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Managing dietary problems
Pancreatic cancer, and treatments such as surgery, chemotherapy and radiation therapy, can affect your ability to eat, digest and absorb essential nutrients. This page explains some common dietary problems and how to manage them.
During and after treatment, it’s important to make sure you are eating and drinking enough to maintain your weight and avoid malnutrition or dehydration. Different foods can affect people differently, so you will need to experiment to work out which foods cause problems for you.
People who have a Whipple procedure may have many questions and concerns about their diet after surgery. The suggestions below may be helpful when you start to eat after surgery.
Changes to the way you eat may make you feel anxious, particularly when you know eating well is important. Some people find it difficult to cope emotionally with the changes to how and what they can eat. Finding ways to enjoy your meals can help you feel more in control and improve your quality of life. It may help to talk about how you feel with your family and friends.
If you have ongoing problems with food and eating, talk to a dietitian. Dietitians are experts in nutrition who can give you specialist advice on how to cope with nutrition-related problems and eating difficulties throughout different phases of the disease.
Poor appetite and weight loss
- Eat small meals frequently, e.g. every 2–3 hours. Have a regular eating pattern rather than waiting until you’re hungry.
- Ensure that meals and snacks are nourishing and include protein, e.g. meat, chicken, fish, dairy products, legumes (e.g. lentils, chickpeas), eggs, tofu, nuts and nut butters.
- Choose nourishing drinks such as milk.
- Add milk powder to cereals, sauces, mashed vegetables, soup, drinks, egg dishes and desserts.
- Add cheese to sauces, soup, baked beans, vegetables, casseroles, salads and egg dishes.
- Add sugar, honey or golden syrup to cereals, porridge or drinks.
- Talk to a dietitian before cutting out particular foods.
- It’s okay to focus on eating foods you enjoy. Relax any low-cholesterol and other dietary restrictions. Gaining or maintaining weight is more important than avoiding extra fat and sugar.
- Have ready-to-eat food available for when you feel like eating or are too tired to cook (e.g. tinned fruit, yoghurt, frozen meals).
Changes in taste or smell
- If food tastes bland, add extra flavouring, e.g. herbs, lemon, lime, ginger, garlic, honey, chilli, pepper, Worcestershire sauce, soy sauce or pickles.
- Some drinks may taste different or be off-putting because of their smell or texture. Choose milkshakes, fresh juice, hot chocolate and other non-alcoholic drinks.
- Choose cold food or food at room temperature without a strong smell. If food smells bother you, ask family or friends to cook.
- If you have a bitter or metallic taste in your mouth, eat moist fruits such as berries or suck boiled lollies.
- Try plain breakfast cereals with less added sugar, such as porridge or bran flakes, instead of cereals with added dried fruit, honey or other sweeteners.
- If you don’t feel like eating meat, try other protein sources, such as cheese, eggs, nuts, dairy foods or legumes (e.g, lentils or chickpeas).
- Talk to your doctor if your stools are pale in colour, oily, smell particularly bad, float and are difficult to flush, or you notice an oily film floating in the toilet. This may be a sign that you do not have enough pancreatic enzymes. You may need to start enzyme replacement therapy or adjust your dose.
- Talk to your doctor about whether to take anti-diarrhoea medicine.
- Drink plenty of liquids (e.g. water, fruit juice or weak cordial) to replace lost fluids.
- Avoid alcohol and limit caffeine and spicy foods as these can make diarrhoea worse.
- Try soy milk or lactose-reduced milk if you develop a temporary intolerance to the sugar in milk (lactose). This can sometimes occur when you have diarrhoea. Hard cheese and yoghurt in small amounts are usually okay.
- If diarrhoea occurs 15–30 minutes after eating, you may be experiencing dumping syndrome. This happens when partially digested food moves into the small bowel too quickly. Speak to your treatment team about this.
- Talk to your doctor about taking nausea medicine half an hour before meals.
- Snack on bland foods such as dry crackers or toast.
- Try to eat a little bit at regular intervals – not eating or skipping meals can make nausea worse.
- Eat and drink slowly. Chew food well.
- Avoid strong odours and cooking smells.
- Suck peppermint or lemon-flavoured boiled lollies.
- Drink ginger beer, ginger ale or ginger tea, or suck on candied ginger.
If you can’t eat a balanced diet or are losing too much weight, your doctor or dietitian may suggest nutritional supplements, e.g. Sustagen, Ensure, Fortisip and Resource. These contain energy, protein and other nutrients that can help you maintain your strength.
Ask a dietitian where to buy supplements, and to advise you on the type and quantity best suited to your needs. Nutritional supplements should be taken in addition to the foods you are able to eat, and are best used as snacks between meals. They are available as:
- ready-made drinks, bars, puddings and custards
- powders to mix with milk or water, or to sprinkle on food.
Seeing a dietitian
A dietitian can prepare eating plans for you and give you advice about nutritional supplements.
Dietitians work in all public and most private hospitals. There may be a dietitian connected to your cancer treatment centre – check with your specialist or cancer care coordinator.
The Dietitians Association of Australia (DAA) can also help you find an Accredited Practising Dietitian who works in your area and specialises in cancer. Visit daa.asn.au or call them on 1800 812 942.
