Diet in pancreatic pancreatitis
Diet in acute pancreatic pancreatitis:
Exacerbation of chronic recurrent pancreatitis in the vast majority of cases proceeds according to the type of acute or subacute pancreatitis.
In the early days, conservative treatment of patients has the features of emergency care. Liquid and carbohydrate food in the least stimulates pancreatic and gastric secretion, enteral nutrition begins with mucous soups, liquid mashed milk kashas, vegetable purees and fruit juice jelly.
With the expansion of the diet, the principle of gradualness is strictly observed, both in terms of increasing the volume and energy value of the diet, and with regard to the inclusion of certain dishes and food products. Finally, taking into account the pathogenetic mechanisms of acute pancreatitis, a diet for pancreatitis usually includes activities aimed at:
- suppression of pancreatic secretion (hunger, aspiration of acidic gastric contents, administration of antacids, anticholinergics, blockers of H2 receptors of histamine, etc.);
- elimination of obstacles to the outflow of pancreatic juice (antispasmodics, intravenous injection of novocain, sakrospinal neocaine blockades, etc.);
- neutralization of aggressive pancreatic enzymes trapped in the bloodstream (protease inhibitors, aminocaproic acid, etc.);
- decrease in the effects of intoxication (infusion of electrolyte solutions, 5% glucose solution, protein preparations, blood, etc., forced diuresis) and suppression of endogenous infection (antibiotics);
- carrying out analgesic and anti-shock therapy.
A mandatory and necessary component of complex treatment of patients with exacerbation of chronic pancreatitis is therapeutic nutrition. Initially, his tasks are reduced to the creation of functional dormancy of the pancreas and other organs of the proximal part of the digestive tract. To this end, the patient is prohibited from eating through the mouth. Providing the same body with the necessary food substances is carried out through parenteral nutrition. In the absence of vomiting and signs of gastro- and duodenostasis, 1-1,5 is allowed to be taken per day of alkaline mineral waters such as Borjomi (room temperature, without gas) and weak tea.
Against the background of ongoing therapy, as the general condition improves (usually on 2-3 day from the onset of exacerbation), it is possible to start the transfer of the patient first to a limited, and then to full enteral nutrition. At the same time, the basic principles of diet therapy for patients with chronic pancreatitis remain in force.
However, therapeutic nutrition in acute pancreatitis and exacerbation of chronic pancreatitis has a number of characteristics. Firstly, since negative effects are possible on the course of the disease of prolonged malnutrition, the transfer of patients to a full-fledged diet should be carried out as soon as possible, especially in the protein part of the diet, since a sufficient amount of protein is necessary to ensure the synthesis of inhibitors of pancreatic enzymes .
In this situation, as well as to reduce the load on the digestive system, it is advisable to use special products for enteral nutrition, replacing one or several meals.
Usually, through 1-2 weeks, the patient can already be prescribed a diet with mechanical and chemical shudders, which he must observe throughout the period of transition of the disease to the stage of persistent clinical remission (usually during 4-6 weeks or more).
Thus, the basis for diet therapy in patients with acute and chronic pancreatitis during the exacerbation is the following principles:
- hunger and parenteral nutrition in the period of pronounced clinical and metabolic signs of the autolytic process in the pancreas;
- transition to a full-fledged diet as soon as possible, especially for the protein quota;
- gradual inclusion of food and food in the diet when the diet is expanding;
- a gradual increase in the amount of food administered and the energy value of the diet when the diet is expanded;
- maximum mechanical and chemical shading of the pancreas and other organs of the proximal GI tract.
Patients are recommended mucous soups from different cereals (oat, rice, semolina, pearl, buckwheat, etc., except for millet) on water or a weak vegetable broth, soup cream from boiled meat; dishes from lean beef, chicken, turkey, rabbit and low-fat varieties of fish – in chopped form, steamed; milk only in dishes, curd freshly prepared, protein steam omelettes; puree from potatoes, carrots, cauliflower; rubbed unsweetened compotes, jelly, jelly, apples in a baked form (excluding Antonovskie), weak tea, Borjomi. All dishes are prepared without salt.
