Diet for pancreatitis: nutritional characteristics, permitted and prohibited foods

30 May 2022

Pancreatitis has long been thought to be caused by alcohol abuse. This false impression is formed because it was first discovered and described by the example of those suffering from alcoholism. But now it is known that its most dangerous, acute stage is almost never 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 severely impairs digestion, threatens the state of the metabolic system, and sometimes the life of the patient. Nutrition in pancreatitis is based mainly on protein (proteins are absorbed by the stomach) and involves careful digestion of food.

Functions of the organs

The pancreas is heterogeneous in structure and function of its tissues. The main part of its cells produces pancreatic juice - a concentrated base with enzymes dissolved in it (or rather their inactive precursors). Pancreatic juice forms the digestive environment of the intestine. Bacteria inhabiting its various departments play an important but ancillary role.

The main bile duct also passes through the tissue of the pancreas. It leads from the gallbladder to the duodenum, flowing at the outlet into its lumen into the main canal of the gland itself. As a result, alkalis, enzymes and bile do not enter the intestine separately, but in the form of a ready-made "mixture".

Inside the glandular tissues, cells of different types are also arranged in groups. They are called islets and they do not synthesize alkalis, but insulin, a hormone responsible for the absorption of carbohydrates from food. Abnormalities in the development, functioning or breakdown of such cells (usually inherited) are one of the scenarios for diabetes. The second is to increase the resistance of the body's cells to the normal insulin they produce.

Causes of the disease

In the acute stage, pancreatitis leads to obstruction of the small ducts of the gland, through which pancreatic juice flows into the main, and then into the lumen of the duodenum. It has the effect of its "self-digestion" of the enzymes accumulated inside. Acute pancreatitis can be caused by the following reasons.

gallstones. They occur due to inflammatory pathology of the liver or gallbladder, abnormalities in the composition of bile (they are caused by sepsis, taking drugs for atherosclerosis, diabetes, the same liver disease).
Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes swelling of the tissues and impairs its function.
Medicines. The toxic effect of atherosclerosis drugs, steroids and some antibiotics.
Deviations in structure or location. They can be congenital (bending of the gallbladder, too narrow ducts, etc. ) or acquired (scars after surgery or traumatic examination, swelling).

Chronic pancreatitis is most common in drunken alcoholics and diabetics "experienced" for at least five years. What matters here is the autoimmune process in the gland that caused the inflammation or the intake of antidiabetic drugs. 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, severe blows to the stomach.

The most common cause of pancreatitis is spasm of the sphincter of Oddi, which ends in the common gallbladder and pancreatic duct. Oddi's sphincter is located at the very exit of it in the duodenum. It usually regulates the "proportional" delivery of pancreatic juice and bile into its cavity, allowing it to almost stop between meals and increase sharply when a person sits at a table. It also prevents the backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) in 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 own dysfunction in medicine. It has been replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (a complication of gallbladder removal). But in fact, its spasm is rare only in the normal functioning of the nervous system. But it is often preceded by neurological disorders or as a result of activation of pain receptors - when it is irritated by stones coming out of the gallbladder, it is injured.

The separation of the causes of acute and chronic pancreatitis is conditional, as the former, even with high-quality treatment, in most cases passes into the latter. And what "feeds" it after the elimination of causal factors is unclear. In some cases (about 30%) none of these processes can explain the occurrence of pancreatitis in a patient.

signs

Acute pancreatitis begins and is accompanied by unbearable (to the point of unconsciousness) pain in the waist throughout the upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not eliminate it, and ordinary heart medications do not help either. A special diet will not relieve the pain either - a doctor is needed here, not a diet. Usually, though not always, its radiation is marked upto the heart, below the clavicle, to the chest, which can confuse patients with pancreatitis with heart attack or exacerbation of osteochondrosis.

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

A characteristic symptom of pancreatitis are rare stools - mushy, containing half-digested food fragments and fats. It appears a few hours after the onset of the disease. By the end of the first day, there is a change in the color of the stool with urine. They are usually colored yellow-brown by bilirubin from the bile, which is used to digest. And due to the obstruction of the canal, it does not enter the intestine. On the second or third day, the patient develops flatulence, "sucking" in the stomach and vomiting at the sight of greasy or spicy food.

