Dr. Baker Answers The PBCers Questions
Alfred L. Baker, M.D.
Question 13
In regard to loss of vitamin A & D & K and its consequences. Because Vit D is a fat soluble vitamin does that mean it helps break down the fat? What does the lack of these vitamins do? Does food take longer to process because of pbc? Some of us suffer from weight gain and a big belly, could this be one of the culprits?
Answer
Vitamin D is not involved in the absorption of fats, proteins, or carbohydrates which are the foods that contribute to body weight. Vitamin D is not involved in the breakdown of fat in the intestine. It's main function is to promote the absorption of calcium which is necessary for normal bone structure. Vitamin D deficiency can thus contribute to bone softening. Vitamin A helps in normal retinal function, and Vitamin A deficiency can lead to night blindness and other eye disorders. Vitamin K is necessary in the liver's manufacture of some proteins required for normal blood coagulation.
All of these are so-called fat soluble vitamins, and require bile secretion from the liver for proper absorption. As PBC advances, the liver may fail to secrete adequate bile acids, and fat soluble vitamin malabsorption may occur.
A "big belly" would not result from problems with fat soluble vitamins. However, you can ask your physician to measure your fat soluble vitamin levels and to prescribe these substances if needed to prevent the complications I mentioned.
Question 14
I was diognosed with PBC on February 10th of this year. I have been having pain often in my upper right side. Can you tell me what causes this? I have heard many others in the group have the same type pain.
Answer
Many patients with PBC have told me about the kind of pain you describe. I don't think there is any clear explanation for this problem. Possibilities include enlargement of the liver with stretching of the capsule of the liver where its pain nerves are located. Adhesions may develop between the liver and the abdominal wall and cause the kind of pain you describe. I think it is important for patients with PBC who are having pain in the liver to have an ultrasound examination or a CT scan of the liver to be sure that there are no other problems causing this discomfort. You may wish to ask your physician about performing one of these tests if it has not been performed in your case.
Question 15
Do you know which herbs we should stay away from, that will do damage to the liver. What are your thoughts on Milk Thissel?
Answer
I recommend the avoidance of herbs that are manufactured in countries other than the United States and Western Europe because some of these substances contain toxic materials that have resulted in serious adverse effects. Herbs that have known hepatic toxicity include but are not limited to: Germander, and chaparral.
Milk Thistle is widely used by patients with liver disorders. I think it is safe, but little evidence supports its effectiveness. Likewise, there is little evidence to support the use of nutritional supplements in patients with PBC. I do recommend that patients take a multi-vitamin tablet daily, and that fat soluble vitamins be monitored and supplemented as needed. A balanced diet, emphasizing several servings of fresh fruits and vegetables daily, maintenance of normal body weight, and avoidance of excessive saturated fats is a recommendation I make to all of my patients.
Question 16
My wife was recently diagnosed with PBC by a local liver specialist. It is apparent that this disease is quite rare. How much importance should one place on obtaining the advice of a doctor specializing in the treatment of PBC?
Answer
You are correct that PBC is an uncommon disease, and otherwise well informed physicians may not be familiar with this disorder. I think it is valuable for a patient with this disease to have periodic consultations with a physician who is experienced in its management. Such a physician can help you to be certain that PBC is indeed the diagnosis; he/she can recommend appropriate therapy. Patients often have questions about the role of liver transplantation, and an expert physician can help you to understand when this procedure might be needed. Such a consultant can usually work with your primary physician to help get the appropriate treatment and necessary follow-up.
Question 17
Since everything is processed through the liver, is there any reason a pre or post transplant PBC patient should avoid hair color, or nail polish?
Answer
We recommend that all patients who receive liver transplants avoid hair coloring and permanents for the first few weeks after the procedure. Otherwise, patients with PBC do not need to avoid these cosmetic enhancements.
Question 18
A number in our group have been diagnosed with Fibromaralgia? Can you tell me what you know of this disease. Is it a "catch all disease" when our doctors don't know what else to tell us?
Answer
Patients with PBC suffer from a number of muscular and articular disorders that lead to pain and discomfort in the arms, shoulders, back, hips, and legs. Fibromyalgia is an inflammatory condition of the muscles and tendons and can be difficult to separate from other rheumatic disorders such as rheumatoid arthritis and osteoarthritis. Treatment of the condition is often helpful but may not result in a complete cure. A rheumatologist, a physician who specializes in muscular and joint disorders, can help to establish the proper diagnosis and administer the best therapy.
THANK YOU!!!