A pancreatic removal (= pancreatectomy) may be necessary in the case of cancer of the pancreas or in the case of treatment-resistant, severe chronic pancreatitis.

In addition to the complete removal of the organ (ectomy), there are also partially conserving surgical procedures (hemipancreatectomy, left pancreatic resection , Kausch-Whipple operation ). A complete pancreatectomy results in type 1 diabetes mellitus .

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Anatomy of the pancreas & description of the endocrine and exocrine function:

Our pancreas consists of a head, a body and a tail.

The main task of the head area is to form enzymes for the utilization of our food and thus nutrients (= exocrine function). These are then released into the small intestine to break down carbohydrates, proteins and fats from our foods. The main task of the tail area of the pancreas is to produce hormones for the metabolism of carbohydrates - insulin and  Glucagon (= endocrine function).

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1. Total pancreatectomy

In total pancreatectomy, the entire pancreas, spleen, duodenum, gallbladder and parts of the biliary tract and stomach are removed.

Consequence: The body cannot produce any insulin or cannot produce enough insulin.

This means that type 3C diabetes mellitus requires insulin. This “secondary” diabetes is characterized by a high sensitivity to insulin. Strict blood sugar control should be avoided due to the risk of hypoglycaemia (low blood sugar). Otherwise, the guidelines for diabetes mellitus type 1 therapy apply.

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2. Partial (partial) pancreatectomy

A distinction is made between the resection of the head of the pancreas, the "Whipple operation" and the resection of the tail of the pancreas, also called resection of the left pancreas or distal pancreatectomy.

During the Whipple operation, the head of the pancreas, the duodenum, the gallbladder, parts of the biliary tract and, depending on the size of the tumor, part of the stomach (partial gastric resection) or the spleen are removed. This means that the pancreas can no longer digest food (especially fats !!!), which leads to exocrine pancreatic insufficiency .

In the resection of the pancreas tail, depending on the extent of the tumor, parts of the pancreatic body, the pancreas tail and the spleen of different sizes are removed. The tail of the pancreas in particular contains cells that produce the hormone insulin. This hormone is crucial for blood sugar regulation. If there is a lack of insulin, sugar cannot be transported into the body cells and there is an excess of sugar, which leads to endocrine pancreatic insufficiency .

The consequence of resection of the tail of the pancreas: the body cannot produce any insulin or can no longer produce enough insulin.

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Why is nutritional therapy important?

Nutritional therapy supports you in promoting and supporting the healing / regeneration process. Furthermore, all effects that affect the operation are included in the consultation and taken into account. Thanks to a wholesome, wholesome selection of foods and the preparation of the meals using technical cooking techniques  flatulence, bloating, pressure in the abdomen and pain are counteracted as a result. You will learn which foods you can safely eat.

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Pancreatic enzymes and MCT fat can help with symptoms such as diarrhea, unwanted weight loss, fat in the stool (= steatorrhea). Please only use this after receiving qualified advice, as there are important things to consider and both products do not have to be used in parallel at the beginning. In the case of an endocrine disorder, this is treated accordingly by taking into account carbohydrate units (= KE units), adjusting the carbohydrate intake and taking appropriate measures. The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed. Weight reduction is recommended if you are overweight / obese. An anti-inflammatory diet can improve the state of health.

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Nutritional therapy for exocrine pancreatic insufficiency:

• Wholesome wholesome food and drink selection as well as food preparation

• Counteract gas and diarrhea

• Vitamin replacement therapy to prevent deficiencies and to provide you with adequate care

• Show supportive medication for flatulence to promote more well-being

• possibly with regard to a dumping syndrome Characteristics: diarrhea symptoms (after gastric surgery)

• Treat any lactose intolerance: Show low or lactose-free food choices

• Possibly enzyme substitution with enzyme training (please only under professional medical / nutritional guidance), taking into account a stomach-preserving operation / operation with partial gastric resection

• possibly MCT fats (please only under professional medical / nutritional guidance)

Therapy for endocrine pancreatic insufficiency:

In the case of endocrine pancreatic insufficiency, the blood sugar level must be checked regularly and, if necessary, supported by insulin injections / insulin administration. If there is an absolute lack of insulin , this is also referred to as type 1 diabetes mellitus. People must be given insulin on a regular basis.

Important: If the antagonist of insulin, the glucagon, is also affected by endocrine pancreatic insufficiency,

this increases the risk of life-threatening hypoglycaemia through the administration of insulin. This must be taken into account when treating pancreatic insufficiency.

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Exocrine disorder:

Digestive enzymes are produced too little / not at all

→ Digestive problems (such as flatulence, pain, nausea, loss of appetite) & diarrhea are the result.

The pancreas produces around 1-2 liters of digestive secretion daily (neutralizes gastric acid & contains digestive enzymes (lipase !!! & others). This reaches the duodenum via the pancreatic duct. Symptoms only appear when 90 percent of the organ function has already failed.

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Symptoms:

• Fat digestion problems (characteristic: visible fat in the stool) = steatorrhea

• nausea

• Vomit

• Fat stool

• Loss of appetite from the complaints

• stomach pain

• Flatulence (meterorism)

• possibly light-colored stool

• unwanted weight loss → Warning, malnutrition!

Disrupted fat digestion causes the fat-soluble vitamins E, D, K and A.  no longer properly recorded. This is how vitamin deficiencies can develop. These in turn cause their own complaints. For example, a severe vitamin K deficiency leads to an increased tendency to bleed. Due to the insufficient production of digestive secretions, a lot of undigested food also gets into the colon. There, intestinal bacteria decompose the food components with strong gas formation. The result is sometimes very painful gas.

