Diet for Pancreatitis: Nutritional Features, Allowed and Prohibited Foods

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 with the example of those suffering from alcoholism. But now it is already known that their most dangerous, acute stage is almost never found in them - that is the "prerogative" of people with a healthy attitude to strong drinks.

Pancreatitis can be the result of excess (now also considered as a form of addiction), pathologies of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the course, digestion is severely disturbed, threatening the condition of the metabolic system, and sometimes the life of the patient. Diet for pancreatitis is mainly based on protein (proteins are digested by the stomach) and involves careful grinding of food.

Organ functions

The pancreas is heterogeneous in structure and function of its substances. The bulk of its cells produce pancreatic juice - a concentrated alkali with enzymes dissolved in it (or rather, its inactive predecessor). Pancreatic juice forms the digestive environment of the intestine. Bacteria that inhabit its various departments play an important but helpful role.

The main biliary tract also runs through the pancreas. It leads from the gallbladder to the duodenum, flows at the very exit and its lumen into the main duct of the gland itself. As a result, alkalis, enzymes and bile are not separated in the intestine, but in the form of a finished "mixture".

Inside the tissues of the gland, cells of a different type are also localized in groups. They are called islands, and they do not synthesize alkali, but insulin, a hormone that is responsible for the absorption of carbohydrates from food. Abnormalities in the development, function or degradation of such cells (usually they are 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 the disease

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

• Gallstones. They occur due to the inflammatory pathology of the liver or gallbladder, abnormalities in the composition of bile (they are caused by sepsis, medications for atherosclerosis, diabetes mellitus, the same liver disease).
• Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causing swelling of the tissues and disrupting its function.
• Medications. The toxic effect of drugs for atherosclerosis, steroid medications and some antibiotics.
• Deviations in structure or place. They can be congenital (bending of the gallbladder, narrow canals, etc. )

Chronic pancreatitis can most commonly be observed in drunken alcoholics and diabetics "with experience" of at least five years. Here, the autoimmune process in the gland that caused the inflammation or intake of antidiabetic drugs is important. But it can also accompany the following diseases.

• Intestinal Pathology. In particular the duodenum, including duodenitis (inflammation of its walls) and erosion.
• Vascular disease. All glands must be actively supplied with blood. A special role is played here by congenital anomalies and disorders of disorder (hemophilia, thrombosis).
• Injuries. Penetrating wounds, interventions, severe blow to the stomach.

The least common cause of pancreatitis is spasm of Oddi's sphincter, which ends in the common gallbladder and pancreas. The sphincter of Oddi lies at the very exit of him into the duodenum. Normally, it regulates the "portioned" supply of pancreas and bile into its cavity, allowing it to almost stop between meals and rise sharply when a person is sitting at the table. It also prevents the backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.

Oddi's sphincter is not susceptible to spasms, as are 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 "post-school cystectomy" "syndromes" (a complication of gallbladder removal). But in fact, his spasm is a rare thing only with the normal functioning of the nervous system. However, he is often overwhelmed with neurological disorders or as a result of the activation of pain receptors - when he is irritated by stones coming out of the gallbladder, his injury occurs.

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

Signs

Acute pancreatitis begins and is accompanied by excruciating (to loss of consciousness) girdle pain throughout the upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not eliminate it, and general "heart" medications do not help either. A special diet will not relieve the pain either - a doctor is needed here, not a diet. Usually, even if not always, its irradiation is noticed upwards, on the region of the heart, below the collarbone, on the thoracic spine, due to which patients may confuse the symptoms of pancreatitis with a heart attack or an enlargement of osteochondrosis. This is also facilitated by the cascading reactions of the body to a stimulus of critical force:

• jumps in blood pressure (hypertension and hypotension are equally likely);
• Interruptions in heart rate;
• Dizziness;
• cold, clammy sweat.

A characteristic symptom of pancreatitis is loose stool - mushy, with semi-digested food fragments and fat. It appears after a few hours from the onset of the disease. At the end of the first day, the discoloration of the fairies with urine is noticeable. They are usually yellow-brown colored by bilirubin from bile, with the help of which digestion has taken place. And because of the blockage in the duct, it does not enter the intestine. On the second or third day, the patient develops flatulence, "sucking" in the abdomen and vomiting at the sight of fatty or spicy foods.

