Chronic Pancreatitis Dietary Advice

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What is the pancreas?

The pancreas is a gland that is located behind the stomach. It has two main functions:

1. It produces enzymes, which help to break down and digest the food we eat.
2. It produces hormones, including insulin, which enables our body to use the glucose (sugar) that is produced from the digestion of certain foods.

What is chronic pancreatitis?
Chronic pancreatitis occurs when there is permanent damage to the pancreas. The most common cause of chronic pancreatitis is long standing alcohol misuse and therefore it is recommended that you avoid drinking alcohol into the future. This will prevent any further damage to your pancreas. It can also be caused by smoking and auto-immune or genetic factors, if the disease is very advanced surgical procedures may be required to help relieve symptoms.

What are the symptoms?
▪ Abdominal pain (mild to severe)
▪ Weight loss
▪ Nausea and vomiting
▪ Oily or fatty stools
▪ Diarrhoea
▪ Cyst formation
▪ Jaundice (yellowing of the skin and eyes)
▪ Recurrent flare ups of acute inflammation
▪ Pancreatic insufficiency (reduced insulin and enzyme production)

What changes can help with symptoms?
It is important to:
• Eat regular meals consisting of nutritionally dense, high protein and higher calorie foods,
• Have snacks between meals,
• Avoid alcohol,
• Stop smoking,
• Some individuals may find that fatty foods make their symptoms worse especially following a flare up of acute pancreatitis. A low-fat diet should NOT be followed long term in chronic pancreatitis as it is not nutritionally complete.

If you experience further weight loss or your appetite remains poor you may require nutritional supplement drinks to help meet your increased requirements. Your dietitian can advise and arrange this if they feel it is necessary. Your GP may arrange for you to have annual blood tests to check your vitamin and mineral status and prescribe supplements if required. They may also refer you for a scan to check your bone density (DEXA scan).

What to do if you are prescribed pancreatic enzyme replacements
Pancreatic enzymes help to digest the food we eat. Pancreatic enzyme insufficiency is a common feature of chronic pancreatitis. As a result you may be recommended enzyme replacement medication to make up for the enzymes your body is no longer producing. If you are prescribed a pancreatic enzyme replacement therapy e.g. Creon®, Nutrizyme®, Pancrex® Or Pancrease® it should be taken with ALL meals, snacks and nutritional supplements. Your dietitian will be able to give you more specific advice about this. If you are losing weight despite taking pancreatic enzymes, discuss increasing the dosage with your Gastroenterology Doctor, GP, Specialist Nurse or Dietitian.

Diabetes occurs when your body is unable to control the amount of sugar (glucose) in your blood. This can happen in chronic pancreatitis because your pancreas is unable produce adequate insulin. Insulin is necessary to take sugar from the blood to the body tissues where it is used for energy. Your doctors will run regular tests to see if you are diabetic but if you are concerned, feel more thirsty than usual or pass a lot of urine mention this to your doctors. You may be started on medication to help regulate your blood sugar and, if required, insulin injections to replace the insulin that your body is unable to produce.

If you are diagnosed with diabetes you should:
• Reduce the amount of sugar you take as well as any food and drinks high in sugar
• Eat a source of high fibre starchy food at each meal e.g. wholemeal bread, pasta, potatoes, rice
• Include a source of protein at each meal e.g. lean meat, fish, eggs, yoghurts
• Take snacks as advised by your dietitian or diabetes specialist nurse
• Talk to your dietitian, diabetes specialist nurse or your doctor if you have any dietary concerns.

Further information:
The following may help give you further information and support on chronic pancreatitis.