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Pancreatic Cancer Diet and Nutrition

Pancreatic Cancer Nutrition Guidelines

The pancreas is an important gland in the body that secretes insulin. It is located near the stomach, small intestine, gallbladder, and the duodenum. The pancreas plays a large role in the digestion of foods. In particular, the insulin that is secreted by the pancreas aids in the digestion of carbohydrates. The pancreas also secretes enzymes that help in the digestion of protein, carbohydrates, and fats. Pancreatic cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination. Regardless of treatment type, pancreatic cancer takes quite a toll on the body in terms of diet and nutrition. Here are some tips and guidelines to optimize nutrition during and after treatment.

  • Maintain a healthy weight. Treatments such as chemotherapy, radiation, and surgery for pancreatic cancer can often contribute to unintentional weight loss. It’s important to avoid excess weight loss during treatment as poor nutrition can cause a decrease in the body’s ability to fight infection.
  • Eat small, frequent meals throughout the day. Eating frequent small meals will ensure your body is getting enough calories, protein, and nutrients to tolerate treatment. Smaller meals may also help to reduce treatment-related side effects such as nausea. Try eating 5 - 6 small meals or “mini” meals about every three hours.
  • Stay hydrated. Drinking enough fluids during cancer treatment is important for preventing dehydration. Aim to drink 64 ounces of fluid daily. Avoid drinking large amounts of caffeinated beverages. Too much caffeine can lead to dehydration.
  • Be observant of changes in bowel habits. Pancreatic cancer and treatments can often lead to changes in bowel habits including diarrhea, constipation, bloating, and gas. It is important for you to communicate with your healthcare team any changes in your bowel habits. Changes in your diet or medications may be necessary to manage these side effects.
  • Choose food that are easy to digest. One key responsibility of the pancreas is to aid in digestion. Pancreatic tumors can affect how effective the pancreas is at digesting foods. Choose soft foods that are east to chew. Eat slowly and chew thoroughly.
  • Choose protein-rich foods. Protein helps the body to repair cells and tissues.  It also helps your immune system recover from illness. Include a source of lean protein at all meals and snacks.  Good sources of lean protein include:
    • Lean meats such as chicken, fish, or turkey
    • Eggs
    • Low fat dairy products such as milk, yogurt, and cheese or dairy substitutes
    • Nuts and nut butters
    • Beans
    • Soy foods

Include whole grain foods. Whole grain foods provide a good source of carbohydrate and fiber, which help keep your energy levels up. Good sources of whole grain foods include:

  • Oatmeal
  • Whole wheat breads
  • Brown rice
  • Whole grain pastas

Eat a variety of fruits and vegetables every day. Fruits and vegetables offer the body antioxidants, which can help fight against cancer. Choose a variety of colorful fruits and vegetables to get the greatest benefit.  Aim to eat a minimum of 5 servings of whole fruits and vegetables daily.

Choose sources of healthy fat. Avoid fried, greasy, and fatty foods, Choose baked, broiled, or grilled foods instead. Healthy fats include:

  • Olive oil
  • Avocados
  • Nuts
  • Seeds

Limit sweets and added sugars. It is not uncommon for individuals with pancreatic cancer to have more difficulty digesting foods high in sugar. You may experience adverse effects after eating foods high in added sugars like desserts and sweets. These foods provide little nutritional benefit and often take the place of other foods that are better for you. You may also experience high blood sugar or high blood glucose levels.

Practice good food safety. Wash your hands often while preparing food. Use different knives and cutting boards for raw meat and raw vegetables. Be sure to cook all foods to their proper temperature and refrigerate leftovers right away.

Talk to your healthcare team before taking any vitamins or supplements. Some medications and cancer treatments may interact with vitamins and supplements.  Choose food first as the main source for nutrients.

Take pancreatic enzymes if prescribed by your healthcare team. Your cancer may affect the functionality of your pancreas which may affect your ability to digest food properly. Your doctor may prescribe pancreatic enzymes for you to take with your meals. Pancreatic enzymes can aid in better digestion and help improve any digestive discomfort or problems you may be having.

