Also known as primary biliary cholangitis, primary biliary cirrhosis (PBC) refers to a type of liver disease that negatively affects the bile ducts in the liver. Over time, the bile ducts, responsible for carrying bile from the liver to the small intestine to support digestion, are completely destroyed. As a result, bile accumulates in the liver, causing liver damage and scarring. If left untreated, the condition can progress to a point where a liver transplant might be required to save a life. 

While there is no absolute cure for primary biliary cirrhosis apart from a liver transplant, specific home remedies and lifestyle tips can be used to slow down its progression and manage the uncomfortable symptoms. Keep reading to learn about these symptoms and some natural management.

Primary Biliary Cirrhosis: Facts at a Glance 

• Primary biliary cirrhosis is a chronic illness that targets and inflames the small bile ducts in the liver, ultimately leading to complete destruction.
• While primary biliary cirrhosis can be diagnosed in any gender at any age, it usually targets women between the ages of 30 to 60 years.
• Every 65 out of 100,000 females in the United States suffer from PBC
• PBC is initially asymptomatic, progresses gradually, and becomes apparent during middle age. 
• There is no cure for PBC; however, a combination of medications and lifestyle tips can be applied to slow down the progression of liver damage and manage the symptoms.

Primary Biliary Cirrhosis Symptoms: How is it Diagnosed?

Primary biliary cirrhosis is an autoimmune disease in which the body’s own defense mechanism rebels against it and starts attacking the liver tissue, particularly the bile ducts. The condition usually progresses slowly, and many patients do not develop any symptoms, especially in the early stages of the disease. In most cases, the initial symptoms include skin itching (pruritis) and fatigue, along with the following:

• Abdominal pain
• Dryness of mouth and eyes
• Join and muscle pain
• Darkening of the skin
• Small white or yellow bumps around the eyes (xanthelasmas) or under the skin (xanthomas)

As the PBC progresses, the following symptoms of cirrhosis may develop:

• Yellowing of the skin (jaundice)
• Fluid accumulation in the abdomen, leading to enlargement and bloating (ascites)
• Swelling of feet and legs (edema)
• Internal bleeding in the esophagus and upper stomach due to enlarged veins (varices)

With the progression of PBC, certain complications begin to arise. One of these complications is osteoporosis, characterized by weakened bones to the extent that fractures may occur. Osteoporosis is usually a sign that PBC is in its late stages, but sometimes, it may happen earlier as well. Additionally, people with PBC with underlying liver cirrhosis are at an increased risk of liver cancer. 

Getting immediate medical treatment is advised as soon as the symptoms or complications of PBC occur. Earlier diagnosis and subsequent treatment can slow down liver damage and maintain the quality of life. 

Treating Primary Biliary Cirrhosis: Conventional Medical Interventions

Treatment for managing primary biliary cirrhosis revolves around medical and surgical interventions described below:

Ursodeoxycholic Acid

Ursodeoxycholic acid (UDCA) is the primary medical treatment for PBC. This medication aims to delay or prevent liver damage in people, particularly if it is started in the early stages of the condition. However, UDCA alone cannot improve certain symptoms of the disease, such as fatigue or skin itching.

People who commence treatment with UDCA are likely to continue it for the rest of their lives. Regular blood tests are warranted to monitor liver functions and confirm if the body responds to the drug. If not, additional treatment might be required. 

Obeticholic Acid

Obeticholic acid (OCA) is a newer treatment drug for PBC that reduces inflammation and improves bile flow. It is offered either on its own as a substitute for UDCA or in combination with it for a better response to treatment. People needing OCA are required to be assessed by a specialist team to confirm it is safe for use. 

Liver Transplant

A liver transplant is the last resort for treatment and is usually offered if the liver damage due to PBC is putting the patient’s life at risk. Planning for a transplant usually begins before significant damage to the liver has been done because:

1. The waiting list for transplants is extensive, and it can take months to undergo the procedure.
2. The better the general state of health, the higher the chances of a successful liver transplant.

Undergoing a transplant successfully manages most of the symptoms associated with PBC; however, most people still complain of excessive fatigue even after the procedure. 

