November is National Pancreatic Cancer Awareness Month. Below are some nutrition guidelines that may be helpful for patients dealing with this diagnosis.
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. 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.
1. Eat 5-6 small meals or snacks throughout the day.
Smaller amounts of food are easier for the body to digest and absorb. It will also help to minimize nausea. Make sure that meals and snacks are balanced, nutritious and include a source of protein. Eat the largest meal when you feel the most hungry. Avoid eating too close to bedtime.
2. Eat foods that contain healthy fat.
Avoid fried, greasy and fatty foods. These foods are hard to digest with an altered pancreas. Choose baked, broiled, or grilled foods instead. Healthy fats include monounsaturated and polyunsaturated fats such as olive oil, nuts, and nut butters.
3. Eat as healthy as possible as allowed by the digestive system.
Fruits, vegetables, lean protein, and whole grains are all nutrient dense foods. Nutrient dense foods are foods that contain protein, complex carbohydrates, healthy fat, vitamins, and minerals all needed by the body to function optimally. Consult a registered dietitian for specific recommendations based on your level of food tolerance
4. Eat whole grain foods when possible.
Cereals, breads, brown rice, whole wheat pasta, and crackers are good whole grain choices. Whole grain foods will have “whole grain flour,” “whole wheat flour,” or “oats” as one of the first 3 ingredients. If diarrhea is an issue, you may need to avoid whole grains due to their higher fiber content. A registered dietitian can provide you with guidelines for following a low residue diet for diarrhea.
5. Avoid excess sugar and sweets.
Since the pancreas plays a key role in the digestion of sugar, there is an increased chance that you will not digest overly sweet foods well. These foods also tend to provide the body with calories but few nutrients.
***If excessive weight loss becomes an issue, your body may need more calories and it is fine if some of them come from sugar as long as you are able to tolerate sweet foods.
6. Try to eat with others when possible.
Typically this makes meal times more enjoyable and may encourage you to eat more than eating alone.
7. 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.
8. Sit up after eating. Wait at least 1 hour before lying down.
Lying down after eating encourages acid to 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 not uncommon 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.
9. 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 wellbeing will make your treatments more bearable.
10. Drink plenty of fluids to avoid dehydration.
Choose beverages that contain nutrients and calories. 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.
11. Avoid or significantly limit all alcoholic beverages.
12. Keep a journal.
Record eating times, foods consumed, and any effects to track and determine which foods are best tolerated.
13. 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.
14. 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. Your doctor will write you a prescription for pancreatic enzymes. If you have questions about your pancreatic enzymes, consult a registered dietitian.
15. Stay on top of your weight.
It is normal to lose some weight after being diagnosed with pancreatic cancer and beginning on 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.
If you have specific questions regarding any of the guidelines, please contact the registered dietitians at The Minnie Pearl Cancer Foundation. We provide one-on-one nutrition guidance and will make more specific recommendations based on cancer type and current nutrition status.