Diet for pancreatitis: nutritional properties, permitted and prohibited foods

30 May 2022

It has long been thought that pancreatitis was caused by alcohol abuse. This false impression was created because it was first discovered and described using the example of those suffering from alcoholism. But it is now known that its most dangerous, acute phase is almost not found in them - this is the "prerogative" of people with a healthy attitude to 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 impairs digestion, threatens the state of the metabolic system and sometimes the life of the patient. The diet for pancreatitis is mainly protein based (proteins are digested by the stomach) and involves careful digestion of food.

Functions of organs

The pancreas is heterogeneous in structure and function of its tissues. The bulk of its cells produce pancreatic fluid - a concentrated alkali with enzymes dissolved in it (or rather, their inactive precursors). Pancreatic fluid forms the digestive environment of the intestines. Bacteria residing in its various departments play an important but auxiliary role.

The main biliary tract also passes through pancreatic tissue. It leads from the gallbladder to the duodenum, flowing at the exit into its lumen into the main canal 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 glandular tissue, cells of a different type are also located in clusters. They are called islands and do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Abnormalities in the development, functioning or degradation of such cells (usually inherited) are one of the scenarios of diabetes mellitus. The second is to increase the body's cells's resistance to the normal insulin they produce.

Causes of the disease

In the acute stage, pancreatitis leads to blockage of small glandular channels, through which pancreatic fluid flows into the main body, and then into the lumen of the duodenum. There is an effect of its "self-digestion" by enzymes accumulated inside. 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, taking medication for atherosclerosis, diabetes mellitus, the same liver diseases).
Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes swelling of the tissue and disrupts its function.
Barna. Toxic effect of drugs for atherosclerosis, steroid drugs and some antibiotics.
Deviations in structure or location. They can be congenital (gallbladder flexion, very narrow canals, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).

Chronic pancreatitis can be most often seen in drunk alcoholics and "experienced" diabetics for at least five years. Here, the autoimmune process in the gland, which caused the inflammation or taking antidiabetic drugs, matters. 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 coagulation disorders (hemophilia, thrombosis) play a special role here.
Injuries. Penetrating wounds, interventions, strong blows to the stomach.

The least common cause of pancreatitis is Oddi sphincter spasm, which terminates in the common gallbladder and pancreatic duct. Oddi's sphincter is located at its exit from the duodenum. Normally, it regulates the "split" supply of pancreatic and bile fluid in its cavity, allowing it to stop almost between meals and increase significantly when a person sits at the table. It also prevents the return of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.

Oddi's sphincter is not prone to spasms, like all smooth muscle "separators" of this type. For a long time, there was no such thing as his dysfunction in medicine. He was replaced by "biliary dyskinesias" and "postcholecystectomy" syndromes (complication of gallbladder removal). But in fact, his spasm is a rarity 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 coming out of the gallbladder, he gets injured.

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

signs

Acute pancreatitis begins and is accompanied by unbearable pain (up to loss of consciousness) of the girdle throughout the upper abdomen, below the ribs. Antispasmodics, painkillers, and antibiotics do not remove it, nor do common "heart" medicines. Even a special diet will not relieve the pain - here you need a doctor, not a diet. Usually, though not always, its radiation is observed upwards, in the region of the heart, below the clavicle, in the thoracic spine, due to which patients may confuse the symptoms of pancreatitis with a heart attack or worsening of osteochondrosis. This is also facilitated by the cascade reactions of the body to a stimulus with critical force:

jumps in blood pressure (hypertension and hypotension are equally likely);
interruptions in heartbeat;
faint;
cold, wet sweat.

A characteristic symptom of pancreatitis is loose-soft stools, which contain fragments of half-digested food and fat. Appears after a few hours from the onset of the disease. At the end of the first day, urine whitening becomes apparent. Normally, they are colored yellow-brown by bilirubin by bile, with the help of which digestion took place. And because of the canal blockage, it does not enter the intestine. On the second or third day, the patient develops bloating, "sucking" in the stomach, and vomiting at the sight of fatty or spicy food.

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

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

effects

Acute pancreatitis is dangerous from the rapid "eating" (two or three days) of pancreatic tissue through and through, 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 spreads rapidly to the abdominal organs), the appearance of multiple erosions, and death.

