Diet for pancreatitis: nutritional features, allowed and prohibited foods

For a long time it was thought that pancreatitis was caused by alcohol abuse. Such a false impression was formed because it was first discovered and described using the example of those suffering from alcoholism. But now it is already 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 disrupts digestion, threatens the state of the metabolic system, and sometimes the life of the patient. Nutrition for pancreatitis is built mainly on a protein basis (proteins are digested by the stomach) and involves careful grinding of food.

Organ functions

The pancreas is heterogeneous in structure and function of its tissues. The main part of its cells produces pancreatic juice - a concentrated alkali 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 auxiliary role.

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

Inside the tissues of the gland, cells of a different type are also located in groups. They are called islets, and they do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Anomalies in the development, functioning or degradation of such cells (usually they are hereditary) are one of the scenarios for diabetes mellitus. The second is to increase the body's cells' resistance 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 main, and then into the lumen of the duodenum. There is an effect of its "self-digestion" by the enzymes accumulated inside. Acute pancreatitis can be caused by the following reasons.

• Gallstones. They arise due to inflammatory pathology of the liver or gallbladder, anomalies in the composition of bile (they are caused by sepsis, taking drugs 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 tissues and disrupts its function.
• Medicines. The toxic effect of drugs for atherosclerosis, steroid drugs and some antibiotics.
• Deviations in structure or location. They can be congenital (bending of the gallbladder, too narrow ducts, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).

Chronic pancreatitis can most often be observed in drunken alcoholics and diabetics "with experience" of at least five years. Here, the autoimmune process in the gland, which caused inflammation or the intake of 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 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 the very exit from it into the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile into its cavity, allows it to almost stop between meals and increase sharply when a person sits down 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.

The sphincter of Oddi 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 was replaced by various "biliary dyskinesias" and "postcholecystectomy" "syndromes" (a complication from removal of the gallbladder). But in fact, his spasm is a rare thing only with the normal functioning of the nervous system. But he often overtakes with neurological disorders or as a result of the activation of pain receptors - when he is irritated by stones emerging from the gallbladder, his injury takes place.

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

signs

Acute pancreatitis begins and is accompanied by unbearable (up to loss of consciousness) girdle pain in the entire upper abdomen, under the ribs. Antispasmodics, painkillers and antibiotics do not remove it, and common drugs "from the heart" do not help either. A special diet will not relieve the pain either - a doctor is needed here, not a diet. Usually, although not always, its irradiation is noted upward, to the region of the heart, under the collarbone, to the thoracic spine, due to which patients may confuse the symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis. This is also facilitated by the cascade reactions of the body to a stimulus of critical strength:

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

A characteristic symptom of pancreatitis is loose stools - mushy, containing semi-digested food fragments and fat. It appears after a few hours from the onset of the disease. By the end of the first day, discoloration of feces with urine becomes noticeable. Normally, 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 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 fatty or spicy food.

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, fatty, 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 perforation of a stomach ulcer) was Princess Henrietta of England, the wife of Duke Philippe 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 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 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 quickly spreads 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 it was accompanied by a breakthrough of the abscess (due to such a scenario, magician Harry Houdini died). If pancreatitis was provoked not by a mechanical obstacle (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 with a breakthrough into the abdominal cavity.

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

• Cholecystitis. And 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 of it.
• Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below it. His inflammation in pancreatitis occurs not so much due to foreign substances entering his cavity from the inflamed gland, but due to the constant insufficiency of intestinal digestion, which he 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 taken into account less carefully. 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. Sometimes cholestasis that occurs during the next exacerbation of pancreatitis is accompanied by jaundice. That is why the pancreatitis diet should not include foods that require increased bile separation. Among them are 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 arise due to the same difficulties with its removal into the duodenal cavity. Cysts tend to periodically become inflamed and suppurate.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, since it causes irritation, accelerated destruction of the affected tissues and their increased response growth. And it's 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 entire gland degrades, the more difficult 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 depleted and also begin to die out. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and the characteristics of the course of pancreatitis) "experience" for the average patient is becoming more and more 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 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 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.

diet therapy

The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually a broad spectrum, since 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 usually take diet number 5, developed by Manuil Pevzner back in Soviet times for patients with cholecystitis and other pathologies that impede the synthesis and outflow of bile. 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 sparing is suitable - it does not require grinding food to a homogeneous mass. And the menu for children most often has to be made from mashed products. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days from its onset) and in the acute stage, 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 individually "fit" into the diet.
• Complete hunger in the first days. With an exacerbation of the pathology, hunger is prescribed. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
• Only stewing and boiling (on water, steamed). Tables No. 5 and 5p do not imply other methods like 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, since 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 too hard 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 fibre. This component, usually valued 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 intestines is that fiber is not digested, absorbed and irritates various sections of the intestine, stimulates peristalsis and the excretion of water. Fiber helps form feces, as it is excreted unchanged. With inflammation of the pancreas, all these properties of the fibers will only worsen the situation. You can eat only carrots, zucchini, potatoes, pumpkin, 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, twigs and stalks 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. There should be at least five meals a day, and the total weight of all foods eaten at a time should not exceed 300 g.
• Ban on soda, coffee, alcohol and kvass. These drinks are best excluded from the diet forever. But if during the period of remission they simply should not be carried away, then during an exacerbation they are strictly prohibited.

Sour vegetables (for example, 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 and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Pureed cereals are used as sources of carbohydrates, mainly buckwheat, rice and oatmeal.

Menu example

The diet menu for pancreatitis should contain enough proteins 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 in the diet more often, as it consists of complex carbohydrates. Sugar can be replaced with diabetic drugs - 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 on the decline may look like this.

Monday

• First breakfast. Boiled chicken breast puree. Rice mashed.
• Lunch. Steamed fish cakes.
• Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
• afternoon tea. Omelet from two eggs.
• First dinner. Chicken meatballs (grind meat with rice). Pureed buckwheat with a dessert spoon of butter.
• Second dinner. Lean, non-acidic 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 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 pasta with lean sour cream.
• First dinner. Steamed turkey breast soufflé. Pureed liquid buckwheat.
• Second dinner. Boiled shrimp puree with boiled rice.

Wednesday

• First breakfast. Fish meatballs with rice (grind the rice together with the fish). Puree from boiled carrots.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Dinner. Soup made from pureed oatmeal, diluted chicken broth and shredded breast. Curd pasta with sour cream.
• afternoon tea. Several florets of boiled cauliflower.
• First dinner. Mashed pasta with cottage cheese. Steam omelet from two eggs.
• Second dinner. Pumpkin porridge. Tea with a few white crackers soaked in it.

Thursday

• First breakfast. Zucchini puree. Chicken steam cutlets.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Dinner. Creamy potato soup with butter. Lean beef puree.
• afternoon tea. Turkey breast soufflé.
• First dinner. Mashed buckwheat. Lean fish soufflé.
• Second dinner. Carrot-pumpkin porridge.

Friday

• First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (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. Several cauliflower florets. Rice pudding.
• First dinner. Minced shrimp in sour cream sauce. Buckwheat puree. Tea with white crackers.
• Second dinner. Carrot 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. Mashed pasta with milk.
• afternoon tea. Oatmeal.
• First dinner. Lean beef pate with butter. Mashed potatoes.
• Second dinner. Pumpkin-carrot porridge. Tea with a few white crackers

Sunday

• First breakfast. Cottage cheese 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 pureed.
• 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 the intake of any fats, food acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals cannot be mashed even with a blender. All legumes, including soybeans, are also being cancelled. 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 the acidity of the stomach, which is highly undesirable in the acute period.