Chronic pancreatitis is also painful, but less severe. They can intensify an hour after a meal, especially if it was inappropriate - cold, fried, smoked, greasy, spicy, accompanied by alcohol. The pain intensifies in the supine position, digestion is disturbed to dyspepsia (when instead of stool comes out almost unchanged food).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of perforation of gastric ulcer) is Princess Henrietta of England, wife of the Duke Philip of Orleans, 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 pets had poisoned her. It is true that it turned out only during an autopsy designed to confirm or dispel this rumor.

Effects

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

Peritonitis is characteristic of many pathologies, including perforated ulcer, cancer of the stomach or intestines, appendicitis, if accompanied by a breakthrough of an abscess (due to such a scenario, the magician Harry Houdini dies). If the pancreatitis is provoked not by a mechanical obstruction (spasm of the sphincter of Oddi, stone, scar, tumor, etc. ), but by an infection, a purulent pancreatic abscess may develop. His untimely treatment also ends in a perforation in the abdominal cavity.

Enzymes and digestive juices of the pancreas sometimes cause enzymatic pleurisy - inflammation of the pleura of the same type as in the case of the peritoneum. Chronic pancreatitis is characterized by delayed complications, but more severely disrupting its work and other organs.

cholecystitis. And cholangitis is an inflammation of the liver ducts. They themselves can cause pancreatitis due to accompanying cholelithiasis, but often form in reverse order - as a consequence.
gastritis. The stomach is not as closely connected to the pancreas as the liver, although it is located just below it. Its inflammation in pancreatitis occurs not so much due to the entry of foreign substances into its cavity by the inflamed gland, but due to the constant insufficiency of digestion of the intestine, which is forced to compensate. The pancreatitis diet is designed to reduce the burden on all digestive organs, but the "interests" of a healthy stomach are taken into account less carefully. The more pronounced the breakdown of the pancreas, the higher the risk of developing gastritis.
reactive hepatitis. It also develops in response to constant bile stagnation and irritation of the liver ducts. Sometimes cholestasis, which occurs during the next exacerbation of pancreatitis, is accompanied by jaundice. Therefore, the diet for pancreatitis should not include foods that require increased bile secretion. Among them are fatty, fried, spicy meats and fish, fish caviar, other by-products of animal origin, smoked meats, alcoholic beverages - digestive stimulants.
Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice, which simulate them, occur due to the same difficulties with its removal in the duodenal cavity. Cysts tend to become inflamed and purulent periodically.
Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, as it causes irritation, accelerated destruction of the affected tissues and their increased response. And it is not always of good quality. The same goes for chronic pancreatitis.
Diabetes. This is far from the first "complication" of chronic pancreatitis. But the faster and more noticeably the whole gland breaks down, the harder it is for surviving islet cells to compensate for the insulin deficiency caused by the death of their "colleagues" in already dead zones. The prospect of diabetes 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 more tangible. Due to the threat, the diet for pancreatitis ideallyshould take into account the reduced content not only of fat but also of simple carbohydrates.

Chronic recurrent inflammation in the tissues of the gland causes scarring and loss of functionality. Progressive intestinal indigestion is inevitable. But in general you can live with pancreatitis for another 10-20 years. The prognosis for its course, quality and life expectancy of the patient is influenced by various "deviations" from the diet and their type, especially in everything related to alcoholic beverages.

dietary therapy

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

Gastroenterologists usually adopt diet number 5, developed by Manuel Pevzner in Soviet times for patients with cholecystitis and other pathologies that interfere with the synthesis and leakage of bile. But later the author himself changed it, creating a diet No. 5p.

