The suffix "itis" means inflammation. Other examples are appendicitis, or arthritis, which is joint inflammation. For those of you who care, "arthro" means joint. I don't know why it isn't called "arthroitis." It must be some Latin thing. At any rate, pancreatitis is a serious disease often accompanied by numerous septic (see Note 1) complications like pneumonia, peritonitis, liver abscesses, infected pseudocysts, and renal failure.
Common causes are alcoholism in men, and gallstones in women.
An inflamed pancreas can cause burning pain in the upper abdomen. The pancreas itself, is located under the stomach and among several vital organs. It is divided into parts; 1) the endocrine section secretes hormones (like insulin, which carries glucose into muscle cells - it is involved in carbohydrate, fat, and protein metabolism) into the bloodstream, and 2) the exocrine system produces digestive enzymes that aid in digestion - that is, to process food for entry into the small intestine, and secretes a fluid essential to neutralizing stomach acids.
There are two types of pancreatitis: 1) acute pancreatitis, which is marked by severe pain in the abdomen; and 2) chronic pancreatitis, which is progressive, and over time, destroys cells in the exocrine pancreas. Both forms may cause severe pain, but either form may also be pain-free The most common symptom is weight loss and elevated blood sugars.
Chronic pain, untreated, can result in a serious depletion of digestive enzymes. Food can no longer be absorbed adequately into the small intestine, which is where nutrients are passed into the bloodstream. Hunger is a normal result, which causes a lot of eating, which overloads the sick pancreas, and causes pain. A condition now exists where the subject is eating a lot, but at the same time, losing weight because of inadequate absorption.
In addition to, or instead of, pain, symptoms may include diarrhea, improper nutrient absorption with weight loss as previously mentioned, and abdominal distension. You may not consider this a symptom, but pancreatitis can lead to diabetes.
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Note 1 - Sepsis is the presence of various pus-forming and other pathogenic (disease causing "stuff," like viruses or microorganisms") organisms, or their toxins, in the blood or tissues.
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More On Acute Pancreatitis
The onset may be marked by sudden and severe abdominal pain, and may be accompanied by nausea and vomiting. One way of thinking about this disease is that it is a disease whereby the pancreas is digesting itself. Not a pleasant thought, but accurate. You may prefer to think of it as self-destruction of the pancreas by its own enzymes.
Causes are many, including an obstruction of the pancreatic duct that drains the pancreas secretions into the small intestine (maybe caused by a gallstone. Again, alcohol is a major one. Others include ulcers, or even an injury. A lot of times, no cause is determined.
More On Chronic Pancreatitis
A common symptom is abdominal pain. Attacks may last from hours to days, but are recurring; which distinguishes them from Acute Pancreatitis. The chronic nature of this disease may lead to gradual damage to the pancreas, which leads to the digestive problem. As with the Acute version, the Chronic version may also be difficult to diagnose. Again, alcohol can be a significant factor. [I'm not suggesting that all sufferers of pancreatitis are alcoholics, but that, once a person gets it, from whatever source, alcohol will exacerbate the condition _ cut it out, if you get the "symptoms."]
By this time, you will have noticed two common threads: severe abdominal pain and alcohol involvement. Take heed.
A victim of pancreatitis may experience some unpleasant consequences, including edema, hemorrhage, necrosis (see Note 2) of pancreatic and surrounding tissue, biochemical abnormality, and multisystem organ failure.
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Note 2 - Necrosis is the death of one or more cells, or a portion of tissue or an organ, resulting from irreversible damage.
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How Pancreatitis Develops
Ordinarily, the pancreas protects itself from self-digestion by releasing its protein-digesting enzymes in forms that don't become active until they enter the duodenum (the beginning of the small intestine). But, under some conditions, not all fully understood; this process can be disturbed. One theory is that pancreatitis can develop from irritation by bile in the case of an obstruction, as from a gallstone. Bile is directed into the pancreas via a "common channel" - up the down tube, as it were. When pancreatic ducts are obstructed, the continued secretion of pancreatic juices damages the ducts, which raises pressures in the pancreas, resulting in pancreatitis. It can also develop when duodenal contents containing the activated enzymes reflux (back up, like a clogged drain) into the duct. In addition to alcohol, pancreatitis can be caused by peptic ulcers, drug metabolic abnormalities, infectious agents, or injury to the pancreas.
Treatment of Pancreatitis
Acute pancreatitis is unlikely to reoccur if the cause was eliminated, like gallstones or alcohol.
Chronic pancreatitis may require insulin. Pancreatic extract might be given to augment underproduction of enzymes. There are no effective pain-killers for this disease, except addictive drugs. [This information dates from 1991, and may no longer be true.] Antibiotics may help - this was not a clear issue in the data from which the information in this article was extracted.
