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  • Managing dietary problems in pancreatic cancer

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    Pancreatic cancer, and treatments such as surgery, chemotherapy and radiotherapy, can affect your ability to eat, digest and absorb food. This can have a significant impact on nutrition, which can become a major focus for many people.

    Common problems include:

    • weight loss
    • poor appetite and feeling full quickly
    • nausea and/or vomiting
    • changes in taste and smell
    • changes in bowel habits
    • poor digestion (maldigestion) and absorption (malabsorption) of fats and proteins caused by a lack of pancreatic enzymes
    • diabetes caused by inadequate insulin production.

    What you can eat and drink may vary from person to person. You may find it helpful to talk to a dietitian for individual advice.

    Eating after a Whipple procedure

    People who have a Whipple procedure may have many questions and concerns about their diet following the surgery. 

    Managing food after a Whipple procedure

    • Eat small meals every 2–3 hours rather than three large meals each day.
    • Ensure that meals and snacks are nourishing and include protein, e.g. meat, chicken, fish, dairy products, eggs, tofu and nuts. This will help recovery and improve your nutrition.
    • Sip only small amounts of liquids during meals to avoid filling up too quickly.
    • Limit foods that produce wind (gas), e.g. legumes (dried beans, peas or lentils); vegetables such as broccoli, Brussels sprouts, cabbage, cauliflower or asparagus; and carbonated (gassy) drinks.
    • Talk to a dietitian or your doctor about vitamin and enzyme supplements if you can’t digest and absorb food properly. You may need a multivitamin supplement to provide calcium, folic acid, iron, vitamin B12 and the fat-soluble vitamins A, D, E and K.
    • Ensure you take the right amount of digestive enzyme supplements, if prescribed.
    • Limit or avoid eating fatty, greasy or fried foods if these cause discomfort, even when taking adequate pancreatic enzymes.
    • Nutritional supplements drinks, such as Sustagen® Hospital Formula, Ensure® and Resource®, are high in energy and protein and have important vitamins and minerals. These may be prescribed after surgery

    Vomiting

    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.

    See your doctor if vomiting lasts for more than a day or if you can’t keep any fluids down, as you may become dehydrated. If you have persistent vomiting, the part of your body that connects your stomach to your small bowel may be blocked. This may be relieved with surgery.

    How to cope with vomiting

    Stage 1 – Small sips

    Don’t try to force food down. Sip small amounts of liquid as often as possible. Try dry ginger ale, cold flat lemonade, weak cordial, cold apple or orange juice. Ensure fizzy drinks are flat before you drink them.

    Stage 2 – Introduce drinks slowly

    If the vomiting has stopped but you still feel nauseated, sip on drinks slowly in small frequent amounts. 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.

    Stage 3 – Introduce solid foods

    Next, 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 regular food portions. 

    Stage 4 – Return to normal diet

    As soon as you can, increase your food intake until you are eating a normal, well-balanced diet. Limit rich foods, such as fatty meats or full-cream dairy products. Your doctor or dietitian may advise you to take additional nourishment (such as supplements) on your good days to make up for the days when you can’t eat properly.

    Diabetes

    Some people develop diabetes before pancreatic cancer is diagnosed or soon after surgery. Diabetes, or high blood sugar levels, can occur if your pancreas is not making enough insulin (a hormone responsible for regulating blood sugar levels).

    The way diabetes is managed varies from person to person but usually includes a combination of dietary changes and medication. If needed, your doctor will advise you on medications and a dietitian will help you manage and change your diet.

    Coping with diabetes

    • Eat small meals and snacks regularly to help control blood sugar levels.
    • If you are taking diabetes medication, you need to include high-fibre carbohydrate foods at every meal to avoid low blood sugar levels. These include wholegrain breads and cereals, vegetables and fruit.
    • For more information about diabetes see diabetesaustralia.com.au.

    Pancreatic enzyme replacement supplements

    The pancreas produces digestive enzymes to help break down the food you eat into basic nutrients that your body can use.

    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 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 fatty bowel movements (stools) that are pale in colour, frothy, loose and difficult to flush
    • weight loss.

    Taking enzyme supplements

    • Take supplements at the same time as food and drink to ensure adequate mixing.
    • Always take supplements with food and drink that contains fat or protein.
    • Slightly higher doses of enzymes may be needed if eating a high-fat meal, 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.
    • Always take the dose as prescribed. Do not change the dose without talking to your doctor first.

    Your doctor may prescribe pancreatic enzymes to help prevent these symptoms. Pancreatic enzymes are available in varying strengths. The dose will be based on, and adjusted to your individual symptoms and dietary intake. It may take time to get this balance right.

    Often people who take pancreatic enzymes will also be prescribed acid-suppressing medicine. This medicine helps the pancreatic enzymes work properly.

    Nutritional supplements

    If you are not able to eat a balanced diet, or are experiencing unintentional weight loss, your doctor or dietitian may suggest that you take nourishing fluids and/or nutritional supplements.

    Nutritional supplements such as Sustagen® Hospital Formula, Ensure® and Resource® contain energy, protein and other nutrients in a concentrated source. Nutritional supplements should be taken in addition to eating your usual meals, i.e. as snacks between meals. They are available as ready-made drinks or in powdered form to be mixed with milk or water.

    Glucose powder supplements can also provide energy, but shouldn’t be used as a meal replacement as they don’t provide protein, vitamins or minerals. Glucose supplements may not be recommended if you have been diagnosed with diabetes.

    Ask a dietitian where to buy the most appropriate supplement for you, and to advise you on the type and quantity

    This website page was last reviewed and updated August 2017.

    Information taken from Understanding pancreatic cancer, last reviewed February 2016 by: A/Prof Vincent Lam, Associate Professor of Surgery, Sydney Medical School & Hepatobiliary, Pancreatic and Transplant Surgeon Westmead Hospital, NSW; Dr Phillip Tran, Radiation Oncologist, Site Director, Sunshine Hospital Radiation Therapy Centre, VIC; Dr Victoria Atkinson, Senior Medical Oncologist, Division of Cancer Services, Princess Alexandra Hospital, QLD; Alison Keay, Upper GI Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; Belinda Steer, Clinical Lead Dietitian, Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, VIC.

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