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Endocrine disorder:

Blood sugar regulating hormones (insulin and glucagon) are not produced sufficiently or not at all

→ Disturbances in glucose metabolism (type 1 diabetes mellitus = absolute insulin deficiency or type 2)

• Insulin is responsible for ensuring that the sugar in the blood (glucose) can be absorbed by the body cells, which means that the blood sugar level drops.

• If, on the other hand, your body needs more energy (e.g. during stress or low blood sugar levels), the hormone glucagon mobilizes energy reserves in the body and thus promotes the release of stored glucose (storage form: glycogen) and the formation of new glucose. Through this the blood sugar level rises.

If the sugar level in the blood is too high, it is called hyperglycaemia.

If it is too low, it is called hypoglycaemia.

Symptoms:

The result is ailments that are also known from diabetes:

• thirst

• frequent need to urinate

• Exhaustion etc.

The lack of insulin also means that brain cells are not receiving enough sugar and therefore not enough energy.

As a result, the body produces so-called ketone bodies for energy production, which can also be transported into the cells without insulin. However, the ketone bodies are acidic, which means that they lower the pH value in the blood .

So gradually a " ketoacidosis " develops with its own symptoms (vomiting, thirst, acetone bad breath, etc.). If glucagon is predominantly lacking in endocrine pancreatic insufficiency, the body can no longer raise a blood sugar level that is too low. This arises, for example, if you haven't eaten for several hours. Normally, the body's energy reserves are then mobilized through the glucagon in order to raise the blood sugar level. If this is not possible, severe hypoglycaemia can occur.

Symptoms:

• Tremble

• Cold perspiration

• Loss of consciousness

In this situation, glucose must be administered urgently so that the brain does not get an undersupply!

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Common dangers / complications after a stomach removal / partial removal

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1. Agastric dystrophy, unwanted weight loss due to a lack of hunger and satiety

2. Malnutrition (lack of energy - falling weight and / or lack of protein (muscle breakdown, note an albumin value of at least 3 (see blood count)

3. Underweight, unwanted weight loss

4. Lack of vitamins and minerals

5. low reservoir function

6. Dumping syndrome (early and late dumping) -> symptoms of diarrhea

7. Shortened food path / contact time -> risk of diarrhea

8. Further effects on digestion: e.g. Grehlin hunger hormone is less / no longer available -> lack of feeling of hunger -> fewer meals or smaller portions -> unwanted weight loss

9. possibly a lactose intolerance can develop

10. Danger of germ colonization (stomach acid and therefore no hydrochloric acid) -> pay attention to hygiene when preparing and storing food and meals.

11. Blind loop syndrome (after a Billroth 2 operation) Mash can get into the feeding loop and there is a risk of inflammation

12. Insufficient stimulation of the enteric hormones -> poorer utilization of food -> unwanted weight loss

13. Fat in the stool - steatorrhea -> shows poor utilization of the food components

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Vitamin B12 : This vitamin can no longer be absorbed after the stomach has been removed - an injection (at least every three months or even weekly (very tall people) is necessary.

Iron : The absorption of iron from food is improved by stomach acid. If this is missing, a deficiency can arise.

Vitamin D and calcium : the administration of a combination preparation optimizes the supply.   

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Dumping syndrome

Dumping syndrome is a common complication after gastric surgery.

Literally translated means “to dump” = “to fall”.

This syndrome can be divided into two phases:

Early dumping:

starts approx. 15-20 min  after eating and manifests itself in the form of a feeling of fullness, abdominal cramps, nausea, vomiting or diarrhea. These symptoms may go away after a few months.

Late dumping:

starts approx. 1-1.5 hours after the meal. Signs are sweating, nausea, restlessness,  Tremors and or cravings.

It occurs less often than early dumping and the symptoms subside relatively quickly.

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I would be happy to explain to you in the consultation how you can avoid the dumping syndrome and how you can counteract it from a dietary point of view.

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Classification of your weight - definition and classification of weight in relation to height.

Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.

BMI and interpretation: BMI: body mass index. Formula: Body weight in kg : (body height in m) 2

Underweight: <18.5

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Nutritional therapy

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• Holistic Nutritional Therapy for Exocrine Pancreatic Insufficiency & or Endocrine Disorder

• Build up to an adapted permanent diet

• Anti-inflammatory nutrition as a basis, individually tailored to you

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Overall fat selection, how should it be designed

• How many animal foods (e.g. meat products, milk and dairy products, cheese, fish products, eggs) are recommended?

• What do I have to look out for when choosing animal foods?

• How can I counteract inflammatory processes through diet?

• Body weight: Weight reduction is recommended if you are overweight / obese.

• In the case of insulin resistance and lipid metabolism disorders, also treat them with nutritional therapy

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency

• Which nutrients do I need in which ratio?

• Get enough fiber (> 30 g / day) through natural foods, possibly fiber substitution

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created.

• add valuable anti-carcinogenic (anti-cancer) secondary plant substances

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• Get enough Omgea-3 fatty acids and essential fatty acids

• How can I boost and support my metabolism with natural foods?

• Coordinate sensible meal frequency for your individual case - meal allocation

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Flatulence, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• long-term maintenance of a jointly defined weight

• Strengthen the stomach and intestines with natural foods

• Additional therapy options

• Dietetic products in support of nutritional therapy

• Food supplements - under certain circumstances, a supplement can be useful

• and other topics

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Any questions? I look forward to your call or email. To contact form

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Assistance:

• KISS self-help groups

• Self-help network

• AdP eV pancreas patients - self-help group

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