Diet for pancreatitis: nutritional features, permissible and prohibited foods

For a long time it was thought that pancreatitis was caused by alcohol abuse. This false impression is formed because it was first discovered and explained using the example of those who suffer from alcoholism. But now it is known that the most dangerous acute stages are almost never found in them - this is the "prerogative" of people with a healthy attitude to liquor.

Pancreatitis can be the result of overeating (now it is also considered a form of addiction), other pathologies of the digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the course, it greatly interferes with digestion, threatens the state of the metabolic system, and sometimes the life of the patient. Nutrition for pancreatitis is built primarily on protein (protein digested by the stomach) and involves careful grinding of food.

Organ function

The pancreas is heterogeneous in its tissue structure and function. The main part of its cells produces pancreatic juice - concentrated alkali with enzymes dissolved in it (or rather, its inactive precursors). Pancreatic juice forms the digestive environment of the intestine. The bacteria that inhabit its various departments play an important but additional role.

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

Within the glandular tissue, cells of different types are also in clusters. They 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 these cells (usually hereditary) is one scenario for diabetes mellitus. The second is to increase the resistance of the body's cells to the normal insulin they produce.

Causes of disease

In the acute stage, pancreatitis causes blockage of the small ducts of the gland, through which pancreatic juice flows into the main duct, and then into the lumen of the duodenum. There is a "self-digesting" effect by the enzymes accumulated in it. Acute pancreatitis can be caused by the following reasons.

• Gallstones. They appear due to inflammatory pathologies of the liver or gallbladder, anomalies in the composition of bile (they are caused by sepsis, taking drugs for atherosclerosis, diabetes mellitus, similar liver diseases).
• Infection. Viruses (mumps, hepatitis, etc. ) or parasites (helminthiasis). The causative agent affects the glandular cells, causing tissue swelling and impairing their function.
• Drug. 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 a duct, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).

Chronic pancreatitis can most often be observed in drunk alcoholics and diabetics "with experience" of at least five years. Here, the autoimmune processes in the glands, leading to inflammation or the intake of antidiabetic drugs, are important. But it can also accompany the following diseases.

• Intestinal pathology. Primarily the duodenum, including duodenitis (inflammation of its walls) and erosions.
• Vascular disease. All glands must be actively supplied with blood. Congenital anomalies and clotting disorders (hemophilia, thrombosis) play a special role here.
• Injury. Penetrating wound, intervention, strong blow to the stomach.

The most common cause of pancreatitis is spasm of the sphincter of Oddi, which terminates in the gallbladder and pancreatic duct. The sphincter of Oddi is located at the exit from it to the duodenum. Normally, this regulates the supply of "portions" of pancreatic juice and bile into their cavities, allowing them to almost stop between meals and increase sharply when a person sits at the table. It also prevents backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the pancreatic cavity or gallbladder.

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

The division of causes of acute and chronic pancreatitis is conditional, since the former, even with high-quality care, in the vast majority of cases pass into the latter. And what "feeds" after the elimination of the causative factor is not clear. In some cases (about 30%), none of these processes can explain the appearance of pancreatitis in patients.

signs

Acute pancreatitis begins and is accompanied by unbearable girdle pain (until loss of consciousness) throughout the upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics don't get rid of it, and common "from the heart" drugs don't help either. A special diet will also not relieve pain - a doctor is needed here, not a diet. Usually, though not always, the radiation is recorded upward, to the area of the heart, below the collarbone, to the thoracic spine, because of which the patient may confuse the symptoms of pancreatitis with a heart attack or an exacerbation of osteochondrosis. This is also facilitated by a cascade of reactions of the body to a critical force stimulus:

• spikes in blood pressure (hypertension and hypotension are equally possible);
• disturbances in the heartbeat;
• faint;
• cold sweat and damp.

A characteristic symptom of pancreatitis is watery stools - mushy, containing partially digested food and fat fragments. Appears after a few hours from the onset of the disease. By the end of the first day, a change in the color of the stool with urine becomes noticeable. Usually, they are colored yellow-brown by the bilirubin from the bile, with the help of which digestion occurs. And due to blockage of the duct, it does not enter the intestine. On the second or third day, the patient experiences flatulence, "sucking" in the stomach and vomiting at the sight of fatty or spicy food.