Eat as healthy as possible as allowed by the digestive system.

  • Nutrient dense foods are foods that contain protein, complex carbohydrates, healthy fat, vitamins, and minerals all needed by the body to function optimally.
  • Fruits, vegetables, lean protein, and whole grains are all nutrient dense foods.
  • Consult a registered dietitian for specific recommendations based on your level of food tolerance.

Try to eat with others when possible.

  • Typically this makes meal times more enjoyable and may encourage you to eat more than eating alone.

Eat slowly and chew food really well.

  • Digestion begins in the mouth.  Smaller food particles are much easier to digest and are less likely to cause discomfort during the digestion process.

Sit up after eating. Wait at least 1 hour before lying down.

  • Lying down after eating encourages acid from the stomach to flow back into the esophagus leading to symptoms of heartburn.
  • Stay in an upright position while food digests.  This will keep the acid from the stomach in the stomach.
  • It is common for pancreatic cancer patients to have heartburn, gas, bloating, and belching.
  • Ask a registered dietitian for guidance on which foods to avoid when you have heartburn, gas, bloating, and belching.

Be as active as possible.

  • Exercise may help to stimulate appetite and endorphin production. Being able to eat more and having an enhanced feeling of well-being will make your treatments more bearable.

Drink plenty of fluids to avoid dehydration.

  • A good starting point is to strive for 8 8-ounce glasses per day.
  • Only take small sips with meals to avoid excessive bloating, gas or feeling too full to eat.
  • The best time to drink fluids is an hour before or after a meal.
  • Choose beverages that contain calories and nutrients such as juices, smoothies, and liquid nutrition supplements.
  • A registered dietitian can provide you with recommendations for which liquid nutrition supplement and how much is best for you.
  • Drink alcohol in moderation, if at all. Alcohol may contribute to dehydration, can lower the abilities of your immune system, and provides no beneficial nutrients.

Be observant of changes in bowel habits.

  • You may experience symptoms of fat malabsorption which can be determined by the frequency of bowel movements and the appearance of stools.  Fat containing stools are often bulky, frequent, foul smelling, and have an oily appearance.
  • These symptoms warrant the need for vitamin A, D, E, and K supplements as well as a multivitamin. You may also need a calcium supplement.
  • Your healthcare team can advise you on choosing these as well as the correct dosage.
  • Ask your oncologist about vitamin B12 injections and iron to avoid becoming anemic.

Stay on top of your weight.

It is normal to lose some weight after being diagnosed with pancreatic cancer and beginning treatment.  If you are losing more than 1 or 2 pounds per week continuously, consult a registered dietitian immediately for recommendations on increasing your calorie intake.

Whipple Procedure Nutrition Guidelines

The pancreas is an essential gland in the body that secretes insulin. It is located near the stomach, small intestine, gallbladder, and the duodenum. The pancreas plays a large role in the digestion of foods. In particular, the insulin that is secreted by the pancreas aids in the digestion of carbohydrates. The pancreas also secretes enzymes that help in the digestion of protein, carbohydrates, and fats. Pancreatic cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination. The most common surgical procedure performed to remove cancer from the pancreas is called a Whipple procedure. A Whipple procedure involves the removal of the head of the pancreas, duodenum, gallbladder, and part of the bile duct. Regardless of treatment type, pancreatic cancer takes quite a toll on the body in terms of diet and nutrition.

If you had a Whipple procedure or other surgery to remove any part of your pancreas as part of your cancer treatment, follow these guidelines after your surgery:

Pancreatic Enzymes

  • Your doctor will write you a prescription for pancreatic enzymes. Take pancreatic enzymes as prescribed.
  • These enzymes are designed to take the place of the enzymes that your pancreas would normally produce to digest protein, carbohydrates, and fat.
  • If you have questions about your pancreatic enzymes, consult a registered dietitian.

