Diet for pancreatitis: nutritional aspects, approved and prohibited foods

Pancreatitis was long thought to be caused by alcohol abuse. This false impression was created because it was first discovered and described using the example of people suffering from alcoholism. But now it is already known that their most dangerous, sharp step is almost never to be found in them - this is the "prerogative" of people with a healthy attitude towards strong drinks.

Overeating (now also considered a form of addiction), pathologies of other digestive organs, endocrine disorders can lead to pancreatitis. Regardless of the etiology, form and stage of the course, it severely interferes with digestion, threatens the state of the metabolic system, and sometimes the life of the patient. Nutrition for pancreatitis is taken primarily on a protein basis (proteins are digested in 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 - concentrated alkali with enzymes dissolved in it (or rather, its inactive precursors). Pancreatic juice makes the digestive environment of the intestine. Bacteria that live in their different compartments play an important but auxiliary role.

The main biliary tract also runs through the pancreatic tissue. It passes from the gallbladder to the duodenum, flowing 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 smooth "mixture".

Inside the glandular tissues, different types of cells are also located in groups. They are called islets, and do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Anomalies in the development, function, or degradation of such cells (usually hereditary) are one of the causes for diabetes mellitus. The second is to increase the body's cellular resistance to the normal insulin they produce.

Causes of the disease

In the crisis, pancreatitis results from obstruction of the small ducts of the gland, through which the pancreatic juice flows into the main layer, and then into the lumen of the duodenum. The accumulated enzymes inside have a "self-digesting" effect. Acute pancreatitis can lead to the following causes.

• Gallstones. 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 diseases).
• Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, disrupts the tissues and interferes with its function.
• Medications. Toxic effect of drugs for Atherosclerosis, steroid drugs and some antibiotics.
• Dialects in structure or setting. They can be congenital (bending of the gallbladder, ducts too narrow, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).

Chronic pancreatitis can often be noticed in intoxicated alcoholics and "experienced" diabetics for at least five years. Here, the autoimmune process in the gland, which is caused by inflammation or intake of antidiabetic drugs, is important. But it can also be accompanied by the following diseases.

• Intestinal pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
• Vascular diseases. Blood must be actively supplied to all glands. Congenital anomalies and coagulation disorders (hemophilia, thrombosis) play a special role.
• Injuries. penetration wounds, interventions, strong blow to the stomach.

The least common cause of pancreatitis is spasm of the sphincter of Oddi, which ends in the common gallbladder and pancreatic duct. Oddi’s sphincter is located at the exit from it into the duodenum. Typically, it controls the "joint" supply of pancreatic juice and bile into its cavity, allowing it to almost stop between meals and increase sharply when one sits down at the table. It prevents the backflow of intestinal contents as well as various pathogens (bacteria, foreign compounds, worms) into the pancreas or gallbladder cavity.

The sphincter of Oddi is not prone to spasms, like all fine muscle "separators" of this type. For a long time, there was no such thing as its own dysfunction in medicine. It replaced "biliary dyskinesias" and "postcholecystectomy" "syndromes" (complicated by removal of the gallbladder). But in reality, his spasm is a rare thing only with the normal functioning of the nervous system. But it is often exacerbated by neurological disorders or as a result of activation of pain receptors - when it is irritated by stones coming from the gallbladder, its injury occurs.

Some causes of acute and chronic pancreatitis are conditional, since the former, even with high-quality treatment, in the vast majority of cases merges into the latter. And it's not clear what "nurtured" it after eliminating causal factors. In some cases (about 30%), none of these processes can explain the appearance of pancreatitis in a patient.

signs

Acute pancreatitis begins and is accompanied by unexplained zone pain (up to loss of consciousness) in the entire upper abdomen, under the ribs. It does not contain antispasmodics, painkillers and antibiotics, nor do common "from the heart" drugs help either. A special diet will not alleviate the pain either - a doctor is needed here, not a diet. Usually, though not always, its irradiation is noted upwards, to the region of the heart, under the collarbone, to the thoracic spine, due to which patients may confuse the symptoms of pancreatitis with a heart attack or worseosteochondrosis. This is also facilitated by the body's cascading reactions to a stimulus of critical strength:

• jumps in blood pressure (hypertension and hypotension less likely);
• heart rate break;
• weakening;
• cold, sweaty clammy.

A characteristic sign of pancreatitis is loose stools - mushy, which contain semi-digestible food fragments and fat. It appears after a few hours from the onset of the disease. By the end of the first day, discoloration of the feces with urine becomes noticeable. They are usually yellow-brown colored by bilirubin from bile, with the help of which digestion has taken place. And because of the obstruction 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 food.

Chronic pancreatitis also occurs with pain, but is less pronounced. They can intensify an hour after eating, especially if it was inappropriate - cold, fried, smoked, fatty, spicy, combined with alcohol. The pain worsens in the supine position, digestion is disrupted up to dyspepsia (when almost unchanged food comes out instead of feces).