Chronic pancreatitis also occurs with pain, but is less pronounced. They can increase an hour after eating, especially if it is inappropriate - cold, fried, smoked, fatty, spicy, accompanied by alcohol. Pain is aggravated in the supine position, impaired digestion to dyspepsia (when barely changed food comes out instead of feces).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of a perforated peptic ulcer) was Princess Henrietta of England, wife of Duke Philippe of Orleans, sister of the Sun King Louis XIV. Due to the painful course of the illness, she was convinced that one of her husband's favorites had poisoned her. True, it turned out that only during the autopsy, which was designed to confirm or dispel these rumors.

Effect

Insidious acute pancreatitis quickly (two or three days) "eats" the pancreatic tissue through and through, as a result of which caustic alkali, bile and digestive enzymes pass 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 perforated ulcers, gastric or intestinal cancer, appendicitis, if accompanied by a breakthrough abscess (because of such a scenario, the magician Harry Houdini died). If pancreatitis is provoked not by mechanical obstruction (spasm of the sphincter of Oddi, stones, scars, tumors, etc. ), but by infection, a purulent pancreatic abscess may develop. His untimely treatment also ended in a breakthrough into the abdominal cavity.

The digestive enzymes and juices 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 that are delayed in time are typical, but more seriously interfere with his work and other organs.

• Cholecystitis. And cholangitis is inflammation of the ducts of the liver. They themselves can cause pancreatitis due to the cholelithiasis that accompanies them, but they often form in the opposite order - as a result.
• Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it lies directly beneath it. Its inflammation in pancreatitis occurs not because a foreign substance enters its cavity from the inflamed gland, but due to the constant insufficiency of intestinal digestion, which is forced to compensate. The pancreatitis diet is designed to reduce the load on all digestive organs, but the "importance" of a healthy stomach is paid little attention to. The more severe the degradation of the pancreas, the higher the risk of developing gastritis.
• reactive hepatitis. It also develops in response to bile stagnation and constant irritation of the liver ducts. Sometimes the cholestasis that occurs during a subsequent 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. Benign neoplasms or foci of stagnation of pancreatic juice simulating them arise due to the same difficulties with their removal into the duodenal cavity. Cysts tend to periodically become inflamed and suppurate.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, as it causes irritation, accelerates the destruction of the affected tissue and increases the growth of its response. And it's not always of good quality. The same is true for chronic pancreatitis.
• Diabetes. This is far from the first "corresponding" complication of chronic pancreatitis. But the faster and more markedly the entire gland is degraded, the more difficult it is for the surviving islet cells to compensate for the insulin deficiency that results from the death of their "companion" in the dead area. They run out and also start to die. The prospect of diabetes mellitus after seven to ten years (often even sooner, depending on the prognosis and characteristics of the course of pancreatitis) "experience" for the average patient becomes increasingly real. Due to the threat, the diet for pancreatitis should ideally take into account the reduction in the content of not only fats, but also simple carbohydrates.

Recurrent chronic inflammation of the glandular tissue causes scarring and loss of function. 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 affected by various "deviations" of the diet and its types, especially in all matters relating to alcoholic beverages.

diet therapy

The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually broad-spectrum, since there is no time to determine the type of pathogen), and sometimes surgical intervention. This 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 completion, the basis of treatment should be a special medical diet.

As a basis, gastroenterologists usually take diet number 5, which was developed by Manuil Pevzner in Soviet times for patients with cholecystitis and other pathologies that inhibit the synthesis and outflow of bile. But then the author himself changed it by making a diet No. 5p.

General requirements

For adult patients with mild disease, table variant No. 5p without mechanical saving is suitable - there is no need to grind food into a homogeneous mass. And the menu for children most often has to be made from pureed 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 occurs for the first time, has several mandatory general rules.

• Simplicity. The recipe should be as simple as possible - no stuffed meat breasts and salads, even if all the ingredients in its composition individually "fit" into the meal.
• Full of hunger in the first days. With an exacerbation of pathology, hunger is determined. That is, only warm alkaline drinks and maintenance of intravenous injections (vitamins, glucose, sodium chloride).
• Just boiled and stewed (on the water, steamed). Table No. 5 and 5p do not imply other methods such as grilling and frying.
• minimal fat. Especially if the attack was accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats with them should be 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 peanuts. 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 in any way, the daily intake of salt remains the same as in a healthy individual - up to 10 g per day.
• Less fiber. This component, usually appreciated by nutritionists and people with digestive problems, is very limited for use in inflammation of the pancreas. The secret of the "magical" effect on the intestines is that fiber is not digested, absorbed and irritates various parts of the intestine, stimulates peristalsis and excretion of water. Fiber helps to form stool, as it is excreted unchanged. With inflammation of the pancreas, all these properties of fiber will only exacerbate the situation. You can only eat carrots, zucchini, potatoes, pumpkin, which are rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage are prohibited, but cauliflower can be consumed (only the inflorescences, twigs and stems are not included).
• Small portion. There are, as before, three times a day in portions weighing a total of half a kilogram or more, with pathology of the pancreas it is impossible. There should be at least five times a day, and the total weight of all food eaten at one time should not exceed 300 g.
• Prohibition of soda, coffee, alcohol and kvass. This drink should be removed from the diet forever. But if during the period of remission they should not be carried away, then during the exacerbation they are strictly prohibited.