Diet in chronic pancreatic pancreatitis:
The main requirements for a diet for patients with chronic pancreatitis are:
- chemical sparing of the stomach and organs of the hepatopancreatoduodenal system;
- Exclusion from the diet of products that have a pronounced stimulating effect on gastric and pancreatic secretion, which have an irritant effect on the mucous membranes and receptor apparatus of the gastrointestinal tract, and also negatively affect the parenchyma of the pancreas and liver;
- mechanical shaking of the stomach and organs of the pancreatoduodenal system is necessary for acute pancreatitis or exacerbation of chronic pancreatitis; in the phase of persistent remission and in the absence of contraindications to the use of unprocessed food, strict observance of this principle is not necessary;
- fractional meals: frequent meals (5-6 once a day) in small portions;
- inclusion in the diet of a somewhat increased (against the physiological norm) amount of protein – 110-120 g per day, of which 60% should be proteins of animal origin. In increased quantities, products rich in lipotropic factors and proteins easily exposed to enzyme systems (cottage cheese, lean meats, fish, egg white, etc.) are introduced;
- restriction of fat in the diet to 60-70 g per day in the acute period of the disease due to the exclusion of free fat (cream, vegetable oil); the amount of fat should be evenly distributed throughout the day;
- restriction in the diet of the quota of simple carbohydrates (30 g of sugar in the pantry), the dishes are prepared without sugar;
- restriction in the diet of table salt (up to 3-5 g per day).
List of recommended products and dishes
- Bread and bakery products. Wheat bread, baking of the previous day or dried, 200-300 g per day, and also in the form of biscuits.
- Soups. Vegetarian vegetables (except cabbage), cereals (semolina, rice, oats, etc., except for millet), with pasta and other pasta, half a plate (250 ml), wiped.
- Meat and poultry dishes. Low-fat varieties of beef, veal, chicken, turkey, rabbit. Meat, free from tendons and fat, in a boiled or steamy form. More often in the form of cutlets, dumplings, meatballs, soufflé, rolls, beef stroganoff, puree, occasionally a piece.
- Dishes from fish. Low-fat fish in boiled or steam form. More often in the form of soufflé, cutlets, dumplings, meatballs, less often a piece.
- Dishes from eggs. Only in the form of a protein omelet.
- Dishes from milk. Curd is non-acidic, better freshly prepared, in-kind or in the form of steam puddings. Kefir is non-acidic, low-fat.
- Fats. The total amount of fat in the diet should not exceed 80. It should not be forgotten that 40 g of animal fat is contained in foods included in the diet.
- Dishes and side dishes from vegetables. Potatoes, carrots, beets, cauliflower, zucchini, pumpkin, green peas cooked, mashed, in the form of mashed potatoes and steam puddings.
- Dishes and side dishes from cereals and pasta. Manna, buckwheat, oatmeal, pearl barley, rice in the form of semi-liquid cereals (with the addition of milk) and in the form of a garnish. Macaroni, homemade noodles, vermicelli. Porridge is often semi-liquid.
- Fruits and berries. Only sweet varieties, apples in a baked form, without sugar.
- Dessert. Kissels, mashed potatoes, jellies, mousses without sugar.
- Beverages. Unsuccessful tea (sugar from the daily norm), alkaline mineral waters such as Borjomi (room temperature, without gas).
- Sauces. Dairy, not strong on vegetable broth, fruit and berry gravies (flour for sauces does not passer with oil).
Prohibited: meat, fish and strong vegetarian broths (especially mushrooms), fatty meat, poultry and fish, fried foods, smoked meats, hot snacks, canned food, sausages, pastry, pies, black bread, ice cream, alcoholic beverages, lard, beef and mutton fat, white cabbage, turnip, radish, rutabaga, spinach, sorrel, radish, cranberries, pickles, marinades, spices, strong coffee, cocoa, chocolate.
Expansion of the diet should be carried out only within the range of dishes recommended for patients with chronic pancreatitis, with the expansion of the diet strictly adhere to the principle of gradualness both with regard to the inclusion of new dishes and food products, and with regard to increasing their volume.
Even with a significant improvement in the state should not be allowed to violate the composition of the diet and diet.