What diet should you adopt in case of chronic pancreatitis?

The onset of the disease is most often asymptomatic, the presence of attacks of acute pancreatitis can guide the diagnosis. Otherwise, we mainly notice:

• weight loss : Chronic pancreatitis causes hypercatabolism (deterioration of the body's nutritional reserves) because the main nutrients are no longer properly absorbed (proteins and lipids). As a result, this hypercatabolism leads to weight loss.

• typical pain : They are located at the top of the stomach, and are similar to daggers. Generally speaking, the pain disappears after 10 years of progression, which corresponds to a very advanced stage of the disease.

• digestive problems : They are accompanied by malabsorption diarrhea, particularly due to creatorrhea and steatorrhea (leakage of proteins and lipids in the stools). The latter are due to the destruction of the pancreatic cells which secrete pancreatic juice. In fact, this juice is composed of enzymes allowing the digestion of proteins and lipids.

• insulin-dependent or insulin-requiring diabetes : The alteration of the endocrine functions of the pancreas limits the secretion of insulin and glucagon. These two hormones help regulate blood sugar levels, but are no longer secreted by the alpha and beta cells of the islets of Langerhans in the pancreas. Indeed, these cells are destroyed in cases of advanced chronic pancreatitis.

Diet plays an essential role in the management of chronic pancreatitis. It is recommended to be followed by a dietician-nutritionist or a doctor-nutritionist to target nutritional deficiencies depending on the patient. As a result, the diet makes it possible to:

• Limit, or even stop, the progression of pancreatic lesions removing the alcohol definitively. Indeed, even occasional ingestion is very poorly tolerated and is accompanied by painful crises. Unfortunately, patients with chronic pancreatitis often struggle to overcome this alcohol dependence. There is therefore a real need to be surrounded and to use specific support with health professionals or appropriate associations.

• Prevent undernutrition and compensate for creatorrhea by increasing intake of foods rich in proteins. Creatorrhea is protein leakage in the stools due to malabsorption of these nutrients. In addition, it is possible to prevent undernutrition by splitting meals in order to promote and increase food intake. This helps to compensate for the hypercatabolism of the disease, which is a strong degradation of the body's reserves to fight inflammation.

• Limit maldigestion of lipids and steatorrhea by avoiding consuming meals that are too high in calories at one time. It is also recommended to avoid meals excessive in lipids by limiting intake of cooked fats. Steatorrhea is leakage of lipids in the stools due to their malabsorption. However, lipid intake should not be reduced overall. Indeed, lipids are digested thanks to taking gastro-protected enzymes given by the doctor.

• Limit the risks of developing diabetes avoiding the isolated intake of sugary products. In addition, it is preferable to move towards foods with a low and medium glycemic index (GI) to limit the rise in blood sugar levels. Adequate fiber consumption is then wise to limit this increase, because fiber has a hypoglycemic role (reduces GI).

• Optimize the action of pancreatic enzymes by limiting fiber intake to between 25 and 30 g per day (“normal light” therapeutic diet). In fact, fibers capture and limit the action of pancreatic enzymes. However, they should not be deleted because they allow the GI to be controlled.

• Limit maldigestion of vitamins A, D, E and K induced by steatorrhea by optimizing the intake of these fat-soluble vitamins. Furthermore, it is not uncommon to see the doctor prescribe supplementation with these vitamins.

Alcohol promotes pancreatic damage and induces pain in patients with chronic pancreatitis.

We recommend you :

• of completely and permanently eliminate your alcohol consumption. Indeed, even occasional and reasonable intake causes pain and promotes pancreatic lesions.

• If stopping alcohol consumption is complicated, it may be wise to contact certain associations or professionals in order to to be supported in this process.

• not to consume “non-alcoholic” drinks like “non-alcoholic” beers because these drinks still contain alcohol, even if the proportions are reduced. Indeed, even a tiny amount of alcohol can promote the progression of pancreatic damage.

Fats undergo oxidation due to heat. This oxidation will have the effect of promoting pain due to pancreatic lesions because it causes the formation of gas in the intestines.

We recommend you :

• of don't cook your fat (oils, butter, industrial sauces, crème fraîche), and preferably consume them raw because they do not undergo oxidation and are therefore better tolerated.

• avoid excess fat in your meals because they are likely to cause malabsorption diarrhea.

Given the risks of developing diabetes following chronic pancreatitis, sugary products should be avoided because they have a high glycemic index (GI). This therefore causes the blood sugar to be high and results in insulin secretions in proportion to the height of the blood sugar.

We recommend you :

• not to consume more than 15 g of sugary products per day (confectionery, candy, soda, chocolate, etc.), and if possible, to eliminate them.

