There is no specific PSC diet and most patients do not have to make any changes, except to continue to eat in a healthy, sensible way. But many PSCers have related digestive issues, such as ulcerative colitis and other gut problems, and need to stick to a specific diet, as advised by professionals.
Liver and your diet
As PSC progresses, your liver may not be able to process nutrients and toxins as it could when you were healthier and you may be advised to modify your diet to accommodate your condition. Generally PSC dietary advice aims to reduce stress on the liver and reduce some of the symptoms of liver disease. If you also have kidney disease, dietary changes will be necessary.
Specifically, you may be asked to reduce your intake of sodium, and monitor your potassium, cholesterol, and other nutrients, including vitamins and minerals. Be sure you know exactly which foods and nutrients you need to avoid or add to your diet. Learn how many calories you need to maintain your weight and how many you need to reach your goal, whether to gain or to lose weight.
Sodium/salt reduction will help to reduce fluid build-up (ascites). You may also need to restrict your fluid intake. Carbohydrate metabolism is also altered in liver disease, which can lead to increased blood sugar. You may be told to cut down on simple sugars in your diet. A low fat diet is often recommended, as well.
Diet issues can be confusing because patients are generally not trained to sort the complexities, especially with regard to PSC and its related diseases. Well-meaning information from non-professionals, such as friends, other patients, advertisements, etc., needs to be checked with a health professional.
You will need assistance working through and understanding the importance of certain diet changes. In certain situations some prescription medications can alter appetite and food metabolism. Your specific diet, if you need one, may not be the same for another PSC patient. Each person is unique.
Ask to meet with a nutritionist recommended by your specialist, a nutritionist knowledgeable about the technical aspects of liver disease. Generally these specialists are found in a large and/or teaching hospital and are registered dietitians or licensed dietitians, certified in medical nutrition. Our members advise that dietary advice from a hospital-related professional will likely be most precise for a particular disease. Not all independent dietitians or nutritionists have heard of PSC and may not provide the best advice; they may not appreciate the complexity of your situation, especially if you have other digestive diseases.
Some PSCers say they find relief from symptoms if they take certain dietary supplements. If you decide to try supplements, you ought to research them thoroughly and ask your doctor before you decide to take them. Formal research on dietary supplements and PSC is limited. Some supplement manufacturing practices may not be consistent or safe. Some supplements can be toxic to the liver and you can inadvertently harm it further. Certain herbal products that are OK for healthy people may be harmful to someone with liver disease.
Healthy eating presentation
At our 2009 annual conference with Northwestern Feinberg School of Medicine, Beth Doerfler, MS, RD, presented a session on Nutrition and Healthy Living. Click here to go to her 2009 conference presentation. She offered three handouts to participants and with her permission, we present them here: grocery list, meal ideas, and snack ideas. While this is a healthy diet for most people, your physician or nutritionist may modify it to fit your medical situation. If you make a change in your diet on your own, be sure to ask your doctor about the safety of your new approach.
Healthy Eating Grocery List
|WHOLE GRAINS||PROTEIN FOODS/DAIRY PRODUCTS|
|Whole grain white bread||Canned tuna, chicken, salmon (packed in water)||Eggs/egg whites|
|Oat bran bread||Tuna or chicken kit (low fat)||Egg Beaters™|
|Whole grain crackers||Crab||Cheese (low fat)|
|Whole wheat pita||Salmon||String cheese|
|Whole wheat English muffin||Sardines (in water)||Cottage cheese (low fat or fat free)|
|Whole wheat tortillas||Shrimp||Skim milk|
|Corn tortillas||Skinless, boneless chicken||Calcium fortified soy milk|
|Whole wheat pasta||Skinless, white meat turkey||Yogurt (light or fat free)|
|Instant brown rice||Lean chicken/turkey sausage||Whey/Soy protein powder|
|Bulgur||Boneless pork chop|
|Barley||Boneless pork loin|
|Potatoes/Sweet potatoes||Lean ham|
|Peas/Corn||“Round” or “loin” beef cut|
|Whole grain waffles||Soy meats/veggie burger|
|Whole grain cereals||Edamame (soybeans)|
|Ground Flax Seed/Flax oil||Raw nuts|
|FRUIT*||VEGETABLES (FRESH OR FROZEN)*||MISCELLANEOUS|
|Applesauce (no sugar added)||Asparagus||Pre-minced garlic|
|Bananas||Brussel sprouts||Lemon/lime juice|
|Blueberries||Cabbage||Low cal salad dressing
|Grapes||Cucumber||Benecol™/Take Control™/Smart Balance™|
|Honeydew||Eggplant||Sour cream (low fat)|
|Kiwi||Green beans||Cream cheese (low fat)|
|Mandarin oranges||Onions (all)||Vegetable oil (canola/olive)|
|Mango||Hearts of palm||Avocado|
|Orange||Kale||Disposable tupperware/plastic bags|
|Papaya||Leeks||Condiments: Sugar free jam, mustard, low fat mayo|
|Individual fruit cups (No added sugar)||Turnips|
|V-8 or tomato juice (low sodium)|
Healthy Breakfast Ideas
Breakfast is the most important meal of the day. Not only does it give you energy to start a new day, but breakfast is linked to many health benefits, including weight control and improved performance.
