Diet for pancreatitis: dietary characteristics, permitted and prohibited foods

Excessive alcohol consumption has long been thought to cause pancreatitis. This misconception came about because it was first discovered and described using the example of alcoholics. But it is already known that the most dangerous, acute stage is almost never found for them - it is the "prerogative" of people with a healthy attitude to spirits.

Pancreatitis can be a consequence of overeating (now also considered a form of addiction), abnormalities of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the course, it significantly impairs digestion, endangers the state of the metabolic system and sometimes the patient's life. The diet for pancreatitis is mainly protein-based (proteins are digested in the stomach) and involves careful chopping of food.

Functions of organs

The pancreas is heterogeneous in terms of tissue structure and function. The main part of its cells produces pancreatic juice, a concentrated alkali with enzymes (or rather inactive precursors) dissolved in it. Pancreatic juice forms the digestive tract. Bacteria that inhabit its various departments have an important but ancillary function.

The main bile duct also passes through the tissues of the pancreas. It leads from the gallbladder to the duodenum, flowing into the lumen of the gland itself. As a result, alkalis, enzymes and bile do not enter the intestines, but in the form of a finished "mixture".

There are also different types of cells in the glandular tissue groups. These are called islets, and they do not synthesize alkali, but insulin, the hormone responsible for the absorption of carbohydrates from food. Anomalies in the development, function, or degradation of such cells (usually inherited) are one of the scenarios for diabetes. The second goal is to increase the resistance of the cells in the body to the regular insulin they produce.

Causes of the disease

In the acute stage, pancreatitis leads to the blockage of the small ducts through which the pancreatic juice enters the main and then the duodenal lumen. It has the effect of "self-digestion" by the enzymes stored inside. Acute pancreatitis can be caused by the following reasons.

• Gallstones. They occur due to inflammatory pathologies of the liver or gallbladder, abnormalities in the composition of the bile (caused by sepsis, the use of drugs for atherosclerosis, diabetes, 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 interferes with its function.
• Medicines. Toxic effects of atherosclerosis, steroid drugs and some antibiotics.
• Structure or location deviations. They may be congenital (curvature of the gallbladder, too narrow channels, etc. ) or acquired (scars after surgery or traumatic examination, swelling).

Chronic pancreatitis is most common in intoxicated alcoholics and diabetics with "seniority" of at least five years. The autoimmune process in the gland that caused the inflammation or ingestion of the antidiabetic medicine is important here. But it can also be accompanied by such 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 (haemophilia, thrombosis) play a special role here.
• Injuries. Piercing wounds, intervention, strong stomach blows.

The less common cause of pancreatitis is spasms of the Oddi sphincter, which ends in the common duct and pancreas. The Oddi sphincter is located at the very exit of it in the duodenum. It usually regulates the "portion" supply of pancreatic juice and bile to its cavity, allowing it to almost stop between meals and increase rapidly when a person sits at a table. It also prevents the outflow of intestinal contents and various pathogens (bacteria, foreign bodies, worms) into the pancreas or gallbladder cavity.

The Oddi sphincter is not subjected to spasms, as are all "smooth muscle" separators. For a long time, there was no such thing as medical dysfunction in medicine. It was replaced by various "syndromes" of "biliary dyskinesia" and "postcholecystectomy" (complication after gallbladder removal). But in reality, his spasms are rare only with the normal functioning of the nervous system. But he often overtakes himself with a neurological disorder or activation of pain receptors - when he is irritated by stones that escape from the gallbladder, he is injured.

The distribution of the causes of acute and chronic pancreatitis is conditional, as the former, even with quality treatment, in most cases passes into the latter. And it is not clear who is "feeding" it after eliminating the causal factors. In some cases (approximately 30%), none of these processes may explain the onset of pancreatitis in a patient.

signs

Acute pancreatitis develops and is accompanied by intolerable (up to loss of consciousness) lumbar pain throughout the upper abdomen, under the ribs. Spasmolytics, painkillers and antibiotics do not remove it, nor do the usual medicines "from the heart". A special diet will not relieve the pain either - you need a doctor here, not a diet. Usually, although not always, its radiation is seen upwards, in the heart area, under the collarbone, in the chest of the spine, as a result of which patients may confuse the symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis. This is also facilitated by the body's cascade responses to the stimulus of critical force:

• blood pressure jumps (hypertension and hypotension are equally possible);
• cardiac arrest;
• fainting;
• cold, wet sweat.

A typical symptom of pancreatitis is loose stools, which contain partially digested food particles and fat. It appears a few hours after the onset of the disease. Until the end of the first day, the color of the feces changes in the urine. They are usually yellowish-brown with bilirubin from the bile, which helped digestion. And because of the channel blockage, it does not fit in the gut. On the second or third day, the patient develops bloating, "sucking in" and vomiting, seeing fatty or spicy food.

