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Our Ask the PBC Doc section provides a forum for you to ask a leading PBC research doctor a question about PBC. We will select the top questions we receive and provide you with the answers on a regular basis. Please send your questions to pbcsociety@yahoo.ca

DISCLAIMER: The following is intended for general information purposes only. It is not intended to be comprehensive. It does not in any way constitute legal or other professional advice, and should not be relied upon as such. The reader is cautioned to consult their own physician and other experts for advice regarding specific health concerns. The Canadian PBC Society is not responsible for the accuracy, completeness, or any action taken on the basis of the information mentioned herein. It is not intended to substitute for and/or supersede one's own physician's advice.

Who is the PBC Doc?

From the desk of Dr. Andrew Mason

Dr. Andrew Mason MBBS MRCPI
Professor, Department of Medicine, University of Alberta
Senior Scholar, Alberta Heritage Foundation for Medical Research
Director of Research, Division of Gastroenterology
Director, The Applied Genomics Center
Dr. Mason trained at the Liver Unit, Kings College Hospital, in London, England and then moved to Washington University, St. Louis as a Gastroenterology Fellow to train in molecular virology. At Ochsner Clinic Foundation, New Orleans he became the Medical Director of Liver Transplantation and an Assistant Professor in the Department of Medicine, Tulane University Medical Center. After relocating to the University of Alberta in 2002, Dr. Mason obtained the Scholar award at the Alberta Heritage Foundation for Medical Research Scholar and then became a Senior Scholar in 2008.

Questions: Issue 1, 2011

Fatigue occurs in up to 80% of patients with primary biliary cirrhosis. However, on diagnosis up to half of the patients that we see in clinic have no symptoms because they are generally picked up on routine screening with abnormal liver tests. Patients with fatigue often have to sleep during the day or find they have little energy to do much in the evenings. This symptom is usually persistent, although some patients do occasionally respond to medications in drug studies that appear to perk them up. However, this response only occurs in a handful of patients and therefore there are no specific drugs associated with the treatment of fatigue in patients with PBC.

Question 2 and 3: 2. I was diagnosed with PBC in 1995 and take prescribed URSO 250 mg, 5tablets per day. I also ADEKs vitamin supplements of A,D,E, and K. In the past 6 months, I have started using Women's One A Day for those aged 50 + in conjunction with ADEKs. I understand from my pharmacist that ADEKs will no longer be manufactured. My question is this: could you please recommend what in your opinion would be an appropriate course of supplements for me to be taking to ensure optimum benefit for someone of my age - almost 56 ?

3. Does the current research support any particular supplementation for PBC patients?

Using women's One-a-Day for those aged greater than 50 should be sufficient for most patients with PBC. There is no proven benefit of using ADEK, and this prescription was made specifically for PBC patients without any evidence that it provided benefit. We usually recommend that patients take an age-appropriate multivitamin, as well as supplements to prevent thinning of bones. This includes vitamin D 1,000-2,000 i.u. a day, as well as calcium supplements. Previously, we used to recommend 1 to 1.5 grams of calcium citrate to prevent boney disease. However, the use of calcium supplements has been questioned recently because a study from New Zealand reported that this may be associated with the development of calcium deposits in arteries. This in turn may be associated with a slightly increased risk of developing heart attacks or other vascular diseases such as stroke. While we do not know for sure what the optimal dose of calcium is now for patients, I think it is probably wise to take some calcium supplementation to avoid the risk of thinning of bones and osteoporosis of 500mg per day.

It is unlikely that either hepatitis A or the treatment for ADHD with Ritalin are triggers for PBC. Both environmental factors are quite common, whereas PBC is rare. Therefore, it is unlikely that either of these could be considered a catalyst for PBC.

Each autoimmune disorder described affects the body in different ways. The main problem with having PBC and liver disease is that it affects the absorption of fat-soluble vitamins, and therefore patients with PBC are more likely to develop thinning of the bones as they do not absorb the calcium and vitamin D. PBC may also effect energy levels and cause itching and dry eyes with dry mouth. The other diseases such as Graves' and diabetes may have some affect on heart function, and patients with diabetes can get blood vessel disease as well as kidney disease if their control of sugar is not good. Patients with ulcerative colitis may get disease of the skin with rashes, as well as arthritis. Generally speaking, if you have a specific disease that is difficult to manage, it is always worth seeing a specialist associated with that disease such as a rheumatologist for arthritis, and endocrinologist for diabetes and Graves' disease, a liver specialist for PBC, or a gastroenterologist for ulcerative colitis. However, if the diseases are well controlled, it may be simpler and more coordinated to see one physician who is familiar but not an expert in all these diseases.

It sounds like Huan fat metabolizer that contains choline methionine and inositol may possibly be a good treatment for patients with fatty liver but there are no studies that I know of that show this. Indeed, the benefit from fatty liver disease from this supplement is questionable, but there are some theoretical data to suggest that choline methionine may be of benefit for patients with fatty liver. I am unsure how this product would be useful for patients with PBC unless they were overweight and suffer from fatty liver as well.

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