Diet for pancreatitis: nutritional features, permitted and prohibited foods

For a long time it was thought that pancreatitis was caused by alcohol abuse. This false impression was formed because it was first discovered and described using the example of people suffering from alcoholism. But now it is already known that its most dangerous acute stage is almost never found there - this is the "prerogative" of people with a healthy attitude towards 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 etiology, form and stage of development, it strongly disrupts digestion, threatens the state of the metabolic system and sometimes the life of the patient. Nutrition for pancreatitis is mainly protein-based (proteins are digested by the stomach) and involves 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 containing dissolved enzymes (or rather their inactive precursors). Pancreatic juice forms the digestive medium of the intestine. The bacteria inhabiting its various departments play an important but auxiliary role.

The main biliary tract also passes through the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing at the very exit of its lumen into the main duct of the gland itself. As a result, alkalis, enzymes and bile enter the intestine 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. Abnormalities in the development, functioning or breakdown of these cells (usually hereditary) 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 disease

In the acute stage, pancreatitis leads to blockage of the small ducts of the gland, through which 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, abnormalities in the composition of bile (they are caused by sepsis, taking drugs for atherosclerosis, diabetes mellitus, the same diseasesliver).
• Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes tissue swelling and disrupts its function.
• Medications. The toxic effect of drugs against atherosclerosis, steroids and some antibiotics.
• Deviations in structure or location. They can be congenital (bending of the gallbladder, ducts that are too narrow, 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 taking antidiabetic drugs, is important. 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 coagulation disorders (hemophilia, thrombosis) play a special role here.
• Injuries. Penetrating wounds, interventions, violent blows to the stomach.

The least common cause of pancreatitis is spasm of the sphincter of Oddi, which ends in the common gall bladder and pancreatic duct. The sphincter of Oddi is located at its very exit in the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile into its cavity, allows it to almost stop between meals and sharply increase when a person sits down at the table. It also prevents backflow of intestinal contents as well as various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.

The sphincter of Oddi is not subject to spasms, like all smooth muscle "separators" of this type. For a long time, his own dysfunction in medicine did not exist. It was replaced by various "biliary dyskinesias" and "post-cholecystectomy" "syndromes" (complication of gallbladder removal). But in fact, his spasm is a rare thing only with the normal functioning of the nervous system. But often he overtakes neurological disorders or as a result of activation of pain receptors - when irritated by stones coming out of the gallbladder, his injury occurs.

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 onset of pancreatitis in a patient.

panels

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

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

A characteristic symptom of pancreatitis is loose stools - mushy, containing fragments of semi-digested food and fat. It appears a few hours after the onset of the disease. By the end of the first day, discoloration of feces with urine becomes noticeable. Normally, they are stained yellow-brown by bile bilirubin, 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 foods.

Chronic pancreatitis also occurs with pain, but not as pronounced. They can intensify an hour after eating, especially if it was inappropriate - cold, fried, smoked, fatty, spicy, accompanied by alcohol. The pain is aggravated when lying down, 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 speak of the likelihood of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Duke Philippe of Orleans, brother of the Sun KingLouis XIV. Due to the typical painful course of the disease, she was sure that one of her husband's favorites had poisoned her. Admittedly, this only turned out during an autopsy, intended to confirm or refute this rumor.

Effects

Acute pancreatitis is dangerous when quickly (two or three days) "eating" pancreatic tissue through and through, as a result of which caustic alkalis, 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 accompanied by a breakthrough of the abscess (due to such a scenario, the magicianHarry Houdini passed away). If the pancreatitis was caused not by a mechanical obstacle (spasm of the sphincter of Oddi, calculus, scar, tumor, etc. ), but by an infection, a purulent pancreatic abscess may develop. His untimely treatment also ends with a breakthrough in the abdominal cavity.

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

• Cholecystitis. And cholangitis is an inflammation of the liver ducts. They themselves can cause pancreatitis due to accompanying cholelithiasis, but they are often formed in the reverse order - as a result.
• Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below. Its inflammation in pancreatitis occurs not so much due to foreign substances entering its cavity from the inflamed gland, but due to the constant insufficiency of intestinal digestion, which it 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 breakdown 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 liver ducts. Sometimes cholestasis that occurs with the next exacerbation of pancreatitis is accompanied by jaundice. That is why the diet for pancreatitis should not include foods that require increased separation of bile. Among them are fatty, fried and 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 in the duodenal cavity. The cysts tend to periodically inflame and fester.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, since it causes irritation, accelerated destruction of the affected tissues and increased growth of their response. And it's not always of good quality. The same is true for chronic pancreatitis.
• Diabetes. It is far from being the first "on-line" complication of chronic pancreatitis. But the faster and more noticeably the entire gland degrades, the more difficult it is for surviving islet cells to compensate for the insulin deficiency that occurs due to the death of their "colleagues" in already dead areas. They are exhausted and also begin to disappear. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and features of the course of pancreatitis) "experience" for the average patient is becoming increasingly tangible. Due to its threat, a pancreatitis diet should ideally take into account the reduced content not only of fats, but also of simple carbohydrates.

