Diet for pancreatitis: nutritional characteristics, allowed and prohibited foods

30 May 2022

For a long time it was thought that pancreatitis was caused by alcohol abuse. This false impression was formed because it was first discovered and described using the example of those who suffer from alcoholism. But it is now known that their most dangerous and acute stage is almost never found in them - this is the "prerogative" of people with a healthy attitude towards strong drinks.

Pancreatitis can be the result of overeating (now also considered a form of addiction), pathologies of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the course, it greatly interferes with digestion, threatens the state of the metabolic system, and sometimes the life of the patient. Nutrition for pancreatitis is primarily built on protein (protein is digested by the stomach) and involves carefully grinding food.

Organ functions

The pancreas is heterogeneous in the structure and function of its tissues. The main part of your cells produces pancreatic juice - a concentrated alkali with enzymes dissolved in it (or rather, its inactive precursors). Pancreatic juice forms the digestive environment of the intestine. The bacteria that inhabit its various departments play an important but auxiliary role.

The main biliary tract also traverses the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing at its exit in its lumen into the main duct of the gland itself. As a result, alkali, enzymes and bile enter the intestine not separately, but in the form of a ready-made "mixture".

Within the gland tissues, cells of a different type are also located in groups. They are called islets and do not synthesize alkalis, but insulin, a hormone responsible for absorbing carbohydrates from food. Abnormalities in the development, functioning or degradation of these cells (they are usually hereditary) are one of the scenarios for diabetes mellitus. The second is to increase the resistance of the body's cells to the normal insulin they produce.

Causes of disease

In the acute phase, pancreatitis leads to blockage of the small ducts of the gland, through which pancreatic juice flows into the main, and then into the lumen of the duodenum. There is an effect of its "self-digestion" by the enzymes accumulated inside it. Acute pancreatitis can be caused by the following reasons.

Gallstones. They arise due to inflammatory pathology of the liver or gallbladder, abnormalities in the composition of bile (they are caused by sepsis, use of drugs for atherosclerosis, diabetes mellitus, the same liver diseases).
Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiases). The causative agent affects the gland's cells, causes the tissues to swell and disrupts their function.
Medicines. The toxic effect of atherosclerosis drugs, steroid drugs and some antibiotics.
Deviations in structure or location. They can be congenital (curvature of the gallbladder, very narrow ducts, etc. ) or acquired (healing after surgery or traumatic examination, swelling).

Chronic pancreatitis may be seen more often in alcoholics and diabetics "with experience" of at least five years. Here, the autoimmune process in the gland, which caused inflammation or taking antidiabetic drugs, is important. But it can also accompany the following diseases.

Intestinal pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and clotting disorders (hemophilia, thrombosis) play a special role here.
injuries. 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 common gallbladder and pancreatic duct. The sphincter of Oddi is located at its exit into the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile in its cavity, allows it to almost stop between meals, and sharply increases when a person sits at the table. It also prevents backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.

The sphincter of Oddi is not prone to spasms, like all smooth muscle "separators" of this type. For a long time, there was not its own dysfunction in medicine. It has been replaced by various "bile dyskinesias" and "post-cholecystectomy" "syndromes" (a complication of gallbladder removal). But in fact, its spasm is a rare thing only with the normal functioning of the nervous system. But he often overcomes it with neurological disorders or as a result of activation of pain receptors - when he is irritated by stones emerging from the gallbladder, his injury occurs.

The division of the causes of acute and chronic pancreatitis is conditional, since the former, even with high-quality treatment, in the vast majority of cases passes to the latter. And what "feeds" it after the causal factors are eliminated is unclear. In some cases (about 30%), none of these processes can explain the appearance of pancreatitis in a patient.

signals

Acute pancreatitis begins and is accompanied by excruciating pain (up to loss of consciousness) in the waist throughout the upper abdomen, under the ribs. Antispasmodics, pain relievers and antibiotics don't remove it, and ordinary "heart" drugs don't help either. A special diet won't ease the pain either - a doctor is needed here, not a diet. Usually, although not always, its radiation is noticed upwards, to the region of the heart, under the collarbone, to the thoracic spine, so patients can confuse the symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis. This is also facilitated by the body's cascading reactions to a critical force stimulus:

jumps in blood pressure (hypertension and hypotension are equally likely);
heart rate interruptions;
fainting;
cold, sticky sweat.

A characteristic symptom of pancreatitis is loose stools - soft, containing fragments of semi-digested food and fat. It appears after a few hours of the onset of the disease. By the end of the first day, discoloration of stool with urine becomes noticeable. Usually, they are colored yellow-brown by bilirubin from bile, with the help of which digestion took place. And because of the blockage of the duct, it doesn't enter the intestine. On the second or third day, the patient develops flatulence, "sucking" the stomach and vomiting at the sight of fatty or spicy foods.

Chronic pancreatitis also occurs with pain, but not as pronounced. They can intensify an hour after eating, especially if it is inappropriate - cold, fried, smoked, greasy, spicy, accompanied by alcohol. Pain is aggravated in the supine position, digestion is disturbed up to dyspepsia (when almost unchanged food comes out instead of feces).

