Diet for pancreatitis: nutritional characteristics, permitted and prohibited foods

For a long time it was thought that pancreatitis was caused by alcohol abuse. This false notion was formed because it was first discovered and described using the example of those with alcoholism. But it is now known that the most dangerous acute stage is almost never found in it - this is the "prerogative" of people who have a healthy attitude towards alcohol.

Pancreatitis can be the result of overeating (now also considered a form of addiction), pathology 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. The diet 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 the 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 that inhabit its various departments play an important but helpful role.

The main bile duct also runs through the pancreatic tissue. It carries from the gallbladder to the duodenum, flowing at the exit to its lumen to 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".

In glandular tissue, cells of different types are also located in groups. 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 such cells (usually they are hereditary) are one of the scenarios for diabetes mellitus. The second is to increase the body’s cell resistance to the normal insulin it produces.

The cause of the disease

In the acute stage, pancreatitis leads to blockage of small ducts of the gland, where the juice of the pancreas flows into the main, and then into the lumen of the duodenum. There is a "self -digestion" effect by the enzymes accumulated in it. Acute pancreatitis can be caused by the following reasons.

• Coral. 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 disease).
• Infection. Viruses (mumps, hepatitis, etc. ) or parasites (helminthiasis). The causative agent affects the glandular cells, causing swelling of the tissue and interfering with its function.
• Medications. Toxic effects of drugs for atherosclerosis, steroid drugs and some antibiotics.
• Deviations in structure or location. They can be congenital (bent gallbladder, ducts too narrow, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).

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

• Intestinal pathology. Mainly the duodenum, including duodenitis (inflammation of its walls) and erosion.
• Vascular disease. All glands must be actively supplied with blood. Congenital anomalies and coagulation disorders (hemophilia, thrombosis) play a special role here.
• injuries. Wounds penetrate, intervene, strong blows to the abdomen.

The most rare cause of pancreatitis is spasm of the Oddi sphincter, which ends in the common gallbladder and pancreatic ducts. The Oddi sphincter is located at its exit into the duodenum. Typically, it regulates the supply of pancreatic and bile juices that are "divided" into its cavity, allowing it to almost stop between meals and increase dramatically when someone is sitting at a table. It also prevents the backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the pancreatic cavity or gallbladder.

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

The division of the causes of acute and chronic pancreatitis is conditional, because the former, even with high -quality treatment, in most cases passes to the latter. And what "feeding" after the elimination of causative factors is unclear. 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 belt pain (up to loss of consciousness) throughout the upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics don’t remove it, and regular "from the liver" medications also don’t help. A special diet won’t relieve the pain either - a doctor is needed here, not a diet. Usually, though not always, its radiation is recorded upwards, to the heart area, below the collarbone, to the thoracic spine, where the patient may confuse the symptoms of pancreatitis with a heart attack or exacerbation of osteochondrosis. This is also facilitated by the body’s cascade response to critical strength stimuli:

• jumps in blood pressure (hypertension and hypotension are equally likely);
• disturbances in heart rate;
• faint;
• cold, dry sweat.

The characteristic symptom of pancreatitis is loose stools - flabby, containing fragments of partially digestible food and fat. It appears after a few hours from the onset of the disease. By the end of the first day, the discoloration of stool with urine becomes noticeable. Usually, they are colored yellow-brown by bilirubin from bile, with the help of which digestion takes place. And because of the blockage of the duct, it does not get into the intestine. On the second or third day, patients experience bloating, "sucking" in the stomach and vomiting when looking at fatty or spicy foods.

Chronic pancreatitis also occurs with pain, but not so significantly. They can rise an hour after a meal, especially if it is not suitable - cold, fried, smoked, fatty, spicy, accompanied by alcohol. The pain worsens in the supine position, digestion is disturbed until dyspepsia (when food barely turns out of the stool).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of penetration of stomach ulcers) was Princess Henrietta of England, wife of Duke Philippe of Orleans, sister of the Sun King Louis XIV. Because of the painful course of the illness, she was sure that one of her husband’s favorites had poisoned her. True, it turned out only during the autopsy, designed to confirm or dispel these rumors.