General

For adult patients with a mild course of the disease is a suitable variant of table No. 5p without mechanical gentle state - does not require digestion of food to a homogeneous mass. And the children's menu most often has to be made from pureed products. Eating during the exacerbation of chronic pancreatitis (especially in the first three days of onset) and in the acute stage, which occurred for the first time, there are several mandatory general 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. In case of exacerbation of the pathology, starvation is prescribed. That is, only a warm alkaline drink and supportive intravenous injections (vitamins, glucose, sodium chloride).
Only stewing and cooking (water, steam). Tables № 5 and 5p do not suggest other methods such as baking and frying.
Minimum fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats with it must be equally strictly limited, because the same agent, bile, breaks them down. They can be consumed no more than 10 g per day, but in any proportions.
No spices. Especially hot and spicy.
No nuts. Seeds are also prohibited. These foods are rich in vegetable oil and are too difficult to consume even in powder form.
Salt to taste. Its consumption does not affect in any way the course of the pathology, the daily salt intake remains the same as in healthy individuals - up to 10 g per day.
Less fiber. This component, usually 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 the fibers are not absorbed, absorb and irritate different parts of the intestine, stimulate peristalsis and water excretion. fiber properties will only worsen the situation. You can eat only carrots, zucchini, potatoes, pumpkin, rich in starch and pulp, but relatively low in hard fiber. White and red cabbage is prohibited, but cauliflower can be consumed (excluding onlyinflorescences, twigs and stems).
Small portions. There are, as before, three times a day in portions with a total weight of half a kilogram or more, with pathologies of the pancreas is impossible. There should be at least five meals a day, and the total weight of all foods eaten at once should not exceed 300 g.
Prohibition of soda, coffee, alcohol and yeast. These drinks are best excluded from the diet forever. But if during the period of remission they simply should not be transmitted, then during the exacerbation they are strictly prohibited.

Pickled vegetables (such as tomatoes) as well as all berries and fruits are also prohibited. They will further stimulate the secretion of bile. The emphasis in the diet should be on non-sour and low-fat dairy products, shrimp, eggs (during the day, not raw or fried). Pureed cereals are used as sources of carbohydrates, mainly buckwheat, rice and oats.

Example of a menu

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

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. Omelet of two eggs.
First dinner. Chicken meatballs (grind meat with rice). Mashed buckwheat with a dessert spoon of butter.
Second dinner. Lean, non-sour cottage cheese, crushed in a blender with a teaspoon of sour cream.

Tuesday

First breakfast. Oatmeal. Boiled cauliflower.
Lunch. Lean beef pate with butter. Tea with milk and a few crumbs of white bread soaked in it.
Dinner. Lean fish soup with rice and water. Milk or fruit jelly without fruit.
afternoon tea. Cottage cheese paste with lean sour cream.
First dinner. Steamed turkey breast souffle. Pureed liquid buckwheat.
Second dinner. Mashed shrimp puree with boiled rice.

Wednesday

First breakfast. Fish meatballs with rice (rice is ground together with fish). Boiled carrot puree.
Lunch. Two tablespoons grated low-fat hard cheese.
Dinner. Puree oatmeal soup, diluted chicken broth and grated breast. Boiled pasta with sour cream.
afternoon tea. A few flowers of boiled cauliflower.
First dinner. Pureed pasta with cottage cheese. Steamed omelette of two eggs.
Second dinner. Pumpkin porridge. Tea with a few white biscuits soaked in it.

Thursday

First breakfast. Zucchini puree. Chicken steamed cutlets.
Lunch. Two tablespoons grated low-fat hard cheese.
Dinner. Cream of potato soup with butter. Lean veal puree.
afternoon tea. Turkey breast souffle.
First dinner. Buckwheat puree. Lean fish souffle.
Second dinner. Carrot and pumpkin porridge.

Friday

First breakfast. Boiled pasta with sour cream. Zucchini puree. Chicken meatballs (grind rice, like meat).
Lunch. Mashed potatoes with butter.
Dinner. Milk soup with mashed pasta. Omelet of two eggs stewed with grated cheese.
afternoon tea. A few cauliflower flowers. Rice pudding.
First dinner. Ground shrimp in sour cream sauce. Buckwheat puree. Tea with white biscuits.
Second dinner. Carrot puree. Milk or fruit jelly without fruit.

Saturday

First breakfast. Pumpkin porridge. Lean beef souffle.
Lunch. Fish meatballs.
Dinner. Rice soup with weak chicken broth and minced meat. Mashed pasta with milk.
afternoon tea. Oatmeal.
First dinner. Lean beef pate with butter. Mashed potatoes.
Second dinner. Pumpkin and carrot porridge. Tea with a few white biscuits

Sunday

First breakfast. Cottage cheese paste with sour cream. Omelet.
Lunch. Zucchini under cheese. Tea with milk and white biscuits
Dinner. Buckwheat soup on diluted beef broth with boiled beef puree. Steamed turkey breast souffle.
afternoon tea. Oatmeal puree.
First dinner. Mashed potatoes. Chicken cutlets.
Second dinner. Rice curd pudding.

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