Microsoft Word - DH Nutrition Therapy for Chronic Pancreatitis.docx

Digestive Health Center

Nutrition Services

Nutrition Guidelines for Chronic Pancreatitis

Patient Education

The pancreas is an organ that:

 Produces pancreatic enzymes to help digest (break down) food in the small

intestine for absorption

 Makes hormones (such as insulin) to help control blood sugars

Chronic pancreatitis is ongoing inflammation of the pancreas. Symptoms can be worse

after eating. Symptoms include:

 Abdominal pain

 Nausea

 Vomiting

 Weight loss

 Fatty stools (stools may also float and/or have a foul odor)

Malabsorption of nutrients can occur from poor digestion of food (due to reduced

pancreatic enzyme activity), which will result in nutrients passing into the stools. This is

seen especially with fat and fat soluble vitamins (A, D, E) as digestion of fat is highly

dependent on pancreatic enzymes.

In some cases, diabetes can develop if the pancreas is not able to make enough insulin

to help control blood sugars, so blood sugars stay high.

Nutritional Guidelines

 Follow a low fat diet, which for chronic pancreatitis is often restricted to 50 grams

of fat, but could also range between 30-50 grams of fat depending on tolerance.

 If you have diabetes, eat recommended serving sizes of low fat carbohydrates to

help control blood sugars (low fat/non fat dairy, fruits, vegetables, whole grains,

beans, lentils etc). Information on serving sizes is available.

 Take pancreatic enzymes as prescribed by your doctor to treat malabsorption.

Take the enzymes before each meal and snack. They will not work if taken at

the end of the meal.

Low Fat Diet Tips

 Eat 4-6 small meals throughout the day

 Spread out your fat intake throughout the day

 Use butter, margarine and cooking oils sparingly

 Bake, grill, roast and/or steam foods. Do not fry or stir fry foods.

 Include fruits, vegetables, whole grains, low fat/non fat dairy daily in your diet

 Add protein to each meal and snack (lean beef, chicken without skin, fish, low

fat/non fat dairy, egg whites, beans, soy etc)

 Avoid all alcohol and foods made with alcohol

 Read food labels. Choose foods labeled "low fat", "non fat", "fat free" and "light"

Foods

Food Groups Foods Recommended Foods to Limit

Meats,

Poultry,

Fish, Eggs

baked, broiled, grilled or steamed:

lean cuts of meats/poultry(without

skin)/fish; canned tuna in water,

eggs, egg whites,

low fat/non fat deli meat slices

fried, fatty or heavily marbled

meats/poultry(withskin), organ

meats (liver etc), duck, fried eggs,

bacon, canned tuna in oil, whole

fat processed meats: hot dogs,

salami, sausages, etc

Dairy

low fat/non fat dairy: milk, cheese,

cottage cheese, cultured yogurt, ice

cream, frozen yogurt, sour cream

creamy/cheesy sauces, cream,

fried cheese, whole fat dairy,

milkshakes, half and half

Meat, Dairy

Alternatives

almond/rice milk and its products,

beans, lentils, soy products, tofu

coconut milk, nuts, nut butters,

refried beans, fried tofu

Grains

whole grains: bagels, breads, bran,

buns, hot/cold cereals, couscous,

low fat crackers, noodles,

pancakes, pastas, light butter

popcorn, English muffins, rice, corn

or flour tortilla, waffles

fried grains, biscuits, croissants,

french fries, fried potato or corn

chips, granola, fried rice, sweet

rolls, muffins

Fruits

fresh, frozen and canned fruits avocado, fried fruits

Vegetables

fresh, frozen and cooked

vegetables

fried/stir fried vegetables

Desserts

applesauce, angel food cake,

gelatin, fruit ice, popsicles,

puddings, sherbet, sorbet, small

amounts of chocolate

fried desserts, brownies, cake,

candy, coconut, cookies, custard,

donuts, pastries, pies

Beverages

coffee, fruit and vegetable juices,

hot chocolate, sport drinks, tea

beverages with cream, eggnog,

sodas

Seasonings,

Condiments

spices/herbs (as tolerated), jam,

butter/margarine/cooking oils (small

amounts), broth, honey, low fat/light

salad dressings, maple syrup, low

fat/fat free mayonnaise, non dairy

creamer, mustard, salt, sugar

lard, meat drippings, regular

mayonnaise, olives, seeds,

regular salad dressings,

shortening, tahini paste

MCT oil and Nutritional Supplements (use if you have or at risk of losing weight)