Effect

Dangerous acute pancreatitis quickly (two or three days) "eats" 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 pervasive peritonitis (inflammation of the peritoneum, which quickly spreads to the abdominal organs), the appearance of various erosions and death.

Peritonitis is a feature of many pathologies, including perforated ulcers, stomach or intestinal cancer, appendicitis, if it is accompanied by the breakthrough of the abscess (due to such a scenario, the magician Harry Houdini died). If pancreatitis is provoked not by mechanical obstruction (spasm of the Oddi sphincter, stones, scars, tumors, etc. ), but by infection, purulent pancreatic abscess may develop. His untimely treatment also ended in a breakthrough into the abdominal cavity.

Enzymes and digestive 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, delayed complications in time are typical, but more seriously interfere with his work and other organs.

• Cholecystitis. And cholangitis is an 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 result of it.
• Gastritis. The stomach is not connected to the pancreas as close to the liver, although it is located just below it. Its inflammation in pancreatitis occurs not due to a foreign substance entering its cavity from an inflamed gland, but due to a persistent insufficiency of intestinal digestion, which is forced to compensate for it. The pancreatitis diet is designed to reduce the burden on all digestive organs, but the "importance" of a healthy stomach is less taken into account. The more pronounced the deterioration of the pancreas, the higher the risk of getting gastritis.
• reactive hepatitis. It also develops in response to persistent stagnation of bile and irritation of the hepatic ducts. Sometimes cholestasis that occurs during 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 meats and fish, fried, spicy, fish caviar, other animal by -products, smoked meats, alcoholic beverages - digestive stimulants.
• Cystosis and pseudocystosis. A benign neoplasm or a stagnant focus of pancreatic juice that simulates it arises because of the same difficulty as its removal into the duodenal cavity. Cysts tend to periodically become inflamed and purulent.
• Cancer of the pancreas. Any chronic inflammation is considered a carcinogenic factor, as it causes irritation, accelerates the destruction of the affected tissue and the growth of the response increases. And it's not always quality. The same is true for chronic pancreatitis.
• diabetes. It is far from the first "aligned" complication of chronic pancreatitis. But the faster and more significantly the entire gland deteriorates, the harder it is for the surviving islet cells to compensate for the insulin deficiency that occurs as a result of the death of their "colleagues" in the dead area. They ran out and even started to die. The prospect of diabetes mellitus after seven to ten years (often faster, depending on the prognosis and course characteristics of pancreatitis) "experience" for normal patients becomes more and more pronounced. Because of its threat, the diet for pancreatitis should take into account the reduced content of not only fat, but also simple carbohydrates.

Chronic recurrent inflammation in 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 influenced by various "deviations" from the diet and its type, especially in all related to alcoholic beverages.

diet therapy

The acute stage of the disease often requires immediate detoxification, appointment of antibiotics (usually broad-spectrum, because there is no time to establish the type of pathogen), and sometimes surgical intervention. It is necessary if the cause of the disease is spasm of the sphincter of Oddi, stones stuck in the ducts or other obstructions (tumors). Upon 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 inhibit the synthesis and outflow of bile. But then the author himself changed it by creating the No. 1 diet. 5p.

General provisions

For adult patients with mild disease, the table variant No. 5p without mechanical sparing is suitable - it does not require food to grind to a homogeneous mass. And menus for children most often need 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 occurs for the first time, has some mandatory general rules.

