Diet for pancreatitis: nutritional characteristics, permitted and prohibited foods.

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

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

organ functions

The pancreas is heterogeneous in structure and function of its tissues. The main part of its cells produces pancreatic juice - a concentrated alkali with dissolved enzymes (or rather, their inactive precursors). Pancreatic juice forms the digestive environment of the intestine. The bacteria that inhabit 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 same outlet into its lumen into the main duct of the gland. As a result, alkalis, enzymes and bile enter the intestine not separately, but in the form of a prepared "mixture".

Within 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 degradation of these cells (generally hereditary) are one of the scenarios of diabetes mellitus. The second is to increase the resistance of the body's cells to the normal insulin they produce.

Causes of the disease

In the acute stage, pancreatitis leads to blockage of the small ducts of the gland, through which pancreatic juice flows into the main pipe, and then into the lumen of the duodenum. There is an effect of its "self-digestion" by the enzymes accumulated inside it. 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 liver diseases).
• Infection. Viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes swelling of the tissues and disrupts their function.
• Medicines. The toxic effect of drugs for atherosclerosis, steroids and some antibiotics.
• Deviations in structure or location. They can be congenital (bending of the gallbladder, too narrow ducts, etc. ) or acquired (scarring after surgery or traumatic examination, swelling).

Chronic pancreatitis can be seen more often in drunken alcoholics and "experienced" diabetics of at least five years. Here, the autoimmune process in the gland, which caused the inflammation or the intake of antidiabetic drugs, matters. But it can also accompany the following diseases.

• Bowel pathology. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
• Vascular diseases. All glands must receive an active blood supply. Congenital anomalies and coagulation disorders (hemophilia, thrombosis) play a special role here.
• injuries. Penetrating wounds, surgeries, heavy blows 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. The sphincter of Oddi is located at the same exit to the duodenum. Normally, it regulates the "portioned" supply of pancreatic juice and bile in its cavity, allows it to almost stop between meals and sharply increase when a person sits at the table. It also prevents the backflow of intestinal contents along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.

The sphincter of Oddi is not prone to spasm, like all smooth muscle "spreaders" of this type. For a long time, there was no such thing as your own dysfunction in medicine. It was superseded by various "biliary dyskinesias" and "post-cholecystectomy" "syndromes" (a complication of gallbladder removal). But in fact, spasm from him is a rare thing only with normal functioning of the nervous system. But he often overcomes it with 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, since the first, even with high-quality treatment, in the vast majority of cases passes into the second. And it is not clear what "feeds" it after the elimination of the 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 excruciating pain (up to loss of consciousness) in the girdle in the entire upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not get rid of it, and ordinary "heart" drugs do not help either. A special diet will also not relieve the pain; a doctor is needed here, not a diet. Usually, but not always, its radiation is noted upwards, to the region of the heart, below the clavicle, to the thoracic spine, so that patients may confuse the symptoms of pancreatitis with a heart attack or an exacerbation of pancreatitis. osteochondrosis. This is also facilitated by the body's cascading reactions to a critical force stimulus:

• jumps in blood pressure (hypertension and hypotension are equally likely);
• interruptions in heart rate;
• Fainting;
• cold sticky sweat.

A characteristic symptom of pancreatitis is loose, soft stools containing semi-digested food fragments and fats. It appears after a few hours from the onset of the disease. At the end of the first day, discoloration of feces with urine is noted. Normally, they are yellow-brown in color from bilirubin in bile, with the help of which digestion was carried out. And due to 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 foods.

Chronic pancreatitis also presents 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 in the supine position, 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 point to the probability of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Duke Philip of Orleans, brother of the Sun King Louis XIV. From the typical painful course of her illness, she was certain that one of her husband's favorites had poisoned her. True, it turned out only during an autopsy, designed to confirm or dispel this rumor.

effects

Acute pancreatitis is dangerous fast (two-three days) "eating" of pancreatic tissue from beginning to end, 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 rapidly 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 it was accompanied by a breakthrough of the abscess (because of such a scenario, the magician Harry Houdini died). If the pancreatitis was not provoked by a mechanical obstacle (sphincter of Oddi spasm, stone, 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, late complications in time are typical, but more seriously disrupt their work and other organs.