Kind of on the flip side of treatment is the word that necrotizing pancreatitis results in some mortality - maybe 3-7%, occasionally higher.
This discussion about pancreatitis has necessarily been pretty generic, for any specific questions about this disease, use the address or phone number at the end of this publication.
This next section is actually about heartburn, but it will take a little lead-in time. As you know, nutrition is a very important ingredient in the fitness puzzle. For those with busy schedules, it can be a problem trying to fit nutritious eating into a day of work, school, exercise, transporting kids, or any of a million other things. Not only eating healthy, but working it in around exercise, and avoiding late night meals can be tricky stuff. But, it is important. You may find yourself skipping meals and/or eating junk food, but that isn't good for an exercising body; or any other body, for that matter. Either late night meals, or eating immediately before exercise, can result in indigestion, an upset stomach, or both of these conditions.
The normal digestive processes include an acid bath for partially digested food going from the stomach to the small intestine. A condition called "reflux," where food being digested goes up the esophagus, which is contrary to the normal flow of events. Clearly it should go down toward the small intestine. The result can be acid indigestion, heartburn, nausea, maybe vomiting, and/or abdominal discomfort. When reflux occurs, acidic stomach contents end up in the throat or mouth. Reflux, and its accompanying bitter taste can be caused by pressure in the abdomen and chest resulting from, for instance, weight training. A good reason not to eat right before a workout. [Other causes include obesity, overeating, and lying down right after eating.]
The types of foods eaten can contribute to getting reflux - foods high in fat, some medications, alcohol, or tomato-based foods; or caffeine or spicy foods, which can exacerbate the problem by increasing acid secretions.
Eating late can be a doublewhammy, it leads to increases in fat deposits as your metabolism slows down for a night of sleep; and the chance for reflux, from lying down, increases. Late eating should be avoided, but if it isn't, you should wait until your food is digested before going to bed. A stomach full of undigested food may give you heartburn or other discomfort - a result of the slop going back up your esophagus. If you sleep flat, and most of us who aren't bats do; it is recommended that you sleep on your side, with your head elevated.
If you use OTC drugs, like NSAIDs (Advil, Motrin, Aleve, etc.); or aspirin, for GI problems, or even muscle soreness from exercise; you run the risk of getting ulcers, as the stomach's mucous lining is eroded (a "feature" of the medication), making the walls susceptible to damage from its highly acidic contents. If you get heartburn or stomach pain frequently, see a doctor.
Steps a person can take to combat the problem are:
The issue of nutrition remains somewhat of a puzzle for many active people. What should I eat, and when? In an attempt to answer these questions, both a general overview and some specific suggestions for grazing (see Note 3) are presented.
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Noter 3 - Grazing is an eating technique wherein several small meals are eaten each day, replacing the traditional big-three-a-day meal pattern. Six mini-meals is a commonly used number.
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Nutrition Before Exercise
For most exercisers (fitness, not competitive), pre-exercise nutrition isn't much different from ordinary healthy nutrition. Start off the day with a nutritious breakfast - this is not a cup of coffee in your car as you drive to work. Get started with some carbohydrates - maybe some cereal and fruit, or toast and juice. If you exercise early, maybe just some water is better; exercise, then eat. Food tolerance with respect to exercise is widely variable; therefore, do what suits you best. Experiment a bit, but be aware that a common admonishment is to avoid eating within 90 minutes before exercise. The key issue is to not begin exercise in either a dehydrated (remember the urine test: if it's yellow - DRINK) or an undernourished condition. Normal healthy eating patterns should be sufficient. In other words, what you eat and drink the day before may be more important than what you do or don't eat or drink right before exercise, especially in the morning.
Nutrition After Exercise
This is especially important for those who are involved in double workouts (e.g., running in the morning and weight training in the afternoon), or endurance events.
The first issue to address is fluid replacement. This is crucial. Water is the important ingredient here. It is used by the body for temperature control, is essential to blood plasma (the liquid component of blood, which allows blood circulation for ferrying around nutrients and waste) and lymph, is important for joint lubrication - it is required for all body cells to function.
The next concern is carbohydrate replacement, which really means glycogen replacement. Within two hours after intense exercise (the earlier in the two-hour window, the better) it is important to re-energize by eating some carbohydrates, which are a major energy source for exercise. Carbohydrates fuel our more intense exercise, while fat is the more prevalent fuel for low to moderate intensity exercise (and that being mainly how we spend our lives, probably explains why our bodies can so easily store it in such abundant amounts). There is a formula to use for calculating how much we should get, but let's keep it simple. As an example, a 150 pound man should ingest about 75 grams of carbohydrates during the two-hour window. That is easily done by having:
Some bodybuilder types claim that a post-exercise feeding should include some protein, but nutrition experts don't necessarily agree. It is only necessary to get an adequate amount of protein during each day (roughly 15% of daily calories). This basic level is necessary for cell building/repairing, but there is no special post-exercise replacement need.
