Diet for pancreatitis: nutritional features, allowed 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 known that its most acute, dangerous phase is almost never there - this is the "privilege" of people who have a healthy attitude to strong drinks.

Pancreatitis can be the result of overeating (now considered a form of addiction), diseases of other digestive organs, endocrine disorders. Regardless of the etiology, form and stage of the process, it causes numerous gastrointestinal disturbances, threatening the state of the metabolic system, and sometimes the life of the patient. Diet for people with pancreatitis is built mainly on a protein basis (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 alkaline substance with enzymes dissolved in it (or rather, their inactive precursors). Pancreatic juice forms the digestive environment of the intestines. The bacteria inhabiting its various parts play an important but auxiliary role.

The main biliary tract also runs through the pancreatic tissue. It leads from the gallbladder to the duodenum, flowing through the main lumen into the main duct of the gland. As a result, alkalis, enzymes and bile enter the intestines not separately, but in a ready-made "mixture".

Inside the tissues of the gland, cells of different types are also located in groups. They are called islets, and they do not synthesize alkaline but insulin, a hormone responsible for absorbing carbohydrates from food. Abnormalities in the growth, functioning or degradation of such cells (usually genetic) are one of the scenarios of diabetes mellitus. The second is to increase the resistance of cells in the body to the normal insulin they produce.

Cause of disease

In the acute stage, pancreatitis leads to obstruction of the small ducts of the gland through which pancreatic juice flows into the main duodenum and then into the lumen of the duodenum. Has its "self-dissolving" effect thanks to the enzymes that accumulate inside. Acute pancreatitis can be caused by the following.

• Gallstones. They arise due to inflammatory pathologies of the liver or gallbladder, abnormalities in the composition of bile (they are caused by sepsis, taking drugs for atherosclerosis, diabetes, similar liver diseases).
• Infection. Viruses (mumps, hepatitis, etc. ) or parasites (helminths). The causative agent affects the cells of the gland, swelling the tissue and disrupting its function.
• Medicines. Toxic effects of anti-atherosclerotic drugs, steroid drugs and some antibiotics.
• Deviation in structure or position. They can be congenital (bending of the gallbladder, ducts too narrow, etc. ) or acquired (scarring after surgery or trauma examination, swelling).

Chronic pancreatitis can often be observed in alcoholics and "experienced" diabetics of at least five years. Here, autoimmune processes in the gland, causing inflammation or taking diabetes medications, are at issue. But it can also be accompanied by the following diseases.

• Intestinal disease. Especially the duodenum, including duodenitis (inflammation of its walls) and erosion.
• Vascular diseases. All glands must be actively supplied with blood. Birth defects and clotting disorders (hemophilia, thrombosis) play a special role here.
• Injured. The piercing wounds, the interventions, the 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 its own exit into the duodenum. Normally, it regulates the "partial" delivery of pancreatic juice and bile into its cavity, allowing it to almost stop between meals and increase sharply when a person sits down at a table. It also prevents the backflow of intestinal substances along with various pathogens (bacteria, foreign compounds, worms) into the cavity of the pancreas or gallbladder.

The sphincter of Oddi does not contract easily, like all smooth muscle "separators" of this type. For a long time, there was no such thing as a medical disorder. It is replaced by many syndromes of "biliary dyskinesia" and "cholecystectomy" (a complication of cholecystectomy). But in reality, his spasms are a rare occurrence that occurs only with the normal functioning of the nervous system. But he often passes with a neurological disorder or as a result of the activation of pain receptors - when he is stimulated by stones emerging from his 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 majority of cases turns to the second. And what "feeds" it after removing the causative factor is unclear. In some cases (about 30%), none of these processes could explain the occurrence of pancreatitis in the patient.

signal

Acute pancreatitis begins and is accompanied by unbearable (until loss of consciousness) pain in the entire upper abdomen, below the ribs. Antispasmodics, pain relievers and antibiotics do not get rid of it, and the usual "from the heart" drugs do not help either. A special diet will not relieve the pain either - a doctor is needed here, not a diet. Often, though not always, its irradiation is noted upward, to the heart region, below the collarbone, to the thoracic spine, so that the patient may mistake the symptoms of pancreatitis for aheart attack or exacerbation of osteonecrosis. This is also facilitated by the body's cascade response to a stimulus of vital power:

• hypertension (hypertension and hypotension are equally likely);
• interruption of heart rate;
• faint;
• cold sweat.

