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Nutritio nMD He alth Care Pro vid e rs G as tro inte s tinal Dis o rd e rs

Pancreat it is: Nut rit io nal Co nsiderat io ns

Pancreatitis
Pancreatitis: Diagnosis
Pancreatitis: Treatment

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.

Pancreatitis: Nutritional
Considerations

Acut e Pancreat it is

Pancreatitis: References

the development of pancreatitis 1 and for an increased severity when it

Maint ain a healt hy body weight . Obesity appears to be a risk factor for
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).
Cont rol t riglyceride levels. To reduce triglycerides, a fatrestricted diet is
advised 3 (See Hyperlipidemia chapter). The only exception may be the
therapeutic use of high doses of omega3 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 triglyceridemiarelated pancreatitis may be well
advised to choose carbohydrates that do not raise triglyceride levels; ie,
ones that are fiberrich and have a low glycemic index.7
Chronic Pancreat it is
Oxidative stress, defined as a disturbance in the balance between pro
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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

Orders
See Basic Diet Orders and Obesity chapter for general recommendations.

What t o T ell t he Family

Acute pancreatitis is usually preventable. To avoid the disease, alcohol must be
eliminated and dietary steps taken to prevent gallstones and
hypertriglyceridemia. A lowfat, highfiber 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
inhibitors 15; and hormone replacement therapy.16

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