Like with every other organ transplant, a liver transplant also carries a risk of complications. There are chances the body may reject the donated liver, which can prove to be life-threatening. For this purpose, medicines to suppress the immune system are often prescribed, which often need to be taken for a lifetime. Most people with a successful transplant live for up to 20 years. 

Home Remedies for Primary Biliary Cirrhosis

As mentioned before, primary biliary cirrhosis has no definitive cure. However, certain lifestyle changes and habits can be adopted to manage the uncomfortable symptoms and improve the life quality. These tips and tricks are described below:

Follow a healthy diet plan

Most experts typically recommend following a Mediterranean diet modified for individual needs to keep the symptoms of PBC under control. Because PBC is an inflammatory disease, a diet that keeps high inflammatory levels in check is best. Here are a few suggestions to ensure that you eat the best diet for a healthy liver:

• Eat at least five servings of fruits and vegetables a day.
• Opt for a moderate amount of lean meat. The exact amount may vary depending on individual needs, and a nutritionist might be able to guide you best on this.
• Incorporate lots of unsaturated fats, such as extra virgin olive oil, omega-3s, fatty fish like salmon, and nuts in your daily life.
• When it comes to shopping for rice, bread, or crackers, aim for ones with whole grains and complex carbohydrates.
• If suitable, drink coffee (in moderation) as it has been found to reduce the risk of liver cancer. Try not to add any sugar or cream to it. 

Say no to unnecessary medications

While over-the-counter medications can work for most people, they are a big no-no for people with PBC. PBC significantly damages the liver, consequently impacting its ability to process certain medications. This is why it is imperative to steer clear of certain medications, such as NSAIDs (ibuprofen and aspirin).

Always ask your doctor before starting a new medication, either over-the-counter or prescription. 

Manage fatigue with exercise and healthy sleeping habits

PBC is often associated with high levels of fatigue that may make everyday life extremely difficult. To combat this fatigue, try exercising whenever possible and at whatever intensity you are comfortable with. Make sure to pace yourself and limit your everyday activities to a level that can be easily managed. 

If you find it difficult to sleep at night, adopt good sleep hygiene by:

• Avoiding nicotine, alcohol, and caffeine at night.
• Ensure that your bed and mattress are comfortable.
• Sleep in the dark with no noise.
• Avoid the use of any electronic gadgets, such as laptops and mobile devices, before going to sleep.
• Avoiding strenuous exercise close to bedtime.

Maintain Oral hygiene

PBC often leads to a dry mouth which, in turn, increases the risk of tooth decay. So ensure to maintain good oral hygiene by regularly brushing your teeth and flossing as required. Visit a dentist regularly to rule out any possibility of decay and manage it in time if found. 

Avoid eating saturated fats

Refrain from saturated fats like butter, cream, and deli meats, as people with PBC often cannot digest these fats. These undigested fats, in turn, may lead to diarrhea, weight loss, and other complications. However, this does not mean one has to eliminate fats from the daily diet altogether. Focus on healthier unsaturated fats to make sure that you fulfill your daily requirements. 

Eliminate sugary foods

Sugary foods and beverages must be avoided at all costs, especially sodas, fruit drinks, and anything with high fructose corn syrup. When you consume such foods, the liver is forced to absorb a lot of sugar which converts into fat inside the body, eventually increasing the risk of fatty liver disease. Alternatively, focus on getting sugar from natural sources.

Cut back on sodium

If you have ascites or edema, cutting back on sodium is extremely important. Start by kicking the salt shaker out from the dinner table and choose seasonings that do not contain any sodium. 

Reducing skin itching 

Chronic itching is one of the most uncomfortable symptoms of PBC. For some, It gets so intense that it leads to scarring. While medication might be prescribed to reduce itchiness, other tips to follow are mentioned below:

• Keep your fingernails short
• Avoid hot baths
• Reduce your sun expose
• Wear cotton clothes
• Avoid using perfumes, scented soaps, bath oils, and talcum powder
• Take a cool bath infused with a cup of baking soda before going to bed

Concluding Remarks

Primary Biliary Cirrhosis is a lifelong illness with uncomfortable symptoms that can quickly deteriorate ones quality of life. While there is no definitive cure for it, the symptoms can be managed with a combination of medicines and lifestyle tips. Make sure to keep in touch with a doctor to monitor the disease and make necessary adjustments in the treatment, as and when required.