A characteristic symptom of pancreatitis is loose - pasty stools, containing fragments of semi-digestible food and fats. It appears a few hours after the onset of the disease. By the end of the first day, the discoloration of stools with urine will become noticeable. Normally, they are yellow-brown in color by bilirubin from the bile, with the help of which digestion takes place. And due to the blockage of the duct, it does not enter the intestine. On the second or third day, the patient experiences bloating, "stuffiness" in the stomach, and vomiting at the sight of fatty or spicy foods.

Chronic pancreatitis also occurs with episodes of pain, but not too pronounced. They can increase an hour after eating, especially if it is not suitable - cold, fried, smoked, fatty, spicy, accompanied by alcohol. Pain is aggravated when lying on the back, digestive disturbances lead to dyspepsia (when mostly unchanged food passes out instead of stool).

One of the most famous victims of acute pancreatitis (many experts point to the possibility of gastric perforation) was Princess Henrietta of England, wife of Duke Philippe of Orleans, brother of Sun King Louis XIV. Because of the typically painful course of the disease, she was certain that one of her husband's favorite items had poisoned her. True, it turned out that only during the autopsy, designed to confirm or dispel this rumor.

Effect

Acute pancreatitis is dangerous by the rapid "eating" (two or three days) of pancreatic tissue, so that caustic alkalis, bile and digestive enzymes enter directly through this "fissure" into the abdominal cavity. This scenario ends with diffuse peritonitis (inflammation of the peritoneum, which rapidly spreads to the abdominal organs), multiple erosions, and death.

Peritonitis is characteristic of many pathologies, including perforated ulcers, gastric or intestinal cancer, and appendicitis, if it is accompanied by a breakthrough of an abscess (due to such a scenario, magician Harry Houdini). dead). If acute pancreatitis is not caused by a mechanical obstruction (spasm of the sphincter of Oddi, stones, scarring, tumor, etc. ) but by infection, a purulent pancreatic abscess may develop. His untimely treatment also ended with a breakthrough into the abdominal cavity.

The enzymes and digestive juices of the pancreas sometimes cause enzymatic pleurisy - pleurisy of the same type as in the case of the peritoneum. For chronic pancreatitis, complications delayed in time are typical, but more serious disrupt the work of it and other organs.

• Cholecystitis. And cholangitis is an inflammation of the liver ducts. They themselves can cause pancreatitis due to accompanying gallstones, but they usually form in the opposite order - as a result of it.
• Gastritis. The stomach is not as closely connected to the pancreas as the liver, although it is located directly below it. Inflammation in pancreatitis occurs not so much because foreign substances enter its cavity from the inflamed gland, but because of the constant deterioration of intestinal digestion, which it is forced to compensate. The pancreatitis diet is designed to reduce the load on all the digestive organs, but the "benefits" of a healthy stomach are considered less carefully. The more pronounced the deterioration of the pancreas, the higher the risk of gastritis.
• reactive hepatitis. It also develops in response to persistent stagnation of bile and irritation of the hepatic ducts. Sometimes cholestasis occurs during subsequent exacerbations of pancreatitis accompanied by jaundice. That is why the diet of people with pancreatitis should not include foods that should enhance the breakdown of bile. Including fatty meat and fish, fried, spicy, caviar, other animal by-products, smoked meat, alcoholic beverages - digestive stimulants.
• Cysts and pseudocysts. Benign tumors or stagnations of pancreatic juice mimic them arise because of similar difficulties in getting it into the duodenal cavity. Cysts tend to become inflamed and swollen periodically.
• Pancreatic Cancer. Any chronic inflammation is considered a carcinogen, since it causes irritation, rapid destruction of affected tissues and increased reactive development of them. And the quality is not always good. The same is true for chronic pancreatitis.
• Diabetes. It is not the first complication "in the line" of chronic pancreatitis. But the faster and more pronounced the entire gland degrades, the harder it is for the surviving islet cells to compensate for the insulin deficiency that occurs due to the death of their "colleagues" in the dead regions. They are exhausted and also begin to die. The prospect of a cure from diabetes at seven to ten years (often even more rapidly, depending on the prognosis and characteristics of the pancreatitis process) "experienced" for the normal patient becomes increasingly tangible. Because of its threat, an ideal pancreatitis diet should include a reduction in the content of not only fats but also simple carbohydrates.

