Diet for pancreatitis: nutritional features, allowed and prohibited foods

For a long time it was believed that alcohol consumption causes pancreatitis. This misconception was created because it was first discovered and described using the example of people suffering from alcoholism. But now it is already knownThat its most dangerous, acute phase is almost never found in them - this is the "privilege" of people with a healthy attitude to strong drinks.

Pancreatitis can be a consequence 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, the metabolic systemcondition and sometimes life-threatening of the patient. Nutrition for pancreatitis is made mainly on the basis of protein (protein is 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 alkaloid with enzymes that dissolve in it (or rather, their inactive precursors). Pancreatic juice forms the digestive environment of the intestine. The bacteria living in its various departments play an important but helpful role.

The main biliary tract also runs through the pancreatic tissue. It leads from the gallbladder to the duodenum, which, upon exit from its lumen, flows into the gland's main duct itself. As a result, alkali, enzymes and bile are not separately, Rather enter the intestine in the form of a ready "mixture".

Inside the glandular tissue, a different type of cells are also located in clusters. They are called islets, and they do not synthesize alkali, but insulin, a hormone responsible for the absorption of carbohydrates from food. Anomalies in the growth, functioning or degradation of such cells (usually they are hereditary) are one of the scenarios of diabetes mellitus. The second is the increased resistance of the body's cells to the normal insulin they produce.

due to disease

In the acute phase, 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. It has the effect of "self-digestion" by enzymes accumulated inside. Acute pancreatitisMay be due to the following reasons.

• Gallstones. They arise due to inflammatory pathologies of the liver or gallbladder, anomalies in the composition of bile (they are caused by sepsis, atherosclerosis, diabetes mellitus, taking drugs for similar liver diseases).
• Infection. viral (mumps, hepatitis, etc. ) or parasitic (helminthiasis). The causative agent affects the cells of the gland, causes inflammation of the tissues and disrupts its function.
• Medicines. Toxic effect of drugs for atherosclerosis, steroid drugs and some antibiotics.
• Deviations in structure or location. They can be congenital (bending of the gallbladder, too narrow ducts, etc. ) or acquired (lesions, swelling after surgery or traumatic examination).

Chronic pancreatitis can often be seen in alcoholics and diabetics "with at least five years of experience". Here, the autoimmune process in the gland, which causes inflammation or the intake of antidiabetic drugs, matters. May also occur with the following diseases.

• Pathology of the intestines. Especially the duodenum, including duodenitis (inflammation of its walls) and erosions.
• Vascular diseases. All glands must be actively supplied with blood. Congenital anomalies and clotting disorders (hemophilia, thrombosis) play a special role here.
• Injuries. penetrating wounds, interference, strong blows to the abdomen.

The least common cause of pancreatitis is spasm of the sphincter of Oddi, which terminates in the common gallbladder and pancreatic duct. The sphincter of Oddi is located in the duodenum at its very exit. Normally, this is the pancreatic in its cavity. Regulates the "partial" supply of juice and bile, allowing it to almost stop between meals and grow rapidly when a person sits down at the table. It allows various pathogens (bacteria, foreign compounds, worms) also prevents the backflow of intestinal contents.

The sphincter of Oddi is not prone to spasm, like all smooth muscle "separators" of this type. For a long time, there was no such thing as a dysfunction of their own in medicine. syndrome" (a complication from the removal of the gallbladder). But in fact, his convulsions are a rarity with normal functioning of the nervous system. But he often accompanies neurological disorders or activation of pain receptorsAs a result, he gets hurt when he gets irritated by the stones coming out of the gallbladder.

The division of the causes of acute and chronic pancreatitis is conditional, since the first, even with high-quality treatment, in most cases passes into the second. And what it "feeds" after the elimination of the causal factors. Not clear. In some cases (about 30%), none of these procedures can explain the presence of pancreatitis in the patient.

