What diet to adopt in case of acute pancreatitis?

Acute pancreatitis is caused by different factors:

• There formation of cholelithiasis, also called “stone” (40% of cases): with a risk of obstruction which can induce stasis (stoppage of circulation) of pancreatic juice, leading to self-digestion of the latter.

• L’ethylism, also called chronic alcoholism (40% of cases): it induces ductal precipitation of pancreatic juice which is modified by alcohol. This juice becomes concentrated and forms a plug, leading to stasis of the latter and self-digestion of the pancreas.

• Other rare cases : pancreatic tumors; post-operative trauma or by accident or weapon; drugs ; viruses; hypercalcemia (high level of calcium in the blood) and hypertriglyceridemia (high level of triglycerides).

We notice different symptoms:

• Typical pain : The pain is constant and is characteristic of this pathology. The pain is located in the upper part of the stomach (epigastrium) and is intense and brutal, similar to stabbing.

• Vomiting : Pain is frequently associated with vomiting caused by intestinal obstruction.

• Rarer symptoms : rapid breathing (polypnea); excessive secretion of urine (polyuria) or complete cessation of urine secretion (anuria); State of shock.

Diet plays a vital role in acute pancreatitis, whether in prevention or in reducing the risk of recurrence. As a result, the diet makes it possible to:

• Limit the formation of gallstones (calculations), thanks to the reduction of foods rich in fat and calories (sweet products, fast food, etc.). In fact, these foods tend to promote the formation of gallstones because they promote too high a bile cholesterol concentration.

• Avoid modification of pancreatic juice induced by alcohol consumption. The latter causes ductal precipitation of pancreatic juice because this juice is modified by alcohol. It thus forms a protein plug leading to stasis of pancreatic juice and self-digestion of the pancreas.

• Limit the increase in secretion of pancreatic lipases, thanks to the reduction of foods rich in lipids and the exclusion of cooking methods using fat (sautéing in oil, frying, cooking in butter). Indeed, overconsumption of foods rich in lipids proportionally increases the secretion of enzymes which allow them to be digested (pancreatic lipases). Nevertheless, the lipids are fundamental to the body for their energetic, structural and hormonal roles. This is why they should not be completely removed from the diet.

• Reduce pancreatic damage and the possibility of chronic pancreatitis by eliminating alcohol. In fact, it is estimated that 80% of cases of chronic pancreatitis are due to alcohol. It is therefore recommended to avoid consuming alcohol during the month following acute pancreatitis.

• Avoid malnutrition and weight loss with foods rich in protein. Indeed, inflammation causes what is called significant hypercatabolism, that is to say that the body draws on its nutritional reserves to fight inflammation. This then leads to risks of significant weight loss and, moreover, a risk of malnutrition (pathological condition favoring certain diseases).

Alcohol consumption promotes the production of gallstones and increases the risk of developing chronic pancreatitis. This hydration helps promote the excretion of residues induced by inflammation of the pancreas into the urine.

We recommend you :

• of eliminate your alcohol consumption for 1 month after the symptoms disappear. It is possible to consume alcohol after 1 month, but in a very reasonable manner (1 glass of wine 2 to 3 times a week maximum). Indeed, alcohol abuse is dangerous for your health, consume in moderation.

• d’avoid all meals containing alcohol : beef bourguignon, braised chicken, rum baba…

• to bring between 1.5 and 2 L of water per day, favoring the consumption of water rich in minerals and bicarbonates. These micronutrients help alkalize the body and promote the excretion of acids induced by inflammation.

Generally speaking, fats induce hypersecretion of pancreatic lipases. However, cooked fats are more complicated to digest than raw fats. Indeed, in addition to secreting lipases to be digested, cooked fats can oxidize and promote inflammation. In this way, cooked fats are very poorly digested by patients affected by acute pancreatitis.

We recommend you :

• d’avoid cooking your fats (butter, oils, fresh creams, industrial sauces and in fast foods), which can cause pain and vomiting.

• of privilege the contributions of raw fat compared to cooked fats, while limiting their intake. Indeed, raw fats are also likely to cause pain and vomiting in small quantities.

• to direct you towards raw oils rich in omega-3 like rapeseed oil, flax vegetable oil, vegetable walnut oil, camelina vegetable oil and hemp vegetable oil for season your raw vegetables and meals, while being reasonable in quantity (10 to 20 g max).