Chronic pancreatitis also occurs with pain, but not so severely. They can get worse an hour after a meal, especially if it was inappropriate - cold, fried, smoked, fatty, spicy, along with alcohol. The pain worsens when lying down, digestion is disturbed until dyspepsia (when there is almost no food left in the stool).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of gastric ulcer perforation) was Princess Henry of England, wife of the Duke of Orleans Philip, brother of King Louis XIV of the Sun. Because of the painful course of her illness, she was convinced that one of her husband's lovers had poisoned her. True, it turned out only during the autopsy, which was intended to confirm or dispel these rumors.

Effects

Acute pancreatitis is dangerous, "eating" quickly (two or three days) through and through the pancreatic tissue, as a result of which corrosive alkali, bile and digestive enzymes enter the abdominal cavity directly. This scenario ends with diffuse peritonitis (inflammation of the peritoneum that spreads rapidly to the abdominal organs), the appearance of several erosions and death.

Peritonitis is common in many pathologies, including perforated ulcers, stomach or intestinal cancers, and appendicitis when accompanied by an abscess rupture (a scenario in which the magician Harry Hudini died). If the pancreatitis was caused by an infection rather than a mechanical barrier (Oddi sphincter spasm, stone, scar, tumor, etc. ), a purulent pancreatic abscess may develop. His untimely treatment also ends with a breakthrough in the abdominal cavity.

Enzymes in the pancreas and digestive juices sometimes cause enzymatic pleurisy, the same type of inflammation in the pleura as in the peritoneum. Chronic pancreatitis is characterized by time-delayed complications that severely interfere with its function and other organs.

• Cholecystitis. And cholangitis is an inflammation of the liver ducts. They themselves can cause pancreatitis due to the accompanying cholelithiasis, but often develop in the opposite order.
• Gastritis. The stomach is not connected to the pancreas as tightly as the liver, although it is located just below it. Its inflammation in pancreatitis is caused not so much by the entry of foreign substances from the inflamed gland into the cavity, but by persistent intestinal indigestion, which it is forced 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 greater the degradation of the pancreas, the greater the risk of developing gastritis.
• reactive hepatitis. It also develops in response to persistent bile stagnation and hepatic duct irritation. Cholestasis, which occurs during the next exacerbation of pancreatitis, is sometimes accompanied by jaundice. Therefore, foods requiring enhanced biliary excretion should not be included in the diet for pancreatitis. These include fatty, fried, spicy meat and fish, fish eggs, other animal by-products, smoked meat, alcoholic beverages - digestive stimulants.
• Cystosis and pseudocystosis. These benign neoplasms or foci of stagnation of pancreatic juice, which mimic them, occur due to the same difficulty in their excretion in the duodenum. Cysts tend to periodically become inflamed and purulent.
• Cancer of the pancreas. Any chronic inflammation is considered a carcinogenic factor because it causes irritation, accelerated destruction of the affected tissue and an enhanced response. And it's not always high 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 degrades, the harder it is for surviving islet cells to compensate for the insulin deficiency caused by the death of their "colleagues" in areas that are already dead. They are exhausted and are also starting to die out. The chances of diabetes after seven to ten years (often even sooner, depending on the prognosis and course of the pancreatitis) become more tangible for the average patient. Due to the risk of pancreatitis, the reduction of not only fat but also simple carbohydrates should ideally be taken into account.

Chronic re-inflammation of the glandular tissues causes loss of scarring and functionality. Progressive intestinal indigestion is inevitable. But in general, with pancreatitis can live another 10-20 years. Its course, quality, and patient life expectancy are affected by a variety of "deviations" from diet and their type, especially in relation to alcohol.

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 detect the type of pathogen) and sometimes surgery. This is necessary if the cause of the disease is spasms of the Oddi sphincter, a stone stuck in the canal or another obstruction (tumor). Upon completion, treatment should be based on a special medical diet.

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

General provisions

In adult patients with mild disease, Table no. Option 5p without mechanical protection - it does not require grinding the food to a homogeneous mass. And the menu for children is most often made up of puree. There are a number of mandatory general rules for eating during the exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute phase that occurred for the first time.

