Diet in diseases of the pancreas and gallbladder

Gallbladder diet
The diet in gallbladder diseases is very similar to the diet in pancreatic and hepatic diseases. It is typical for this group of diseases that dietary treatment has played a crucial role in the past. Today, on the it is typical that dietary treatment has some significance in prevention and only limited symptomatic significance - in relief from pain. Diets have lost their significance in treatment

Bile is stored and thickened in the gallbladder. The main function of bile is fat emulsification, which allows the action of digestive enzymes. Bile also has an excretory function (it eliminates harmful substances from the body). Many substances pass through the so-called enterohepatic circulation, meaning the substances return to the body after reabsorption from the intestine.

Gallstones (cholelithiasis) is a very common disease. It occurs both in relative malnutrition in developing countries (up to 70%) and in developed countries with excessive food intake (30-60% of adults in Europe). It is more common in women, probably due to estrogen. Other risk factors include obesity, long-term parenteral nutrition and constipation. That is probably due to the effect of deoxycholate produced by intestinal bacteria. Influence of the BMI and waist circumference is more visible at a younger age. The protective effect of vegetables and fiber has only been demonstrated in some studies. Alcohol consumption probably slightly protects against gallstones (cholelithiasis) and higher cholesterol intake does not have a significant impact on the development of cholelithiasis in humans. Intake of sugar, starch and potatoes probably increases the risk of developing cholelithiasis. In diagnosed cholelithiasis, a diet with general fat restriction is appropriate. A sufficient amount of quality fat-free protein and relatively more carbohydrates should be taken before surgery. More or less, there is no evidence that a fat-restricted diet plays a role in already existing cholelithiasis. Rather, gradual mild weight reduction and a healthy, balanced diet, without any deficiency diseases preoperatively are appropriate. Children with gallstones have small fat and protein reserves and tend to have malnutrition.

The daily bile production is about 1000 ml and the gallbladder contains about 70 ml of bile that is concentrated 10-20 times. Normally, bile is excreted within 5-20 minutes after a meal. The regularity of intake (e.g. 5 times a day) and the food restriction 2-3 hours before going to bed are recommended in the prevention against gallstones. It is advised to chew all bites well while eating and to eat in a good mental state without any stress.

A special diet is recommended after biliary colic, which helps the movement of the gallstone to pass through the biliary tract. Acute colic requires plenty of fluids. Suitable is tea, crackers, cooked fruit, cooked rice during the next days, pasta, carbohydrate (sugar) diet. We serve protein first in bread, potatoes and plant foods. Later on skimmed milk, yoghurts, cottage cheese, and lean meat could be served. For quite a long period of time fats, such as butter, should be excluded from the diet. Even cheese should not be served at first. Grain and flour products are the main components of the diet. We exclude spices and eggs from the diet, too. We recommend cooked and stewed meat, rice mash, milk diluted in water, mashed potatoes without fat, leafy vegetables or carrots.

Prof. Páv showed that a diet with a prevalent amount of gallbladder-type carbohydrates did not require a reduction or increase of the dose of insulin in diabetes patients in 1980s. The most common mistake in clinical practise is reducing insulin dose in belief that the intake of carbohydrates is more complex and at the same time the amount of food intake is smaller in general. The dose of insulin may sometimes need to be slightly increased because of on going inflammation.

A more varied diet is possible when suffering from chronic gallbladder disease. This diet is very individual and depends on the tolerance of specific meals in a particular individual. Most patients do not eat fatty meats, spreads rich in fats, creams and mayonnaise salads. The fat that is contained in a dough is more suitable. Carefully, butter or vegetable fats can be added to the diet with maximum of 30 g/day. Sour dairy products are tolerated better, as are sweet foods, cottage cheese and non-aromatic cheese with up to 30% of fat. Fats should only be raw, not burnt. Eating only egg whites, veal, fish and lean beef. Pork, tendons and intestines are unsuitable for the diet. Pastries rather older and unleavened. The greatest variability is in the tolerance of vegetables. Carrots, cauliflower, asparagus, spinach are usually well tolerated. Fruits that are well tolerated are, especially, apples, apricots, peaches and tangerines, while on the other hand garlic and onions are not tolerated well. In the acute stages of gallbladder inflammation (cholecystitis) we serve a tea diet, eventually tea and biscuits. After that we can switch to a gallbladder No. 4 diet for the period of 2–3 days, resp. strictly saving with the exclusion of free fat.

Rules of the saving strict gallbladder diets
(also noted as 4S)
 * This diet is not energetically and biologically complete, and therefore following the diet for a long time is not possible.
 * The diet is mostly carbohydrates. Meat and dairy proteins are completely excluded.
 * The level of protein intake is up to 30 g/day and is covered mainly by vegetable proteins.
 * Fats in diet are below 20 g/day. Using free fats for greasing pans and in food preparation is prohibited.
 * The content of vitamins and minerals is not complete due to the fact that only certain types of food are permitted. It is usually not necessary to follow a strict diet for a long period of time.

Technological preparation of meals for the 4S diet
It is as gentle as possible. The meal should be cooked gently. First, everything should be served in a form of a mush. Pans should not be greased. After an acute period of the disease (biliary colic or gallbladder inflammation) there is a transitional period with a subsequent adjustment to the diet: after 2-3 days of the strict 4S diet, other foods are gradually being added - egg whites, non-fat dairy products (cottage cheese, melted cheese and cheese sliced with up ​​to 30% fat, yoghurts with up to 2% fat), cooked lean meat (chicken breasts, fish fillets, lean beef, rabbits). This diet is very individual and the cooperation of the dietitian with the patient is necessary to eliminate foods that are causing problems. The diet is still non-greasy with the exclusion of free fats. After this period, we switch to the usual gallbladder saving diet in hospitals, usually referred to as No. 4 diet. We administer it in chronic inflammation of the gallbladder, when gallstones present, after the end of acute problems, and also after removal of the gallbladder (cholecystectomy).

Gallbladder Diet Rules No. 4

 * The diet has a saving character both by choosing food and by adjusting it.
 * By choosing low-fat foods and a limited amount of fat for lubrication and food preparation, we reduce the total amount of fat to 60 g / day. We won't fry.
 * Individual food selection will prevent the patient's subjective difficulties from worsening.
 * We provide a rich diet with plenty of vitamins and minerals.

Technological preparation of dishes for gallbladder diet No. 4
It is as gentle as possible, we cook the dishes gently, first we serve everything in a mush, we do not grease.