Preventing Recurrence of Acute Pancreatitis through Dietary Intervention
The incidence of acute pancreatitis in the UK is rising, with as many as 420 people per million of the population now affected. Anyone who has experienced acute pancreatitis knows just how painful and unpleasant its duration is, bringing with it the risk of pancreatic cysts and necrosis, as well as potentially adverse effects on the cardiovascular and respiratory systems; five percent of cases result in mortality. Although some people experience only one episode of the disease, it will often reoccur, particularly if the underlying cause is not managed. While medical intervention is often required to prevent its recurrence, lifestyle changes can also help to reduce this risk. Here we look at two of the risk factors influenced by diet and how this can be manipulated favourably.
If gallstones become lodged in the bile duct, this can impact on the pancreatic enzymes, causing them to be activated and digest the pancreatic tissue; this is the most common cause of pancreatitis in the UK. Gallstones are formed from cholesterol, so anyone with high cholesterol is more likely to experience them. Although this can be hereditary or the consequence of another disease, a diet high in saturated fat – which comes predominantly from animal products – can contribute to raised cholesterol and therefore potentially acute pancreatitis. Being overweight and taking little activity can also increase cholesterol levels. Your gallbladder might be removed if you have gallstones, otherwise dietary steps can help.
Blood cholesterol can be lowered as follows:
• Reduce intake of saturated fats and ideally replace them with mono-unsaturates.
• In place of butter choose a margarine based on olive oil and use either this or rapeseed oil in cooking.
• Low fat versions of dairy foods should be selected, though soya-based versions of these might be beneficial, as these have been shown to aid cholesterol lowering.
• Red meat such as beef, lamb and pork tend to be higher in saturated fats, as do processed meats such as bacon and sausages, so these should be eaten less often, favouring poultry and fish instead. As high consumption of red and processed meats is a known risk factor for pancreatic cancer, they may also be implicated directly in pancreatitis.
• Other foods high in saturated fat to be limited include pastries, take-aways, ready meals, cakes, chocolate and biscuits; reducing consumption of these will also aid weight loss.
• Soluble fibre, which is found in fruit, vegetables, pulses (peas, beans and lentils) and oats, can also bring down cholesterol levels.
High levels of triglycerides in the bloodstream are a known risk factor for acute pancreatitis, contributing to around 5% of cases. They are the main components of the fat present in foods and following digestion and absorption they are reformed. Although it is not completely clear why raised triglycerides trigger acute pancreatitis, it is thought to relate to an increase in the particles that transport fats in the blood. These block blood capillaries leading to local tissue damage and if exposed to the digestive enzymes released by the pancreas, the resulting fatty acids cause further injury and the release of substances that trigger inflammation. High levels of triglycerides can be inherited or more commonly occurs secondary to another medical condition. While treatment of these conditions can help to lower triglycerides, as will medications specifically designed to reduce their synthesis, dietary factors can also contribute to their blood levels.
Not only can a high consumption of alcohol trigger acute pancreatitis directly, but it can also increase triglycerides. Consuming a diet high in carbohydrates, particularly if these are predominantly from refined sources such as white bread and rice, or sugar-rich foods, can also push up triglyceride levels. Saturated fats which raise cholesterol levels are also thought to elevate triglycerides too. If you are overweight or partake in limited exercise, these factors can be other culprits for raised blood fats.
As well as taking the steps discussed above to lower saturated fat intake, the following will also help to bring triglyceride levels down:
• If you drink alcohol, reduce your intake and if possible stop drinking altogether; in some people even small amounts of alcohol can be all that it takes to increase triglyceride production.
• Limit intake of sugar-rich foods such as desserts, confectionary and soft drinks and when choosing a carbohydrate to accompany a meal, choose one which will be broken down more slowly into sugars; good examples include granary or rye bread, pasta, basmati rice, sweet potato and oats.
• Cutting back on sugary foods will also be beneficial for weight loss, though portion control and aiming for 30 minutes of activity each day will additionally help.
• Numerous studies have shown the importance of omega-3 fatty acids in lowering triglyceride levels; these are most commonly found in oily fish such as mackerel, salmon and sardines. We should aim to include oily fish at least weekly for general health, but as higher doses of omega-3 are required to lower triglycerides than this can provide, a supplement would be beneficial; your doctor may even decide to prescribe a high dose omega-3 supplement for you. Omega-3 fatty acids also provide an additional benefit in preventing the recurrence of acute pancreatitis, as they help to block the pathway that triggers inflammation.
Additional dietary considerations
Fruit and vegetables should continue to be eaten freely, particularly as their antioxidant content can help to reduce levels of free radicals, which trigger inflammation. Anyone whose intake is limited should strongly consider a supplement containing vitamins A, C and E. (Selenium ACE could be bought as an all in one tablet, DO NOT think more is better and stick to the dosage – Chairman) However, as cooking and processing food can reduce its antioxidant content, anyone who has had acute pancreatitis may benefit from taking a supplement. Selenium is another antioxidant, which many people lack, as its content in food has fallen due to the use of intensive farming methods which deplete soil selenium; supplements are available and there is evidence that these may be beneficial in pancreatitis.
Although the sources of fat and protein in the diet should be manipulated to control the risk factors for recurrence of pancreatitis, overall levels do not usually have to be reduced. Significant weight loss can occur during and after an attack of acute pancreatitis, as both energy and protein requirements are increased, which is coupled with a reduced dietary intake as a consequence of medical management and a slow return to normal diet while symptoms are still present. Limiting fat and protein could therefore compound malnutrition. Blood tests taken during an attack of acute pancreatitis will usually show low liver protein levels for albumin. This can be used as a marker of nutritional status, but it is important to bear in mind that during an inflammatory response the liver puts its efforts into the production of the C-reactive protein needed for the removal of dying cells; on recovery levels of albumin typically return to normal.
Everyone who has had acute pancreatitis should follow a balanced diet, but if you have gallstones or raised triglycerides additional dietary changes will help prevent its recurrence.
(Some other thoughts…. Avoid ALL PORK and it derivatives, bacon, sausage etc as this meat contains the highest fat content. Beware of mouthwash as most contain alcohol which you then absorb through your cheeks – why do you think alcoholics drink it? – Chairman)