Symptoms

Acute pancreatitis begins and is accompanied by unbearable (up to loss of consciousness) groin pain throughout the upper abdomen, below the ribs. Antispasmodics, painkillers and antibiotics do not make it go away, and even the usual drugs "by heart" do not helpA special diet will also not relieve the pain - a doctor is needed here, not diet. Usually, although not always, it is noted radiating upward, into the region of the heart, below the collarbone, to the thoracic spineDue to which patients can confuse the symptoms of pancreatitis with exacerbation of heart attack or osteochondrosis. This is also facilitated by the body's cascade reactions to stimulation of vital forces:

• jumps in blood pressure (hypertension and hypotension are equally likely);
• heart rate interruption;
• fainting;
• Cold, sticky sweat.

A characteristic symptom of pancreatitis is loose stools - tarry, consisting of pieces of semi-digested food and fat. It appears after a few hours from the onset of the disease. By the end of the first day, discoloration of feces with urine is notedThey are usually yellowish-brown in color by bilirubin from bile, which helps digestion. And due to blockage of the duct, it is unable to enter the intestine. On the second or third day, the patient has a stomach ache. Vomiting occurs when you see bloating, "sucking" in the stomach and fatty or spicy food.

Chronic pancreatitis is also accompanied by pain, but not so pronounced. They can intensify an hour after eating, especially if it was inappropriate - cold, fried, smoked, fatty, spicy, with alcohol. Pain in the supine positionIncreases, 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 possibility of perforation of a stomach ulcer) was Princess Henrietta of England, wife of Philip the Duke of Orleans, brother of the Sun King Louis XIV. The typical painful course of the diseaseBecause of this, she was sure that one of her husband's favorites had poisoned her. True, it turned out only during an autopsy, which was designed to confirm or dispel this rumor.

influence

Acute pancreatitis is dangerous by rapid (two or three days) "eating" of pancreatic tissue through and through, as a result of which caustic alkali, bile and digestive enzymes enter the abdominal cavity directly through this "fistula". This scenario ends with diffuse peritonitis (inflammation of the peritoneum, which quickly spreads to the abdominal organs), the appearance of multiple caries and death.

Peritonitis is characterized by a number of pathologies, including a perforated ulcer, cancer of the stomach or intestines, appendicitis if it was accompanied by breakthrough abscess (because of such a scenario, the magician Harry Houdini died). If pancreatitis was a mechanical obstruction. was provoked not by (spasm of the sphincter of Oddi, stone, scar, tumor, etc. ), but by an infection, a purulent pancreatic abscess can develop. His untimely treatment also ends with a breakthrough in the abdominal cavity.

The 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, complications of delay in time are typical, but more seriously its work and others. obstructs organs.

• Cholecystitis. And cholangitis is an inflammation of the hepatic 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 this.
• Gastritis. The stomach is not as closely associated with the pancreas as the liver, although it is located directly beneath it. Its inflammation in pancreatitis is not caused by foreign substances entering its cavity from the inflamed gland, but by intestinal digestion. Occurs due to constant insufficiency, which it is forced to make up for. Pancreatitis diets are designed to reduce the load on all digestive organs, but take into account less carefully the "interests" of a healthy stomachThe more pronounced the deterioration of the pancreas, the higher the risk of developing gastritis.
• Reactive hepatitis. It also develops in response to constant stagnation of bile and irritation of the hepatic ducts. Sometimes jaundice is accompanied by cholestasis that occurs during the next exacerbation of pancreatitis. That is why such foods in the pancreatitis dietShould not contain substances that require the separation of bile. These include fatty, fried, pickled 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 imitating them arise because of similar difficulties with its removal into the duodenal cavity. The cysts periodically become inflamed and suppurate.
• Pancreatic cancer. Any chronic inflammation is considered a carcinogenic factor, as it causes irritation, accelerated destruction of affected tissues and increased reactivity. And this is not always of good quality. The same for chronic pancreatitisThat's the truth.
• Diabetes. This is far from the first "in-line" complication of chronic pancreatitis. But the faster and more markedly the entire gland is depleted, the more likely it is for living islet cells to die of their "colleagues" in already dead areas. The more difficult it is to compensate for the insulin deficiency caused. They become depleted and even die. The likelihood of diabetes mellitus after seven to ten years (often even more severe, depending on the prognosis and characteristics of pancreatitis)The "experience" for the average patient is becoming more and more tangible. Because of its danger, the diet for pancreatitis should ideally take into account not only a low content of fats, but also simple carbohydrates.

