At the heart of the pancreas disease is an inflammatory process with degenerative changes in the parenchyma of the organ that, when acute pancreatitis can lead to pancreatic necrosis, and with a chronic, often recurrent form – to development fibrosis of the parenchyma and sclerosing the gland tissue. This disrupts the digestive function of the gland (mainly proteins), and then intrasecretory, in which the insular apparatus is involved in the pathological process, which is manifested by a violation of carbohydrate metabolism and development hyperglycemia, glucosuria.
Diet with pancreatic disease, basic principles
Diet in pancreatic disease, first of all, should be aimed at reducing the pain syndrome, reducing the secretory function of the pancreas, reducing hyperfermentemia, restoration of disturbed processes metabolism. To the basic principles of diet therapy for patients with acute / chronic pancreatitis in the acute stage are:
- hunger and parenteral nutrition with expressed metabolic and clinical signs of the presence in the pancreas of the autolytic process;
- transfer of the patient as soon as possible to adequate nutrition (especially regarding the protein norm);
- gradual expansion of the diet by including new foods and dishes in the diet;
- gradual increase in the caloric content of the diet and the amount of diets during the expansion of the diet;
- ensuring maximum shaking of the pancreas and digestive tract organs from adverse factors of influence.
Along with the observance of bed rest and medication for the purpose of reducing the secretion of gastric and pancreatic enzymes to a patient with acute / chronic pancreatitis, 2-3 daily fasting is prescribed in the acute stage. During this period it is allowed to use non-carbonated mineral water of Borjomi at room temperature, fractional in 250 ml 4-5 times – a total of 1-1,5 l / day and decoction of dogrose (1-2 glass).
Since 3-th day with a mild course of pancreatitis, patients are prescribed a diet. The low-calorie diet (1500-1800 Kcal: 60-80 g protein (25 g protein of animal origin), 50-60 g fat, 200-300 g carbohydrates), the most sparing, day diet includes products that provide a physiological protein norm with a severe restriction in the diet of fats and digestible carbohydrates.
Refractory fats and simple carbohydrates (honey, sugar, confectionery, jam) are limited. Excluded are dishes that stimulate the secretion of pancreatic juice and contain a lot of fiber.
The menu includes semi-viscous, liquid and semi-liquid dishes; 50 g of white breadcrumbs; 5-6 g table salt: these are cereal soups on a weak vegetable broth or water (mucous or thoroughly wiped), soup cream from well-boiled meat; steam cutlets, soufflé, knels; chicken eggs, cooked soft-boiled, protein omelet (1-2 per week); steam pudding from fresh cottage cheese; puddings / mashed potatoes from vegetables, steamed (cauliflower, zucchini, potatoes, carrots), mashed porridge on water, jelly, jelly, mashed potatoes from fresh / dry fruits, mousse on aspartame, fructose, not strong tea, broth of a dogrose; add butter to the ready meals.
It is prohibited to introduce other foods and dishes into the diet. Drinking regime for patients – 2 l / day free fluid. Nutrition for the disease PZD fractional (6-8 times / day), the volume of food intake in one portion is not more than 300
After 5-10 days, when the exacerbation of the patient subsides, the patient is transferred to a non-eroded (second) version 5P Diet, which the patient must observe throughout the period of the disease and transition to the stage of persistent clinical remission (3-12 months). Its goal is to prevent recurrences and progression of pancreatitis, to correct the arising nutritional disorders.
At the heart of the diet during the period of aggravation of the exacerbation and the stage of remission in chronic pancreatitis, increased protein intake in the diet (110-120 g / day, 60% – animal proteins) with a sharp restriction of fats to 60-70 g / day (20% vegetable ), and in some cases (with pronounced steatorrhea) to 30-50 g / day and restriction of carbohydrates to 300 g / day, predominantly mono- and disaccharides, and in cases when the diabetes they are completely excluded.
Also, it is strictly forbidden to include in the diet products that stimulate the secretion of digestive juices and are rich in extractives. It is important to add to the diet of such patients fat-soluble vitamins and enzyme preparations. The amount of table salt is reduced to 6-8 g / day. The power of this option Diets – 2500-2700 Kcal.
