From the Guidelines
A diet for pancreatitis should focus on low-fat, easily digestible foods to reduce pancreatic stimulation and inflammation, with a recommended approach of starting with clear liquids during acute episodes, then gradually introducing a soft, bland diet as symptoms improve, as suggested by the ESPEN guidelines 1. The goal is to minimize pancreatic workload by eating 6-8 small meals daily rather than 3 large ones.
- Include lean proteins like skinless poultry, fish, egg whites, and low-fat dairy
- Complex carbohydrates such as whole grains, vegetables, and fruits
- Healthy fats in small amounts from olive oil, avocados, and nuts Completely avoid alcohol, which is a major trigger for pancreatitis, as well as fried foods, full-fat dairy, red meat, processed meats, pastries, and sugary foods that can stimulate pancreatic enzyme production 1. Stay well-hydrated with water and avoid caffeine and carbonated beverages. This diet works because high-fat foods require more pancreatic enzymes for digestion, which can aggravate an already inflamed pancreas, as noted in the ESPEN guidelines on enteral nutrition: pancreas 1. Smaller, more frequent meals prevent overwhelming the pancreas with digestive demands at once. If you experience weight loss or malnutrition, pancreatic enzyme supplements may be needed with meals to aid digestion, typically starting at 25,000-40,000 units of lipase per meal, adjusted based on symptoms and fat content of meals, as recommended by the ESPEN guidelines on enteral nutrition: pancreas 1. In cases of severe necrotising pancreatitis, enteral nutrition (EN) is indicated and should be supplemented by parenteral nutrition if needed, as suggested by the ESPEN guidelines on nutrition in acute pancreatitis 1. The jejunal route is recommended if gastric feeding is not tolerated, and a peptide-based formula is recommended for enteral nutrition, given overnight 1. Parenteral nutrition (PN) is only indicated when EN is not possible, such as in severe stenosis of the duodenum prior to surgery, as noted in the ESPEN guidelines on enteral nutrition: pancreas 1.
From the Research
Diet for Pancreatitis
- The optimal diet for pancreatitis depends on the severity and type of pancreatitis, with different approaches recommended for acute and chronic cases 2, 3.
- For acute pancreatitis, early oral nutrition with a low-fat "soft food" diet is recommended, with enteral nutrition preferred over parenteral nutrition if oral feeding is not tolerated 2, 3, 4.
- Enteral nutrition has been shown to reduce complications, length of hospital stay, and mortality in patients with acute pancreatitis, compared to parenteral nutrition 3, 4.
- In chronic pancreatitis, a physiological diet with adequate replacement of pancreatic enzymes is recommended, with a low-fat diet and oral nutritional supplements used in cases of intolerance to physiological nutrition 2, 5.
- Malnutrition is a common complication of chronic pancreatitis, and nutritional management should be multifactorial, including abstinence from alcohol and nicotine, and diet modification 2, 5.
- Vitamin D supplementation has been shown to be effective in chronic pancreatitis, while antioxidant treatment has limited evidence for efficacy 5.
Key Considerations
- Nutritional support should be started early in the course of acute pancreatitis, within 24 hours of admission 3, 4.
- The choice of enteral nutrition formula should be based on the individual patient's needs, with a semielemental formula with omega-3 fatty acids recommended in some cases 3.
- Parenteral nutrition may be necessary in some cases, but should be used with caution due to the risk of complications 4, 6.
- Nutritional management of chronic pancreatitis should be individualized, taking into account the patient's specific nutritional needs and deficiencies 5.