Nutrition & Diet for Pancreatitis an interview with Dietitian Dietitian, Ruth Logan

Bill Sankey (Dip PE, Grad Dip Mgt, MBA) © Copyright Bill Sankey, 2006. All Rights Reserved. www.pancreatitisanddietsupport.com

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Nutrition & Diet for Pancreatitis an Interview with Dietitian, Ruth Logan Vision Health & Fitness Interviewer I understand the general dietary guidelines given to people who suffer from pancreatitis are that they should eat a low-fat, high carbohydrate diet. Is this correct? If so why is that the case?

RL: This is correct. The reason being that the pancreas is responsible for producing many digestive enzymes including those that assist with fat breakdown. Alcohol also needs to be avoided. In acute cases people often cannot take food orally for a few days and thereby require intravenous fluids.

Interviewer Is there any ‘rule of thumb’ about the total percentage of fat someone with pancreatitis should have in their diet? Like, is it best to have less than 20% fat?

RL: I suggest the lowest possible fat intake to begin with and then gauge tolerance. Rather than a percentage, I usually prefer to work in grams/day and aim for less than 30 grams (1.06ozs) for women and less than 50 grams (1.8ozs) for males which are low fat diets. It all comes down to individual tolerance. Fatty diarrhoea will result if the person eats more fat than tolerated.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer Does it matter what type of fat is included in the diet or is it the total amount of fat that’s most important? For instance, I understand that saturated fats of animal origin (meat, butter etc) and the manufactured unsaturated fats in margarines and shortenings can cause increased cholesterol levels, but does this make any difference to the person with pancreatitis? RL: This is not so important in the acute stage as all fats need to be restricted however for long term health maintenance it is important to restrict saturated fat. Some sufferers who need the extra calories may tolerate a special type of fat called MCT oil better due to its’ easier digestibility.

Interviewer Does this advice vary for the level of severity of the condition?

RL: Obviously each person will differ in their tolerance so it will vary.

Interviewer I’ve also heard that protein intake should be restricted. Is that right or are there any particular types of protein (e.g.: red meat) that should be limited more so than others?

RL: Lean protein choices are good to include so it is important to trim/remove any visible fat from protein foods.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer Are there any general guidelines in terms of total calorie intake?

RL: Each person needs enough energy or calories to maintain a healthy weight but this will also vary on the stage of their illness, metabolic issues and activity levels so once again there is no rule to fit all people.

Interviewer The Pritikin Diet is low in fat. Would it be suitable for a person with pancreatitis?

RL: To a point but I find it quite restrictive and difficult for people to follow in a social setting. If you enjoy the foods suggested and don’t find it too hard it is generally quite healthy.

Interviewer Are there any particular foods that are better or worse than others?

RL: Certainly fatty foods and alcohol are the critical ones to limit or avoid.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer When a person has an attack of pancreatitis they are often fed intravenously and then gradually re-introduced to solid foods. Why is this done and what sorts of foods would be included in the early stages?

RL: The gut requires complete rest during an acute attack. As the inflammation resolves and the gut function improves, the patient can gradually reintroduce foods. Low fat, light, easy to digest foods are used once nourishing liquids are tolerated.

Patients always start with clear fluids then progress to nourishing

fluids then a light diet.

Interviewer Many people with pancreatitis are required to take enzymes to aid digestion. How do these work?

RL: These enzymes replace those lost with the decline in pancreatic function.

Interviewer Are there any specific diet guidelines for people on enzyme therapy?

RL: Most people take these (2-3) each time they eat to improve digestibility of the food consumed.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer Many people with pancreatitis take pain relieving drugs.

Are there any diet

guidelines for people in this situation?

RL: If people are taking drugs containing codeine it is important to watch bowel function as these drugs slow the bowel and can lead to problems with constipation. Always remember to take extra fluid to help relieve the bowels too.

Interviewer People with pancreatitis are at increased risk of developing diabetes mellitus. Why is this so?

RL: It depends which part of the pancreas is involved as a small section of the pancreas is responsible for producing insulin – this hormone is required for carbohydrate uptake by the muscles.

Interviewer What general advice would you give to those who face this risk?

RL It is not possible to avoid this but if diagnosed with diabetes seek dietary advice and assistance.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer It is recommended that people with any degree of pancreatitis refrain from consuming alcohol. Why is this?

RL Many cases of pancreatitis are caused by excessive alcohol intake in which case the patient needs to avoid alcohol totally. For others, it can cause further inflammation of the pancreas which is why it is necessary to limit or avoid intake.

Interviewer I’ve read about some people with pancreatitis who just can’t eat solid foods. What advice would you give to them?

RL If this is the case a complete liquid food alternative such as Sustagen Hospital or Ensure may be taken to provide all the essential nutrients for good health.

Interviewer Some people have found success in minimizing pancreatitis attacks by taking vitamins and mineral supplements and antioxidants. Do these work?