Peritonitis is characteristic of many pathologies, including a perforated ulcer, cancer of the stomach or intestines, appendicitis, if accompanied by an penetration of the abscess (because of such a scenario, the magician Harry Houdini died). If pancreatitis is not provoked by a mechanical obstruction (Oddi sphincter spasm, stone, scar, tumor, etc. ), but from an infection, a purulent pancreatic abscess may develop. His premature treatment also ends with a penetration into the abdominal cavity.

Enzymes and pancreatic fluid sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as in the case of the peritoneum. For chronic pancreatitis, time-delayed complications are typical, but more serious that disrupt its work and other organs.

Cholecystitis. And cholecystitis is inflammation of the liver ducts. They themselves can cause pancreatitis due to the cholelithiasis that accompanies them, but they often form in the opposite order - as a result.
Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is directly below it. Its inflammation in the pancreas does not occur so much because of foreign substances entering its cavity from the inflamed gland, but because of the constant insufficiency of intestinal digestion, which it 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 considered with less care. The more pronounced the degradation of the pancreas, the higher the risk of developing gastritis.
reactive hepatitis. It also develops in response to persistent bile stagnation and irritation of the hepatic ducts. Sometimes cholestasis that appears during the subsequent exacerbation of pancreatitis is accompanied by jaundice. This is why the pancreatitis diet should not include foods that require increased bile secretion. Among them are fatty meat and fish, fried, spicy, fish caviar, other animal by-products, smoked meat, alcoholic beverages - digestive stimulants.
Cystosis and pseudocystosis. These benign neoplasms or foci of pancreatic fluid stagnation that simulate them arise because of the same difficulties with its removal in the duodenal cavity. Cysts tend to periodically become inflamed and suppurative.
Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor because it causes irritation, accelerated destruction of the affected tissues and increased growth of their response. And it is not always good quality. The same goes for chronic pancreatitis.
Diabetes. It is far from the first "in a row" complication of chronic pancreatitis. But the faster and more noticeable the entire gland degrades, the harder it is for surviving island cells to compensate for the lack of insulin that occurs due to the death of their "colleagues" in already dead areas. They are impoverished and also starting to die. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and course characteristics of pancreatitis) the "experience" for the average patient is becoming increasingly tangible. Because of its threat, a diet for pancreatitis should ideally take into account the reduced content of not only fats but also simple carbohydrates.

Chronic recurrent inflammation in the glandular tissue causes scarring and loss of functionality. Progressive insufficiency of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis for its progress, quality and longevity of the patient is affected by various "deviations" from the diet and their type, especially in everything related to alcoholic beverages.

diet therapy

The acute phase of the disease often requires urgent detoxification, the appointment of antibiotics (usually a broad spectrum, as there is no time to determine 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 canal or another obstruction (tumor). Upon its completion, the basis of treatment should be a special medical diet.

As a basis, gastroenterologists usually take diet number 5, developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other pathologies that inhibit bile synthesis and excretion. But later the author himself changed it by creating diet no. 5p.

General provisions

For adult patients with a mild course of the disease, a variant of table no. 5p without mechanical saving is convenient - does not require grinding food to a homogeneous mass. And the menu for children most often has to be made from puree products. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days from its onset) and in the acute phase, which occurred for the first time, there are some general mandatory rules.

Simplicity. Recipes should be as simple as possible - without stuffed breasts and meat salads, even if all the ingredients in their composition individually "fit" into the diet.
Complete hunger in the first days. With a worsening of the pathology, starvation is described. That is, only a warm alkaline drink and intravenous maintenance injections (vitamins, glucose, sodium chloride).
Just stew and simmer (in water, on steam). Table no. 5 and 5p do not imply other methods like baking and frying.
Minimal fat. Especially if the attack is accompanied (or caused) by cholecystitis, cholecystitis. Vegetable and animal fats with it should be just as strictly restricted, 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 banned. These types of foods are rich in vegetable oil and are very difficult to eat even in powder form.
Salt to taste. Its consumption does not affect in any way the course of the pathology, the daily intake of salt remains the same as in healthy individuals - up to 10 g per day.
Less fiber. This component, commonly valued by nutritionists and people with digestive problems, is strictly restricted to use in inflammation of the pancreas. The secret of its "magical" effect on the intestine is that the fibers are not digested, not absorbed and irritate various parts of the intestine, stimulate peristalsis and water extraction. Fiber helps in the formation of feces, as it is excreted unchanged. With inflammation of the pancreas, all these properties of the fibers will only make the situation worse. You can eat only carrots, zucchini, potatoes, squash, rich in starch and pulp, but relatively poor in fiber. Cabbage and red cabbage is prohibited, but cauliflower can be consumed (excluding only inflorescences, twigs and stalks).
Small parts. There, as before, three times a day in portions with a total weight of half a kilogram or more, with pathology of the pancreas is impossible. There should be at least five meals a day, and the total weight of all foods eaten at the same time should not exceed 300 g.
Prohibition of soda, coffee, alcohol and kvass. These drinks are best excluded from the diet forever. But if during the period of forgiveness they simply should not be removed, then during a deterioration they are strictly forbidden.

