Diet for pancreatitis: nutritional features, allowed and prohibited foods

For a long time, pancreatitis was thought to be caused by alcohol abuse. This false impression was created because it was first discovered and described using those suffering from alcoholism. But now it is already known that the most dangerous, acute stage is almost never found in them - this is the "privilege" of people with a healthy attitude to strong drinks.

Pancreatitis can be the result of overeating (now considered a form of addiction), pathologies of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the course, it greatly disrupts digestion, threatens the state of the metabolic system, and sometimes the life of the patient. Nutrition for pancreatitis is made mainly on a protein basis (proteins are digested by the stomach) and includes careful grinding of food.

Organ functions

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

The main bile duct also passes through the pancreatic tissue. It flows from the gallbladder to the duodenum, from its outlet to its lumen, into the main duct of the gland. As a result, alkali, enzymes and bile enter the intestine not separately, but in the form of a ready-made "mixture".

Inside the tissues of the gland, different types of cells are also found in groups. They are called islets and do not synthesize alkali, but synthesize insulin, a hormone responsible for the absorption of carbohydrates from food. Abnormalities in the development, functioning or degradation of such cells (they are often inherited) are one of the scenarios of diabetes mellitus. The second is to increase the resistance of body 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 duct, and then into the lumen of the duodenum. It has an effect of "self-digestion" by the enzymes that accumulate in 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 (including taking drugs for sepsis, atherosclerosis, diabetes mellitus, the same liver diseases).
• Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causing swelling of the tissues and impairing their function.
• Medicines. Toxic effect of drugs for atherosclerosis, steroid drugs and some antibiotics.
• Deviations in structure or location. They can be congenital (bending of the gallbladder, very narrow ducts, etc. ) or acquired (scarring, swelling after surgery or traumatic examination).

Chronic pancreatitis is most common in drunk alcoholics and diabetics with at least five years of "experience". Here, the autoimmune process in the gland that causes inflammation or the intake of antidiabetic drugs is important. However, it can also accompany the following diseases.

• Intestinal pathology. Duodenum, including especially 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 spasm of the sphincter of Oddi, which ends in the common gallbladder and pancreatic duct. The sphincter of Oddi is located at the exit of the duodenum from it. Normally, it regulates the "partial" supply of pancreatic juice and bile into its cavity, allowing it to almost stop between meals and increase sharply when a person sits at the table. At the same time, it prevents the reflux of intestinal contents into the cavity of the pancreas or gallbladder, along with various pathogens (bacteria, foreign compounds, worms).

The sphincter of Oddi is not prone to spasms, like all smooth muscle "splitters" of this type. For a long time, there was no such thing as self-dysfunction in medicine. It was replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (a complication from gallbladder removal). But in fact, its spasm is a rare thing only with the normal functioning of the nervous system. But often it is overtaken by neurological disorders or as a result of the activation of pain receptors - when it is irritated by stones coming out of the gallbladder, its injury occurs.

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

marking

Acute pancreatitis begins and is accompanied by excruciating (up to loss of consciousness) girdle pain in the entire upper abdomen, under the ribs. Antispasmodics, pain relievers, and antibiotics won't make it go away, and common "heart" remedies won't help either. A special diet also does not relieve pain - a doctor is needed here, not a diet. Often, but not always, its irradiation is noted up, in the region of the heart, below the collarbone, in the thoracic spine, so patients may confuse the symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis. This is also facilitated by the body's gradual reactions to the critical strength stimulus:

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

A characteristic sign of pancreatitis is loose stools - mushy, containing half-digested food particles and fat. It occurs a few hours after the onset of the disease. At the end of the first day, the color change of the stool with the urine becomes noticeable. Normally, they are colored yellow-brown by bilirubin from the bile where digestion takes place. And due to the blockage of the duct, it does not enter the intestine. On the second or third day, the patient develops "sucking" in the stomach and vomiting, flatulence at the sight of fatty or spicy food.

Chronic pancreatitis also presents with pain, but it is not very pronounced. They can intensify an hour after a meal, especially if it is inappropriate - cold, fried, smoked, fatty, spicy, accompanied by alcohol. In the supine position, the pain is aggravated, indigestion worsens 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 possibility of gastric ulcer perforation) was Princess Henrietta of England, wife of Philippe, Duke of Orleans, sister of the Sun King Louis XIV. Because of the typically painful course of the disease, she was sure that one of her husband's favorites had poisoned her. True, it only came to light during an autopsy designed to confirm or dispel this rumor.