Studies show that eating a healthy breakfast can help give you:
- A more nutritionally complete diet, higher in nutrients, vitamins and minerals,
- Improved concentration and performance in the classroom or the boardroom,
- More strength and endurance to engage in physical activity, and lowercholesterol levels.
Whole grain + Lean Protein + Fruit/Vegetable = A well-balanced, high-energy breakfast with a healthful combination of fiber, vitamins, minerals and antioxidants.
To make a healthy breakfast, choose one item from each column.
|Quaker Oat Squares™
|Skim or soy milk
sliced and peeled
|Cream of wheat
(1/2) w/ Splenda
|Whole grain white bread
|Peanut butter or almond butter
|High fiber/whole grain bagel
|Lox (1-2 slices), low-fat cream cheese
|Tomato and onion|
|Whole grain waffle
|Skim or soy milk
|Whole grain pancake
|Soy or turkey sausage
|Scrambled egg beaters™ or egg whites (1/4 cup)||Avocado
|Melted low fat cheese
|Skim or soy milk
|Applesauce w/ cinnamon
(no sugar added)
|Note: If you don’t have time to fix breakfast, consider a protein bar or protein shake with a serving of fruit.
Protein bars: SlimFast™, Balance™, Pria™, Zone Perfect™, Luna™, Lara™
Protein shakes: SlimFast™, Glucerna™, Carnation Instant Breakfast™
Healthy Lunch/Dinner Ideas
Whole grain + Lean Protein + Fruit/Vegetable = A well-balanced, high-energy meal is a healthful combination of lean protein with fiber, vitamins, minerals, and antioxidants.
- To make a healthy meal each day, choose one item from each column
- Enjoy adding heart healthy fats such as olive oil and avocado to your fruits and vegetables to increase flavor and nutrients
- Peeling and cooking fruits and vegetables helps to improve your tolerance for fiber
|Whole grain white bread (2 slices)||Turkey breast (3 oz)||Tomato and lettuce, baby carrots|
|Instant brown rice
(1/2 cup cooked)
|Firm tofu, cubed (3 oz)||Steamed broccoli and tomatoes with 1 tbsp olive oil|
(1 oz shredded) with pureed black beans (1/2 cup)
|Salsa or 4 oz tomato juice|
(1 cup cooked)
|Skinless chicken breast slices
|Lean ground turkey
|Sautéed mushrooms and fresh tomatoes|
|Instant wild rice
|Steamed carrots and cilantro|
|Whole grain white bagel
|Melted low fat cheese (1 slice) with tuna fish (3 oz mixed with lite mayo or mustard)||Spinach, tomato and cucumber slices (peeled)|
|Whole wheat pita
|Hummus (1/4 cup)||Lettuce, tomato, cucumber|
|Baked sweet potato
|Grilled turkey sausage
|Grilled asparagus spears|
|Whole grain crackers
|Pureed Lentil soup
(1 cup diced)
|Note : If you don’t have time to pack or grab lunch, consider a frozen meal with a serving of fruit and/or vegetables.
