Diet & nutrition with pancreatic cancer

Cancer may result in weight changes — you may find it hard to gain weight or to keep weight on. This may be because of the treatments or the cancer itself.

It is important to maintain your weight and eat well. Maintaining your weight, particularly your muscle mass, will also help you cope better, recover faster, feel less tired and reduce the likelihood and severity of side effects. If you struggle to keep weight on, it is important to seek support from a dietitian.

Tips to help you maintain your weight and muscle mass:

• Try to eat nourishing foods and fluids – high in energy and high in protein
• Include protein-rich foods – poultry, fish, meat, eggs, tofu, legumes, dairy products, nuts and seeds. Aim to base each main meal around a high-quality protein
• Try to eat the most nourishing part of the meal first
• Take advantage of when your appetite is the strongest. This might mean having a larger meal in the morning and a smaller meal in the evening.
• Monitor for signs of malabsorption – If you are showing any of these signs, ask your doctor or dietitian about using a pancreatic enzyme replacement therapy, such as Creon (insert trademark symbol)
• Ask about using nutritional supplements.

You may lose your appetite because of the effects of cancer itself, the treatment, or other side effects, such as feeling sick, not enjoying the smell of food, or feeling upset. Loss of appetite is a common problem in people with pancreatic cancer and during treatment. Early satiety (feeling full

Tips on loss of appetite:

• Eat small meals frequently, e.g. every 2–3 hours. Keeping to a regular eating pattern rather than waiting until you are hungry will mean your body gets the nourishment it needs to
• Try to eat the most nourishing part of the meal first (before you become full), such as high-energy and high-protein foods and fluids
• When you do feel hungry — eat! If you feel hungrier at certain times of the day or week (e.g. between chemotherapy cycles) eat a bit more.
• Use a smaller plate – a big plate of food may put you off
• Eat what you feel like, when you feel like it – have cereal for dinner or a main meal at lunch
• Include a variety of foods in your diet
• Sip fluids throughout the day
• replace water, tea and coffee with drinks or soups that add energy (kilojoules/calories), such as milk, milkshake, smoothies, replacement drinks or soup.
• Relax dietary restrictions – maintaining your weight or regaining weight you have lost is more important than avoiding full-fat and other high-energy foods.
• Gentle physical activity can stimulate appetite – take a short walk around the block.
• Eat with others
• Make your eating environment relaxed, positive, and enjoyable

Some treatments and their side effects can change the way some foods taste or smell. Chemotherapy can change the taste receptors in the mouth. Food may taste bitter or metallic, or may not have as much flavour as before. You may say things like “Food tastes like cardboard”, “Food tastes metallic”, or “I’ve gone off things I used to enjoy eating”.

It is common to have taste changes and it can take several months for taste changes to return to normal.

**If you have a sore mouth, mucositis, thrush, sore throat, or swallowing difficulties, talk to your doctor, speech pathologist, dentist or dietitian – some suggestions will not be suitable.

Tips to help you cope with changes in taste:

• Add extra flavour to food if it tastes bland – like fresh herbs, lemon, lime, ginger, garlic, soy sauce, honey, chilli, or pepper. You may also find that you can no longer stomach these things, and that bland food is more appetising. Do whatever works for you.
• Experiment with different food, as your tastes may change
• If meat tastes bad during treatment, replace it with other protein sources like cheese, eggs, nuts, dairy foods, baked beans, lentils, or chickpeas
• Add small amounts of sugar to food if it tastes bitter or salty
• Use a straw when drinking
• Change from using metal cutlery to plastic or bamboo cutlery
• If you have a bitter or metallic taste in your mouth, eat fresh fruits or suck on hard lollies
• If food is too sweet, add small amounts of lemon juice. Try plain breakfast cereals (e.g., oats or wheat biscuits) that do not have any added sugar
• Ensure you keep your mouth clean by cleaning your teeth and rinsing your mouth out regularly. If you use mouthwash, try to ensure it is alcohol-free

Tips on coping with changes in smell:

• Eat cold food or food at room temperature (hot food smells more)
• Reheat pre-prepared meals in the microwave so the cooking smell doesn’t put you off
• Stay out of the kitchen, if possible, when food is being prepared
• Ask family or friends to cook
• Use the exhaust fan, open the kitchen window or cook outside to help reduce cooking smells

Feeling sick and vomiting are often side effects of cancer, its treatment, or some medicines. They often occur together, but not always.