The final post-exercise recovery issue to address is electrolyte (see MAF FITNESS NEWSLETTER, Issue 2, 1995) replacement. These minerals are especially important for endurance athletes, or, actually, for anyone who exercises long enough or hard enough to sweat a lot. Typically, you don't need to worry about this. Normal nutrition, especially fruits and vegetables, will replace lost minerals. Potassium (a major electrolyte) can be replaced by a banana, some orange juice, raisins, other fruit juices - a host of foods in a normal diet will do the trick. Sodium is another electrolyte that can be depleted by intense sweating, but so much food contains salt (sodium chloride) that this is not a problem.
Now that we have touched on eating and exercise, let's address the "I don't have time to eat right" problem. For really busy people, it is difficult to eat at "right" times. You have all heard it for years: breakfast is the most important meal of the day. And it is. And it is probably the most abused. There are tons of excuses for skipping it, but none are legitimate. Something as simple as a bowl of cereal with fruit, or even some juice and milk, can get you going in the morning. Don't skip this meal, even if you are not hungry. One solution for the "too busy" person is the previously described eating style called "grazing." Lots of snacks, all day long, instead of regular large meals. Grazing takes some planning and preparation, but it can be a good eating strategy.
To start off, there is the 6-5-4-3-2 system to consider. Choose foods using this system:
Serving sizes are:
Note that meat alternatives are protein sources like beans and rice, or fish.
Stick to low fat items, and don't go more than five hours without eating. This is because of the glucose "thing" - liver glycogen (glycogen is the storage form of glucose, which normally comes from the metabolic breakdown of carbohydrates - glucose is the only fuel used by the brain, and, in its absence, will cannibalize muscle tissue to create more) can be depleted in 4-6 hours. Take some snacks to work - fresh or dried fruit, yogurt, bagels, Graham crackers, fig bars (a good low-fat cookie, but watch those calories), low-fat crackers, carrot sticks or other raw veggies, vegetable soup, peanut butter sandwiches - you get the idea. You can nibble all day. But don't forget about calories - don't graze on M&Ms, candy bars, chips, etc. Keep a stock of good snacks in your desk or company refrigerator. Don't let yourself use the "I forgot my stuff" excuse.
The last big ugly issue to tackle is the late "I'm starving" dinners. For those who skip meals all day, arrive home late and famished - you know who you are - you are at risk. Late "stuffing" is common among this group, and can lead to GI troubles, loss of sleep, as well as substantial weight gain; which leads to increased risk of a bunch (plethora?) of health problems.
This group has a serious problem about which I hardly know what to say. But I'll find something.
First, try to avoid the "I'm famished" condition by fol lowing the grazing strategy. Then make your late meal a light one. Then allow time for digestion - taking a short walk to help speed it up is good, but probably light years from reality.
Second, if you failed at the first suggestion, try it again, because that's all there is!
Here are some quick meals for home, or they could be frozen, then microwaved at work. This is just a brief sample; there are dozens of books on the market that are full of lowfat, easy to prepare meals. I just want to motivate you to do exactly that.
Turkey Chili (serves 10, or so they say)
In a large pot, brown the turkey with chopped onions. Add beans, tomatoes, seasonings, and salsa. Cook until hot. [Each serving is about 228 calories; 24% from fat.]
Barbecue Chicken (serves four)
Preheat oven to 350°. Line cookie sheet with aluminum foil. Pour remainder of barbecue sauce on top of the chicken. Add the cut veggies. Add another layer of aluminum foil, and join with bottom foil to fold sides together. Bake about 35 minutes. [Each serving is about 263 calories; 15% from fat.]
Here is a sample of 1-minute meals (see Note 4) - anybody can find time for these snack-meals.
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Note 4 - More 1-minute meals may be found in a book called Eating on the Run, by Evelyn Tribole, published by Leisure Press, a division of Human Kinetics publishers. Another good source of nutrition, including recipes, is Sports Nutrition Guidebook, by Nancy Clarke, and also published by Leisure Press.
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Tropical Smoothie
Mix this stuff in a blender. [About 209 calories; 0% fat.]