Frozen meals : Lean Cuisine™, Healthy Choice™, Amy’s™, Smart Ones™, South Beach™, Kashi™, Trader Joe™ varieties
SNACK IDEAS (100-200 calories)
- Low fat cottage cheese (4oz individual pack) with:
- an individual fruit cup (no sugar added)
- cinnamon and Splenda
- Pack of low sugar oatmeal
- Yogurt (Stonyfield Farms or Okios Greek Yogurt = 120-150 calories):
- yogurt and 1 tablespoon nuts
- yogurt and 1 tablespoon of bran cereal
- yogurt and a handful of berries
- yogurt and Vitamuffin (80calories)
- Applesauce (no sugar added)
- Drinkable light low fat yogurt (Dannon Light n’ Fit Smoothies)
- Low fat pudding with Cool Whip(Jello pudding cups = 60calories)
- Sugar Free Jell-O cups with Cool Whip
- Orville Redenbacher mini bags of popcorn (100 calories)
- www.cocoavia.com chocolate bars (80-100 calories)
- Pear or apple with Laughing Cow Cheese Light (1 wedge = 35 calories)
- Apple with 2 Tbsp of Better N’ Peanut Butter (2TBSP = 100 calories)
- Fiber One Chewy Bars (Oats and Peanut Butter OR Oats and Chocolate = 140-150 calories)
- 100 calorie pack varieties
- Nature Valley Fruit Crisps – Cinnamon Apple (1 pouch = 50 calories)
- Low Sodium V8 (4 or 8oz)
- Artichoke hearts out of the can
- String Cheese (Sargento Light = 50calories)
- Whole Grain English Muffin (1/2) and 1 slice low fat cheese (veggie slices = 35-40 calories)
- La Tortilla Factory whole grain tortilla or whole grain pita (1) and 2 tablespoons hummus (Oasis roasted red pepper hummus = 25 calories for 2 TBSP)
- Low Fat Cottage cheese (4 oz serving) with fresh tomatoes
- Jicama slices with lime
- Grape tomatoes
- Soynuts (handful)
- Unsalted nuts (walnuts, cashews, almonds, pepitas) a handful ¼ c = 220 calories
- Peeled cucumbers with Laughing Cow Cheese Light
- Reduced Fat Triscuits or All Bran Crackers (18 = 120 calories) with Laughing Cow Cheese Light
- Mini carrots and/or celery with low fat dressing
- Whole grain crackers (RyKrisp, Wasa, Rice Cakes) with Laughing Cow Light and/or turkey slices, tomato/cucumber/ mustard
Count calories and exercise to lose weight
Even without PSC, nutrition and exercise are important. Since around 80 percent of PSC patients have some form of IBD, nutrition is very important. Most PSCers do better on low fat (30 gms/day) diets. Anything that stresses your liver or kidneys should be minimized (alcohol, for example). With your narrowed bile ducts, it’s very important to avoid dehydration, as the bile will get thick and not flow well, contributing to the possibility of a cholangitis “attack.”
I’ve not been successful at dieting without counting calories (including grams of fat), combined with exercise. If I really want to lose weight, that’s what I do. Vitamins are probably a good idea. I suspect even more so if you have a j-pouch, but I’d ask your doctor about that.
In order to lose a pound a week, you need to cut back about 500 calories/day. Exercise counts! If you walk 3 miles a day, you get to subtract 300 calories. For a fairly active person, the rule of thumb is to take your weight (in pounds) and multiply by 15 – that’s the caloric intake required to maintain your weight. So, if I wanted to lose a pound a week, I’d go from 2625 calories (175×15) per day to 2125 calories. Those 500 calories are about two Krispy Kreme doughnuts, which I can easily forego (not to mention the accompanying 28 gms of fat!).
Exercise sensibly, as much as you are able, even if it’s “just” walking (and there is nothing wrong with walking-it is a great form of exercise). There are several reasons for exercising, not the least of which is that it’s good for you physically and mentally. (It helps lower your stress levels!) Exercising also makes recovery from a liver transplant-if it comes to that-much quicker.
If you’re going to take a supplement, make sure your doctor at least knows you’re doing it, and hopefully, agrees it will not do harm. Just because they are “all natural” or organic, does not mean they are harmless. Some common supplements used with PSC are: Milk Thistle (silymarin), SAMe (S-adenosylmethionine), ADEK vitamins (fat-soluble vitamins), Calcium with vitamin-D, probiotics, and Omega-3 (fish oil).
There are many research studies on the above. None are a magic bullet, and results are often conflicting. Check our PSC literature site for more details by clicking here.