Diet for pancreatitis: dietary characteristics, permitted and prohibited foods

30 May 2022

Pancreatitis has long been thought to be caused by alcohol abuse. This misconception is due to the fact that it was first discovered and described as an example of alcoholism. However, it is now known that its most dangerous, acute stages are almost never found - it is the "prerogative" of people with a healthy attitude towards spirits.

Pancreatitis can be a consequence of overeating (now also considered a form of addiction), other gastrointestinal pathologies, endocrine disorders. Regardless of the etiology, form and stage of the course, it severely disrupts digestion, threatening the state of the metabolic system and sometimes the life of the patient. The diet for pancreatitis is mainly protein-based (protein is digested by the stomach) and requires 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 - concentrated alkali with enzymes dissolved in it (more precisely, their inactive precursors). Pancreatic juice forms the digestive environment of the intestine. Bacteria living in its various compartments play an important but supportive role.

The main bile duct also passes through the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing in its outlet into its lumen into the main duct of the gland itself. As a result, alkalis, enzymes and bile do not enter the gut alone, but in the form of a prepared "mixture".

In glandular tissues, different types of cells are also present in groups. They are called islets and do not synthesize alkali, but insulin, the hormone responsible for the uptake of carbohydrates from food. Anomalies in the development, function, or breakdown of such cells (usually inherited) are one scenario of diabetes. The second is to increase the body's resistance to the normal insulin they produce.

Causes of the disease

In the acute stage, pancreatitis causes a blockage in 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" on internally accumulated enzymes. Acute pancreatitis can be caused by these causes.

Gallstones. They occur due to inflammatory pathology of the liver or gallbladder, abnormalities in the composition of the bile (they are caused by sepsis, taking drugs for atherosclerosis, diabetes, the same liver diseases).
Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The pathogen damages glandular cells, causes tissue swelling, and disrupts its function.
Medications. Toxic effects of atherosclerosis drugs, steroids and some antibiotics.
Structure or location deviations. 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 drunk alcoholics and diabetics who have "at least five years of experience. "

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. Penetrating wounds, interventions, severe stomach blows.

The least common cause of pancreatitis is spasm of the Oddi sphincter, which ends in the common gallbladder and pancreas. The Oddi sphincter is at the very exit of it into the duodenum. It usually regulates the "partial" entry 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 intestinal contents from entering the pancreas with various pathogensor gallbladder cavity.

Oddi's sphincter is not prone to spasms, like all smooth muscle "separators. " For a long time, there was no such thing as dysfunction in medicine itself. But in reality, his spasm is rare only during normal nervous system activity. But it is often overtaken by neurological disorders or by the activation of pain receptors - when it is irritated by stones protruding from the gallbladder, trauma occurs.

The distinction between the causes of acute and chronic pancreatitis is conditional, as the former, even with qualitative treatment, in many cases transitions to the latter. And what "feeds" it after eliminating the causal factors is unclear. In some cases (about 30%), none of these processes can explain the occurrence of pancreatitis to the patient.

signs

Acute pancreatitis begins and is accompanied by unbearable (until loss of consciousness) pain in the entire upper abdomen, under the ribs. Antispasmodics, painkillers, and antibiotics do not relieve it, nor do regular medications "from the heart" help relieve pain. , under the clavicle, into the thoracic spine, which may confuse patients with symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis, which also facilitates the body's cascade response to a critical force stimulus:

high blood pressure (hypertension and hypotension are equally likely);
heart rhythm problems;
fainting;
cold, damp sweat.

A characteristic symptom of pancreatitis is loose stools, which contain fragments of semi-digested food and fat. It appears a few hours after the onset of the disease. At the end of the first day, a change in the color of the stool with the urine is noticeable. They are usually yellowish brown to bile bilirubin, which aids digestion. And due to the blockage of the gutter does not enter the intestine. On the second or third day, the patient develops bloating, "sucks in" the stomach, and vomits when he sees fatty or spicy foods.

Chronic pancreatitis also presents with pain, but is less pronounced. They can get worse an hour after a meal, especially if it was inappropriate - cold, fried, smoked, greasy, spicy, along with alcohol. The pain worsens when lying down, and digestion to dyspepsia (when almost unchanged food passes out of the stool).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of gastric ulcer perforation) was Princess Henrietta of England, the wife of the Duke of Orleans Philippe, brother of King Louis XIV of the Sun. Due to the typical course of the painful illness, she was certain that she had been poisoned by one of her husband’s loved ones. True, this only became clear during the autopsy to confirm or deny this rumor.