Recurrent chronic inflammation in the tissues of the gland causes scarring and loss of function. The gradual deterioration of intestinal digestion is inevitable. But in general, you can live with pancreatitis for another 10 to 20 years. A patient's prognosis for course, quality, and life expectancy is influenced by a variety of "deviations" from their diet and type, especially in everything alcoholic beverages are involved.

diet therapy

The acute phase of the disease often requires urgent detoxification, the appointment of antibiotics (usually broad-spectrum, because there is no time to identify the 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). Once completed, the basis of treatment should be a special medical diet.

Basically, gastroenterologists often apply the number 5 diet, developed by Manuil Pevzner in the Soviet era for patients with cholecystitis and other pathologies that interfere with the synthesisand the flow of bile. But later the author himself changed it by creating the 5p diet.

General regulations

For adult patients with mild disease, a non-mechanical variant of the 5p table is appropriate - which does not require grinding the food to a homogeneous mass. And children's menus are often made from mashed products. Diet during the acute phase of chronic pancreatitis (especially during the first three days of onset) and in the acute phase, when it occurs for the first time, there are some general rules that must be followed. .

• Simplicity. Recipes should be as simple as possible - do not stuff brisket and meat salad, even if all the ingredients in their preparation are "fit" for the diet.
• Totally hungry for the first few days. With an exacerbation of the pathology, hunger is prescribed. That is, only drinking warm alkaline water and intravenous maintenance (vitamins, glucose, sodium chloride).
• Only stew and boil (waterproof, 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 cholangitis or cholecystitis. Vegetable and animal fats with it must be equally strictly limited, since the same agent, bile, will break them down. They can be consumed no more than 10 g per day, but in any proportion.
• Unseasoned. Especially spicy and hot.
• No seeds. Seeds are also prohibited. These foods contain a lot of vegetable oils and are difficult to eat even in powder form.
• Salt to taste. Its consumption does not affect the pathological process in any way, the daily salt intake remains the same as in healthy people - up to 10 g per day.
• Low fiber. This ingredient, often appreciated by nutritionists and those with digestive issues, is strictly limited for use in pancreatitis. The secret of its "miracle" effect on the intestinal tract is that fiber is not digested, absorbed and stimulates different parts of the intestine, stimulating peristalsis and water excretion. Fiber helps with stool formation, as it is excreted unchanged. When the pancreas is inflamed, all these properties of fibers will only make the situation worse. You can eat only carrots, zucchini, potatoes, pumpkins, rich in starch and pulp but relatively poor in sclerosis. White and red cabbage is prohibited, but cauliflower can be eaten (except inflorescences, branches and stalks).
• Small portions. As before, three times a day with a total weight of half a kilogram or more, with pancreatic pathology 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.
• Prohibit soda, coffee, alcohol and kvass. These drinks are best excluded from the diet for good. But if during the period of remission they are not carried away, then during the exacerbation they are strictly forbidden.

Sour vegetables (for example, tomatoes), as well as all berries and fruits, are also prohibited. They will further stimulate bile secretion. Diet should be focused on non-acidic and low-fat dairy products, shrimp, eggs (every day, do not eat raw or fried). Pureed grains are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.