Nausea

Is stomach discomfort and the sensation of wanting to vomit. Nausea can be a precursor to vomiting the contents of the stomach and may be caused by treatment, stress, food odours, gas in the gastrointestinal tract, motion sickness or even the thought of having treatment.

Tips on how to cope with nausea:

• Have a light snack before treatment and wait a few hours before eating again.
• Eat small meals 5–6 times during the day. Going without food for long periods can make nausea worse.
• Snack on dry or bland foods, e.g. crackers, toast, dry cereals, bread sticks or pretzels
• Choose cold foods or foods at room temperature instead of hot, fried, greasy or spicy foods.
• Eat and drink slowly and chew your food well.
• Try foods with ginger, e.g. ginger biscuits, or ginger beer.
• Avoid foods that are overly sweet, fatty, fried, spicy or oily, or that have strong smells.
• Brush teeth regularly to help reduce unpleasant tastes that may make you feel nauseated.
• Do not eat your favourite food when feeling nauseated to avoid developing a permanent dislike
• Suck on hard lollies – flavoured with ginger, peppermint, or lemon.
• Try ginger food and drink items, such as candied ginger, ginger beer, ginger ale, or ginger tea. Talk to your dietitian doctor or pharmacist about ginger supplements.
• Take anti-nausea medicines as prescribed. Let the doctor know if the medicines don’t seem to be working.

Vomiting

Is the forcible emptying (“throwing up”) of stomach contents through the mouth. Vomiting can follow nausea and may be caused by treatment, stress, food odours, gas in the gastrointestinal tract, motion sickness or even the thought of having treatment.

Vomiting is more serious than nausea. Vomiting can cause dehydration and increase the risk of malnutrition. See a doctor if you are vomiting for more than one day, especially if you cannot keep water down.

Tips on how to cope with vomiting:

• See your doctor if you can’t keep fluids down, or if vomiting lasts for more than 24 hours, as you may become dehydrated.
• Take small sips of water or clear liquids, such as ginger ale, soda water or sports drinks like Gatorade or Hydrolyte. Dilute sweet drinks. If you feel like a fizzy drink, open it, and let it sit for 10 minutes or so, and drink it when it’s a bit flat. Sucking on crushed ice cubes or an iceblock can be soothing.
• Once you are handling sips okay, try some different drinks, such as consommé and clear broths, weak tea, herbal tea, fruit drinks, beef and chicken stocks. Have small, frequent meals and snacks throughout the day.
• Introduce bland, starchy foods, such as plain biscuits, bread or toast with honey or jam, peanut butter, rice, yoghurt or fruit. Trying to attempt small, frequent servings.
• Consume a little bit more each time until you are eating a well-balanced diet

Living with pancreatic cancer and its treatments can result in changes to your bowel habits. This could be differences in the appearance, consistency, and/or the smell of your stools.

Constipation

This is when your bowel motions are infrequent and difficult to pass. It can be caused by different factors including: regularly taking opioid medicines; having a diet low in fibre; not getting enough exercise; not having enough fluids to drink (dehydration); or having a low overall food intake.

Tips on how to manage constipation:

• Soften stools by drinking 8–10 glasses of fluid a day, e.g. water, herbal tea, milk-based drinks, soup, prune juice
• Eat foods high in fibre, e.g. wholegrain breads, cereals or pasta; raw and unpeeled fruits and vegetables; nuts and seeds; legumes and pulses
• If you are increasing the amount of fibre in your diet, increase fluids to prevent the extra fibre making constipation worse
• Ask your doctor about using a laxative, stool softener and/or fibre supplement.
• Exercise – check with your doctor, exercise physiologist or physiotherapist about the amount and type of exercise that is right for you.