Solid Food

  • Gradually increase food intake until eating a normal solid food diet.
  • The progression will most likely be from clear liquids to full liquids, and eventually to soft solids. This progression will vary from person to person.

Fat

  • Avoid fried, greasy and fatty foods. These foods are hard to digest with an altered pancreas.
  • Choose baked, broiled, or grilled foods instead.
  • After a Whipple procedure, it is often recommended to limit fat intake to no more than 40-60 grams per day.

Nutrient Dense Foods

  • Eat as healthy as possible as allowed by the digestive system.
  • Nutrient dense foods are foods that contain protein, complex carbohydrates, healthy fat, vitamins, and minerals all needed by the body to function and heal.
  • Fruits, vegetables, lean protein, and whole grains are all nutrient dense foods.
  • Consult a registered dietitian for specific recommendations based on your level of food tolerance.

Meal Frequency

  • Eat small, frequent meals. Try to eat something every 2-3 hours. Smaller amounts of food are more easily digested and nutrients are better absorbed.
  • Smaller meals have less potential to cause gas or bloating.
  • A common side effect from a Whipple procedure is a delay in stomach emptying called gastroparesis. Smaller meals reduce the feeling of excessive fullness.
  • Include a protein source with each meal and snack. Protein can be found in the form of meats, dairy products, nuts, or beans.

Fluid Intake

  • Drink plenty of fluids to avoid dehydration.
  • A good starting point is to strive for 8 8-ounce glasses per day.
  • Only take small sips with meals to avoid excessive bloating, gas or feeling too full to eat.
  • The best time to drink fluids is an hour before or after a meal.
  • Choose beverages that contain calories and nutrients such as juices, smoothies, or liquid nutrition supplements.

Alcoholic Beverages

  • Avoid all alcoholic beverages.

Management of Nausea

  • Limit liquids and choose dry, easy-to-digest foods such as crackers, toast, dry cereal, oatmeal or a plain baked potato.
  • Liquids should be sipped 1 hour before or after food is eaten.
  • Your doctor can also prescribe a medicine to help with managing your nausea.

Management of Diarrhea

  • Limit or reduce excess fiber and gas forming foods such as beans, whole grains, raw vegetables, and fruit.
  • Avoid sweets and foods containing a lot of sugar.
  • Increase fluid intake to avoid dehydration.
  • Strive for 5-6 small meals of low fiber foods such as applesauce, bananas, white toast, oatmeal, crackers, or a plain baked potato.
  • Avoid dairy products other than yogurt containing live cultures called probiotics.

Loss of Appetite

  • This is a common occurrence after a Whipple procedure.
  • Foods also may not taste that same as before.
  • Be patient and re-introduce easy-to-digest foods slowly.
  • You may also need to eat when you are not feeling hungry in order to meet the nutritional needs of your body. This will help you recover faster.
  • Appetite typically improves 4-6 weeks after surgery.

Food Journal

  • Keep a journal of eating times, foods consumed, and if the food caused any digestive problems. This will help you determine which foods are best tolerated.

Liquid Nutrition Supplements

  • Due to altered digestion, absorption, and limitations on solid food intake, a liquid nutrition supplement may be an appropriate addition to help you meet your nutritional needs.
  • Consult a registered dietitian for the best recommendation and the amount of supplement needed by your body.

Vitamins and Mineral Supplements

  • You may experience symptoms of fat malabsorption which can be determined by the frequency of bowel movements and the appearance of stools.
  • Fat containing stools are often bulky, frequent, foul smelling, and have an oily appearance.
  • These symptoms warrant the need for vitamin A, D, E, and K supplements as well as a multivitamin. You may also need a calcium supplement.
  • Ask your oncologist about vitamin B12 injections and iron to avoid becoming anemic.
  • Your healthcare team can advise you on choosing vitamins and supplements as well as the correct dosage.

