Diet for Pancreatitis: Nutritional Profile, Allowed and Prohibited Foods

Pancreatitis has long been thought to be caused by alcoholism. This false impression is formed because it was first discovered and described using the example of alcoholics. But it is now known that their most dangerous and acute stages are almost never found in them - the "privilege" of those with a healthy attitude to spirits.

Pancreatitis can be the result of overeating (now also considered a form of addiction), pathological changes in other digestive organs, and endocrine disorders. Regardless of the etiology, form and stage of the disease course, it greatly disrupts digestion, threatens the state of the metabolic system, and sometimes endangers the patient's life. Nutrition for pancreatitis is primarily based on protein (which is digested by the stomach) and involves careful grinding of food.

organ function

The tissue structure and function of the pancreas is heterogeneous. The main part of its cells produces pancreatic juice - a concentrated base in which enzymes (or rather, their inactive precursors) are dissolved. Pancreatic juice forms the digestive environment of the gut. The bacteria that inhabit its various sectors play an important but auxiliary role.

The main bile duct also runs through pancreatic tissue. It leads from the gallbladder to the duodenum, where it flows into its lumen at the exit and into the main duct of the gland itself. As a result, bases, enzymes, and bile do not enter the gut individually, but as a ready-made "mixture. "

Within the glandular tissue, different types of cells are also distributed in groups. Known as pancreatic islets, they don't synthesize base, but insulin, a hormone responsible for absorbing carbohydrates from food. Abnormal development, function or degradation of such cells (often inherited) is a condition of diabetes. The second is to increase the resistance of body cells to the normal insulin they produce.

cause of disease

In the acute phase, pancreatitis causes blockage of the glandular ducts through which pancreatic juice flows into the main duct and then into the duodenal lumen. The enzymes accumulated inside it have the effect of "self-digestion". Acute pancreatitis can be caused by the following reasons.

• Gallstones. They are due to inflammatory pathology of the liver or gallbladder, abnormal bile composition (they are caused by sepsis, taking atherosclerotic drugs, diabetes, the same liver disease).
• Infect. Viruses (mumps, hepatitis, etc. ) or parasites (helminthiasis). Pathogens affect gland cells, causing the tissue to swell and disrupt its function.
• drug. Toxic effects on atherosclerotic drugs, steroid drugs and some antibiotics.
• Deviations in structure or location. They may be congenital (curved gallbladder, too narrow duct, etc. ) or acquired (scarring, swelling after surgery or trauma examination).

Chronic pancreatitis is most common in alcoholics who are intoxicated and in people with diabetes who have been "experienced" for at least five years. Here, autoimmune processes in the glands that cause inflammation or take antidiabetic drugs are important. But it can also accompany the following diseases.

• Intestinal Pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosions.
• Vascular disease. All glands must actively supply blood. Congenital abnormalities and coagulation disorders (hemophilia, thrombosis) play a special role here.
• Injuried. Penetrating wounds, interventions, strong blows to the stomach.

The least common cause of pancreatitis is spasm of the sphincter of Oddi, which ends in the gallbladder and pancreatic duct. The sphincter of Oddi is located at the outlet of the duodenum. Normally, it regulates the "partial" supply of pancreatic juice and bile into its cavity so that it almost stops between meals and increases sharply when a person sits at a dining table. It also prevents the backflow of intestinal contents into the pancreatic or gallbladder cavity along with various pathogens (bacteria, foreign compounds, worms).

The sphincter of Oddi is less prone to spasms, like all smooth muscle "splitters" of this type. For a long time, his own medical dysfunction was absent. It was replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (complications of cholecystectomy). But in fact, his spasms are only rare if the nervous system is functioning properly. But he was often overtaken by neurological disease or due to the activation of pain receptors - his injuries occurred when he was stimulated by a stone that appeared in his gallbladder.