If your GP refers you to a dietitian, you may be eligible for a Medicare rebate. If you have private health insurance, you may be eligible for a rebate depending on your type and level of cover.
The DAA has information on the typical fee for private dietitian consultations.
The pancreas produces digestive enzymes to help break down food. When you have pancreatic cancer, or have had pancreatic surgery, your body may not be able to make enough of these digestive enzymes. This affects the body’s ability to digest food, particularly fat and protein, and to absorb vital nutrients. This is often referred to as pancreatic exocrine insufficiency (PEI). Signs of PEI include abdominal pain; bloating and excessive wind; diarrhoea or oily stools (poo) that are pale in colour, frothy, loose and difficult to flush; and weight loss.
To help prevent these symptoms, your doctor may prescribe pancreatic enzymes, sometimes with acid-suppressing medicine.The dose will be based on, and adjusted to, your symptoms and diet. It may take time to get this balance right. A dietitian can help you and your doctor work out the correct dose.
Taking enzyme supplements
- Take enzyme capsules with water and the first mouthful of food to ensure adequate mixing. With larger meals, you may also need to take them halfway through the meal.
- Always take enzymes with any food or drink that contains fat or protein. Slightly higher doses may be needed with high-fat meals, e.g. fried foods and pizza. You don’t need to take enzymes for simple carbohydrates that digest easily, e.g. fruit, fruit juice, black tea and coffee.
- Take enzymes as prescribed. Do not change the dose without talking to your doctor or dietitian first.
Vomiting can occur as a result of the cancer or its treatment. For some people, just the thought of treatment or eating or the smell of food can make them feel unwell. There is a range of anti-nausea medicines that you can take regularly to control symptoms. If the one you are prescribed doesn’t work, let your doctor or nurse know so you can try another medicine.
Let your doctor know if vomiting lasts for more than a day or if you can’t keep any fluids down, as you may become dehydrated. Signs of dehydration include a dry mouth, dark urine, dizziness and confusion.
If you have persistent vomiting, the duodenum (the first part of the small bowel) may be blocked, so it is important to see your doctor as soon as possible. You may need surgery to clear the blockage.
Steps to recovery after vomiting
Take small sips – Don’t try to force food down. Sip small amounts of liquid as often as possible. Try flat dry ginger ale, cold flat lemonade, weak cordial, or cold apple or orange juice.
Introduce nourishing fluids – If the vomiting has stopped but you still feel sick, sip small amounts of drinks slowly and often. Start with cold or iced drinks. Prepare milk or fruit drinks with some water so they are not too strong. You can also try diluted fluids such as clear broth or weak tea.
Start solid food – Next, try to eat small amounts of solid foods, such as plain dry biscuits, toast or bread with honey or jam. Stewed fruits and yoghurt are also good. Aim to eat small amounts of food often, rather than three large meals a day.
Return to normal diet – As soon as you can, increase your food intake until you are eating a normal, balanced diet. Limit rich foods, such as fatty meats or full cream dairy products. Your doctor or dietitian may suggest extra nourishment (such as supplements) on your good days to make up
for the days you can’t eat properly.
Insulin is a hormone that controls the amount of sugar in the blood. Diabetes, or high blood sugar levels, can occur if your pancreas is not making enough insulin. This is why some people develop diabetes shortly before pancreatic cancer is diagnosed (when the cancer is affecting how much insulin the pancreas can make) or soon after surgery (when some or all of the pancreas has been removed).
The way diabetes is managed varies from person to person but often includes both dietary changes and insulin injections. Sometimes medicines are given as tablets that you swallow.
Your GP can help you manage the condition, but you will usually be referred to an endocrinologist, a specialist in hormone disorders. You may also be referred to a dietitian for help with changing your diet.
Coping with diabetes
- Eat small meals and snacks regularly to help control blood sugar levels.
- Talk to your endocrinologist or GP about medicines to help control the diabetes.
- If you are taking diabetes medicine, include high-fibre carbohydrate foods at every meal to avoid low blood sugar levels. Wholegrain breads and cereals, vegetables and fruit are all suitable foods.
- For more information about diabetes, talk to your doctors and dietitian. You can also contact Diabetes Australia or call them on 1300 136 588.
This information is reviewed by
This information was last reviewed February 2020 by the following expert content reviewers: Dr Lorraine Chantrill, Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Marion Bamblett, Nurse Unit Manager, Cancer Centre, Fiona Stanley Hospital, WA; Prof Katherine Clark, Clinical Director of Palliative Care, Northern Sydney Local Health District Cancer and Palliative Care Network, and Conjoint Professor, Northern Clinical School, The University of Sydney, NSW; Lynda Dunstone, Consumer; Kate Graham, Accredited Practising Dietitian – Upper GI Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Gina Hesselberg, Radiation Oncologist, St George Hospital Cancer Centre, NSW; Dr Marni Nenke, Endocrinologist and Mary Overton Early Career Research Fellow, Royal Adelaide Hospital, SA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Nicholas O’Rourke, Head of Hepatobiliary Surgery, Royal Brisbane Hospital and The University of Queensland, QLD; Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC; Gail Smith, Consumer.