Weight Loss

  • It is normal to lose up to 5-10% of your body weight after having a Whipple procedure.
  • If you are continuing to lose weight exceeding 5-10% of your pre-surgery weight, you may need to consult a registered dietitian for recommendations on increasing your calorie intake.

Post-Whipple Procedure

  • A Whipple procedure is a surgery used to treat pancreatic cancer. This surgery includes the removal of the head of the pancreas, the surrounding lymph nodes, the gallbladder, the duodenum and often part of the stomach.
  • With the loss of part of your digestive tract, your meals are not absorbed as well. Your surgeon may prescribe digestive enzymes and vitamins after surgery. Your surgeon will also recommend a special diet to help keep you nourished.
  • Immediately after surgery, you may need intravenous (IV) feeding or a feeding tube leading to your digestive tract. As you begin to recover from surgery, you will first need to follow a clear liquids diet. Finally, your surgeon will recommend a Whipple diet.
  • The Whipple diet is low-fat, low-sugar, and low-fiber soft foods. The Whipple diet may be short term. If this is the case, your surgeon will recommend that you slowly add in new foods to your diet as you begin to feel better. The Whipple diet may also be long term and need to be adopted as a lifestyle change.
  • For a meal plan to meet your specific needs and food habits, ask your healthcare team for a referral to a registered dietitian who specializes in oncology. If you continue to lose weight or don’t have enough energy, a registered dietitian can help you develop a healthy meal plan.

Pancreatic Cancer, and Diabetes

The pancreas is the organ in the body that releases insulin. When cancer develops in the pancreas, it damages the tissue. Your pancreas may not be release insulin properly, or your pancreas may not release enough insulin. This may lead to diabetes because your body’s cells may not be able to use the blood sugar molecules properly.

It is not uncommon for someone with cancer to have elevated blood sugar (glucose) levels. Your doctor may have even told you that you have diabetes. Diabetes is simply high blood sugar. Your doctor may also call these glucose levels, but glucose and blood sugar mean the same thing. Insulin is a hormone made by the pancreas that helps your body use and store glucose.

High blood sugar levels can occur when your pancreas does not produce enough insulin or your body isn’t able to use the insulin properly. When this happens, your body is not able to use the sugar from food. Instead, the sugar stays in your blood making high blood sugar levels.

Will my pancreas function normally after treatment?

  • The pancreas cannot replace damaged cells with healthy ones.
  • Medications may provide the body with the needed hormones (insulin and glucagon) that the pancreas releases. Digestive enzymes can also be taken as a medication if the pancreas can no longer produce them.

What can I do to control my blood sugar levels?

  • Take medication as prescribed. Be sure to talk with your healthcare providers and/or your pharmacist if you have any questions about your medication.
  • Monitor your intake of carbohydrates. Carbohydrates are foods that break down to sugar in the body. Examples include bread, pasta, rice, fruit, milk, yogurt, potatoes and corn.
    • Speak with a registered dietitian or a certified diabetes educator about your specific carbohydrate intake recommendations.
    • Stay as active as possible. Exercise is very helpful when it comes to controlling blood sugar levels. Even a 10 minute walk every day can help.
    • Check your blood sugar levels regularly throughout the day.

How do I check my blood sugar?

  • If you do not have a blood glucose meter, ask your doctor, pharmacist, or registered dietitian for information on how to get one.
  • Follow your doctor’s recommendations for checking blood sugar. For example, if the doctor says to get a fasting blood sugar every day, check your sugar before you eat breakfast in the morning. If the doctor says to check your blood sugar twice a day, then make sure you follow that suggestion.
  • The most important times to check your blood sugar are first thing in the morning, after meals, and right before bed. If you are having problems controlling your blood sugars, consider checking your blood sugars more often throughout the day.
  • Your healthcare team can tell you how often and when you should check your blood sugars during the day.
  • When checking blood sugars, it is a good idea to keep a log. In the log record the time, blood sugar, and medications taken to help determine trends.

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