Effects

Acute pancreatitis is dangerous quickly (two or three days) after and through "eating" the pancreatic tissue, which causes alkaline alkaline, bile and digestive enzymes to enter the abdominal cavity directly through the abdomen. This scenario results in diffuse peritonitis (inflammation of the peritoneum that spreads rapidly to the abdominal organs), multiple erosions, and death.

Peritonitis is common in many pathologies, including perforated ulcer, cancer of the stomach or intestine, appendicitis if accompanied by an outbreak of an abscess (a magician Harry Houdini died as a result of this scenario). If the pancreatitis is not caused by a mechanical obstruction (spasm of the Oddi sphincter, stone, scar, tumor, etc. ) but by infection, a purulent pancreatic abscess may develop. His untimely treatment also results in a breakthrough in the abdominal cavity.

Pancreatic enzymes and digestive juices sometimes cause enzymatic pleurisy, an inflammation of the same type of pleura as the peritoneum. Chronic pancreatitis is characterized by complications of delayed but more severe dysfunction and other organs.

Cholecystitis. And cholangitis is an inflammation of the liver ducts. They themselves can cause pancreatitis due to the gallstones that accompany them, but often develop in the opposite order as a consequence.
Gastritis. The stomach is not as closely related to the pancreas as the liver, although it is directly below it. Its inflammation in pancreatitis is caused not so much by foreign matter entering its cavity from the inflamed gland as 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 not taken into account so carefully. The more severe the pancreatic degradation, the higher the risk of developing gastritis.
reactive hepatitis. It also develops in response to persistent bile stiffness and irritation of the hepatic ducts. Sometimes cholestasis, which occurs during the next exacerbation of pancreatitis, is accompanied by jaundice. This is why the pancreatitis diet should not include foods that require higher bile excretion. These include fatty, fried, spicy meat and fish, fish caviar, other animal products, smoked meat, alcoholic beverages - digestive stimulants.
Cystosis and pseudocystosis. These benign tumors, or foci of stagnation of pancreatic juice that mimic them, result in the same difficulty in removing it into the duodenal cavity. Cysts tend to ignite and rot periodically.
Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor because it causes irritation, accelerates the destruction of damaged tissues, and increases the growth of their response. And it’s not always good quality. The same is true for chronic pancreatitis.
Diabetes. This is far from the first complication of chronic pancreatitis. However, the sooner and more noticeably the entire gland degrades, the more difficult it is for surviving islet cells to compensate for the lack of insulin caused by the death of their "colleagues" in dead areas. They are running out and are also starting to fade. The prospect of "experience" of diabetes after seven to ten years (often even faster, depending on the prognosis and course of pancreatitis) is becoming more and more palpable to the average patient.

Chronic recurrent inflammation in glandular tissues causes scarring and loss of functionality. Progressive intestinal indigestion is inevitable. But in general, you can live another 10-20 years with pancreatitis. Its prognosis, quality, and patient life expectancy are affected by a variety of "deviations" from diet and their type, especially everything related to alcoholic beverages.

diet therapy

The acute stage of the disease often requires urgent detoxification, prescription of antibiotics (usually on a broad spectrum because there is no time to determine the type of pathogen), and sometimes surgical intervention. This is necessary if the cause of the disease is spasm of the Oddi sphincter, a stone trapped in a duct or other obstruction (tumor). At the end of treatment, the basis of treatment should be a special medical diet.

Gastroenterologists usually follow 5 diets developed during the Soviet era by Manuil Pevzner for patients with cholecystitis and other pathologies that interfere with bile synthesis and drainage. However, the author himself later changed it by creating diet no. 5p.