• Cholecystitis. And cholangitis is inflammation of the liver ducts. They themselves can cause pancreatitis due to the accompanying cholelithiasis, but often form in the opposite order, as a consequence.
• Gastritis. The stomach is not connected to the pancreas as closely as the liver, although it is located directly below it. Its inflammation in pancreatitis occurs not so much because of the entry of foreign substances into its cavity from the inflamed gland, but because of the constant insufficiency of intestinal digestion, which is forced to compensate. The diet for pancreatitis is designed to reduce the load on all digestive organs, but the "interests" of a healthy stomach are less carefully taken into account. The more pronounced the degradation of the pancreas, the greater 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 during the next exacerbation of pancreatitis is accompanied by jaundice. That is why the diet from pancreatitis should not include foods that require further separation of bile. Among them are fatty, fried, 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 that simulate them arise due to the same difficulties with their removal in the duodenal cavity. Cysts tend to become inflamed and ooze periodically.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, since it causes irritation, accelerated destruction of the affected tissues and an increase in their growth response. And it's not always good quality. The same is true for chronic pancreatitis.
• Diabetes. It is far from the first "in line" complication of chronic pancreatitis. But the faster and more noticeably the entire gland degrades, the more difficult it is for the surviving islet cells to compensate for the insulin deficiency that occurs due to the death of their "colleagues" in already dead areas. They run out and also begin to die out. The prospect of diabetes mellitus after seven to ten years (often even faster, depending on the prognosis and the characteristics of the course of pancreatitis) "experience" for the average patient is becoming more and more tangible. Due to its threat, a diet for pancreatitis should ideally take into account the reduced content of not only fat, but also simple carbohydrates.

Chronic recurring inflammation in the gland tissues causes scarring and loss of functionality. Progressive insufficiency of intestinal digestion is inevitable. But, in general, you can live with pancreatitis for another 10 to 20 years. The prognosis of its course, quality and life expectancy of the patient is influenced by various "deviations" from the diet and its type, especially everything related 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 a spasm of the sphincter of Oddi, a stone stuck in the duct or another 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 back in Soviet times for patients with cholecystitis and other pathologies that prevent the synthesis and outflow of bile. But then the author himself changed it by creating diet No. 5p.

General provisions

For adult patients with a mild course of the disease, a variant of the table No. 5p without mechanical sparing is suitable; it does not require grinding the food until obtaining a homogeneous mass. And the children's menu must often be made from crushed 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 occurred for the first time, has several mandatory general rules.

• Simplicity. Recipes should be as simple as possible: no stuffed breasts and no 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 the pathology, starvation is prescribed. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
• Just stewed and boiled (in water, steamed). Tables No. 5 and 5p do not imply other methods such as baking and frying.
• Minimal fat. Especially if the attack is accompanied (or caused) by cholangitis, cholecystitis. Vegetable and animal fats with it should be equally strictly limited, since the same agent - bile - breaks them down. No more than 10 g per day can be consumed, 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 difficult to eat, even in powder form.
• Salt to taste. Its consumption does not in any way affect the course of the pathology, the daily intake of salt remains the same as in healthy people - up to 10 g per day.
• Less fiber. This component, generally valued 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, it is absorbed and irritates various sections of the intestine, stimulates peristalsis and excretion of water. Fiber helps form stool as it is excreted unchanged. With inflammation of the pancreas, all these properties of the fibers will only worsen the situation. You can only eat carrots, zucchini, potatoes, pumpkins, rich in starch and pulp, but relatively poor in hard fiber fibers. 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 foods eaten at one time should not exceed 300 g.
• Prohibition of soft drinks, 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 carried, then during an exacerbation they are strictly prohibited.