One of the most famous victims of acute pancreatitis (many experts point to the likelihood of a stomach ulcer perforation) was Princess Henrietta of England, wife of Duke Philippe of Orleans, brother of the Sun King Louis XIV. Because of the typical painful course of the disease, she was certain that one of her husband's favorites had poisoned her. True, it was discovered only during an autopsy, designed to confirm or dispel this rumor.

Effects

Acute pancreatitis is dangerous by fasting (two or three days) "eating" of pancreatic tissue completely, as a result of which caustic alkali, bile and digestive enzymes enter through this "fistula" directly into the abdominal cavity. This scenario ends with diffuse peritonitis (inflammation of the peritoneum, which rapidly spreads to the abdominal organs), the appearance of multiple erosions, and death.

Peritonitis is characteristic of many pathologies, including perforated ulcer, cancer of the stomach or intestine, appendicitis, if accompanied by a ruptured abscess (due to this scenario, magician Harry Houdini died). If pancreatitis was caused not by a mechanical obstacle (sphincter of Oddi spasm, stone, scar, tumor, etc. ), but by an infection, a purulent pancreatic abscess may develop. Its premature treatment also ends with a breakthrough in the abdominal cavity.

Enzymes and digestive juice from the pancreas sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as in the case of the peritoneum. For chronic pancreatitis, late complications are typical, but they more seriously interrupt your work and other organs.

Cholecystitis. And cholangitis is inflammation of the hepatic ducts. They themselves can cause pancreatitis due to the cholelithiasis that accompanies them, but they usually form in the opposite order - as a consequence of this.
Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below it. Your inflammation in pancreatitis occurs not so much due to foreign substances entering your inflamed gland cavity, but due to the constant failure of intestinal digestion, which is forced to compensate. The pancreatitis diet is designed to reduce the load on all digestive organs, but the "interests" of a healthy stomach are less carefully considered. The more pronounced the degradation of the pancreas, the greater the risk of developing gastritis.
reactive hepatitis. It also develops in response to the constant stagnation of bile and irritation of the hepatic ducts. Cholestasis that occurs during the next exacerbation of pancreatitis is sometimes accompanied by jaundice. This is why the pancreatitis diet should not include foods that require greater separation of bile. Among them are fatty, fried, spicy meats and fish, fish caviar, other animal by-products, smoked meats, alcoholic beverages - digestive stimulants.
Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice that simulate them arise due to the same difficulties with their removal to the duodenal cavity. Cysts tend to periodically inflame and ooze.
Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor as it causes irritation, accelerated destruction of the affected tissues and their increased growth response. And it's not always of good quality. The same goes for chronic pancreatitis.
Diabetes. It is far from the first "online" complication of chronic pancreatitis. But the faster and more visibly the entire gland degrades, the harder it is for the surviving islet cells to compensate for the insulin deficiency that occurs due to the death of their "colleagues" in already dead areas. They are exhausted and also begin to die. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and characteristics of the course of pancreatitis) "experience" for the average patient is becoming increasingly tangible. Because of their threat, a diet for pancreatitis must take into account the reduced content not only of fats, but also of simple carbohydrates.

Chronic recurring inflammation in the gland's tissues causes scarring and loss of functionality. Progressive insufficiency of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10 to 20 years. The prognosis for its course, quality and life expectancy of the patient is influenced by several "deviations" of the diet and its type, mainly in everything related to alcoholic beverages.

diet therapy

The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually a broad spectrum, as there is no time to establish the type of pathogen), and sometimes surgical intervention. It is necessary if the cause of the disease is a spasm of the sphincter of Oddi, a stone stuck in the duct, or another obstacle (tumor). After its completion, the basis of treatment should be a special medical diet.

As a basis, gastroenterologists often take diet number 5, developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other pathologies that prevent the synthesis and output of bile. But then the author himself changed that by creating the #5p diet.

general provisions

For adult patients with a mild disease course, a variant of table #5p without mechanical economy is suitable - it does not require grinding food into a homogeneous mass. And the children's menu most of the time has to be made out of crumpled products. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days after onset) and in the acute phase, which occurred for the first time, has several mandatory general rules.

Simplicity. Recipes should be as simple as possible - no stuffed breasts and meat salads, even if all the ingredients in their composition "fit" individually into the diet.
Complete hunger for the first few days. With an exacerbation of the pathology, starvation is prescribed. That is, just a hot alkaline drink and maintenance IV injections (vitamins, glucose, sodium chloride).
Just stewing and boiling (in water, steam). Tables #5 and 5p do not imply other methods such as roasting and frying.
Minimal fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats must be equally strictly limited, as the same agent, bile, breaks them down. They can be consumed no more than 10 g per day, but in any proportion.
No spices. Especially hot and spicy.
No nuts. Seeds are also prohibited. These types of foods are rich in vegetable oil and are very difficult to eat, even in powdered form.
Salt to taste. Its consumption does not affect the course of the pathology in any way, the daily intake of salt remains the same as in healthy individuals - up to 10 g per day.
Less fiber. This component, generally valued by nutritionists and people with digestive problems, is strictly limited to use in inflammation of the pancreas. The secret of its "magical" effect on the intestines is that fiber is not digested, absorbed and irritates various sections of the intestine, stimulates peristalsis and water excretion. Fiber helps form stools as it is excreted unchanged. With inflammation of the pancreas, all these fiber properties only make the situation worse. You can eat only carrots, zucchini, potatoes, squash, rich in starch and pulp, but relatively low in hard fiber fiber. White and red cabbage is prohibited, but cauliflower can be eaten (only inflorescences, twigs and stems are excluded).
Small portions. There are, as before, three times a day in portions with a total weight of half a kilo or more, with pancreatic pathologies it is impossible. There should be at least five meals a day, and the total weight of all foods eaten at one time should not exceed 300 g.
Prohibition of soda, coffee, alcohol and kvass. These drinks should be excluded from the diet forever. But if during the period of remission they simply should not be taken, then during an exacerbation they are strictly prohibited.

