CHRONIC PANCREATITIS

Chronic pancreatitis is characterized by progressive,

permanent damage to pancreatic tissue, resulting in the impaired secretion
of digestive enzymes and bicarbonate. About 70 to 80 percent of the cases
are due to excessive alcohol consumption. Most patients with chronic
pancreatitis experience persistent abdominal pain, which may worsen with
eating and experience nausea and vomiting. Although all macronutrients
are maldigested, the symptoms of fat malabsorption are typically the most
severe. A fecal fat concentration over 9.5 g/100 g in a patient with
suspected maldigestion strongly suggests a pancreatic cause of
steatorrhea. The normal range for fecal fat testing is 2 to 7 grams over 24
hours. Seventy-two (72) hours test period would be 21 grams. Your doctor
will review results that are higher than normal.
Long-term illness is associated with reduced secretion of insulin and
glucagon, and diabetes eventually develops in 30 to 50 percent of patients.

Medical Therapy for Chronic Pancreatitis

The objectives of nutrition therapy are to reduce malabsorption and
correct malnutrition.
Pancreatic enzyme replacement is the primary treatment for
steatorrhea and other symptoms of malabsorption. Most enzyme
preparations are enteric-coated to resist stomach acidity and do not
dissolve until they reach the small intestine. Enteric-coated medications or
enzyme preparations are coated to withstand gastric acidity and dissolve
only at the higher pH of the small intestine. If the patient uses non-enteric
coated pills, acid-suppressing drugs are also required. Monitor fecal fat
concentrations to determine if the enzyme treatment has been effective.

DIET-DRUG INTERACTION
Antisecretory drugs (proton-pump inhibitors, H2 blockers)

Gastrointestinal effects: Diarrhea, constipation, nausea, vomiting,

and abdominal pain (proton-pump inhibitors)
Dietary interactions: May decrease iron, calcium, folate, and vitamin
B12 absorption
Pancreatic enzyme replacements
 Gastrointestinal effects: constipation, nausea, vomiting, diarrhea,
abdominal cramps, irritation of GI mucosa
Metabolic effects: Elevated serum or urinary uric acid levels (with high
doses), allergic reactions (rare)

Nutrition Therapy for Chronic Pancreatitis

Give high-protein and high-calorie diets to patients who are
hypermetabolic and underweight. Protein needs may range between 1.0
and 1.5 grams per kg DBW per day, and energy intakes should be about
35 kilocalories per kg DBW per day. Give dietary supplements to correct
deficiencies, possibly due to malabsorption or the alcohol abuse that
caused the disease.
Patients should avoid alcohol and quit smoking, as these substances
can exacerbate illness and interfere with health.

What not to eat if you have pancreatitis

Limit the following foods because they will make the pancreas release
digestive enzymes too soon and attack the pancreas instead of breaking
down the food.
1. Red meat, organ meats, fried foods, fries, potato chips, mayonnaise,
margarine and butter, full-fat dairy, pastries and desserts with added
sugars, and beverages with added sugars
2. Avoid trans-fatty acids in your diet if you are trying to combat
pancreatitis.
3. Fried or heavily processed foods, like French fries and fast-food
hamburgers, are some of the worst offenders.
4. Limit organ meats, full-fat dairy, potato chips, and mayonnaise
5. Cooked or deep-fried foods might trigger a flare-up of pancreatitis.
You'll also want to cut back on the refined flour in cakes, pastries, and
cookies. These foods can tax the digestive system by causing your
insulin levels to spike.

Pancreatitis recovery diet

If you're recovering from acute or chronic pancreatitis, avoid drinking
alcohol. If you smoke, you'll also need to quit. Focus on eating a low-fat diet
that won't tax or inflame your pancreas.
Stay hydrated. Drinking plenty of fluids is essential. Pancreatitis can cause
dehydration. Many healthcare providers recommend keeping a water bottle
and drinking at least 8 cups of water during the day. 
Electrolyte abnormalities in pancreatitis are often associated with
dehydration, prolonged vomiting, and calcium deposits in pancreatic fat.
People with chronic pancreatitis often experience malnutrition due to their
decreased pancreas function. The most deficient are Vitamins A, D, E, and
K.

Diet tips
Always check with your doctor or dietician before changing your eating
habits when you have pancreatitis. Here are some tips they might suggest:
•Eat between six and eight small meals daily to help recover from
pancreatitis because this is easier on your digestive system than eating two
or three large meals.
• Use MCTs as your primary fat since this type of fat does not require
pancreatic enzymes for digestion. MCTs can be found in coconut oil and
palm kernel oil and is available at most health food stores. Given the
shorter chain length of MCTs, they're rapidly broken down and absorbed
into the body. Unlike longer-chain fatty acids, MCTs go straight to your
liver, where they can be used as an instant energy source or turned into
ketones. Ketones are substances produced when the liver breaks down
large amounts of fat.
• Avoid overeating fiber at once, as this can slow digestion and result in
less-than-ideal absorption of nutrients from food. Fiber may also make your
limited amount of enzymes less effective.
•Take a multivitamin supplement to ensure you get the nutrition you need.