One of the most famous victims of acute pancreatitis (many experts the likelihood of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Duke Philippe de Orleans, brother of Sun King Louis XIV. Because of the usual painful course of the disease, she was convinced that one of her husband's loved ones had poisoned her. True, it came to light only during an autopsy, designed to confirm or dispel this rumor.

Effects

Acute pancreatitis is dangerous by "eating" pancreatic tissue rapidly (two or three days) through and through, resulting in alkali, bile and digestive enzymes passing through this "fistula" directly into the abdominal cavity. This case ends with diffuse peritonitis (inflammation of the peritoneum, which spreads rapidly to the abdominal organs), the appearance of multiple erosions and death.

Peritonitis is characterized by many pathologies, including perforated ulcer, cancer of the stomach or intestines, appendicitis, if accompanied by a rupture of the abscess (because of such a case, the magician Harry Houdini died). If pancreatitis is induced not by mechanical obstruction (spasm of the sphincter of Oddi, stone, scar, tumor, etc. ), but by infection, a purulent pancreatic abscess may develop. His miscarriage treatment also ends with rupture of the abdominal cavity.

Enzymes and digestive juice of the pancreas sometimes cause enzymatic pleurisy - an inflammation of the pleura similar to that of the peritoneum. For chronic pancreatitis, complications are usually time-delayed, but interfere with its work and other more serious organs.

• Cholecystitis. And cholangitis is an inflammation of the liver ducts. They can cause pancreatitis themselves due to the cholelithiasis that accompanies them, but they often form in the opposite order - as a result.
• gastritis. The stomach is not attached to the pancreas as closely as the liver, although it is located just below it. Its inflammation in pancreatitis does not occur so much because of foreign substances entering the cavity from the inflamed gland, but because of the persistent insufficiency of the intestinal digestion, which it is forced to compensate. The pancreatitis diet is designed to reduce the burden on all digestive organs, but the "benefits" of a healthy stomach are not taken into account as carefully. The more significant the degradation of the pancreas, the higher the risk of developing gastritis.
• reactive hepatitis. It also develops in response to persistent bile stagnation and irritation of the hepatic ducts. Sometimes jaundice is accompanied by cholestasis that occurs during the next exacerbation of pancreatitis. This is why the diet of pancreatitis should not include foods that require increased bile separation. These include fatty, fried, spicy and fish meats, fish caviar, other animal by - products, smoked meats, alcoholic beverages - digestive stimulants.
• Cystosis and pseudocystosis. These benign neoplasms or foci of pancreatic juice stagnation simulate them due to the same difficulties in their transfer into the duodenal cavity. Cysts are usually inflamed and suppurate periodically.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, because it causes irritation, accelerated destruction of affected tissues and increased response growth. And it is not always of good quality. The same is true for chronic pancreatitis.
• Diabetes. It is far from the first "online" complex of chronic pancreatitis. But the faster and more noticeably the whole gland degrades, the more difficult it becomes for the islet cells to survive the insulin deficiency that occurs due to the death of their counterparts in areas that are already dead. They are exhausted and also start to die out. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and characteristics of the course of pancreatitis) "experience" for the average patient is becoming more and more tangible. Given its threat, a diet for pancreatitis should ideally include reduced content not only fats, but also simple carbohydrates.

The chronic recurrent inflammation in the tissues of the glands causes scarring and loss of function. Progressive insufficiency of intestinal digestion is inevitable. But in general, you can survive 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 their type, 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 establish the type of pathogen), and sometimes surgical intervention. It is necessary if the cause of the disease is spasm of Oddi sphincter, a stone stuck in the duct or other obstruction (tumor). Upon completion, the basis of treatment should be a special medical diet.

As a basis, gastroenterologists usually adopt diet number 5, developed by Manuil Pevzner back in Soviet times for patients with cholecystitis and other pathologies that inhibit bile synthesis and outflow. But later the author himself changed it through diet No. 5p.

General provisions

For adult patients with a mild course of the disease, table version No. 5p without suitable mechanical saving - no need to grind food into a homogeneous mass. And often the menu for children must be made of crushed products. Nutrition during the exacerbation period of chronic pancreatitis (especially in the first three days from its onset) and in the acute phase, which occurred for the first time, some general rules are mandatory.