Hula Bagel
On bagel halves, spread the rest of the ingredients (mixed, of course). [250 calories; 0% fat] Peanut Butter/Banana Shake
Blend the milk, frozen banana, and vanilla. Add peanut butter while blending. [295 calories; 27% fat]
Peach Smoothie
Combine all ingredients in a blender until smooth. [324 calories; 0% fat]
The Quickie - You certainly have time for this one!
Pour milk into a cup and drink it. Pour juice and drink it. [198 calories; 0% fat]
Basic Sandwich
Make a sandwich. [about 225 calories; 15% fat]
Cereal and Milk
Put ingredients in a bowl. Use spoon to transfer contents to mouth. [about 196 calories; trace of fat]
A comment on the use of peanut butter. It is very high in fat, but there are some redeeming qualities: 1) most of the fat is unsaturated, 2) it contains some nutrients: e.g., protein, and 3) it tastes good. Used sparingly, it can be a good element in a healthy diet. A good tip is to buy natural-style and drain off the oil to eliminate some of the fat.
Another issue is acceptable fat percentage in a daily diet. There are some proponents of 30%; I prefer 20%, and I am not alone. You will notice that some of the recipes provided above exceed the 20% mark, but they are only a small part of one's daily caloric intake.
As a Personal Trainer, I have some updates to the MAF FITNESS NEWSLETTER on abdominal exercises (February 1995 issue), and the leg training issue (March 1995).
First, abdominals. You mentioned an exercise called "suck-'em-ins," an exercise for the transverse abdominal muscle; which is rarely mentioned, but is important to developing a flat, abdominal wall. Since this exercise is new to most people, here is a way to get acquainted with it. Pull your belly button in toward your spine. Repeat this five times, just to get used to the way it feels. Now, pull it in and hold it for one minute, while remembering to breath normally. Now that you are acquainted, maintain this "pulled in" position during all other abdominal exercises. In addition, try to maintain this position for the rest of your life. Make it part of your constant body awareness. Of course you understand that this "pulled in" position is not a maximal effort. Just try to maintain a slight, but constant tension. The goal is that eventually there will be no thought process involved in this action, none what-so-ever.
Now legs, specifically bodyweigh-only squats, which were not addressed. This is a good exercise for the beginner, especially one with no equipment or gym membership. Starting in a standing position with your arms out in front of you at about shoulder height, feet about shoulder width apart - whatever is comfortable; sit back as if lowering yourself into a chair. As you sit back (squat), raise your arms. Your head should remain in the neutral position (face forward), but your eyes should be looking up at about a 45° angle. Squat until your thighs are parallel to the floor (or less, if that is all you can do). Two critical checkpoints are your back - it should remain vertical, and your knees - they should not project beyond your toes. A straight back, to keep the weight on your legs, not your lower back; and knees over ankles to prevent knee injury from increased shearing
force caused by being projected beyond your toes. Also, your weight should be supported on your heels in both the up and the down movements. Both raising your arms and looking up during the squat, help you to maintain a vertical back.
J.L., Myrtle Creek, OR
Here is a synopsis of another article on the importance of a warm-up before any exercise or sports activity, whether it is weight training, tennis, swimming, golf, cyc-ling, or just about anything. [Editor's com-ment: Sports Il-lustrated seems to consider poker to be a sport, but it really doesn't require a warm-up.]
As you may know, the reasons for a warm-up include im-proving flexibility, strength, extensibility of tendons, and blood flow to muscles. It is a good idea to do a general warm-up for the entire body - some aerobic activity like walking, jogging, using a stair stepper, stationary bike, treadmill, etc. For example, running - start slow and gradually build-up speed; or weight training - start each body part with a light, "throw-away" set. That is, start with one or more light sets which are not counted as part of your workout. After your general warm-up may be a good time to do some stretching, although it may be that stretching is more appropriate after your workout when muscles are fully warmed up and are at their maximum flexibility.
In physiological terms, a warm-up, in addition to simply increasing muscle temperature,
increases your heart rate, blood pressure, and oxygen con-sumption; dilates blood vessels; and in-creases muscle and tendon elas-ticity. It also helps to reduce lactic acid buildup and fatigue, and stimulates motor units in the muscles in preparation for increased work. It is important to move body parts to be exercised through a full range-of-motion; not just to warm them up.
D.K., Hayward, CA
Due to production costs, beginning with the January 1996 issue of the MAF FITNESS NEWSLETTER, it has become necessary to charge new subscribers $12.00 per year (payable to M. A. Fenner). Current subscribers may feel free to make a donation, or not. Thanks for understanding the realities of today's business environment.
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For questions, call (408) 739-0501, or write to:
MAF, 964 Ponderosa Ave., Suite 25, Sunnyvale, CA 94086-8931
Email to Mike_Fenner@netcom.com