Repeated inflammation of the glandular tissue results in scarring and reduced functionality. Progressive insufficiency of intestinal digestion is inevitable. But in general, you can live with pancreatitis for the next 10-20 yearsThe prognosis for the patient's course, quality and life expectancy is influenced by various "deviations" from diet and their type, especially in everything related to alcoholic beverages.

diet therapy

The acute phase of the disease often requires immediate detoxification, the appointment of antibiotics (usually a broad spectrum, as the type of pathogen does not have time to establish), and sometimes surgical intervention. This is necessary if the diseaseThe cause is a spasm of the sphincter of Oddi, a stone or some other obstruction (tumor) stuck in the duct. After its completion, the basis of treatment should be a special medical regimen.

As a basis, gastroenterologists usually take Diet No. 5, developed by Manuel Pevzner in Soviet times for patients with cholecystitis and other pathologies that impede the synthesis and outflow of bile. But later the author himself created Diet No. 5p. changed it.

general Provisions

For adult patients with a mild course of the disease, a variant of table number 5p without mechanical sparing is suitable - it does not require grinding food to a homogeneous mass. And the menu for children often consists of mashed products. There are several mandatory general rules for nutrition during the period of exacerbation of chronic pancreatitis (especially in the first three days before its onset) and in the acute phase, which occurred for the first time.

• Simplicity. Recipes should be as simple as possible - no stuffed breast and meat salad, even if all the ingredients in their composition "fit" into the diet individually.
• Full appetite in the first days. With exacerbation of the pathology, appetite is determined. That is, only a warm alkaline drink and maintenance intravenous injections (vitamins, glucose, sodium chloride).
• Boiling and boiling only (on water, steamed). Tables No. 5 and 5p do not contain other methods such as baking and frying.
• Minimal fat. Especially if the attack of cholangitis is accompanied by (or caused by) cholecystitis. Vegetable and animal fats with it should be strictly limited, as the same agent, bile, breaks them down. Their intake is 10 g per dayNot more than, but can be done in any proportion.
• No seasoning. Especially hot and spicy.
• No nuts. Seeds are also forbidden. These types of foods are rich in vegetable oil and are very difficult to eat even in powder form.
• Salt to taste. Its intake in no way affects the course of the pathology, the daily salt intake remains the same as in healthy individuals - up to 10 g per day.
• Low fiber. This ingredient, commonly valued by nutritionists and people with digestive problems, is strictly limited for use in inflammation of the pancreas. The secret of its "magic" effect on the intestines is that fiber is not digested, absorbedAnd irritates various sections of the intestine, stimulating peristalsis and excretion of water. Fiber helps to form stool, as it is excreted in unchanged form. With inflammation of the pancreas, all these properties of fibers only conditionYou can only eat carrots, zucchini, potatoes, pumpkin, which are rich in starch and pulp, but relatively poor in hard fiber fiber. White and red cabbage is prohibited, but cauliflower can be consumed(only inflorescences, twigs and stalks are excluded).
• Small portions. As before, three times a day in portions with a total weight of half a kilogram or more, with pancreatic pathology it is impossible. At least five meals a day should be eaten and all food eaten at onceThe total weight of the substances should not exceed 300 grams.
• Ban soda, coffee, alcohol and kvass. These beverages are forever excluded from the diet. But if they should not be simply given away during periods of remission, they are strictly prohibited during exacerbationsIs.