Meat and fish are foods rich in proteins, they are therefore important in preventing weight loss. However, fatty meats and fish, as their name suggests, are rich in lipids. It is therefore preferable to opt for lean meats and fish to limit hypersecretion of pancreatic lipases.

We recommend you :

• to bring a source of lean meat (poultry, guinea fowl, rabbit) or lean fish (coalfish, cod, hake, whiting, sole) to every lunch and evening because they are rich in proteins and low in lipids.

• of restrict your consumption of fatty meats (leg of lamb, mutton, beef mince, rib and beef steak) and oily fish (salmon, bluefin tuna, mackerel, sardines, herring).

• not to consume low-fat fatty meats and fish like hamburger steaks with 5% fat. Indeed, these foods are enriched with additives in order to limit the lipid content, and these additives are likely to cause digestion problems.

Cheeses and milk are foods rich in proteins allowing you to limit weight loss. However, cheeses are foods very rich in lipids, so they will induce a strong secretion of lipases. Concerning milks, the milk entire contains a lipid content instead high unlike skimmed and semi-skimmed milk.

We recommend you :

• limit your cheese consumption to 3 times a week, with 30 g maximum per dose.

• of favor skimmed and semi-skimmed milk because they are less rich in lipids than whole milks.

• In case of acute pancreatitis due to hypercalcemia, it is best to limit the consumption of dairy products because they are foods rich in calcium. Concerning plant-based “milk” (plant-based soya, almond, spelled drinks, etc.), these drinks contain little calcium if they are not enriched, but they are likely to be rich in lipids. In this specific case, it is wise to move towards skimmed or semi-skimmed milk, while limiting their consumption to a glass a day.

Cooking methods using fat increase the secretion of pancreatic lipases, and therefore promote pancreatic damage. Conversely, gentle cooking helps limit lipid intake and promotes intestinal comfort.

We recommend you :

• d’avoid cooking which promote the lipid malabsorption such as frying and stir-frying (adding fat to cook a food in a pan).

• of favor gentle cooking methods : in water, in the oven, on the grill, in foil or steam.

Dried fruits (oilseeds and dried fruits) are condensed foods very rich in lipids. It is therefore preferable to opt for fresh fruits which are devoid of lipids.

We recommend you :

• to limit your consumption of oilseeds (almonds, cashews, pistachios, etc.) and dried fruit (dried apricots, dried pineapple, dried banana, etc.).

• to favor the consumption of fresh fruits for your snacks because they have zero or almost zero lipid content.

• Regarding the banana, it is possible to consume it in cases of acute pancreatitis because, despite prejudices, it contains very little lipids (less than 0.5 g of lipids per 100 g of banana, Ciqual 2022.). In fact, prejudices about this fruit refer to its high carbohydrate content (19.7 g of carbohydrates per 100 g of banana, Ciqual 2022.) and not in lipids.

Typically, patients stay in the hospital for up to 48 hours after symptoms disappear. Patients are fed with parenteral nutrition (directly into the veins) until pain and vomiting disappear, and after transit resumes. Oral food is gradually reintroduced in order to limit the secretions of pancreatic juice.

DAY 1 :

Depending on the patient's condition during the day: 

• TTB (tea, herbal tea, broth)
• Then YBC (yogurt, broth, compote) with 0% yogurt

DAY 2:

• Breakfast : rusk + jelly
• Lunch : fat-free starchy foods
• Dinner : fish in court broth + 0% dairy + cooked fruit

If you have been cared for by dietitians in hospital, we recommend that you continue this protocol from food consumed on the last day in hospital (DAY 1 or DAY 2).

DAY 3:

• Adding lean meats, fish or eggs without added fat
• Adding the bread

DAY 4:

• Breakfast : Adding 10 g of butter
• Lunch and dinner: Adding cooked vegetables

DAY 5:

Adding 2 x 10 g of oil to raw vegetables or preparations (not during cooking) during the day

Snack 1:

• Cottage cheese
• Oatmeal
• Honey

Lunch :

• Coalfish in foil
• Semolina
• Roasted eggplant

Snack 2:

• Melon slice
• Grated carrots with a little walnut oil

Dinner :

• Curry turkey escalope
• Coquillettes + a little raw butter
• Steamed broccoli