The pancreas is an important digestive organ in the body with endocrine and exocrine functions. Pancreatic juice is the most important digestive fluid. There are many enzymes involved in the digestion of proteins, fats and sugars, which are indispensable substances for food digestion. The pancreatic lipase, which digests fat, is unique to the pancreas, and once the pancreas is diseased, the first thing that happens is that fat digestion is impaired. If the pancreatic islets are damaged, the secretion of insulin will be reduced, which may contribute to the development of diabetes. Pancreatitis is characterized by edema of the pancreas and surrounding tissues, cellular fluid exudation and fat necrosis. The etiology of acute and chronic pancreatitis is unknown, and factors may include chronic alcohol abuse, bile duct disease, gallstones, certain medications, trauma, hypertriglyceridemia, and certain infections such as viral infections. In Western societies, alcohol is the main cause of chronic pancreatitis, and gallstones are the most common cause of acute pancreatitis.
Pancreatitis occurs mostly due to trauma, bile duct infection, metabolic disorders, gallstone disease, tumors, heavy alcohol abuse, and overeating. These factors strongly stimulate the pancreas to over-secrete pancreatic juice, and at the same time cause obstruction of the pancreatic duct, increased internal pressure, rupture of the pancreatic vesicles, leakage and reflux of pancreatic juice, resulting in self-digestion of the pancreatic tissue, edema, congestion, hemorrhage, necrosis and other lesions of the pancreas and surrounding tissues. Pancreatitis can be divided into 2 types: acute and chronic. Acute pancreatitis is characterized by sudden onset of severe and persistent pain in the upper middle abdomen, which may involve the left waist, left back and left shoulder; if the condition continues to deteriorate and the pancreas becomes hemorrhagic and necrotic, it may produce symptoms of peritoneal irritation such as abdominal distension, abdominal wall tension, total abdominal pressure and rebound pain, and even critical manifestations such as ascites, hyperthermia and shock. Acute hemorrhagic necrotizing pancreatitis is a dangerous condition with poor prognosis and high mortality; acute pancreatitis can be transformed into chronic with repeated attacks. Chronic pancreatitis is mainly manifested as intermittent episodes, which can have symptoms such as abdominal pain, indigestion, and steatorrhea, making various nutrients malabsorption, prone to multiple nutrient deficiencies, and the pancreatic function can be reduced over time.
Principles of nutritional treatment
Dietary carelessness is an important cause of pancreatitis attacks, so dietary treatment is very important for the prevention and treatment of pancreatitis. Patients with pancreatitis have metabolic disorders caused by reduced pancreatic secretion, and the diet must avoid excessive fat and stimulating foods in order to facilitate the rest of the pancreas, relieve pain, avoid further attacks, and promote the repair of damaged pancreatic tissue. Pain due to pancreatitis is partly related to pancreatic enzymes and bile secretion, and nutritional regulation should minimize the stimulation of these enzymes.
Acute pancreatitis
1. In the acute phase, the fasting system should be strictly enforced at the beginning of the acute attack in order to inhibit the secretion of pancreatic juice, reduce the burden on the pancreas and avoid aggravation of pancreatic injury. Usually not less than 3 days, do not eat too early.
2. During the recovery period, after the condition is relieved and the symptoms basically disappear, fat-free and high-sugar fluids such as juice, jelly, lotus root powder, rice soup, vegetable juice, protein water, mung bean soup and other foods can be given. Foods such as thick chicken soup, thick fish soup, broth, milk, soy milk and egg yolk are prohibited. This period dietary nutrient imbalance, low energy and various nutrient content, should not be used for a long time.
3, dietary contraindications, after the condition is gradually stabilized, the amount of diet can be increased and changed to low-fat semi-liquid. Protein should not be too much, and supply sufficient sugar. Forbid to eat fatty and stimulating food, such as chili, coffee, strong tea, etc. Absolutely forbid to drink.
4, replenish electrolytes, electrolyte disorders often occur after fasting, such as potassium, magnesium, sodium, calcium and other minerals are prone to decline, the diet should be combined with clinical electrolyte changes in a timely manner to supplement.
5.Small amount of multiple meals, 5-6 meals per day, each meal to give 1 to 2 kinds of food. Pay attention to the use of soft and easily digestible food. Do not overeat.
6, cooking methods, preferably using the method of burning, boiling, braising, brining, boiling, etc., prohibit frying, deep-frying, cooking, baking and other methods. Do not use or use less vegetable oil when cooking. The total amount of fat for the whole day is 20 to 30g.
Chronic pancreatitis
The nutritional treatment of chronic pancreatitis is basically the same as that of acute pancreatitis, during the acute attack, fasting; when the disease is in remission, high sugar, low-fat, less residue semi-fluid diet can be given.
1, fat, limit the amount of fat, the condition is improving can be increased to 40-50g / d. If necessary, can be supplemented with medium-chain triacylglycerol, instead of some dietary fat.
2.Protein, supply 50～70g of protein per day, pay attention to the use of foods containing less fat and high biomass protein, such as egg white, chicken, shrimp, fish, tofu, beef lean meat and other foods.
3, sugar, because the energy required by sugar supplementation is the main, can supply more than 300g per day. Cereals, cane sugar, brown sugar, honey and other foods can be used.
4, cholesterol, chronic pancreatitis is mostly accompanied by biliary disease or pancreatic arteriosclerosis, cholesterol supply <300mg/d is appropriate.
5, vitamins, should be supplied adequately, more use of food rich in B vitamins, vitamin A, vitamin C. Especially vitamin C should be supplied 300mg/d. In particular, vitamin C should be supplied more than 300mg per day, and if necessary, tablets should be given orally.
6, food selection, the principle of food selection is rich in nutrition, easy to digest, less irritating. High protein, high sugar, low-fat diet, such as soy milk, soy products, skim milk, fish, pork liver, chicken, lean pork, lean beef, egg whites and other foods. Vegetables can be used such as potatoes, spinach, carrots, cowpeas, lettuce, coronary, bitter vegetables, etc.; orange juice and other juices are also suitable for consumption. Avoid foods with chemical and mechanical stimulation, and limit MSG to 6g/d or less. Forbid the use of foods containing a lot of fat, such as fried foods. Use a small number of meals and avoid overeating.
7, eat less and more meals, it is advisable to eat less and more meals, 4 to 5 meals per day is appropriate. Cooking and processing should make the dishes light, fine, soft, without cooking oil, can take steam, boil, braise, boil, burn, stew and other methods. More fancy varieties should be changed to promote patients’ appetite. Fat-rich meat, dried fruits, oil nuts, soy, fried foods and crispy snacks are forbidden to eat. Avoid all alcohol and spicy and other stimulating foods and spices.
8.Drinking alcohol is strictly prohibited.