Diarrhoea

This means your bowel motions are watery, urgent and frequent. You may also get abdominal cramping, wind and pain. Frequent loose stools can occur because you are not digesting food or absorbing nutrients properly, cancer treatment, medicines, infections, reactions to certain foods and anxiety can all cause diarrhoea.

Diarrhoea can result in dehydration, so it’s important to stay hydrated by drinking extra fluids. Every time you have a loose bowel movement you should drink an extra cup of non-caffeinated fluid. If you have diarrhoea for several days, see your doctor so he/she can determine the cause and help to manage your diarrhoea. Your doctor may decide to prescribe you anti-diarrhoea or over-the-counter medication. In some cases, Creon © may be recommended.

Tips on how to manage diarrhoea:

• Drink plenty of fluids to avoid becoming dehydrated. Water and diluted cordials are better than high-sugar drinks, alcohol, caffeinated fluids – remember signs of dehydration are smaller amounts of dark urine
• Choose low-fibre foods, e.g. bananas, mashed potato, rice, pasta, white bread, oats, steamed chicken without the skin, white fish.
• Avoid foods that increase bowel activity, e.g. spicy, fatty or oily foods; caffeine; alcohol or artificial sweeteners.
• Try soy milk or lactose-free milk if you develop a temporary intolerance to milk (lactose)
• Don’t eat too many raw fruit and vegetable skins and wholegrain cereals as they may make diarrhoea worse
• Avoid foods and drinks that are high in sugar, such as cordial, soft drinks and lollies – especially if you’ve had a Whipple procedure
• avoid foods sweetened with artificial sweeteners such as sorbitol, mannitol and xylitol. These are often marketed as ‘sugar-free’
• It may also help to eat small, frequent meals throughout the day, rather than three large meals.

Pale, floating or foul smelling stools ‘steatorrhoea’

Stools that are smellier than usual, floating, oily, pale-coloured (often beige, tan, cream or white) or difficult to flush are often an indication that your body is not absorbing fat and other nutrients in your food well. Instead, these nutrients are passing through the bowel undigested, which can cause cramping, pain, bloating or changes in stool consistency.

Tips on managing steatorrhoea:

• If you notice these symptoms, speak with your doctor and get referred to a dietitian
• These symptoms can be treated by taking pancreatic enzyme replacement supplements, such as Creon ©

National Continence Program

As part of the National Continence Program, the Toilet Map provides information on over 19,000 publicly available toilets across Australia, including accessibility, opening hours and facilities https://toiletmap.gov.au

Some chemotherapy drugs and some pain medicines can make your mouth dry, cause mouth ulcers, or change the amount of saliva in your mouth. A dry mouth can increase the risk of tooth decay and infections such as oral thrush, which will make eating harder.

Tips to lesson discomfort with mouth sores:

• suck on ice cubes
• eat soft foods – stews, soups, scrambled eggs and smoothies
• cold foods and fluids may be more comfortable than hot
• avoid ‘coarse’ foods that can irritate your mouth, such as crackers, toast, nuts and seeds
• avoid spicy or very hot foods
• use a straw and direct liquids away from the areas where mouth sores are most painful.
• Talk to your doctor about medication or mouth washes to help manage the pain and allow you to eat more comfortably.
• Ulcers may also be present in your digestive tract, causing discomfort in the stomach or bowel and diarrhoea.

Tips to relieve a dry mouth:

• Suck on ice cubes
• Keep your mouth clean with regular mouthwashes to prevent infections
• Gargle with 1⁄2 tsp salt or 1 tsp bicarbonate of soda in a glass of water
• Choose an alcohol-free mouthwash to avoid irritating your mouth further
• Use a soft toothbrush when cleaning your teeth
• Ask your dentist or health care team about suitable mouth rinses or oral lubricants
• Limit alcohol and coffee as these are dehydrating fluids, and avoid smoking
• avoid ‘coarse’ foods that can irritate your mouth, such as crackers, toast, nuts and seeds
• avoid spicy or very hot foods
• Soften food by dipping it into milk, soup, tea or coffee
• moisten with sauce, gravy, cream, custard
• Sip fluids with meals and throughout the day
• Chew sugar-free gum to stimulate the flow of saliva