The division of acute and chronic causes of pancreatitis is conditional, as the first, even with high-quality treatment, goes into the second in the vast majority of cases. After removing causal factors, what "feeds" it is unclear. In some cases (about 30%), none of these processes explained the presence of pancreatitis in patients.

sign

Acute pancreatitis begins with excruciating (until unconscious) band-like pain throughout the upper abdomen, below the ribs. Antispasmodics, painkillers, and antibiotics won't get rid of it, nor will common medicines "from the heart". Special diets also don't reduce pain -- doctors, not diets, are needed here. Often, though not always, it beams up the heart area, below the collarbone, the thoracic spine, so patients may confuse the symptoms of pancreatitis with a heart attack or worsening of osteochondrosis. This is also facilitated by the body's cascade of responses to critical-intensity stimuli:

• Blood pressure jumps (high and low blood pressure are equally likely);
• heart rate interruption;
• syncope;
• Cold, clammy sweat.

A characteristic symptom of pancreatitis is loose stools - mushy, containing half-digested food fragments and fat. It appears a few hours after the onset of the disease. By the end of the first day, the discoloration of the stool with the urine becomes apparent. Usually, they are stained yellow-brown by bilirubin in bile, which is digested with the help of bile. And because of the blockage of the duct, it doesn't get into the intestines. On the second or third day, the patient develops flatulence, "sucks" in the stomach, and vomits at the sight of greasy or spicy food.

Chronic pancreatitis is also associated with pain, but it is less pronounced. An hour after eating, they intensify, especially when inappropriate - cold, fried, smoked, fatty, spicy, and accompanied by alcohol. Supine pain is exacerbated and digestion is disturbed until dyspepsia (when little changed food is passed rather than feces).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of a perforated gastric ulcer) was Princess Henrietta of England, wife of Philip, Duke of Orleans, brother of the Sun King Louis XIV. Due to the typically painful course of the disease, she was convinced that one of her husband's favorites had poisoned her. Admittedly, it only emerged during the autopsy to confirm or dispel this rumor.

Effect

Acute pancreatitis is dangerous because the pancreatic tissue is "eaten" quickly (two or three days), with the result that caustic, bile and digestive enzymes pass directly through this "fistula" into the abdominal cavity. The condition culminates in diffuse peritonitis (inflammation of the peritoneum that spreads rapidly to the abdominal organs), multiple erosions, and death.

Peritonitis is characteristic of many diseases, including perforated ulcers, gastric or bowel cancer, appendicitis, if it is accompanied by a breakthrough of an abscess (due to this condition, the magician Harry Houdini died). If pancreatitis is not caused by a mechanical disorder (spasm of the sphincter of Oddi, stones, scars, tumors, etc. ), but rather by an infection, a purulent pancreatic abscess may develop. His ill-timed treatment also ended in a breach of the abdominal cavity.

The enzymes and digestive juices of the pancreas can sometimes cause enzymatic pleurisy - the same type of inflammation of the pleura as the peritoneum. With chronic pancreatitis, the time delay of complications is typical, but more serious can interfere with its work and other organs.

• cholecystitis. Cholangitis is inflammation of the liver ducts. They can themselves cause pancreatitis due to the cholelithiasis that accompanies them, but they usually form in the opposite order - as a result of it.
• gastritis. The connection of the stomach to the pancreas is not as tight as that of the liver, although it is located just below the pancreas. Its inflammation in pancreatitis is not so much due to the entry of foreign substances from the inflamed glands into its lumen, but rather due to a persistent lack of digestion in the gut, which it is forced to compensate. The pancreatitis diet aims to reduce the load on all digestive organs, but the "benefits" of a healthy stomach are not considered carefully enough. The more degenerated the pancreas, the higher the risk of gastritis.
• Reactive hepatitis. It also develops in response to persistent stasis of bile and stimulation of the hepatic ducts. Cholestasis, which sometimes occurs during the next exacerbation of pancreatitis, is accompanied by jaundice. This is why pancreatitis diets should not include foods that require increased bile separation. These include fatty, fried, spicy meat and fish, caviar, other animal by-products, bacon, alcoholic beverages - digestive stimulants.
• Cysts and pseudocysts. The appearance of these benign tumors, or pancreatic juice stasis foci that mimic them, arises from the same difficulty in migrating them into the duodenal lumen. Cysts tend to periodically become inflamed and purulent.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogen because it causes irritation that accelerates the destruction of affected tissues and their response to growth. And it's not always good quality. The same is true of chronic pancreatitis.
• diabetes. It is far from the first "first-line" complication of chronic pancreatitis. But the faster and more pronounced the entire gland degenerates, the more difficult it is for the surviving islet cells to compensate for the insulin deficiency that occurs due to the death of their "colleagues" in areas that have already died. They have dried up and are beginning to die out. The prospect of diabetes seven to ten years later (often even sooner, depending on the prognosis and characteristics of the pancreatitis course) becomes increasingly apparent to the "experience" of the average patient. Because of its threat, a pancreatitis diet should ideally take into account not only a reduction in fat content, but also simple carbohydrate content.