Effects

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

It is characteristic of many pathologies, including peritonitis, perforated ulcer, cancer of the stomach or intestines, appendicitis, if it is accompanied by a breakthrough of the abscess (due to such a scenario, the magician Harry Houdini died). Untimely treatment of pancreatitis with a mechanical obstacle (spasm of the sphincter of Oddi, stone, wound, tumor, etc. ) also ends with a breakthrough into the abdominal cavity.

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

• cholecystitis. And cholangitis is inflammation of the liver ducts. They can cause pancreatitis due to the accompanying cholelithiasis, but as a result they usually occur in the reverse order.
• Gastritis. Although the stomach is located just below the pancreas, it is not as closely connected as the liver. Its inflammation in pancreatitis occurs not due to foreign substances entering its cavity from the inflamed gland, but due to the constant insufficiency of intestinal digestion, which it has to compensate for. The pancreatitis diet is designed to reduce the load on all digestive organs, but the "interests" of a healthy stomach are taken into account less carefully. The more pronounced the deterioration 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. Sometimes accompanied by cholestasis, jaundice, which occurs during the next exacerbation of pancreatitis. Therefore, the pancreatitis diet should not include foods that require increased bile separation. These include fatty, fried, spicy meat 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 simulating them appear due to the same difficulties as their removal into the duodenal cavity. Cysts tend to become inflamed and suppurated periodically.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, because it causes irritation, accelerated destruction of the affected tissues and increased response growth. And it's not always good quality. The same is true for chronic pancreatitis.
• Diabetes. It is far from the first "sequential" complication of chronic pancreatitis. But the faster and more markedly the entire gland deteriorates, the more difficult it is for the surviving islet cells to compensate for the insulin deficiency caused by the death of their "colleagues" in the already dead zones. They become extinct and at the same time begin to die. After seven to ten years for the average patient (usually even faster, depending on the prognosis and features of the course of pancreatitis), the possibility of diabetes mellitus "experience" becomes more and more tangible. Because of its threat, the 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 failure of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis for the course, quality and life expectancy of the patient is influenced by various "deviations" from the diet and its types, especially in everything related to alcoholic beverages.

diet therapy

The acute stage of the disease usually requires immediate detoxification, the appointment of antibiotics (usually a wide spectrum, since 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 duct, or another obstruction (tumor). After its completion, the basis of treatment should be a special medical diet.

Basically, gastroenterologists often take diet number 5, developed by Manuel Pevzner in Soviet times for patients with cholecystitis and other pathologies that prevent the synthesis and outflow of bile. But later the author changed that by creating diet number 5p.

General provisions

For adult patients with a mild disease course, a table No. The 5p variety is suitable - it does not require grinding food into a homogeneous mass. And the menu for children should most often be made of pureed products. There are several mandatory general rules of nutrition in the period of exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute stage, which appeared for the first time.

• Simplicity. Recipes should be as simple as possible - there should be no stuffed breasts and meat salads, even if all the components in their composition individually "fit" into the diet.
• Complete hunger in the first days. With exacerbation of the pathology, hunger is prescribed. That is, just a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
• Boiling and boiling only (in water, steamed). Tables 5 and 5p do not refer to other methods such as cooking and frying.
• Minimum oil. Especially if the attack is accompanied (or caused by) cholangitis, cholecystitis. Vegetable and animal fats should be equally strictly limited, since the same substance, bile, breaks them down. They can be consumed no more than 10 g per day, but in any proportion.
• No seasoning. Especially hot and spicy.
• No nuts. Seed is also prohibited. Such food is rich in vegetable oil and is very difficult to eat, even in powder form.
• Salt to taste. Its consumption does not affect the course of the pathology in any way, the daily salt intake remains the same as in healthy individuals - up to 10 g per day.
• Less fiberOften valued by nutritionists and people with digestive issues, this ingredient is strictly limited for use in pancreatitis. The secret of its "magical" effect on the intestines is that fiber is not digested, absorbed and irritates various parts of the intestine, stimulating peristalsis and water excretion. Fiber helps form stool as it is excreted unchanged. With inflammation of the pancreas, all these properties of fibers will only aggravate the situation. You can only eat carrots, zucchini, potatoes, squash, rich in starch and pulp, but relatively poor in hard fiber fibers. White and red cabbage is prohibited, but cauliflower can be consumed (only inflorescences, branches and stems are excluded).
• Small portions. As before, it is impossible with pancreatic pathologies in portions with a total weight of half a kilogram or more three times a day. 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.
• Ban on soda, coffee, alcohol and kvass. These drinks are best removed from the diet forever. But it is strictly prohibited during an exacerbation, if in the period of remission they simply should not be carried.

