Chronic Pancreatitis and Ketogenic Diet

My doctor recommends a low-carb diet (no grains, no fruit) to his patients with pancreatitis & pancreatic cancer.

Have you talked with a dietitian? Do they have you on enzymes? Each of us are going to be unique with our bodies of what we can handle. I couldn't gain weight for three years then all of a sudden I started to gain weight (honestly I don't know why probably stress because I will be having my pancreas removed). However, I did change some foods … rather I changed when I ate them, I started eating cereal at night instead of mornings. I usually eat chicken breast and this past month I purchased boneless/skinless thighs. I don't eat red met therefore I always get ground turkey. I also started eating more cream of wheat in the mornings. It's almost as though I had to force myself to eat more past the point of when I was full (I eat slow since I am always nauseous). Instead of apples I eat applesauce, instead of raw veggies I eat frozen steamed veggies (they're easier to digest). I slowly and I mean slowly incorporated either butter or olive oil into my diet since I don't have a gallbladder or appendix. Once I was able to tolerate it, I started cooking with it. I do eat a lot of carbs, either pasta or jasmine rice. I like to make spaghetti noodles and toss them in the pan with butter, soy sauce and fresh minced garlic (I fry it a little and call them garlic noodles). Any frozen fruits especially mangos I make sorbets with them. You can be creative. I tend to get bored real quick with foods, so I am always looking up new ways of cooking. I stay away from orange juice but I can eat oranges (they're a natural anti-inflammatory). I think the only only reason I have been gaining is because I am eating right before I go to sleep (something I never used to do before). Try and keep a positive outlook and I wish you luck.

I eat more carbs than anything else, as everything I have read (Dr.'s) and from personal experience, fat (and very high protein) leads to pain. This has to do with the generation of Lipase from the pancreas (for fat break-down), thus causing pain.

I ended up coming up with things I could cook with it being low fat (that my wife would also eat). Lots of stir frys (without oils) with lean chicken or turkey. I haven't had red meat, cheese, butter or any form of alcohol in 2 years (I was a social drinker before). I take enzymes and a cocktail of antioxidants and to be honest I haven't felt "sick" in probably 6 months or more. To be on the strict diet is worth it to me, and I am also an athlete (cyclist) at 36 years old. I initially lost weight my first few years but now I am putting on muscle again. I am like you in that they don't know the cause (idiopathic).

Some things I have found I can snack/eat without issue:

egg-white omelets

Soy crisps (instead of potato chips)

Stir frys

Almond milk (low fat version) and cereal

sushi (lean types with no fatty sauces, some avocado OK)

pastas with no oils

fajitas (no oil)

all fruits/veggies (I can handle them raw for some reason)

rice dishes

lean meats

turkey burger with no cheese and 99% lean meat

If you are craving fat I would look into cooking with medium-chain triglycerides (e.g. Coconut oil). These are fats that are easily broken down in the body with minimal strain to the pancreas.

Also, on top of enzymes my antioxidant/cocktail is (this helped a bunch for me):

Grape see extract

Vit C

SAM-E

Alpha GPC

• A low-fat diet may be effective in patients with dyspepsia associated with endosonographic evidence of mild pancreatic disease, who do not habitually drink alcohol.

• Low-fat diet (<20 g of fat/d) may be effective in patients with dyspepsia associated with mild pancreatic disease6 as a symptom-relieving effect was found in the present study. They had taken fat-free diet before entry into the study, and average fat intake in Japanese male and female is reported as 66.3 and 54.8 g/d in their 20s, 63.1 and 53.6 g/d in their 30s, and 60.9 and 53.9 g/d in their 40s,13 although how much daily fat had the patients in the present study taken before entry into the study was not accurately measured. Low-fat diet is also useful for initiating oral nutrition after mild acute pancreatitis.14 It is reported that low-fat diet may produce minimal stimulation of cholecystokinin and relate to reduction of secretin release leading to inhibition of stimulation of the exocrine parenchyma and a decrease in pancreatic secretory pressure and volume5 and thereby to alleviation of pain. It is also reported that a low-fat diet may lead to long painfree intervals in patients with pancreatitis.6

• Dietary fat is the strongest nutritional stimulant of pancreatic secretion.Among normal nutrients, fat is the strongest stimulus for CCK release and exocrine pancreatic secretion. doi: 10.1016/j.clnu.2013.02.002

• High fat intake increased the risk of CP progression: Fat intake was classified as high when the daily caloric intake in fat exceeded 30% of the total daily intake of calories recommended by US Food and Nutrition Board

• Diets containing a high proportion of calories as carbohydrate for 2 weeks are associated with lower interdigestive and postprandial pancreatic secretion than diets that have a high fat content. https://www.ncbi.nlm.nih.gov/pubmed/2227289

• **Considering the association between continuous abdominal pain and high fat diet, a reduction of fat intake seems like a tempting intervention in order to alleviate symptoms. Even though randomized clinical trials are lacking, clinical experience is in accordance with a pain relieving effect of dietary fat reduction and a low fat diet has been recommended for treatment of pain in CP. However, malnutrition is an important complication and cause of morbidity in longstanding CP and a low fat intake may aggravate this. **

• Prospective randomized clinical trials are needed to shed light on the benefits and hazards of diet modifications in CP. In conclusion, an association between high fat diet and a low age at diagnosis and age at onset and continuous abdominal pain was observed in this cross-sectional caseecase study in a large cohort of patients with CP. The study provides new information for the understanding of the pathophysiology of CP and the results need to be taken into consideration in dietary counseling of patients with CP. doi: 10.1016/j.clnu.2013.02.002