Chronic pancreatitis also occurs 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. Pain is aggravated in the supine position, digestion is disturbed until 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 perforation of an abdominal ulcer) was Princess Henrietta of England, wife of Duke Philippe of Orleans, brother of 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 turned out only during an autopsy, designed to confirm or dispel this rumor.

Effects

Acute pancreatitis is dangerous by fast (two or three days) "eating" of pancreas through and through, as a result of which corrosive alkalis, bile and digestive enzymes enter the abdominal cavity directly through these "fistulas". This scenario ends with diffuse peritonitis (inflammation of the peritoneum that spreads rapidly 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 intestines, appendicitis when accompanied by an abscess rupture (due to such a scenario, the magician Harry Houdini died). If pancreatitis was not provoked by a mechanical obstruction (spasm of the sphincter of Oddi, stone, scars, tumor, etc. ), but by an infection, a purulent pancreatic abscess may develop. Its unfair treatment also ends with a perforation in the abdominal cavity.

Enzymes and digestive juices of the pancreas sometimes cause enzymatic pleurisy - inflammation of the pleura of the same kind as in the case of the peritoneum. For chronic pancreatitis, complications that are delayed in time are typical, but more seriously interfere with their work in other organs.

• Cholecystitis. In cholangitis 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 consequence.
• Gastritis. The abdomen is not as closely connected to the pancreas as the liver, although it lies directly below it. Its inflammation in pancreatitis occurs not so much because of foreign substances entering its cavities from the inflamed gland, but because of the constant insufficiency of the intestinal digestion, which it 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 less carefully considered. The more pronounced the degradation of the pancreas, the higher the risk of developing gastritis.
• reactive hepatitis. It also develops in response to the constant stagnation of bile and irritation of the hepatic ducts. Occasionally cholestasis, which occurs during the next enlargement of the pancreatitis, is accompanied by jaundice. Therefore, the pancreatitis diet should not include foods that require enhanced bile separation. These include fatty, fried, spicy meats and fish, fish caviar, other animal products, smoked meats, alcoholic beverages - digestive stimulants.
• Cystosis and Pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice, which they simulate, are caused by the same difficulties with its removal in the duodenal cavity. Cysts tend to periodically become inflamed and suppurate.
• Pancreatic cancer. Any chronic inflammation is considered as a carcinogenic factor because it causes irritation, accelerates destruction of the affected substances and their enhanced reaction growth. And it is not always good quality. The same is true for chronic pancreatitis.
• Diabetes. It is far from the first "in line" complication of chronic pancreatitis. But the faster and more noticeably the whole gland degrades, the more difficult it is for the surviving island cells to compensate for the insulin deficiency caused by the death of their "colleagues" in already dead areas. They are exhausted and even starting to die out. 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 concrete. 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 tissues of the gland 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 the patient's course, quality and life expectancy is influenced by various "deviations" from the diet and its type, especially in all that is associated with alcoholic beverages.

Diet therapy

The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually a broad spectrum because 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 that is stuck in the canal or another obstruction (tumor). Upon completion, the basis of treatment should be a special medical diet.

As a basis, gastroenterologists usually use diet number 5, developed by Manuil Pevzner back in the Soviet Union for patients with cholecystitis and other pathologies that interfere with the synthesis and excretion of bile. But later, the author himself changed 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 sparing is suitable - it does not require food for a homogeneous mass. And the menu for kids has to be made mostly of mixed products. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days of its onset) and in the acute stage, which occurs 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 in the first days. With an increase in the pathology, hunger is prescribed. That is, only a hot alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
• Only stewing and cooking (on water, steamed). Tables Nos. 5 and 5p do not imply any other methods than 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 not be consumed more than 10 g per day, but in any proportion.
• No spices. Particularly warm and spicy.
• No nuts. Seeds are also forbidden. These types of foods are rich in vegetable oils and are difficult to eat even in powder form.
• Salt to taste. Its consumption in no way affects the course of the pathology, the daily salt intake remains the same as in healthy people - up to 10 g per day.
• Less Phases. This ingredient, commonly appreciated by nutritionists and people with digestive problems, is strictly limited for use in inflammation of the pancreas. The secret of its "magic" effect on the intestine is that the fiber does not digest, absorbs and irritates different sections of the intestine, stimulates peristalsis and excretion of water. Fiber helps to form feces because they are 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, pumpkin, rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage are forbidden, but cauliflower can be consumed (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 kilogram or more, with pancreatic pathologies it is impossible. It should be eaten at least five times a day, and the total weight of all the foods eaten at one time should not exceed 300 g.
• Prohibit soda, coffee, alcohol and kvass. These drinks are best excluded from the diet forever. But if during the period of remission they should simply not be removed, then they are strictly prohibited during an enlargement.