MCT oil

 MCT (Medium Chain Triglyceride) is a type of fat that is absorbed directly into the

blood without the need for pancreatic enzymes to break it down

 It is found in coconut and palm kernel oils

 Mix MCT oil into your foods. Start with 1-3 TBSP of MCT oil total for the day

Nutritional Supplements

 Drink fat free high calorie and protein juice nutritional supplements such as

Ensure Clear or Resource Juice Breeze at least twice daily

 MCT rich nutritional supplements such as Peptamen or Vital are available too

50 Gram Fat Sample Menu

Meal Food Choices

Breakfast

1 egg omelet with spinach (protein, vegetable)

1 slice sourdough toast with 1 teaspoon margarine (grain)

½ cup cream of wheat (grain)

½ cup of blueberries (fruit)

Tea or coffee

Snack

Fruit smoothie:1 cup almond or soy milk blended with 1 cup low fat

vanilla yogurt and banana (dairy substitute, dairy, fruit)

Lunch

Turkey and cheese sandwich: 2 slices whole wheat bread, 2 oz lean

turkey breast, 1 slice low fat Swiss cheese, 1 TBSP low fat

mayonnaise, mustard, tomato slices (protein, grain, dairy)

½ cup apple juice (fruit)

Snack

1 cup low fat cottage cheese (dairy)

1 cup cut up cantaloupe cubes (fruit)

Ensure Clear Nutritional Supplement

Dinner

3 oz broiled fish (protein)

½ cup brown or white rice (grain)

½ cup cooked carrots (vegetable)

1 soft, white dinner roll (grain)

1 teaspoon margarine (fat)

Tea or coffee

Snack

3 graham cracker squares (grain)

½ cup strawberries (fruit)

1 cup low fat 1% milk (dairy)

Food Labels

Food labels can provide valuable information to help you follow a low fat diet.

Low Fat Milk 1%

Tips:

The food label included here is an

example of a low fat food.

 Look for the "total fat" in grams.

The grams of fat listed on the label is for

one standard serving. If you eat two

servings, you will get twice as many

grams of fat.

Definition of Terms on Food Labels

Low Fat

 Foods labeled "low fat" have no

more than 3 grams of fat per serving

Fat Free/Non Fat

 Foods labeled "non fat" or "fat

free" have less than 0.5 gram fat per

serving

Light

 Foods labeled "light" have 50%

less fat then the regular version of the

product

Resources

"Nutrition Treatment of Deficiency and Malnutrition in Chronic Pancreatitis: A Review"

Nutrition in Clinical Practice August 2010

"Pancreatitis Nutrition Therapy"

Nutrition Care Manual (Academy of Nutrition and Dietetics)

Not for reproduction or publication without permission

Direct inquiries to Digestive Health Center at Stanford Hospital and Clinics NS 12/2012

Nutrition Facts

Serving Size 1 cup (240 ml)

Servings Per Container 16

Amount Per Serving

Calories 105 Calories from Fat 21

% Daily Value

Total Fat 2g 4%

Saturated Fat 2g 8%

Trans Fat 0g

Cholesterol12mg 4%

Sodium 107mg 4%

Total Carbohydrate 13g 4%

Dietary Fiber 0g 0%

Sugars13g

Protein 8g

Vitamin A 10% Vitamin C 0%

Calcium 30% Iron 0%

*Percent Daily Values are based on a 2000 calorie

diet. Your daily values may be higher or lower

depending on your calorie needs:

Calories 2000 2500

_________________________________________

Total Fat Less Than 65g 80g

Saturated Fat Less Than 20g 25g

Cholesterol Less Than 300 mg 300 mg

Sodium Less Than 2400 mg 2400 mg

Potassium 3500 mg 3500 mg

Total Carbohydrates 300g 375g

Dietary Fiber 25g 30g

Calories per gram:

Fat 9 Carbohydrate 4 Protein 4