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Managing your diet and nutrition
Pancreatic cancer and its treatment can affect your ability to eat, digest and absorb essential nutrients. This section explains some common diet and nutrition 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.
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. You can also call Cancer
Council 13 11 20 – our experienced health professionals can arrange for you to speak with a Cancer Connect volunteer who has had a similar cancer experience.
Some people find that complementary therapies such as relaxation, meditation and acupuncture help them cope with diet and nutrition problems. Always tell your cancer care team if you are using or would like to try any complementary therapies.
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. 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. Dietitians Australia can also help you find an Accredited Practising Dietitian who works in your area and specialises in cancer. Visit dietitiansaustralia.org.au/find-an-apd or call them on 1800 812 942.
If your GP refers you to a dietitian, you may be eligible for a Medicare rebate to help cover the cost. If you have private health insurance, you may be able to claim part of the cost.
If you can’t eat a balanced diet or are losing too much weight, your doctor or dietitian may suggest nutritional supplements such as Sustagen, Ensure, Fortisip or Resource. These provide energy, protein and other nutrients that can help you maintain your strength.
A dietitian can recommend the right nutritional supplement for you and let you know where to buy it and how much to use. Nutritional supplements should be taken in addition to the foods you are able to eat, and are best used as snacks between meals.
Supplements are available as:
- ready-made drinks, bars, puddings and custards
- powders to mix with milk or water, or to sprinkle on food.
During and after treatment for pancreatic cancer, changes to what you can eat, how you feel about eating and how your body absorbs food can all lead to unplanned weight loss. The tips below may help. For information in other languages, visit petermac.org/nutritioninfo.
Have regular meals – Eat small meals frequently (e.g. every 2–3 hours), and have a regular eating pattern rather than waiting until you’re hungry. Keep ready-to-eat food on hand for when you are too tired to cook (e.g. tinned fruit, yoghurt, frozen meals).
Choose nourishing food and drink – Ensure that meals and snacks are nourishing and include protein such as meat, chicken, fish, dairy products, legumes (e.g. lentils, chickpeas), eggs, tofu, nuts and nut butters. Choose nourishing drinks (e.g. milk, smoothies). A dietitian may also suggest
nutritional supplement drinks.
Load up your food – There are different ways to add extra kilojoules to your food:
- 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.
- Use a powdered nutritional supplement recommended by your dietitian
Adjust to taste changes – You may find your sense of taste changes after treatment. If food tastes bland, add extra flavouring such as herbs, lemon, lime, ginger, garlic, honey, chilli, pepper, Worcestershire sauce, soy sauce or pickles. Eating moist fruits such as berries or sucking boiled lollies can help if you have a bitter or metallic taste in your mouth.
Avoid strong food smells – If food smells bother you, ask family or friends to do the cooking. You may also prefer cold food or food at room temperature without a strong smell.
Talk to a dietitian – A dietitian can help if you are finding it hard to work out the right foods to help you gain weight. You should also check with a dietitian before cutting out particular foods.
Follow your appetite – It’s okay to focus on eating foods that you enjoy. Gaining or maintaining weight is more important at the moment than avoiding extra fat and sugar.
Nausea and vomiting can occur because 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 see your doctor as soon as possible. You may need surgery to clear the blockage.
Coping with nausea
- Talk to your doctor about taking anti-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.
- Drink ginger beer, ginger ale or ginger tea, or suck on candied ginger.
- Suck peppermint or lemon-flavoured boiled lollies.
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, slowly introduce more nourishing fluids. 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, or congee (rice porridge) with little texture. Stewed fruits and yoghurt are also good. Aim to eat small amounts of food often, rather than three large meals a day.
- Return to a 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 nutritional supplements) on your good days to make up for the days you can’t eat properly.
Diarrhoea is when your bowel motions become watery, urgent and frequent. You may also get abdominal cramping, wind and pain. Surgery for pancreatic cancer, chemotherapy, radiation therapy to the abdomen, medicines, infections, reactions to certain foods, and anxiety can all cause diarrhoea.
If the tips below don’t work, talk to your doctor about whether to take anti-diarrhoea medicine. You should also let your doctor know if your stools are pale in colour, oily, very smelly, 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.
If diarrhoea occurs 15–30 minutes after eating, you may have dumping syndrome. This happens when partially digested food moves into the small bowel too quickly. Speak to your team about ways to manage this.
- Drink plenty of liquids (e.g. water, fruit juice, weak cordial) to replace lost fluids.
- Avoid alcohol and limit caffeine and spicy foods as these can all make diarrhoea worse.
- Try lactose-reduced milk or soy milk if you develop a temporary intolerance to the sugar in milk (lactose). This can sometimes occur when you have diarrhoea. Small amounts of hard cheese and yoghurt are usually okay.
- Always let your treatment team know about any bowel changes. For further support and tips, you can call the National Continence Helpline on 1800 33 00 66.
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 will affect your 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 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 (e.g. CREON), sometimes with acid-suppressing medicine. The dose will be adjusted depending on 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 when having food or drink that contains fat or protein. Slightly higher doses may be needed with high-fat meals, e.g. fried foods, pizza. You don’t need to take enzymes for simple carbohydrates that digest easily, e.g. fruit, fruit juice, black tea, coffee.
- Take enzyme supplements as prescribed. Do not change the dose without talking to your doctor or dietitian first.
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.
- Talk to your doctors and dietitian for more information about diabetes.
- Visit the National Diabetes Services Scheme or call them on 1800 637 700. They can provide advice on managing diabetes and put you in touch with support programs near you.
This information is reviewed by
This information was last reviewed February 2022 by the following expert content reviewers: Dr Benjamin Loveday, Hepato-Pancreato-Biliary (HPB) Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Dr Katherine Allsopp, Palliative Medicine Physician, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW; Hollie Bevans, Senior Dietitian, Radiotherapy and Oncology, Western Health, VIC; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Amanda Maxwell, Consumer; Prof Michael Michael, Medical Oncologist, Lower and Upper GI Oncology Service, Co-Chair Neuroendocrine Unit, Peter MacCallum Cancer Centre and University of Melbourne, VIC; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Gold Coast University Hospital, QLD; Meg Rogers, Nurse Consultant Upper GI/NET Service, Peter MacCallum Cancer Centre, VIC; Ady Sipthorpe, 13 11 20 Consultant, Cancer Council WA.