Sour vegetables (for example, tomatoes), as well as all berries and fruits, are also prohibited. They will further stimulate bile secretion. Nutritional emphasis should be on non-acidic and low-fat dairy products, shrimp, eggs (daily, not raw or fried). Porridge cereals are used as a source of carbohydrates, especially buckwheat, rice, and oatmeal.

Sample menu

The diet menu for pancreatitis should contain 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 in the diet more often, as it contains complex carbohydrates. Sugar can be replaced with diabetes drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant taste), aspartame. A diet during periods when exacerbations or primary inflammation of the pancreas have decreased may look like this.

Monday

• First breakfast. Puree the boiled chicken breast. Rice is mashed.
• Have lunch. Steamed fish cake.
• Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
• afternoon tea. Omelet of two eggs.
• First dinner. Chicken meatballs (grind meat with rice). Buckwheat porridge with a butter dessert spoon.
• Second dinner. Lean, non-sour cottage cheese, crushed in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Oatmeal. Boiled cauliflower.
• Have lunch. Lean beef pate with butter. Tea with milk and some white bread crumbs is 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 nonfat sour cream.
• First dinner. Steamed turkey breast souffle. Crushed liquid buckwheat.
• Second dinner. Puree boiled shrimp with boiled rice.

Wednesday

• First breakfast. Fish balls with rice (grind rice with fish). Puree from boiled carrots.
• Have lunch. Two tablespoons grated low-fat hard cheese.
• Dinner. Soup made from oatmeal porridge, watery chicken stock, and shredded breast. Curd pasta with sour cream.
• afternoon tea. A few boiled cauliflower florets.
• First dinner. Mashed pasta with cottage cheese. Steamed omelet from two eggs.
• Second dinner. pumpkin porridge. Tea with a little white crackers soaked in it.

Thursday

• First breakfast. zucchini porridge. Chicken slices.
• Have lunch. Two tablespoons grated low-fat hard cheese.
• Dinner. Creamy potato soup with butter. Puree lean beef.
• afternoon tea. Turkey breast souffle.
• First dinner. Mashed buckwheat. Lean fish souffle.
• Second dinner. Carrot-pumpkin porridge.

Friday

• First breakfast. Curd pasta with sour cream. zucchini porridge. Chicken meatballs (grind rice, like meat).
• Have lunch. Mashed potatoes with butter.
• Dinner. Milk soup with mashed pasta. Omelet of two steamed eggs with grated cheese.
• afternoon tea. A few cauliflower florets. Rice pudding.
• First dinner. Chopped prawns in sour cream sauce. Puree the buckwheat. Tea with white crackers.
• Second dinner. Puree the carrots. Milk or fruit jelly without fruit.

Saturday

• First breakfast. pumpkin porridge. Lean beef souffle.
• Have lunch. fish meatball.
• Dinner. Rice soup with weak chicken stock and minced meat. Mashed pasta with milk.
• afternoon tea. Oatmeal.
• First dinner. Lean beef pate with butter. Mashed potato.
• Second dinner. Pumpkin-carrot porridge. Tea with some white biscuits

Sunday

• First breakfast. Cottage cheese pasta with sour cream. Omelet.
• Have lunch. Zucchini under a layer of cheese. Tea with milk and white crackers
• Dinner. Buckwheat soup with thin beef broth with stewed beef puree. Steamed turkey breast souffle.
• afternoon tea. wheat porridge.
• First dinner. Mashed potato. Chicken pieces.
• 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 your intake of any fats, dietary acids and fiber. Also, don't eat fresh bread. Under the ban millet, wheat, corn. This cereal cannot be mashed even with a blender. All legumes, including soybeans, are also cancelled. They are rich in vegetable protein, which vegetarians appreciate. But they are also "guilty" of increased gas formation, increased gastric acidity, which is especially undesirable in the acute period.