References:
DeBruyne, L. K. et al. (2016). Nutrition & Diet Therapy (19th ed.). Boston,
USA: Cengage Learning

Healthline. (2018). Chronic Pancreatitis. Retrieved from:

https://www.healtline.com/health/chronic-pancreatitis
 NUTRITION AND DIET THERAPY
FINAL APPLICATION

Course/Year/Section: __________ Group #: ___________

Group Members: ______________ Date Submitted: _______

A. CASE TITLE: Retired Executive with Chronic Pancreatitis (50pts)

B. CASE DETAILS:
Mr. CP is a 62-year-old man with chronic pancreatitis. He
reluctantly resigned as a president of an import/export company in his early
fifties when his problems with alcohol and declining health seriously
impaired his abilities to run the company. His wife divorced him shortly
after that, and currently lives alone.

At 5 feet 11 inches tall, Mr. CP weighs 125 pounds. He continues to

experience frequent severe abdominal pain and steatorrhea. Mr. CP has
been advised to follow a high kilocalorie, high protein diet with no fat
restrictions and uses enzyme replacement with meals, but he has difficulty
eating enough food. He has not used alcohol for eight months. Mr. CP
takes pain medications, acid-suppressing drugs, and a multivitamin daily.

C. NUTRITION IN PRACTICE:
1. Calculate and interpret the National Status (NS) of Mr. CP
using the BMI formula. (Show your solution) (5pts)
2. What are the possible reasons for Mr. CP's difficulty with maintaining
weight?
1. due to alcoholism
2. ___________________
3. emotionally unstable - due to his divorce from his wife and he lives
alone
4. _________________
5. has maldigestion of fats - steatorrhea
6. __________________

2. Therapies/rehabilitations recommended for Mr. CP.  

1. ________________
2. ________________  
3. ________________
    
 3. Explain why malabsorption develops in chronic pancreatitis. (2pts)  
  
 4. Which nutrients are most likely to be affected?  
1. ___________________ 
2. ___________________
3. ___________________
4. ___________________
5. ___________________  
    
5. How can Mr. CP’s physician determine whether the enzyme replacement
is effective? (2pts)
_____________________________________________________  
        
   If the patient will experience the GI effect of pancreatic enzyme
  replacement such as:
1. ____________  
2. ____________  
3. ____________ 
4. irritation to GI mucosa  
    
 6. Explain why Mr. CP must continue to use acid suppressants. (2pts) 
   1. __________________________________________  
   2. __________________________________________  
    

 7. If Mr. CP continues to experience steatorrhea, what measure would you

suggest? (2pts)
1. Medical Treatment
            ____________________________________________
      2. Therapeutic Diet
              ___________________________________________
Keep them hydrated. Give an electrolyte beverage or keep a
bottle of water for them.

8.  What complications may develop if fat malabsorption continues?  

   1. _______________________ 
  2. _______________________ 
  3. _______________________ 
   4. Worse is death  
 

9. RECOMMENDED DIETARY MANAGEMENT FOR MR. CP. (20pts)

DIET MANAGEMENT RATIONALE

1. (Diet 2 pts) 1. Use of ____________ or 1. Due to decreased

(PERT)
2. Give avocado, olive oil, fatty
fish, nuts and seeds and
coconut oil in moderation.
pancreas function.
Mr. CP depends on
PERT only.
2._________________

3. Avoid mayonnaise, 3. __________________

 margarine, and full fat dairy, Due to steatorrhea
pastries, sugary drinks, and
all high-fat foods.
2. High Calorie 1. Frequent small meals or 1.______________
give ____ small meals daily.

2. ____kcal/kg DBW 2. For weight loss and

malnutrition
Limit foods rich in fiber ___________________

3. Give dark leafy vegetables, 3.These foods are rich in

red berries, blueberries, __________and will help
sweet potatoes, grapes, and reduce the inflammation
carrots. of the pancreas.

4. Give plenty of water, and 4.________________

Limit drinks with caffeine like
sodas, coffee, tea, and Caffeine, etc. can
energy drinks. aggravate abdominal pain.

3. (Diet 2pts) 1. Give high-quality protein like 1. For fluid and electrolytes
fish, eggs, and poultry imbalance brought by
steatorrhea

2. ____g/KDBW 2. _______________

3. Give well-cooked lean meat 3. For the production of

and poultry. ___________ (IF) that
helps in the absorption of
B12
4. Avoid giving red meats and 4.These foods will
organ meats. overburden the damaged
pancreas
4.Supplementations 1. __________________ 1. No pancreatic lipase to
of __________ emulsify fat-soluble
(2pts) Multivitamin vitamins food sources.
supplementation must be 2. __________________
prescribed by the doctor.