Q:A close friend of mine has been diagnosed with pancreatitis, although he is "clean living" as he hardly drinks and doesn't smoke. I understand the illness can be controlled by drugs, and he is on a cocktail of them. Unfortunately, he hardly eats

A:Pancreatitis is the inflammation of the pancreas, a gland that releases insulin, glucagon and enzymes for digestion. The condition comes in two forms: acute, which is shortlived but often fatal, and can be resolved completely if the patient survives the critical phase, or chronic, which is irreversible and degenerative even after the cause is removed.

The conventional view is that pancreatitis is caused by the very things your friend has avoided: high intakes of alcohol and drugs. It is often brought on after damage to the gallbladder through drink, but also because of infection or injury.

Symptoms are severe abdominal pain which radiates into the back, fever, loss of appetite (so it's little wonder your friend won't eat much), nausea and vomiting. Jaundice can also occur.

If it hasn't been caused by alcohol or drug abuse, the next most likely cause is gallstones. In fact, 80 per cent of all cases of pancreatitis are caused either by alcohol abuse or gallstones. It seems that gallstones are more likely to cause chronic pancreatitis.

You are right to suggest that the condition can be contained with drugs creon and co-proxamol are some of the more popular but specialists are beginning to look at endoscopic retrograde cholangiopancreatography (ERCP) as a way of removing the offending gallstones (if indeed that is the cause). However, a recent study among 126 patients found that the technique was far from helpful; indeed, 14 patients given ERCPs, compared with seven who had conservative management of their condition, died within three months (N Eng J Med, 1997; 336: 237-42).

In short, conventional medicine seems to as yet have few answers to this condition.

A careful diet to balance blood sugar and support the pancreas needs to be developed, possibly by a nutritonist, with special emphasis on insulin.

Alternative medicine, and its many offshoots, claims to have suitable treatments, but you must remember that you are well outside the field of total self-help here. Any unorthodox approach should be carried out only with an experienced practitioner.

Options to consider include fasting from all fluids and foods for a short period, followed by the introduction of a diet similar to that suggested to diabetics. Refined sugars, caffeine and alcohol should be strictly avoided, and your friend would be better having small and frequent meals with complex carbohydrates, vegetables and small amounts of fruits. Exercise is also very important as this can help stabilize blood sugar.

Supplements that could help include chromium, pancreatin enzymes with meals, pancreas glandular extract, vitamin B complex with extra niacin and pantothenic acid, vitamin C, acidophilus and magnesium.

Other programmes your friend could undertake, again under professional supervision, include aromatherapy (majoram and lemon), herbs (equal parts of the glycerates of fringetree bark, balmony, and milk thistle, a teaspoonful of which to be taken three times day), hydrotherapy and juice therapy (carrot, Jerusalem artichoke, beet, garlic).

A detox therapy might help, provided the condition is not chronic, and hydrogen peroxide therapy has had some success.