• Simplicity. The recipe should be as simple as possible - no stuffed breasts and meat salads, although all the ingredients in their composition individually "fit" into the diet.
• Complete starvation in the first few days. With pathological severity, starvation is established. That is, only warm alkaline drinks and maintenance of intravenous injections (vitamins, glucose, sodium chloride).
• Just boil and bring to a boil (over water, steam). Table No. 5 and 5p do not imply other methods such as 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 limited, because the same agent, bile, breaks it down. They can be eaten no more than 10 g per day, but in any portion.
• No spices. Especially hot and spicy.
• No nuts. Seeds are also prohibited. This type of food is rich in vegetable oils and is too difficult to eat even in powder form.
• Salt to taste. Its use does not affect the pathological course in any way, the daily salt intake remains the same as for a healthy individual - up to 10 g per day.
• Less fiber. This component, usually appreciated by nutritionists and people with digestive problems, is limited to use in inflammation of the pancreas. The secret of the "magical" effect on the intestine is that fiber is not digested, absorbed and irritates various parts of the intestine, stimulates peristalsis and excretion of water. Fiber helps form feces, as it is excreted unchanged. With inflammation of the pancreas, all the properties of these fibers will only worsen the condition. You can eat only carrots, zucchini, potatoes, pumpkin, rich in starch and pulp, but relatively poor in hard fiber. White and red cabbage are prohibited, but cauliflower is edible (only inflorescences, twigs and stalks are excluded).
• Small parts. There are, as before, three times a day in portions with a total weight of half a kilogram or more, with pathology of the pancreas is impossible. There should be at least five meals a day, and the total weight of all foods eaten at one time should not exceed 300 g.
• Prohibition of soda, coffee, alcohol and kvass. This drink should be excluded from the diet forever. But if during the period of remission they can not be carried away, then during the deterioration they are prohibited altogether.

Sour vegetables (e. g. , tomatoes), as well as all berries and fruits, are also prohibited. They will further stimulate bile secretion. Emphasis in nutrition should be on non -acidic and low -fat dairy products, shrimp, eggs (daily, not raw or fried). Whole grains are used as a source of carbohydrates, especially buckwheat, rice and oats.

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 consists of complex carbohydrates. Sugar can be replaced with diabetes medications - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant taste), aspartame. Nutrition during a period of deterioration or primary inflammation of the pancreas is already decreased may look like this.

Monday

• First breakfast. Pure boiled chicken breast. Mashed rice.
• Lunch. Steamed fish cake.
• dinner. Rice soup in chicken broth is diluted in half with water. Milk jelly.
• tea time. Omelet from two eggs.
• First dinner. Chicken meatballs (meat grind with rice). Pure 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 some white breadcrumbs soaked in it.
• dinner. Fish soup made from lean fish with rice and water. Fruit milk or jelly without fruit.
• tea time. Cottage cheese pasta with lean sour cream.
• First dinner. Steamed turkey breast soufflé. Pure liquid soba.
• Second dinner. Pure boiled shrimp with boiled rice.

Wednesday

• First breakfast. Fish meatballs with rice (grind rice with fish). Puree of boiled carrots.
• Lunch. Two tablespoons of grated low -fat hard cheese.
• dinner. Soup made from pure oatmeal, diluted chicken broth and chopped breast. Buttermilk pasta with sour cream.
• tea time. A few bunches of boiled cauliflower.
• First dinner. Mashed pasta with cottage cheese. Steam an omelet from two eggs.
• Second dinner. Pumpkin porridge. Tea with some white crackers soaked in it.

Thursday

• First breakfast. Pure zucchini. Cut the chicken steam.
• Lunch. Two tablespoons of grated low -fat hard cheese.
• dinner. Creamy potato soup with butter. Pure lean beef.
• tea time. Turkish breast souffle.
• First dinner. Soba mashed. Lean fish souffle.
• Second dinner. Carrot-pumpkin porridge.

Friday

• First breakfast. Buttermilk pasta with sour cream. Pure zucchini. Chicken meatballs (rice grind, like meat).
• Lunch. Mashed potatoes with butter.
• dinner. Milk soup with mashed pasta. Omelet from two steamed eggs with grated cheese.
• tea time. Some cauliflower buds. Rice pudding.
• First dinner. Chopped shrimp in sour cream sauce. Pure room. Tea with white crackers.
• Second dinner. Pure carrot. Fruit milk or jelly without fruit.

Saturday

• First breakfast. Pumpkin porridge. Lean beef soufflé.
• Lunch. fish meatballs.
• dinner. Rice soup with weak chicken broth and minced meat. Pasta mashed with milk.
• tea time. Oatmeal.
• 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. Zucchini under a layer of cheese. Tea with milk and white crackers
• dinner. Buckwheat soup on beef broth diluted with boiled beef puree. Steamed turkey breast soufflé.
• tea time. Pure oatmeal.
• First dinner. Mashed potatoes. Cut the chicken.
• Second dinner. Rice pudding.

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