Example menu

Diet for people with pancreatitis needs to have enough protein and carbohydrates. But "brute force" with the latter is best avoided by limiting sugar and honey to drinks and dishes. Buckwheat, a favorite cereal of diabetics, should be included in the diet more often, as it includes complex carbohydrates. Sugar can be replaced with diabetes drugs - fructose, xylitol and sorbitol (when added to hot dishes, they create an unpleasant aftertaste), aspartame. Diet during an exacerbation or primary inflammation of the declining pancreas may look like this.

Monday

• First breakfast. Shredded boiled chicken breast. Crushed rice.
• Lunch. Steamed fish cake.
• Dinner. Rice soup in chicken broth diluted by half with water. Milk jelly.
• afternoon tea. Omelet from two eggs.
• First dinner. Chicken meatballs (ground meat with rice). Pureed buckwheat with a spoonful of dessert butter.
• Second dinner. Lean, non-acidic cottage cheese, ground in a blender with a teaspoon of sour cream.

Tuesday

• First breakfast. Oatmeal. Boiled Cauliflower.
• Lunch. Lean beef pate with butter. Milk tea and some white bread crumbs soaked in it.
• Dinner. Fish soup cooked from lean fish with rice and water. Milk or fruit jelly without fruit.
• afternoon tea. Cheese pasta with lean sour cream.
• First dinner. Steamed turkey breast soufflé. Pureed liquid buckwheat.
• Second dinner. Puree boiled shrimp with boiled rice.

Wednesday

• First breakfast. Fish balls with rice (grinding rice together with fish). Puree boiled carrots.
• Lunch. Two tablespoons low-fat grated cheese.
• Dinner. The soup is made with finely ground oatmeal, diluted chicken broth, and shredded breast. Frozen pasta with sour cream.
• afternoon tea. Some boiled cauliflower.
• First dinner. Mashed pasta with cheese. Steam omelette from two eggs.
• Second dinner. Pumpkin porridge. Tea with some white rice cake soaked in it.

Thursday

• First breakfast. Minced zucchini. Steamed chicken cutlet.
• Lunch. Two tablespoons low-fat grated cheese.
• Dinner. Butter cream potato soup. Minced lean beef.
• afternoon tea. Turkey breast.
• First dinner. Crushed buckwheat. Lean fish soufflé.
• Second dinner. Carrot - pumpkin porridge.

Friday

• First breakfast. Frozen pasta with sour cream. Minced zucchini. Chicken meatballs (ground rice, minced meat).
• Lunch. Mashed potatoes with butter.
• Dinner. Milk soup with pasta. Omelette from two steamed eggs with grated cheese.
• afternoon tea. Some cauliflower. Rice cake.
• First dinner. Minced shrimp with sour cream sauce. Finely ground buckwheat flour. White tea.
• Second dinner. Pureed carrots. Milk or fruit jelly without fruit.

Saturday

• First breakfast. Pumpkin porridge. Lean beef soufflé.
• Lunch. Fish ball.
• Dinner. Rice soup with weak chicken broth 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 crackers

Sunday

• First breakfast. Spaghetti with sour cream sauce. Olet.
• Lunch. Zucchini under the cheese mantle. Milk tea and white cookies
• Dinner. Buckwheat soup on beef broth diluted with ground beef. Steamed turkey breast soufflé.
• afternoon tea. Crushed oat flour.
• First dinner. Mashed potato. Chicken fat.
• Second dinner. Milk rice pudding.

The diet for pancreatitis should exclude from the diet all confectionery and pastries, including chocolate and cocoa. You need to limit your intake of fats, food acids and fiber. Also, do not eat fresh bread. Under the ban, wheat, corn. It is not possible to grind these grains even with a blender. All legumes, including soybeans, are also being phased out. They are rich in vegetable protein, which is valued by vegetarians. But they are also guilty of increasing gas production, increasing stomach acid, which is very undesirable in the acute phase.