• Simplicity. Recipes should be as simple as possible - without stuffed breasts and meat salads, even if all the ingredients in them "fit" into the diet separately.
• Complete hunger in the first days. Hunger is exacerbated by an exacerbation of the pathology. That is, only a warm alkaline drink and maintenance of intravenous injections (vitamins, glucose, sodium chloride).
• Only stewing and cooking (on water, steamed). In tables no. 5 and 5p do not specify other methods, such as baking and baking.
• Minimum fat content. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats must be restricted as much as possible, because the same product, bile, breaks them down. They can be consumed up to 10 g per day, but in any proportion.
• Without spices. Extremely hot and spicy.
• Without nuts. Seeds are also prohibited. These types of foods are rich in vegetable oils and are too difficult to eat, even in powder form.
• Salt to taste. Its use in no way affects the course of the pathology, daily salt intake remains the same as in healthy individuals - up to 10 g per day.
• Less fiber. This component, which is commonly evaluated by nutritionists and people with indigestion, is severely restricted for use in inflammation of the pancreas. The secret of its "magic" effect on the intestine is that the fiber is not digested, absorbed and irritates various stages of the intestine, stimulates peristalsis and water excretion. Fiber helps to form faeces because it is excreted unchanged. With inflammation of the pancreas, all these fiber properties will only worsen the situation. You can eat only carrots, zucchini, potatoes, pumpkin, which are rich in starch and pulp, but relatively poor in hard fiber. White and red cabbages are prohibited, but cauliflowers may be consumed (only inflorescences, branches and stems are excluded).
• Small portions. It is, as before, three times a day in portions of a total weight of half a kilogram or more, with pancreatic pathologies this is not possible. There should be at least five meals a day and the total weight of all meals eaten at one time should not exceed 300 g.
• Prohibition of soda, coffee, alcohol and kvass. It is best to exclude these drinks from your diet forever. But if they simply should not be removed during the remission period, they are strictly prohibited during exacerbation.

Sour vegetables (such as 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 acid-free and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Cereal purée is used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.

Example menu

The diet for pancreatitis should include enough protein and carbohydrates. But the "brutal force" with the latter can best be avoided by restricting the addition of sugar and honey to beverages and foods. Buckwheat, which is the most popular cereal for diabetics, should be included in the diet because it consists of complex carbohydrates. Sugar can be replaced by drugs for diabetes - fructose, xylitol and sorbitol (when added to hot foods, they give an unpleasant aftertaste), aspartame. Diet during the period when the pancreatic exacerbation or primary inflammation is already decreasing may look like this.

Monday

• First breakfast. Boiled chicken breast puree. Rice puree.
• For 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 the meat with rice). Buckwheat puree with a dessert spoon of butter.
• The second dinner. Lean, unleavened cottage cheese, chopped in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Oat flakes. Boiled cauliflower.
• For lunch. Lean beef pate with butter. Tea with milk and a little white bread crumbs soaked in it.
• Dinner. Fish soup 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 in souffle. Puree of liquid buckwheat.
• The second dinner. Boiled shrimp puree with boiled rice.

Wednesday

• First breakfast. Fish cutlets with rice (grind rice with fish). Puree of boiled carrots.
• For lunch. Two tablespoons grated low-fat hard cheese.
• Dinner. Soup from oatmeal puree, diluted chicken broth and chopped breast. Cottage cheese pasta with cream.
• afternoon tea. Several flowers of boiled cauliflower.
• First dinner. Pasta puree with cottage cheese. Steam omelette from two eggs.
• The second dinner. Pumpkin porridge. Tea with some white crackers soaked in it.

Thursday

• First breakfast. Zucchini puree. Chicken steam cutlets.
• For lunch. Two tablespoons grated low-fat hard cheese.
• Dinner. Creamy potato soup with butter. Lean beef puree.
• afternoon tea. Turkey breast souffle.
• First dinner. Buckwheat puree. Lean fish souffle.
• The second dinner. Carrot-pumpkin porridge.

on Friday

• First breakfast. Cottage cheese pasta with cream. Zucchini puree. Chicken meatballs (grind rice, for example, meat).
• For lunch. Mashed potatoes with butter.
• Dinner. Milk soup with pasta puree. Omelet of two eggs steamed with grated cheese.
• afternoon tea. Several cauliflower flowers. Rice pudding.
• First dinner. Shrimp in sour cream sauce. Buckwheat puree. Tea with white crackers.
• The second dinner. Carrot puree. Milk or fruit jelly without fruit.

on Saturday

• First breakfast. Pumpkin porridge. Lean beef souffle.
• For lunch. Fish cutlets.
• Dinner. Rice soup with weak chicken broth and minced meat. Pasta puree with milk.
• afternoon tea. Oat flakes.
• First dinner. Lean beef pate with butter. Mashed potatoes.
• The second dinner. Pumpkin-carrot porridge. Tea with some white crackers

Sunday

• First breakfast. Cottage cheese pasta with cream. Omelette.
• For lunch. Zucchini under the rind. Tea with milk and white crackers
• Dinner. Buckwheat soup on diluted beef broth with boiled beef puree. Steamed turkey breast in souffle.
• afternoon tea. Oatmeal puree.
• First dinner. Mashed potatoes. Chicken cutlets.
• The second dinner. Rice-curd pudding.

The pancreatitis diet requires the exclusion of all confectionery and pastry products, including chocolate and cocoa. You should limit your intake of any fats, food acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals cannot be ground even with a blender. All legumes, including soybeans, are also being phased out. They are rich in vegetable proteins, so they are appreciated by vegetarians. But they are also "to blame" for increased gas production, an increase in stomach acidity, which is very undesirable in the acute period.