The menu and the set of products in the second version of the diet is expanded. The diet includes dried wheat bread or breadcrumbs up to 200-300 g per day. Vegetables are allowed except for cabbage and cereal soups (except for millet), also with the addition of vermicelli. Outside the period of exacerbation, you can add a little sour cream or butter. Meat dishes are prepared from low-fat varieties of meat or poultry in boiled form (meatballs, cutlets, knels, rolls, mashed potatoes), fish dishes from low-fat river fish with a piece or in steam, boiled, chopped form; chicken eggs only in the form of a protein omelet; From fats it is allowed to use vegetable oils (olive, sunflower) and unsalted butter.
Dairy products are presented in the diet in the form of homemade non-acidic cottage cheese, neostroygo cheese, sour-milk products. As a vegetable and food from them, the diet includes potatoes, beets, carrots, zucchini, pumpkin. Unsweetened baked apples, compotes, jelly, jelly are allowed. xilithia, weak tea, a decoction of wheat bran and dog rose.
Diet treatment with symptoms of severe insufficiency of the exocrine function of the pancreas (syndrome of impaired absorption and digestion, steatorry) it is advisable to diversify using specialized products for dietary nutrition – puree and homogenized products made of veal, beef, chicken meat, beef tongues, vegetables and fruits.
After operations on the pancreas (especially often with a cyst, which is a tumor – a capsule with liquid contents), the passage of the contents through the intestine is disrupted, which contributes to the development dysbiosis и constipation. Symptoms of malabsorption are often absent. In such cases, the basic Diet 5 for the pancreas is modified. In the diet increases the content of vegetables and unsweetened fruits, reduces the amount of easily digestible carbohydrates to avoid fermentation and flatulence.
RџSЂRё lipomatosis pancreas (fatty degeneration) dietary nutrition corresponds to the second option Table No. 5 on Pevzner. Diet in case of exacerbation and worsening of the condition of the patient in remission – the first option 5P Table. In this case, the food during exacerbation should start again from the fasting period.
When problems arise in patients with chronic pancreatitis, clinical signs of development diabetes diet therapy is adjusted taking into account the disturbed carbohydrate metabolism, approaching as much as possible to the physiological norm of nutrition. In such cases, Diet , which excludes in the diet:
- purines (extractive nitrogenous substances);
- products that promote swelling and fermentation processes in the intestine (cabbage, legumes);
- products formed during frying;
- products rich in lipotropic substances and calcium;
- products containing many essential oils and irritating the mucous membrane of the digestive tract (pepper, onions, garlic);
- salt – up to 6 g per day.
The diet includes products containing complex carbohydrates: bread, cereals (excluding manna and rice); fruits, berries and vegetables that contain less than 5 g of carbohydrates in 100 g of products (cucumbers, zucchini, cauliflower) and are limited to vegetables / fruits containing 5-10 g carbohydrates per 100 g of product (beet, carrots, oranges, mandarins). The ability of any products to raise blood glucose levels is characterized by glycemic index. And the index is lower, so this product is more suitable for the patient.
In the diet of patients with pancreatitis include dried bread, biscuits and white wheat rusks in the total volume of 200-300 g / day, mashed or slimy cereal / vegetable soups with vermicelli, noodles with butter or sour cream. Be sure to include lean meat (rabbit, lean young lamb, beef), boiled or cooked steamed poultry (chicken, turkey), rabbit – steam, boiled or baked (mashed potatoes, patties, knels, souffle, rolls).
During the period of remission, low-fat meat, rabbit, chicken is allowed to be served in a boiled form with a piece. Fish dishes are prepared from low-fat varieties of fish (cod, pike, ice, perch, pike perch, carp) in boiled form, chopped or chunk. Chicken eggs are included in the diet in the form of soft-boiled eggs or a steam omelet (up to 2 eggs per day).
It is important to include in the diet dairy dishes and especially non-acidic cottage cheese (preferably home-made), as well as dishes based on it – puddings, casseroles. As garnishes in the diet should be present porridge from various cereals and pasta viscous or in a grated condition, vermicelli, homemade noodles, pasta, which are prepared with the addition of milk in the ratio (1: 1) or on water.
For vegetable garnishes recommended beets, carrots, cauliflower, young beans, pumpkin in boiled, baked or wiped. Fats are predominantly unsalted butter and vegetable refined oils, which are added directly to the prepared meals. From sweet dishes in the diet include compotes of pureed fresh and dried fruit, jelly, kissel, mousse of juice on sorbitol or xylitol. As drinks, mineral non-carbonated water, broth of wild rose, unsweetened fruit juices, weak tea with lemon.