Whipple procedure nutrition guidelines
The Whipple Procedure is the most common surgery used to remove cancer from the pancreas. The procedure removes the head of the pancreas, duodenum, gallbladder and part of the bile duct.
- The Whipple Procedure affects part of the digestive tract, which changes the way meals are absorbed. Your surgeon may prescribe digestive enzymes and vitamins after surgery as supplements to help with digestion. These enzymes are designed to take the place of the enzymes that your pancreas would normally produce to digest protein, carbohydrates and fat. A special post-surgery diet prescribed by your surgeon will 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 consists of 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.
If you had a Whipple procedure to remove any part of your pancreas as part of your cancer treatment, follow these guidelines after your surgery:
- Gradually increase food intake until eating a normal, solid food diet.
- The diet progression will most likely begin with clear liquids to full liquids and eventually to soft solids. This progression will vary from person to person.
- 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.
- Eat healthy foods your body can digest.
- 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.
- Eat small, frequent meals. Try to eat something every two to three 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.
- Drink plenty of fluids to avoid dehydration.
- A good starting point is to strive for eight eight-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.
- 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 one 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 five to six small meals of low fiber foods such as applesauce, bananas, white toast, oatmeal, crackers, or plain baked potatoes.
- 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 the 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 four to six weeks after surgery.
- Keep a journal detailing 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.
- It is normal to lose up to five to ten percent of your body weight after having a Whipple procedure.
- If you are continuing to lose weight exceeding five to ten percent of your pre-surgery weight, you may need to consult a registered dietitian for recommendations on increasing your calorie intake.