Bearing in mind these practical issues, an easy alternative to non-stimulatory enteral feeding would be no feeding until body stores become depleted. Indeed, no study has yet tested whether enteral feeding is better than no feeding in clinical practice, although a small underpowered study suggested that the cytokine response was no different . If pancreatic rest is useful, then this is the surest way of imposing it. The problem is that we have no easy way of knowing when body stores run out. From studies in starved healthy volunteers, it has been estimated that protein stores last about 14 days , but with protein catabolism, patients will become depleted earlier. A further concern is that starvation, like TPN and bowel rest, will result in disuse atrophy of the mucosa, stasis, bacterial overgrowth and increased permeability, and increased risk of infection from enteric organisms, thus exacerbating the pathological changes associated with acute pancreatitis. With these considerations in mind, it would be prudent to start nutritional support before the 2nd week of illness.
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WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.