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

Menu Example

The diet menu for pancreatitis should include enough protein and carbohydrates. But "brute 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 more often in the diet as it is made up of complex carbohydrates. Sugar can be replaced by diabetic drugs - fructose, xylitol and sorbitol (when added to hot plates, they give an unsympathetic aftertaste), aspartame. The diet during the period when the enlargement or primary inflammation of the pancreas is already in decline may look like this.

Monday

• First breakfast. Cooked Chicken Breast Puree. Rice mixed.
• Lunch. Steamed fish cakes.
• Dinner. Rice soup and chicken broth in half diluted with water. Milk jelly.
• Afternoon tea. Omelette of two eggs.
• First meal. Chicken meatballs (flour meat with rice). Pureed buckwheat with a dessert spoon of butter.
• Second meal. Lean, non-sour cottage cheese, crushed in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Oatmeal. Cooked cauliflower.
• Lunch. Lean beef pate with butter. Tea with milk and some white bread crumbs in it.
• Dinner. Fish soup from lean fish with rice and water. Milk or fruit jelly without fruit.
• Afternoon tea. Her cheese pasta with low-fat sour cream.
• First meal. Steamed turkey breast soufflé. Puree liquid buckwheat.
• Second meal. Cooked Shrimp Puree with Cooked Rice.

Wednesday

• First breakfast. Fish meatballs with rice (the rice is ground together with the fish). Puree of boiled carrots.
• Lunch. Two tablespoons grated low-fat hard cheese.
• Dinner. Soup of pureed oatmeal, diluted chicken broth and grated breast. Curd pasta with sour cream.
• Afternoon tea. Various flowers of boiled cauliflower.
• First meal. Mix pasta with cottage cheese. Steam omelet from two eggs.
• Second meal. Pumpkin Porridge. Tea awakened with some white crackers in it.

Thursday

• First breakfast. Zucchini puree. Chicken Steam Chops.
• Lunch. Two tablespoons grated low-fat hard cheese.
• Dinner. Cream potato soup with butter. Lean beef puree.
• Afternoon tea. Turkey Breast soufflé.
• First meal. Mix buckwheat. Lean fish souffle.
• Second meal. Carrot Pumpkin Porridge.

Friday

• First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (grab rice, like meat).
• Lunch. Mashed potatoes with butter.
• Dinner. Milk soup with mixed pasta. Steamed omelette from two eggs with grated cheese.
• Afternoon tea. Various cauliflower flowers. Rice Pudding.
• First meal. Chopped shrimp and sour cream sauce. Buckwheat Puree. Tea with white crackers.
• Second meal. Muert Puree. Milk or fruit jelly without fruit.

Saturday

• First breakfast. Pumpkin Porridge. Lean beef soufflé.
• Lunch. Fish meatballs.
• Dinner. Rice soup with weak chicken broth and minced meat. Mix pasta with milk.
• Afternoon tea. Oatmeal.
• First meal. Lean beef pate with butter. Mashed potatoes.
• Second meal. Pumpkin Carrot Porridge. Tea with some white crackers

Sunday

• First breakfast. Rural cottage pasta with sour cream. Omelette.
• Lunch. Zucchini under a cheese coat. Tea with milk and white crackers
• Dinner. Buckwheat soup on diluted beef broth with boiled beef puree. Steamed turkey breast soufflé.
• Afternoon tea. Oatmeal puree.
• First meal. Mashed potatoes. Chicken Chops.
• Second meal. Rice-Kurdpudding.

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, food acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals can not even be mixed with a blender. All legumes, including soybeans, are also canceled. They are rich in vegetable protein, for which they are valued by vegetarians. But they are also "guilty" of increased gas formation, an increase in stomach acidity, which is highly undesirable in the acute period.