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

Menu example

The diet menu for pancreatitis should contain enough protein and carbohydrates. But with the latter, "brute force" is best avoided by limiting the addition of sugar, honey to drinks and meals. 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 drugs - fructose, xylitol and sorbitol (it gives an unpleasant taste when added to hot dishes), aspartame. This is what the diet may look like in the period when the exacerbation or primary inflammation of the pancreas is already decreasing.

Monday

• First breakfast. Boiled chicken breast puree. Rice porridge.
• Lunch. Steamed fish cake.
• Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
• afternoon tea. Omelet from two eggs.
• First dinner. Chicken patties (grind the meat with rice). Pureed buckwheat with a teaspoon of butter.
• Second dinner. Fat-free, non-acidic cottage cheese crushed in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Rolled oats. Boiled cauliflower.
• Lunch. Lean beef pate with butter. Tea with milk and a few crumbs of white bread dipped in it.
• Dinner. Fish soup made from lean fish with rice and water. Fruit-free milk or fruit jelly.
• afternoon tea. Pasta with cottage cheese with fat-free sour cream.
• First dinner. Steamed turkey breast soufflé. Purified liquid buckwheat.
• Second dinner. Boiled shrimp puree with boiled rice.

Wednesday

• First breakfast. Fish cakes with rice (grind the rice with the fish). Puree from boiled carrots.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Dinner. Soup made from oatmeal, diluted chicken stock and minced breast. Curd pasta with sour cream.
• afternoon tea. A few florets of boiled cauliflower.
• First dinner. Cottage cheese macaroni puree. Steam omelet from two eggs.
• Second dinner. Pumpkin puree. Tea with a few white crackers dipped in it.

Thursday

• First breakfast. Pumpkin puree. Chicken steam cutlet.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Dinner. Creamy potato soup with butter. Lean pork puree.
• afternoon tea. Turkey breast souffle.
• First dinner. Buckwheat porridge. Lean fish souffle.
• Second dinner. Pumpkin puree with carrots.

Friday

• First breakfast. Curd pasta with sour cream. Pumpkin puree. Chicken patties (grind rice, like meat).
• Lunch. Mashed potatoes with butter.
• Dinner. Milk soup with mashed pasta. Omelet from two eggs steamed with grated cheese.
• afternoon tea. A few cauliflower flowers. Rice pudding.
• First dinner. Shredded shrimp in sour cream sauce. Buckwheat porridge. Tea with white crackers.
• Second dinner. Carrot puree. Fruit-free milk or fruit jelly.

Saturday

• First breakfast. Pumpkin puree. Fat-free beef souffle.
• Lunch. Fish cake.
• Dinner. Rice soup with weak chicken stock and ground beef. Milk pasta puree.
• afternoon tea. Rolled oats.
• First dinner. Lean beef pate with butter. Mashed potatoes.
• Second dinner. Pumpkin-carrot porridge. Tea with a few white crackers

Sunday

• First breakfast. Pasta with cottage cheese with sour cream. Omelette.
• Lunch. Zucchini under the cheese crust. Tea with milk and white crackers
• Dinner. Buckwheat soup on diluted broth with boiled beef porridge. Steamed turkey breast soufflé.
• afternoon tea. Oatmeal porridge.
• First dinner. Mashed potatoes. Chicken chop.
• Second dinner. Rice pudding.

The pancreatitis diet requires the exclusion of all sweets and pastries from the diet, including chocolate and cocoa. You should limit your intake of any fats, food acids, and fiber. Also, do not eat fresh bread. Under the forbidden millet, wheat, corn. These grains cannot be crushed even with a blender. All legumes, including soybeans, are also being cancelled. They are rich in vegetable protein, which is valued by vegetarians. But, at the same time, it is "to blame" for increased gas formation, an increase in stomach acidity, which in the acute period is quite undesirable.