Understanding Chronic Pancreatitis and Nutrition
*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.
Chronic pancreatitis and nutrition
Chronic pancreatitis is a long-term, irreversible inflammatory disease that causes progressive replacement of normal pancreatic tissue into scar tissue.
Causes of chronic pancreatitis
It can be caused by smoking, excessive use of alcohol, genetic mutations, some autoimmune diseases, a severe episode of pancreatitis or recurrent pancreatitis, among others. It can also run in families. Sometimes the cause is never discovered.
Chronic pancreatitis and nutrition
As the disease progresses over time, your pancreas becomes more inflamed and damaged. It can lose its ability to produce essential enzymes needed for your body's normal nutritional process, to break down foods. Without these essential enzymes, your body may have trouble digesting food and absorbing nutrients.
The pancreas also makes hormones, such as insulin that is crucial for body sugar control. A small group of patients with chronic pancreatitis are at risk of developing diabetes.
Chronic pancreatitis can cause maldigestion, malabsorption, and malnutrition
Some diseases make it hard for your body to digest food properly. Maldigestion is the term used for impaired digestion.
Malabsorption, on the other hand, is the term used when food is poorly absorbed. The body only absorbs and digests small amounts of food. This prevents the body from absorbing key nutrients.
Both maldigestion and malabsorption can lead to malnutrition.
Exocrine pancreatic insufficiency
People with chronic pancreatitis develop maldigestion and malabsorption because they don't produce enough enzymes to digest food. This is called exocrine pancreatic insufficiency.
Signs of malnutrition in chronic pancreatitis
People with chronic pancreatitis who are malnourished often lose fat and muscle that leads to weight loss. You don't have to be thin to be malnourished though. People who are normal body weight range or overweight, can also be malnourished, no matter how much food they consume. It all depends on how nutritious the food is and how well their body digests and absorbs the nutrients.
Signs of malnutrition in chronic pancreatitis
If you're malnourished you might feel tired, weak, or have a lack of energy. Cuts or scrapes might take longer than usual to heal. Malnourishment affects how well your immune system works and how your body's cells can repair or rebuild themselves.
As chronic pancreatitis progresses, another symptom that occurs is fatty, foul-smelling stool. This is called steatorrhea.
What causes steatorrhea?
If you notice bulky, pale, greasy and foul-smelling stool when you move your bowels, this is steatorrhea. The fatty stool is caused by your body's inability to produce pancreatic lipase so fat can't be absorbed. Steatorrhea is considered to be a late-stage symptom of chronic pancreatitis where a significant amount of the pancreas is damaged.
Nutritional assessment for chronic pancreatitis
People with chronic pancreatitis should have a nutritional assessment and follow-up by a registered dietitian. Dietitians use nutrition screening tools to assess if people are getting enough nutrients from their diet. Typically, a dietician will measure your height and weight to determine your body mass index. The dietitian also needs to know if you have recently lost weight unintentionally, if your appetite is less than usual, and if you show signs of serious illness.
Additional nutritional screening by a dietitian
During your first visit with a dietitian, you may be asked to keep a journal of what you eat over the course of a few days. The dietitian needs an idea of what your diet is like, how often you eat, and when you eat. Once that is established, the dietitian will look for other clues about your nutritional health, such as your activity level.
Additional nutritional screening by a dietitian
Your medical history and test reports are also full of information for your dietitian to work with. Blood tests can tell if you’re lacking vitamins and minerals, stool tests can show if your body is losing fat, and other tests can show things like how strong your bones are.
Nutritional plan and monitoring
Once your dietitian has a good idea about your nutritional status, it's time for the two of you to work as a team to make plans that incorporates good nutrition. Your dietitian will monitor your progress to see how well your nutrition changes are helping your body. And if needed, you both can tweak your diet to see if you can make more improvements.
Nutritional plan and monitoring
If you have exocrine pancreatic insufficiency pancreatic enzyme replacement therapy will be prescribed by your doctor.
Nutritional plan and monitoring
Follow-up is important because people with chronic pancreatitis are at risk for developing complications, such as diabetes. Other complications include osteoporosis (thinning bones) and pancreatic cancer.
Managing nutrition in people with chronic pancreatitis
A good diet, good hydration, nutritional supplements and when indicated, pancreatic enzymes, are the major parts in the effort to manage nutrition in chronic pancreatitis. However, people with the disease may also need to make some lifestyle changes. One of the most important is to stop drinking alcohol and smoking cigarettes. If they have trouble doing so on their own, there are programs that can help.
References
-
Brennan G.T., Saif M.W. Pancreatic Enzyme Replacement Therapy: A Concise Review. JOP. 2019;20(5):121-125.
-
Duggan S.N. et al. Patients with chronic pancreatitis are increased risk for osteoporosis. Pancreas. 2012 Oct;41(7):1119-1124.
-
Duggan S.N., Conlon K.C. A Practical Guide to Nutritional Management of Chronic Pancreatitis. Practical Gastro. June 2013. Nutrition issues in gastroenterology, Series #118.
-
Erchinger F. et al. Fecal fat and energy loss in pancreas exocrine insufficiency: the role of pancreatic enzyme replacement therapy. Scand J Gastroenterol. 2018 Sep;53(9):1132-1138.
-
Forsmark C.E. et al. The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent. Aliment Pharmacol Ther. 2020 May;51(10):958-967.
-
Kondrup J. et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003 Aug;22(4):415-421.
-
Rasmussen H.H. et al. Nutrition in chronic pancreatitis. World J Gastroenterol. 2013 Nov 14;19(42):7267-7275.
-
Rysz J. Nutrition and malnutrition in chronic pancreatitis. J Food Sci Technol. ISSN: 2472-6419. Vol. 3; Issue 5. 431-439.
- Zuvarox T., Belletieri C. Malabsorption Syndromes. [Updated 2021 Mar 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
Chronic pancreatitis is a long-term, inflammatory disease that causes progressive replacement of normal pancreatic tissue into scar tissue. Its causes are numerous, and as disease progresses the pancreas becomes inflamed and damaged. There is loss of ability to produce enzymes needed for normal digestive processes which cause maldigestion, malabsorption and malnutrition. Persons with chronic pancreatitis should have a nutritional assessment and follow-up by a registered dietitian. A dietitian will assess your nutritional status and recommend a good nutrition plan as well as monitor your progress to see how well your nutrition plan and changes are helping your body. A good diet, good hydration, the right nutritional supplements and when necessary, pancreatic enzymes treatments are important in managing your nutrition in chronic pancreatitis.
-
Share with family and friends:
Click here to take our SURVEY
Your feedback is important to us! We will use your feedback to develop future areas of content about pancreatic diseases which will help other patients, caregivers and families.