General provisions

For adult patients with a mild course of the disease, Table no. Option 5p without mechanical saving - no need to grind food to a homogeneous mass. And the menu for kids usually has to be made from grated products. Diet during the exacerbation of chronic pancreatitis (especially in the first three days after its onset) and in the acute stage, which first appeared, has some 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" into the diet separately.
Complete hunger in the first days. When the pathology worsens, hunger is given. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
Only stewed and boiled (on water, steamed). Tables 5 and 5p do not specify other methods, e. g. , baking and baking.
Minimum fat content. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats must be restricted with it, as they are broken down by the same substance, bile. They can be consumed up to 10 g per day, but in any proportion.
No spices. Extremely sharp and spicy.
No nuts. Seeds are also prohibited. This type of food is rich in vegetable oil and is too difficult to eat even in powder form.
Salt to taste. Its consumption does not affect the course of the pathology, the daily rate of salt remains the same as in healthy individuals - up to 10 g per day.
Less fiber. This component, which is most commonly seen by nutritionists and people with digestive problems, is severely restricted for use in inflammation of the pancreas. The secret of its "miraculous" effect on the intestine is that the fibers are not digested, are not digested and irritate various parts of the intestine, promote peristalsis and water excretion. only carrots, zucchini, potatoes, pumpkins rich in starch and pulp, but relatively poor in fiber. White and red cabbages are prohibited, but cauliflowers may be used (only inflorescences, twigs and stems are excluded).
Small portions. There are, as before, three times a day portions with a total weight of half a kilogram or more, with pancreatic pathologies this is not possible. Eat at least five times a day and the total weight of all foods eaten at one time should not exceed 300 g.
Prohibit soda, coffee, alcohol and kvass. It is best to eliminate these drinks from your diet permanently. But if they simply cannot be taken away during remission, then they are strictly forbidden during exacerbation.

Sour vegetables (such as tomatoes) as well as all berries and fruits are also prohibited. They will further stimulate the excretion of bile. Emphasis should be placed on non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Cereal purees are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.

Example menu

The pancreatitis diet menu should include enough protein and carbohydrates. However, "brutal forces" with the latter are best avoided by restricting the addition of sugar, honey to drinks and meals. to hot dishes they give an unpleasant aftertaste), aspartame. The diet at a time when the pancreatic exacerbation or primary inflammation is already declining, may look like this.

Monday

First breakfast. Boiled chicken breast puree. The rice is crushed.
Lunch. Steamed fish cakes.
Dinner. Rice soup in chicken broth diluted halfway with water. Milk jelly.
afternoon tea. Omelet of two eggs.
First dinner. Chicken dumplings (grind the meat with rice). Grind buckwheat with a dessert spoon of butter.
Second dinner. Lean, unleavened curd, 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 soaked in several crumbs of white bread.
Dinner. Fish soup made from lean fish with rice and water. Milk or fruit jelly without fruit.
afternoon tea. Curd pasta with lean sour cream.
First dinner. Steamed turkey breast souffle. Crushed liquid buckwheat.
Second dinner. Boiled shrimp puree with boiled rice.

on wednesday

First breakfast. Fish cutlets with rice (grind the rice with the fish). Puree of boiled carrots.
Lunch. Two tablespoons of grated low-fat hard cheese.
Dinner. Soup made from pureed oatmeal, diluted chicken broth and chopped breasts. Curd pasta with sour cream.
afternoon tea. Several inflorescences of boiled cauliflower.
First dinner. Mashed pasta with curd. Steamed omelette from two eggs.
Second dinner. Pumpkin porridge. Tea with 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 souffle.
First dinner. Grated buckwheat. Lean fish souffle.
Second dinner. Carrot-pumpkin porridge.

Friday

First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken dumplings (grind rice like meat).
Lunch. Mashed potatoes with butter.
Dinner. Milk soup with pasta. Omelet made of two eggs cooked with grated cheese.
afternoon tea. Several cauliflowers. Rice pudding.
First dinner. Ground 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 souffle.
Lunch. Fish cutlets.
Dinner. Rice soup with weak chicken broth and minced meat. Crushed pasta with milk.
afternoon tea. Oatmeal.
First dinner. Lean beef pate with butter. Mashed potatoes.
Second dinner. Pumpkin-carrot porridge. Tea with some white crackers

Sunday

First breakfast. Curd pasta with sour cream. Omelettes.
Lunch. Zucchini under the cheese coat. Tea with milk and white crackers
Dinner. Buckwheat soup on dilute 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 removal of all confectionery and cakes from the diet, including chocolate and cocoa. You need to limit your intake of any fats, nutrients and fiber. Also, do not eat fresh bread. Millet, wheat, corn under the ban. These grains cannot be crushed even with a grinder. All legumes, including soybeans, are also withdrawn. They are rich in plant proteins, which makes them valuable to vegetarians. But they are also "to blame" for the increased gas production, the increase in stomach acidity, which is highly undesirable in the acute period.