• Simple. Recipes should be as simple as possible - no stuffed breasts and meat salads, even if all the ingredients in their composition alone "fit" into the diet.
• Total hunger in the first days. With exacerbation of the pathology, starvation is prescribed. That is, only alkaline hot drink and maintenance of intravenous injections (vitamins, glucose, sodium chloride).
• Only stewing and boiling (on water, steamed). Tables 5 and 5p do not imply other methods such as baking and frying.
• minimal fat. Especially if the attack is accompanied (or caused) by cholecystitis, cholecystitis. Vegetable and animal fats must also be strictly restricted, since they are broken down by the same agent, bile. They can be consumed no more than 10 g per day, but in any proportion.
• No spices. Especially hot and spicy.
• No nuts. Seeds are also prohibited. These types of foods are rich in vegetable oil and are too hard to eat even in powder form.
• Salt to taste. Its consumption does not interfere with the course of pathology in any way, the daily salt intake is the same as for healthy individuals - up to 10 g per day.
• Less fiber. This component, which is generally appreciated by nutritionists and people with digestive problems, is strictly limited for use in inflammation of the pancreas. The secret of its "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 feces, as it excretes unchanged. With inflammation of the pancreas, all these symptoms of the fibers will only make the situation worse. 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 can be consumed (only inflorescences, twigs and stalks 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 is impossible. There should be at least five meals a day, and the total weight of all foods eaten at a time should not exceed 300 g.
• Prohibition of soda, coffee, alcohol and kvass. It is best to exclude these drinks from the diet forever. But if during the remission period they should not be given away, then during aggravation they are strictly prohibited.

Sour vegetables (for example, tomatoes), as well as all berries and fruits, are also prohibited. They stimulate further bile secretion. The emphasis in nutrition should be on non-acidic and low-fat dairy products, shrimp, eggs (every other day, not raw or fried). Purified cereals are used as sources of carbohydrates, mainly buckwheat, rice and oatmeal.

Example menu

The diet menu for pancreatitis should include plenty of proteins and carbohydrates. But "brute force" is best avoided by the latter by limiting sugar, adding honey to drinks and dishes. Buckwheat, a favorite cereal for diabetics, should be included in the diet more often, as it is composed of complex carbohydrates. Sugar can be substituted for diabetic drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant aftertaste), aspartame. It is possible to look like this in a diet during the period when the primary inflammation or inflammation of the pancreas is already in decline.

Monday

• First breakfast. boiled chicken breast puree. Crushed rice.
• Lunch. steamed fish cakes.
• Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
• afternoon tea. Omelet from two eggs.
• The first dinner. Balls of chicken meat (grind meat with rice). Pureed 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 a few crumbs of white bread soaked in it.
• Dinner. Fish soup made from lean fish with rice and water. Fruit-free milk or jelly.
• afternoon tea. Cottage cheese pasta with sour sour cream.
• The first dinner. Steamed turkey breast soufflé. Purified liquid buckwheat.
• Second dinner. Puree shrimp cooked with boiled rice.

Wednesday

• First breakfast. Fish meatballs with rice (grind the rice together with the fish). Puree from boiled carrots.
• Lunch. Two tablespoons of low-fat grated hard cheese.
• Dinner. Soup made from pure oatmeal, diluted chicken broth and chopped breast. Pasta curd with sour cream.
• afternoon tea. Some florets of boiled cauliflower.
• The first dinner. mashed pasta with cottage cheese. Steam omelette from two eggs.
• Second dinner. Pumpkin porridge. Tea with a few white crackers soaked in it.

Thursday

• First breakfast. zucchini puree. Chicken steam cutlets.
• Lunch. Two tablespoons of low-fat grated hard cheese.
• Dinner. Creamy potato soup with butter. lean beef puree.
• afternoon tea. Turkey breast soufflé.
• The first dinner. mashed buckwheat. Lean fish soufflé.
• Second dinner. Carrot-pumpkin porridge.

Friday

• First breakfast. Pasta curd with sour cream. zucchini puree. Chicken meatballs (grind rice, like meat).
• Lunch. Mashed potatoes with butter.
• Dinner. Milk soup with mashed pasta. Omelet from two steamed eggs with grated cheese.
• afternoon tea. Some cauliflower florets. rice pudding.
• The first dinner. Minced shrimp in sour cream sauce. Pure buckwheat. Tea with white crackers.
• Second dinner. Pure carrot. Fruit-free milk or jelly.

Saturday

• First breakfast. Pumpkin porridge. lean beef soufflé.
• Lunch. Fish meat balls.
• Dinner. Rice soup with weak chicken broth and minced meat. mashed pasta with milk.
• afternoon tea. Oatmeal.
• The first dinner. Lean beef pate with butter. Bruins.
• Second dinner. Pumpkin-carrot porridge. Tea with a few white crackers

Sunday

• First breakfast. cottage cheese pasta with sour cream. Omelette.
• Lunch. Zucchini under a coat of cheese. Tea with milk and white crackers
• Dinner. Buckwheat soup on a beef broth diluted with cooked beef puree. Steamed turkey breast soufflé.
• afternoon tea. Purified oatmeal.
• The first dinner. Bruins. Chicken cutlets.
• Second dinner. Rice curd pudding.

The diet for pancreatitis requires the exclusion of all confectionery and pastries, including chocolate and cocoa, from the diet. You need to limit the intake of any fats, food acids and fiber. Also, do not eat fresh bread. Under the ban millet, wheat, corn. These cereals can not even be brushed with a blender. All legumes, including soybeans, are also being phased out. They are rich in vegetable protein, which is appreciated by vegetarians. But they are also "guilty" of increased gas formation, increased stomach acidity, which is highly undesirable in the acute period.