Chronic recurrent inflammation in glandular tissue can lead to scarring and loss of function. Progressive deficiencies in intestinal digestion are inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis of a patient's disease course, quality and life expectancy is affected by various "biases" in diet and its type, especially everything related to alcoholic beverages.

diet therapy

The acute phase of the disease usually requires urgent detoxification, administration of antibiotics (often broad-spectrum because there is no time to determine the type of pathogen), and sometimes surgical intervention. This is necessary if the cause of the disease is spasm of the sphincter of Oddi, stone stuck in the duct, or other obstruction (tumor). After completion, the basis of treatment should be a special medical diet.

As a basis, gastroenterologists typically follow the No. 5 diet developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other diseases that hinder bile synthesis and outflow. But then the author changed it himself, creating Diet No. 5p.

General provisions

For less ill adult patients, a variant of Table 5p without mechanical retention is appropriate - it does not require grinding food into uniform pieces. Children's menus usually have to be made from mashed products. There are several mandatory general rules for nutrition during the exacerbation phase of chronic pancreatitis (especially the first three days after the onset) and the acute phase of the first appearance.

• Simple. The recipe should be as simple as possible - no stuffed breast and meat salad, even though all of its ingredients are individually "fit" for the diet.
• Completely hungry for the first few days. As the pathology worsened, starvation was prescribed. That is, only warm alkaline drinks and maintenance IVs (vitamins, dextrose, sodium chloride).
• Only simmered and boiled (over water, steamed). Tables 5 and 5p do not imply other methods such as baking and frying.
• Minimum fat. Especially if the attack is accompanied by (or caused by) cholangitis, cholecystitis. Plant and animal fats must be similarly restricted because the same substance, bile, can break them down. They are not to be consumed in more than 10 grams per day, but in unlimited proportions.
• No spice. Especially hot.
• No nuts. Seeds are also banned. These types of foods are rich in vegetable oils and can be difficult to eat even in powdered form.
• Salt to taste. Its consumption does not affect the pathological process in any way, and the daily salt intake is the same as in healthy people - up to 10 grams per day.
• less fiber. Often valued by nutritionists and people with digestive issues, this ingredient is strictly limited for pancreatic inflammation. The secret to its "magic" effect on the gut is that fiber is not digested, absorbed and stimulates various parts of the gut, stimulating peristalsis and excretion of water. Fiber helps form stool because it's not excreted. As the pancreas becomes inflamed, all these properties of fiber only make the situation worse. You can only eat carrots, zucchini, potatoes, and squash, which are rich in starch and pulp, but relatively poor in hard fiber. Cabbage and red cabbage are prohibited, but cauliflower can be eaten (except inflorescences, shoots and stems only).
• small portion. As before, three times a day with a total weight of half a kilo or more, pancreatic lesions are not possible. Eat at least five meals a day, and the combined weight of all foods at one time should not exceed 300 grams.
• Soda, coffee, alcohol and kvass are prohibited. These beverages are best left out of the diet forever. However, if during remission they should not be taken at all, during exacerbation they are strictly prohibited.

Sour vegetables (such as tomatoes) and all berries and fruits are also banned. They further stimulate the secretion of bile. Nutritional focus should be on non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Grain purees are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.