Chronic recurrent inflammation in the tissues of the gland causes scarring and loss of functionality. The progressive insufficiency of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10-20 years. The prognosis of 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.

dietetic

The acute stage of the disease often requires urgent detoxification, the appointment of antibiotics (usually 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 some other 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 in Soviet times for patients with cholecystitis and other pathologies that interfere with the synthesis and outflow of bile. But later the author himself changed it, 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 into a homogeneous mass. And the menu for children most often should consist of pureed products. Nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days after 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 or 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 pathology, hunger is prescribed. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
• Only simmer and boil (over water, steam). Tables #5 and 5p do not involve other methods like baking and frying.
• Minimal fat. Especially if the attack is accompanied (or provoked) by cholangitis, cholecystitis. Vegetable and animal fats must also be strictly limited, because the same agent, bile, breaks them down. They can be consumed no more than 10 g per day, but in any proportion.
• No spices. Particularly hot and spicy.
• No nuts. Seeds are also prohibited. These types of foods are high in vegetable oil and are too hard to eat even in powdered 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 fiber. This component, usually prized by nutritionists and people with digestive problems, is strictly limited to use in inflammation of the pancreas. The secret of its "magical" effect on the intestines is that the fibers are not digested, absorbed and irritate various sections of the intestine, stimulate peristalsis and water excretion. Fiber helps form feces, as it is excreted as is. With inflammation of the pancreas, all these properties of fibers will only aggravate the situation. You can only eat carrots, zucchini, potatoes, pumpkin, which are rich in starch and pulp, but relatively low in hard fiber. White and red cabbage is prohibited, but cauliflower can be eaten (only inflorescences, twigs and stems 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 food eaten at once should not exceed 300 g.
• Prohibition of soda, coffee, alcohol and kvass. It is better to exclude these drinks from the diet forever. But if during the period of remission they simply should not be washed 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. Nutritional emphasis 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.

Sample menus

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 consists of complex carbohydrates. Sugar can be replaced with diabetes 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 declining may look like this.

Monday

• First breakfast. Mashed boiled chicken breast. Rice puree.
• Lunch. Steamed fish cakes.
• Having dinner. Rice soup in chicken broth diluted by half with water. Milk jelly.
• afternoon tea. Two egg omelet.
• First dinner. Chicken meatballs (minced meat with rice). Pureed buckwheat with a dessert spoon of butter.
• Second dinner. Lean, non-acidic cottage cheese, mashed in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Groats. Boiled cauliflower.
• Lunch. Lean beef pate with butter. Tea with milk and a few white bread crumbs dipped in it.
• Having dinner. Fish soup made from lean fish with rice and water. Milk or fruit paste without fruit.
• afternoon tea. Cottage cheese pasta with lean sour cream.
• First dinner. Steamed turkey breast soufflé. Pureed liquid buckwheat.
• Second dinner. Mashed boiled shrimp with boiled rice.

Wednesday

• First breakfast. Fish meatballs with rice (mould the rice with the fish). Mashed boiled carrots.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Having dinner. Soup made with mashed oatmeal, diluted chicken broth and shredded brisket. Curd pasta with sour cream.
• afternoon tea. Several bunches of boiled cauliflower.
• First dinner. Cottage cheese pasta puree. Steamed omelette from two eggs.
• Second dinner. Pumpkin porridge. Tea with a few white crackers dipped in it.

Thursday

• First breakfast. Zucchini puree. Steamed chicken cutlets.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Having dinner. Creamy buttery potato soup. Lean beef mash.
• afternoon tea. Turkey breast soufflé.
• First dinner. Buckwheat puree. Lean fish soufflé.
• Second dinner. Carrot-pumpkin porridge.

Friday

• First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (ground rice, like meat).
• Lunch. Mashed potatoes with butter.
• Having dinner. Milk soup with mashed pasta. Omelet of two steamed eggs with grated cheese.
• afternoon tea. Several bunches of cauliflower. Milk rice.
• First dinner. Chopped prawns in sour cream sauce. Buckwheat puree. Tea with white crackers.
• Second dinner. Carrot puree. Milk or fruit paste without fruit.

Saturday

• First breakfast. Pumpkin porridge. Lean beef soufflé.
• Lunch. Fish meatballs.
• Having dinner. Rice soup with weak chicken broth and minced meat. Pureed pasta with milk.
• afternoon tea. Groats.
• First dinner. Lean beef pate with butter. Mashed potatoes.
• Second dinner. Pumpkin-carrot porridge. Tea with some white crackers

Sunday

• First breakfast. Cottage cheese pasta with sour cream. Omelette.
• Lunch. Courgettes under a layer of cheese. Milk tea and white crackers
• Having dinner. Buckwheat soup on diluted beef broth with boiled mashed beef. Steamed turkey breast soufflé.
• afternoon tea. Pureed oatmeal.
• First dinner. Mashed potatoes. Chicken cutlets.
• Second dinner. Curd rice.

The pancreatitis diet requires the exclusion from the diet of all sweets and pastries, including chocolate and cocoa. You should limit the intake of fats, dietary acids and fiber. Also, do not eat fresh bread. Under the prohibition of millet, wheat, corn. These cereals cannot be pureed even with a blender. All legumes, including soybeans, are also canceled. They are rich in vegetable proteins, for which they are appreciated by vegetarians. But they are also "guilty" of increased gas formation, increased acidity of the stomach, which is highly undesirable in the acute period.