Acidic vegetables (for example, tomatoes), as well as all berries and fruits, are also prohibited. They will further stimulate the secretion of bile. The emphasis in nutrition 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 oats.

menu example

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 is made up of complex carbohydrates. Sugar can be replaced with drugs for diabetes: 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 can look like this.

Monday

• First breakfast. Boiled chicken breast puree. Rice puree.
• Lunch. Steamed fish cakes.
• Dinner. Rice soup in chicken broth diluted in half with water. Jelly Milk.
• afternoon tea. Two-egg omelette.
• First dinner. Chicken meatballs (ground meat with rice). Buckwheat puree with a dessert spoon of butter.
• Second dinner. Low-fat, non-acidic cottage cheese, shredded in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Oatmeal. Boiled cauliflower.
• Lunch. Lean meat pate with butter. Tea with milk and some soaked white breadcrumbs.
• Dinner. Fish soup based on lean fish with rice and water. Milk or fruit jelly without fruit.
• afternoon tea. Cottage cheese pasta with lean sour cream.
• First dinner. Steamed turkey breast soufflé. Liquid buckwheat puree.
• Second dinner. Boiled shrimp puree with boiled rice.

Wednesday

• First breakfast. Fish meatballs with rice (grind the rice together with the fish). Mashed boiled carrots.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Dinner. Soup made from mashed oats, diluted chicken broth and shredded chicken breast. Curd pasta with sour cream.
• afternoon tea. Several boiled cauliflower florets.
• First dinner. Pasta puree with cottage cheese. Two-egg steamed omelette.
• Second dinner. Pumpkin porridge. Tea with some soaked white biscuits.

Thursday

• First breakfast. Zucchini puree. Steamed chicken cutlets.
• Lunch. Two tablespoons of grated low-fat hard cheese.
• Dinner. Creamy potato soup with butter. Lean meat puree.
• afternoon tea. Turkey breast souffle.
• First dinner. Shredded buckwheat. Lean fish soufflé.
• Second dinner. Carrot and pumpkin porridge.

Friday

• First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (ground rice, like meat).
• Lunch. Mashed potatoes with butter.
• Dinner. Milk soup with mashed pasta. Two steamed egg omelette with grated cheese.
• afternoon tea. Several cauliflower florets. Rice pudding.
• First dinner. Chopped shrimp in sour cream sauce. Buckwheat puree. Tea with white biscuits.
• Second dinner. Mashed carrots. Milk or fruit jelly without fruit.

Saturday

• First breakfast. Pumpkin porridge. Lean meat soufflé.
• Lunch. Fish meatballs.
• Dinner. Rice soup with weak chicken broth and minced meat. Pasta puree with milk.
• afternoon tea. Oatmeal.
• First dinner. Lean meat pate with butter. Mashed potatoes.
• Second dinner. Pumpkin and carrot porridge. Tea with some white biscuits

Sunday

• First breakfast. Cottage cheese pasta with sour cream. Tortilla.
• Lunch. Zucchini under a layer of cheese. Tea with milk and white biscuits
• Dinner. Buckwheat soup on beef broth diluted with boiled beef puree. Steamed turkey breast soufflé.
• afternoon tea. oatmeal puree
• First dinner. Mashed potatoes. chicken cutlets.
• Second dinner. Rice curd pudding.

The diet for pancreatitis requires the exclusion from the diet of all confectionery and pastry products, including chocolate and cocoa. You should limit your intake of fats, dietary acids, and fiber. Also, don't eat fresh bread. Under the ban on millet, wheat, corn. These cereals cannot be crushed even with a blender. All legumes, including soy, will also be cancelled. They are rich in vegetable protein, which is why they are appreciated by vegetarians. But they are also "guilty" of increased gas formation, an increase in the acidity of the stomach, which is very undesirable in the acute period.