Acute Pancreatitis Might Be Better Managed Through Personalised Nutrition

Acute pancreatitis (AP) is a highly unpleasant gastrointestinal illness.

The number of people affected by it is rising and it is not entirely clear why. It afflicts up to 45 people in every 100,000 in the population and the healthcare costs of hospitalization are close to $2.5 billion in the USA alone (Yadav & Lowenfels, 2013; Xiao et al., 2016). Very often gall stones, too much drinking of alcohol and other diseases can bring on the condition. There is one other particular cause and that is the consumption of too much fat in the diet (Ding et al., 2019).

It seems that if appropriate supplementation using prebiotics and probiotics, omega-3 fatty acids and glutamine is timed right, then AP can be managed to large extent. A significant review by Jiangnan University in China has assessed all these nutrients and found them to be a good alternative in intervention to current medical practice (Pan et al., 2017). At the moment there are no effective drugs available to prevent or remedy the situation.

When the researchers looked at the various supplements they found some interesting aspects. Glutamine and prebiotic fibre for example when administered at the right time, appears to reduce hospitalisation and reduces the time for total parental nutrition. On the hand, the results from probiotic supplementation seemed less certain. According to the survey, when multiple species were tried they did not reduce the risk of infectious complications and there was a statistical association with an increased risk of death (mortality). Those are quite surprising results when the prebiotic fibre actually reduced the overall complications from acute pancreatitis.

What Is The Best Nutritional Intervention ?

If AP can be caught early enough, then feeding with single species rather than a multi-species probiotic appears to be more successful. Feeding with Bifidobacterium reduces markers of AP like the inflammation creating cytokines. There is also a general better gut functioning and this equated to a shorter stay in hospital.

The review suggests that further clinical trials with probiotics with a single species is needed before a clear recommendations can be made.

The Role Of Vitamin Supplementation

A few studies indicated a role for vitamins in ameliorating the effects of AP. High doses of vitamin C have always been beneficial to many in hospitalised situations because of its antioxidant benefit. It seems vitamin C can reduced some of the painful symptoms of AP by boosting immune function and blocking lipid breakdown through free radical peroxidation. Generally though, multiple vitamin application using vitamin C with A and E was not so conclusive. This however is from a single study and the researchers suggest that time and level of dose are critical as a therapy.

The Role Of Fish In reducing Acute Pancreatitis

Fish are a good source of omerga-3 fatty acids. It seems that fish of all types are associated with a reduced risk of non-gallstone related pancreatitis. Again, markers of inflammation such as cytokine levels are reduced by supplementation with fish oil.

Many of the conclusions to be drawn are quite general. Personalised nutrition may be the way forward where a particular combination of nutritional therapies are suggested. AP is such a variable condition fraught with different conditions and complications, that a number of therapies appropriate to the situation are suggested. All needs further investigation.

If you want to know more about glutamine in supplementation, there is an article about it for bodybuilders who use it regularly.

References

Bansal, D., Bhalla, A., Bhasin, D.K., Pandhi, P., Sharma, N., Rana, S, et al. (2011) Safety and efficacy of vitamin-based antioxidant therapy in patients with severe acute pancreatitis: a randomized controlled trial. Saudi J. Gastroenterol. 17 pp. 174–9. PMID: 21546719  doi:10.4103/1319-3767.80379

Ding, Y., Zhang, M., Wang, L., Yin, T., Wang, N., Wu, J., … & Xiao, W. (2019). Association of the hypertriglyceridemic waist phenotype and severity of acute pancreatitis. Lipids in health and disease, 18(1), pp. 93 (Article)

Pan, L-L., Li, J., Shamoon, M., Bhatia, M., Sun, J. (2017) Recent Advances on Nutrition in Treatment of Acute Pancreatitis. Front Immun. https://doi.org/10.3389/fimmu.2017.00762

Xiao, A. Y., Tan, M. L., Wu, L. M., Asrani, V. M., Windsor, J. A., Yadav, D., & Petrov, M. S. (2016). Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. The Lancet Gastroenterology & Hepatology, 1(1), pp. 45-55 (Article)

Yadav, D., Lowenfels, A.B. (2013) The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology (2013) 144:1252–61. PMID: 23622135 doi:10.1053/j.gastro.2013.01.068