Pancreatitis: Nutritional Considerations
Alcohol use, smoking, body weight, diet, genetic factors, and medications all affect the risk of developing pancreatitis. Diet may also have an important role after diagnosis. Dietary recommendations differ, depending on whether the condition is acute or chronic.
Maintain a healthy body weight. Obesity appears to be a risk factor for the development of pancreatitis1 and for an increased severity when it occurs.2 Gallstones are a risk factor for acute pancreatitis, one that occurs more frequently in obese persons. Diets low in fat and high in fiber are helpful for gallstone prevention and for obesity prevention and management (See chapters on gallstones and obesity).
Control triglyceride levels. To reduce triglycerides, a fat–restricted diet is advised3 (See Hyperlipidemia chapter). The only exception may be the therapeutic use of high doses of omega–3 fatty acids, which may reduce triglycerides by 30% to 50%.4 Foods with a high glycemic index, particularly sucrose (table sugar) and high fructose corn syrup, also tend to raise triglycerides.5,6 Patients with triglyceridemia–related pancreatitis may be well–advised to choose carbohydrates that do not raise triglyceride levels; ie, ones that are fiber–rich and have a low glycemic index.7
Oxidative stress, defined as a disturbance in the balance between pro–oxidants and antioxidants leading to cellular damage, is a frequent finding in patients with chronic pancreatitis. A known source of this imbalance is the metabolism of xenobiotics, resulting in glutathione depletion and subsequent damage to pancreatic acinar cells.8 Patients with chronic pancreatitis have demonstrably low tissue levels of antioxidant enzymes.9 These patients also have lower blood concentrations of several antioxidants, including selenium (a glutathione precursor), vitamin A, vitamin E, and several carotenoids, compared with patients who have acute pancreatitis and with controls.10 Some studies have suggested that antioxidant supplements (combinations of either selenium, beta carotene, and vitamins C and E, or methionine, vitamin C, and selenium) ameliorate the pain associated with chronic (not acute) pancreatitis, diminish the frequency of acute exacerbations, and reduce the need for pancreatic surgery.8,11
Avoidance of alcohol reduces the risk of both acute and chronic pancreatitis.12 The risk for chronic pancreatitis in particular is exacerbated by the combination of smoking and alcohol intake.13
See Basic Diet Orders and Obesity chapter for general recommendations.
What to Tell the Family
Acute pancreatitis is usually preventable. To avoid the disease, alcohol must be eliminated and dietary steps taken to prevent gallstones and hypertriglyceridemia. A low–fat, high–fiber diet can help prevent gallstones and lower triglycerides, but medication may be necessary to lower triglycerides enough to prevent pancreatitis. Chronic pancreatitis may be a result of oxidative stress in persons with low concentrations of antioxidant enzymes, low antioxidant intake, or both, and may respond to a therapeutic diet and antioxidant supplements. Avoidance of medications known to elevate risk for this condition may be necessary. These drugs include atypical antipsychotics (clozapine, olanzapine, and risperidone)14; protease inhibitors15; and hormone replacement therapy.16
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