diet has helped them – but no matter what you choose you must avoid gluten and processed food.
  • Avoid alcohol.
  • Avoid excess sugar and sugary foods; choose fresh fruit or dried fruits instead.
  • Drink 2 liters of water or herbal tea each day. You may drink good quality coffee and black tea but do not add cow’s milk to it.
  • Avoid artificial sweeteners (see


Follow the principles of eating in the book “Healing Autoimmune Disease”. Make these principles a way of life. Eat plenty of avocados, as these contain high amounts of vitamin E which reduces liver scarring.

Orthodox medicine

Cholestyramine (or colestipol) may reduce the itching; this drug works by reducing blood levels of bile acids and improving the clearance of bile acids in the skin.

Ursodeoxycholilc acid (or actigall) may also improve clearance of bile from the bloodstream.

See your doctor every 3 to 4 months for check up and liver function tests.

Recommended supplements for primary biliary cholangitis

  • Livatone Plus Capsules
    Take 2 capsules with food twice daily – This will stimulate the phase 1 and 2 detox pathways in the liver, improve liver function and reduce inflammation.
  • MSM Plus Vitamin C
    Take 1 teaspoon once or twice daily in water or raw vegetable juice – MSM is an organic sulfur food powder. Sulfur may assist in preventing further scar tissue.
  • Vitamin D
    Take 2000 to 5000 I.U.  daily. Vitamin D helps to reduce inflammation.
  • N-Acetyl-Cysteine (NAC)
    Take one to two capsules twice daily, 15 minutes before food.

The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.



  1. TESS ENROUGHTY October 31, 2021 at 6:33 am - Reply

    I have a progressed form of PBC as result of Primary Sjogren’s Syndrome which was triggered by cancer treatment. I have read plenty of articles that discourage use of antioxidants IF there is a possibility of recurrence. So, I’m nervous about taking NAC and other antioxidants apart from D3, k2, A, C, E and MethylB12 and Methylfolate. I’m wondering if you would please further address your recommended use of NAC and MSM. I drink Milk Thistle tea a few times a day. Are there any recommendations you may offer? BTW I have recommended your books for years. Thank you for your work!
    Also, do you recommend Lysine for tissue repair?
    And how about Lecithin? Thank you.

    • Louise B December 1, 2021 at 2:34 pm - Reply

      Hi Tess,

      It is our understanding that antioxidants prevent the production of free radicals that are often considered the beginnings of cancer development. NAC is an important precursor to ensure sufficient glutathione, the body’s strongest antioxidant and immune booster. MSM is also an important compound that reduces inflammation and encourages healing. Anyone concerned about the reoccurrence of cancer is recommended to take selenium and iodine daily for immune function.

      Kind regards,

  2. Cara Kopchak January 11, 2024 at 6:02 pm - Reply

    Thank you for the helpful article! I have PBC and take urso currently. I saw this article and another older article on here about PBC and have a quick question. In the older article it recommends taking glutamine powder and selenium…in this article those are excluded and MSM and NAC are mentioned. Do you no longer recommend the glutamine or selenium?

    • Jessah April 2, 2024 at 12:09 pm - Reply

      Hi Cara,

      Thank you for reaching out.
      I can’t find the article that has recommended glutamine, but for PBC the main supplements we recommend are Livatone and Selenomune.
      For further liver support, we would also recommend NAC and MSM Plus Vitamin C (now called Collagen food).
      Selenium is already in Livatone Plus. Selenomune contains Selenium plus other immune boosting minerals.
      Where are you located?

      Kind regards,
      Jessah Shaw

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