• avoid consuming sugary products in isolation. In fact, it is preferable to consume these foods at the end of a meal in order to avoid too high a rise in blood sugar levels.

• to consume these sweet products with foods rich in fiber, such as fresh fruits and vegetables, as well as oilseeds. In fact, fiber helps reduce the glycemic index thanks to its hypoglycemic effect.

These oils provide quality lipids to the body. Since the consumption of lipids is possible thanks to the gastro-protected enzymes prohibited by the doctor, these oils will be very well tolerated and will ensure daily lipid intake.

We recommend you :

• to consume these vegetable oils by adding them to your preparations cold (raw vegetables, cooked vegetables) and not during cooking. Indeed, raw fats do not undergo oxidation and are therefore better tolerated.

• to favor the oils rich in omega-3 or who have a good omega-3 / omega-6 ratio : rapeseed vegetable oil, hemp vegetable oil, flax vegetable oil, walnut vegetable oil, camelina vegetable oil.

• alternate oils rich in omega-3 with an oil rich in omega-6 such as sunflower oil. Indeed, sunflower oil is an oil rich in omega-6, but is also rich in vitamin E. It thus makes it possible to partially compensate for the losses of vitamin E induced by steatorrhea.

These foods are rich in protein, so they help limit weight loss and malnutrition induced by the hypercatabolism of chronic pancreatitis.

We recommend you :

• consume a source of protein (meat, fish, eggs, legumes) at each lunch and dinner meal to optimize protein intake.

• to favor the gentle cooking methods to cook your food (cooking in the oven, steaming, in foil, in water, etc.).

• to favor fatty meats affiliated with Bleu Blanc Cœur because they are naturally enriched in omega-3, which are unsaturated fatty acids essential to the body.

• to alternate the consumption of lean meats (poultry, rabbit) with the consumption of fatty meats (beef, horse, veal).

• consume lean fish (cod, saithe, whiting, hake) and introduce 1 to 2 times a week fatty fish (mackerel, herring, sardines, salmon, tuna) because they are foods naturally rich in omega-3.

• to direct you towards affiliated eggs Blue White Heart which are naturally enriched with omega-3. In fact, they come from chickens fed a diet essentially based on flax seeds.

• to consume once a week legumes (lentils, red beans, chickpeas) as a source of protein on the plate or as a replacement for starchy foods.

Fruits and vegetables are a family of foods rich in fiber and micronutrients. In this way, they make it possible to compensate for the losses of certain fat-soluble vitamins (A, E, K) due to steatorrhea. In addition, their richness in fiber makes it a perfect accompaniment to starchy foods in order to regulate blood sugar levels. Indeed, fibers have a role hypoglycemic, which makes it possible to avoid too high a rise in blood sugar and, in this way, hypersecretion of insulin.

We recommend you :

• to consume as little as possible 300 to 400 g of vegetables per day.

• preferably eat your fruits and vegetables raw in order to retain as many vitamins as possible.

• having at least one fruit or vegetable at each meal (fruit as a snack, vegetables with meals).

• to move towards fruits and vegetables rich in vitamin A : carrots, spinach, red pepper, pumpkin, apricot, passion fruit, mango.

• to consume fruits and vegetables rich in vitamin E : avocado, mango, blackcurrant, spinach, asparagus, watercress.

• to move towards fruits and vegetables rich in vitamin K : green cabbage, spinach, broccoli, grapes, plum, apple.

These two families of foods are rich in fiber and vitamins. Be careful, however, with excess of these foods, because their richness in fiber can be harmful to the action of enzymes allowing the digestion of food.

We recommend you :

• of favor whole grain products (brown rice, wholemeal pasta, semolina, quinoa) with refined cereal products, in order to reduce the glycemic index of the meal and compensate for losses in fat-soluble vitamins.

• to consume whole grain products at least once a day.

• to consume oilseeds as a snack in order to provide maximum vitamins to the body: almonds, brazil nut, macadamia nuts, pecan nuts, pine nuts, walnut kernels.

Dairy products are a significant source of protein for the body. In this way, they help fight weight loss and malnutrition. In addition, thanks to the prescription of gastro-protected enzymes, whole milks and cheeses are tolerated by patients with chronic pancreatitis.

We recommend you :

• to consume 1 to 2 dairy products per day to optimize protein intake.

• to consume 30 g of cheese max per day.

• to favor the dairy products enriched with vitamin D.

Snack 1:

• Endive salad with olive oil

Lunch :

• Saithe fillet
• Potatoes
• Cauliflower

Snack 2:

• Natural yogurt
• A few pecans

Dinner :

• Zucchini soup
• Grated cheese
• Sour cream
• Dark chocolate square