Sour 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 is on non-acidic and low-fat dairy products, shrimp, eggs (every other day, Raw or not fried). Pure cereals are used as a source of carbohydrates, mainly buckwheat, rice and oatmeal.

menu example

The diet menu for pancreatitis should contain enough proteins and carbohydrates. But "brute force" with the latter is best avoided by adding sugar, honey to drinks and dishes. A favorite cereal for diabetics, buckwheatCereal, should be included in the diet more often, as it contains complex carbohydrates. Sugar can be replaced by diabetes drugs - fructose, xylitol and sorbitol (when added to hot dishes, they give an unpleasant tasteare), aspartame. Diet during the period when acute or primary inflammation of the pancreas is already on the decline, may look like this.

monday

• First breakfast. Boiled chicken breast puree. Rice mashed.
• Dinner of the day. Steamed fish cakes.
• Dinner. Rice soup in chicken broth diluted in half with water. Milk jelly.
• Afternoon tea. Omelette from two eggs.
• First dinner. Chicken meatballs (grind meat with rice). Pure buckwheat with a spoonful of butter.
• Second dinner. Lean, non-acidic cottage cheese, crushed in a blender with a spoonful of sour cream.

Tuesday

• First breakfast. Oatmeal. Steamed cauliflower.
• Meal of the day. Lean beef pate with butter. Milk tea and some white bread crumbs soaked in it.
• Dinner. Fish soup made 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. Pure liquid buckwheat.
• Second dinner. Steamed shrimp puree with steamed rice.

Wednesday

• First breakfast. Fish meatballs with rice (grind rice with fish). Pure boiled carrots.
• Dinner of the day. Two tablespoons grated low-fat hard cheese.
• Dinner. Soup made from pureed oatmeal, diluted chicken broth and chopped breast. Curd pasta with sour cream.
• Afternoon tea. Several florets of steamed cauliflower.
• First dinner. Mashed pasta with cheese. Steam omelet from two eggs.
• Second dinner. Pumpkin porridge. Some white crackers soaked in tea.

Thursday

• First breakfast. Zucchini puree. Chicken steam cutlets.
• Dinner of the day. Two tablespoons grated low-fat hard cheese.
• Dinner. Creamy potato soup with butter. Lean beef puree.
• Afternoon Tea. Turkish Breast Soufflé.
• First dinner. Mashed buckwheat. Lean fish soufflé.
• Second dinner. Carrot-pumpkin porridge.

Friday

• First breakfast. Curd pasta with sour cream. Zucchini puree. Chicken meatballs (grate rice like meat).
• Dinner of the day. Mashed potatoes with butter.
• Dinner. Milk soup with mashed pasta. Omelette of two boiled eggs with grated cheese.
• Afternoon tea. Many cauliflower florets. Pudding.
• First dinner. Minced shrimp in sour cream sauce. Buckwheat puree. Tea with white crackers.
• Second dinner. Carrot puree. Milk or fruit jelly without fruit.

Saturday

• First breakfast. Pumpkin porridge. Lean beef soufflé.
• Dinner of the day. Fish meatballs.
• 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 potatoes.
• Second dinner. Pumpkin-carrot porridge. Tea with some white crackers

sunday

• First breakfast. Cheese pasta with sour cream. Omelette.
• Dinner. Zucchini under a cheese coat. Tea with milk and white crackers
• Dinner. Buckwheat soup on diluted beef broth with boiled beef puree. Steamed turkey breast soufflé.
• Afternoon tea. Oatmeal pure.
• 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 pastries, including chocolate and cocoa. You need to limit the intake of any fats, food acids and fiber. Also do not eat fresh bread. Under restrictionsMillet, Wheat, Maize. These grains cannot even be mashed with a blender. All legumes, including soybeans, are also being discarded. They are rich in vegetable proteins, for which they are valued by vegetarians. But theyThere are also "guilties" of increased gas formation, increased acidity of the stomach, which is highly undesirable in the acute period.