Sour vegetables (for example, tomatoes), as well as all berries and fruits, are also prohibited. They will further stimulate bile secretion. Emphasis on nutrition should be on non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Baked cereals are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.

Example menu

The diet menu for pancreatitis should contain enough protein and carbohydrates. But the "brutal force" with the latter is best avoided by limiting the addition of sugar, honey to drinks and dishes. Buckwheat, a favorite cereal for diabetics, should be included in the diet more often, as it consists of complex carbohydrates. Sugar can be replaced with diabetic medicines - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant taste), aspartame. Diet during the period when the primary deterioration or inflammation of the pancreas is already declining may seem so.

Monday

First breakfast. Boiled chicken breast puree. Rice puree.
Lunch. Steamed fish cakes.
Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
afternoon tea. Omelette from two eggs.
The first dinner. Meat chicken (mince meat with rice). Buckwheat puree with a dessert spoon of butter.
The second dinner. Lean, non-acidic cottage cheese, crushed in blender with a teaspoon of sour cream.

Tuesday

First breakfast. Bollgur. Boiled cauliflower.
Lunch. Lean beef with butter. Milk tea 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. Pasta with cottage cheese with sour cream without fat.
The first dinner. Steamed turkey breast souffle. Liquid buckwheat puree.
The second dinner. Boiled shrimp puree with boiled rice.

Wednesday

First breakfast. Be it fish with rice (wife rice with fish). Puree from boiled carrots.
Lunch. Two tablespoons of low-fat hard cheese.
Dinner. Soup made from mashed oats, diluted chicken broth and minced breast. Pasta with cottage cheese with sour cream.
afternoon tea. Some boiled cauliflower.
The first dinner. Mashed pasta with cottage cheese. Steamed omelette from two eggs.
The second dinner. Pumpkin porridge. Tea with some white crackers soaked in it.

Thursday

First breakfast. Pumpkin zucchini. Steamed chicken kittens.
Lunch. Two tablespoons of low-fat hard cheese.
Dinner. Creamy potato soup with butter. Lean beef puree.
afternoon tea. Souffle with turkey breast.
The first dinner. Buckwheat puree. Lean fish souffle.
The second dinner. Carrot-pumpkin porridge.

Friday

First breakfast. Pasta with cottage cheese with sour cream. Pumpkin zucchini. Meat chicken (rice is minced, like meat).
Lunch. Mashed potatoes with butter.
Dinner. Milk soup with mashed pasta. Omelette from two boiled eggs with grated cheese.
afternoon tea. Some cauliflower. Rice pudding.
The first dinner. Minced shrimp in sour cream. Buckwheat puree. Tea with white crackers.
The second dinner. Carrot puree. Milk or fruit jelly without fruit.

Saturday

First breakfast. Pumpkin porridge. Lean beef souffle.
Lunch. Be it fish.
Dinner. Rice soup with weak chicken broth and minced meat. Mashed pasta with milk.
afternoon tea. Bollgur.
The first dinner. Lean beef with butter. Mashed potatoes.
The second dinner. Pumpkin-carrot porridge. Tea with some white crackers

Sunday

First breakfast. Pasta with cottage cheese with sour cream. Omelette.
Lunch. Zucchini under a cheese coat. Milk tea and white crackers
Dinner. Buckwheat soup in diluted beef juice with boiled beef puree. Steamed turkey breast souffle.
afternoon tea. Mashed oats.
The first dinner. Mashed potatoes. Pole cutlet.
The second dinner. Rice curd pudding.

The pancreatitis diet requires the exclusion from the diet of all sweets and pastries, including chocolate and cocoa. You need to limit your intake of any fats, dietary acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals can not be mashed even with a blender. All legumes, including soy, are also being canceled. They are rich in plant proteins, which are valued by vegetarians. But they are also "guilty" of increasing gas formation, an increase in stomach acidity, which is highly undesirable in the acute period.