Menu example

Dietary menus for pancreatitis should contain adequate protein and carbohydrates. However, by limiting the addition of sugar and honey to beverages and dishes, it is best to avoid the "brute force" of the latter. Buckwheat is a favorite grain for people with diabetes and should be included in the diet more frequently because it consists of complex carbohydrates. Sugar can be replaced with diabetes medications - fructose, xylitol and sorbitol (which give an unpleasant aftertaste when added to hot dishes), aspartame. A diet during a period of exacerbation or primary inflammation of the pancreas that is already declining may look like this.

on Monday

• First breakfast. Cooked chicken breast puree. Rice is mashed.
• Lunch. Steamed fish cakes.
• dinner. Dilute the chicken soup with rice by half with water. Milk jelly.
• afternoon tea. Omelette from two eggs.
• First dinner. Chicken meatballs (meat with rice). Buckwheat puree and butter dessert scoop.
• Second dinner. Lean, non-acidic cheese, grated in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. oatmeal. Cooked cauliflower.
• Lunch. Lean Beef Sauce with Butter. The tea is soaked in it with milk and some white bread crumbs.
• dinner. Dashi is made from lean fish with rice and water. Milk or jelly without fruit.
• afternoon tea. Cottage Cheese Pasta with Thin Sour Cream.
• First dinner. Steamed Turkey Breast Souffle. Puree liquid buckwheat.
• Second dinner. Cooked prawn paste served with rice.

Wednesday

• First breakfast. Fish ball rice (grind the rice with the fish). Cooked mashed carrots.
• Lunch. Two tablespoons grated low-fat hard cheese.
• dinner. A soup made with oatmeal, diluted chicken stock, and breast meat. Curd pasta with sour cream.
• afternoon tea. Several poached cauliflower.
• First dinner. Pasta mashed with cheese. Steam an omelet with two eggs.
• Second dinner. Pumpkin porridge. Tea with a few slices of white biscuits.

Thursday

• First breakfast. Zucchini puree. Chicken steamed patties.
• Lunch. Two tablespoons grated low-fat hard cheese.
• dinner. Cream of potato soup with butter. Lean beef puree.
• afternoon tea. Turkey Breast Souffle.
• First dinner. Buckwheat mash. Skinny fish soufflé.
• Second dinner. Carrot Pumpkin Porridge.

Friday

• First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (milled rice, like meat).
• Lunch. Mashed potatoes with butter.
• dinner. Milk soup with mashed pasta. Two egg omelet steamed with grated cheese.
• afternoon tea. Several cauliflower florets. Rice pudding.
• First dinner. Shrimp in sour cream sauce. Buckwheat mash. Tea with white biscuits.
• Second dinner. Carrot puree. Milk or jelly without fruit.

Saturday

• First breakfast. Pumpkin porridge. Lean Beef Souffle.
• Lunch. Fish Ball.
• dinner. Rice soup with light chicken broth and minced meat. Pasta mashed with milk.
• afternoon tea. oatmeal.
• First dinner. Lean Beef Sauce with Butter. Mashed potatoes.
• Second dinner. Pumpkin Carrot Porridge. Tea with a few slices of white biscuits

Sunday

• First breakfast. Cottage cheese pasta. Omelet.
• Lunch. Zucchini under a cheese coat. Milk tea and white biscuits
• dinner. The buckwheat soup is diluted with boiled beef puree to dilute the beef soup. Steamed Turkey Breast Souffle.
• afternoon tea. Oatmeal.
• First dinner. Mashed potatoes. Chicken chop.
• Second dinner. Rice tofu pudding.

The diet for pancreatitis requires the exclusion of all sweets and pastries from the diet, including chocolate and cocoa. You need to limit your intake of any fats, food acids and fiber. Also, don't eat fresh bread. Under the prohibition of millet, wheat, and corn. These grains cannot be mashed even with a blender. All legumes, including soybeans, are also canceled. They are high in plant protein and therefore valued by vegetarians. But they're also "guilty" for increasing gas formation, which increases stomach acidity, which is highly undesirable in the acute phase.