RL Once again I expect this to be varied for each person. I suggest they check with their medical professional to ensure the supplements can do no harm before they start any alternative therapy.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer What types and daily amounts would you suggest?

RL I cannot suggest dosage as this would be very variable however I always recommend food first then if desired take a once daily complete supplement as a top up. Be wary of taking lots of different potions and pills as you may overdose!

Interviewer Some have also found success with Chinese medicine. Any thoughts on this?

RL Always worth a try if traditional medicine cannot provide the answers but once again first check that it can do no harm.

Interviewer For those interested in preventing diseases of the pancreas would you recommend any particular dietary advice?

RL Healthy living – moderate or little alcohol, low fat eating, regular exercise. Nothing to excess!! There are some things we just cannot avoid however.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer Stevia has been promoted as aiding pancreatic function. Do you know if it has any real benefit?

RL I doubt it. Stevia is a low calorie sweetener in herbal form, which may be good if the patient has diabetes but not good for the ill person needing to take in extra calories

Interviewer Gallstones are often a causal factor in a person getting pancreatitis. Does diet play a role in someone getting gallstones?

RL Being overweight and eating excess fat may promote gallstones but some stones are formed from excess calcium or uric acid which the body has not been excreting efficiently.

Interviewer Why is nutrient absorption sometimes an issue?

RL If the food is not being digested properly the nutrients cannot be absorbed by the gut.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer Is there anything that can be done to help someone who is getting ill from odors of food cooking?

RL Find someone else to cook for them, eat more cold foods, prepare foods prior to eating then reheat quickly in the microwave to reduce odours.

Interviewer Is maintaining adequate water intake particularly important with this condition?

RL Water is always important and is necessary to reduce risk of dehydration and assist bowel function.

Interviewer Hot, spicy foods like curries and chillies are often ‘off the menu’ for pancreatitis sufferers. Why is this?

RL Mainly due to poor tolerance but this is very individual.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer Are there any food enhancers that are suitable replacements to curry etc?

RL Herbs may be better tolerated than heavy spices. Also try garlic and fresh ginger for flavour.

Interviewer Do you know of any particular diet/cuisines (e.g.: Indian, Chinese etc) that are known to have an affect on pancreatitis sufferers?

RL Not that I know of but possibly due to rich, fatty foods or heavily spiced foods. In India they generally use a lot of spice and ghee which is fatty and in other cultures a lot of coconut cream is used in cooking e.g. Thai.

Interviewer Is there a process of finding a suitable diet for each individual? For instance is it a matter of noting the effects of different foods and meals and eliminating those foods that cause concern? RL Trial and error! Yes, seek help from a dietitian if you are having trouble.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer It is sometimes recommended that sufferers eat several smaller meals during the day in order to reduce the strain on the pancreas to aid digestion. Is this correct?

RL I always find people can manage better if they eat little and often.

Interviewer Do you have any particular meal regimes that you’d recommend?

RL Eat 4-5 times daily with a larger lunch and lighter dinner. This helps you to feel less full going to bed.

Interviewer Are there any particular alternative foods that you would recommend to people? For example would you recommend sufferers drink soy milk instead of dairy milk? Is low-fat soy milk preferable? Tofu instead of meat etc?

RL People need to eat foods they tolerate and enjoy.

I wouldn’t necessarily

recommend soy over dairy milk. Yes all options should be at least fat reduced or no fat. I’d only recommend tofu if the patient likes it!

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer We hear a lot about the glycaemic index nowadays. Is this of any importance to pancreatitis sufferers?

RL Yes, particularly for those with diabetes.

Interviewer It’s generally recommended that a healthy diet be high in fibre. Are high fibre foods more difficult to digest?

If so, would this mean that a person with

pancreatitis should try to reduce the amount of fibre in their diet? If this is the case, are there any options available to them to substitute the loss of fibre and still maintain healthy bodily functions?

RL Not necessarily. I would definitely not recommend a reduction in fibre for the person with pancreatitis!

They could try increasing soluble fibres such as

psyllium husk, oats, rice, fruit and vegetables to maintain a soft bowel motion. Metamucil and other bowel softeners are available commercially if needed.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved

Nutrition & Diet for Pancreatitis – An Interview with Dietitian, Ruth Logan

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Interviewer We’ve heard of some people who have restricted themselves to fluids only when they’ve had blood tests revealing raised Lipase and Amylase levels.

Is this

sound advice? If so, are there any particular fluids that help this situation? Any that should be avoided?

RL Yes. If they are experiencing pain or abdominal discomfort they might be able to rest the gut and therefore reduce inflammation. I suggest clear fluids first then as the pain settles reintroduce the fluids mentioned previously (Sustagen and Ensure). Mainly try to avoid anything high in fat or rich, such as full cream milk drinks or those containing ice cream.

© Copyright Bill & Jenny Sankey 2006. All Rights Reserved