Sour vegetables (eg tomatoes) as well as all berries and fruits are also prohibited. They will further stimulate the secretion of bile. The emphasis in nutrition should be on non-acidic, low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Puree cereals are used as sources of carbohydrates, mainly buckwheat, rice and oats.

menu example

The diet menu for pancreatitis should contain enough protein and carbohydrates. But it's best to avoid "brute force" with the latter limiting the addition of sugar, honey to drinks and dishes. Buckwheat, a favorite cereal of diabetics, should be included in the diet more often as it consists of complex carbohydrates. Sugar can be replaced by diabetic drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant taste), aspartame. The diet during the period when the exacerbation or primary inflammation of the pancreas is already in decline can be like this.

Monday

First breakfast. Cooked chicken breast puree. Crushed rice.
Lunch. Steamed fish cakes.
Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
afternoon tea. Two egg omelet.
First dinner. Chicken meatballs (grind meat with rice). Buckwheat pureed with a dessert spoon of butter.
Second dinner. Low-fat, non-acidic cottage cheese, crushed in a blender with a teaspoon of sour cream.

Tuesday

First breakfast. Oat. Cooked cauliflower.
Lunch. Lean beef pate with butter. Tea with milk and some white bread crumbs soaked in it.
Dinner. Fish soup made from lean fish with rice and water. Milk or fruit jelly without fruit.
afternoon tea. Cottage cheese dough with skim milk cream.
First dinner. Steamed turkey breast souffle. Liquid buckwheat puree.
Second dinner. Cooked shrimp puree with boiled rice.

Wednesday

First breakfast. Fish meatballs with rice (grind the rice together with the fish). Boiled carrot puree.
Lunch. Two tablespoons of grated low-fat hard cheese.
Dinner. Soup made from oat puree, diluted chicken stock and shredded breast. Cottage cheese dough with sour cream.
afternoon tea. Several boiled cauliflower florets.
First dinner. Kneaded dough with cottage cheese. Two-egg steam omelet.
Second dinner. Pumpkin porridge. Tea with some white biscuits soaked in it.

Thursday

First breakfast. Zucchini puree. Steamed chicken cutlets.
Lunch. Two tablespoons of grated low-fat hard cheese.
Dinner. Creamy potato soup with butter. Lean meat puree.
afternoon tea. Turkey breast souffle.
First dinner. Crushed buckwheat. Lean fish souffle.
Second dinner. Pumpkin carrot porridge.

Friday

First breakfast. Cottage cheese dough with sour cream. Zucchini puree. Chicken meatballs (grind rice, like meat).
Lunch. Mashed potatoes with butter.
Dinner. Milk soup with kneaded dough. Omelet of two steamed eggs with grated cheese.
afternoon tea. Several cauliflower florets. Sweet rice.
First dinner. Minced shrimp in sour cream sauce. Buckwheat puree. Tea with white cookies.
Second dinner. Carrot puree. Milk or fruit jelly without fruit.

Saturday

First breakfast. Pumpkin porridge. Lean meat souffle.
Lunch. Fish meatballs.
Dinner. Rice soup with weak chicken broth and minced meat. Dough kneaded with milk.
afternoon tea. Oat.
First dinner. Lean beef pate with butter. Mashed potatoes.
Second dinner. Pumpkin and carrot porridge. Tea with some white cookies

Sunday

First breakfast. Cottage cheese dough with sour cream. Omelet.
Lunch. Zucchini under a layer of cheese. Tea with milk and white cookies
Dinner. Buckwheat soup in beef broth diluted with boiled beef puree. Steamed turkey breast souffle.
afternoon tea. Oat puree.
First dinner. Mashed potatoes. Chicken cutlets.
Second dinner. Rice curd pudding.

The diet for pancreatitis requires the exclusion from the diet of all confectionery and pastries, including chocolate and cocoa. You need to limit your intake of fats, dietary acids and fiber. Also, don't eat fresh bread. Under the ban corn, wheat, corn. These cereals cannot be crushed even with a blender. All pulses, including soybeans, are also being cancelled. They are rich in vegetable proteins, for which they are appreciated by vegetarians. But they are also "guilty" of increased gas formation, an increase in stomach acidity, which is highly undesirable in the acute period.