Diet and nutrition when living with pancreatic cancer
Cancer itself and cancer treatment place extra demands on your body.
It is very important to maintain good nutrition before, during, and after cancer treatment. Treatments may involve surgery, chemotherapy, radiotherapy, immunotherapy, or a combination of these. These treatments can cause you to lose your appetite and energy, putting you at an increased risk for malnutrition.
Your food choices when you have cancer and are undergoing treatment may be very different from what you are used to eating. The main goal is to try to keep your weight constant, maintain muscle strength, maintain a healthy weight, and have more energy, all of which help your body to heal properly, improve your quality of life and give you the energy to cope with all the new challenges treatment may bring.
The role of the pancreas and the digestive system
The pancreas is a part of the digestive system. It produces pancreatic enzymes and hormones that are essential for digesting and absorbing the foods we eat. Any disease or treatment targeting the pancreas can affect digestion, nutrient absorption and blood sugar regulation.
The pancreas serves two main functions in the body:
- It produces enzymes that help you to digest and absorb food.
- It produces hormones, including insulin and glucagon, which help to control your blood sugar levels.
Any changes to the pancreas, including those caused by pancreatic cancer and its treatment, can result in problems with blood sugar control and/or digestion.
Tips on good nutrition during treatment
Good nutrition can also help to:
- manage the side effects of treatment
- speed up recovery after treatment
- heal wounds and rebuild damaged tissues after surgery, radiotherapy, chemotherapy or other treatment
- improve your body’s immune system and ability to fight infections.
Overall, try to make food choices that provide you enough calories (to maintain your weight), protein (to help rebuild tissues that cancer treatment may harm), nutrients such as vitamins and minerals, and fluids (essential for your body’s functioning). Also, exercise can help with appetite and digestion issues related to treatment.
Some tips on good nutrition during treatment.
- You may need more energy (kilojoules/calories).
- Eat small, frequent meals or snacks, rather than three large meals a day.
- Ask for a referral to a dietitian – discuss eating issues, weight issues, muscle loss
- Do some light physical activity, such as walking, to improve appetite and mood, reduce fatigue, help digestion, and prevent constipation.
- Check with your doctor or dietitian before taking vitamin or mineral supplements or making other changes to your diet.
- Relax dietary restrictions, e.g. choose full-cream rather than low-fat milk.
- Consider using nutritional supplements if you cannot eat enough – discuss options with your doctor, palliative care specialist or dietitian.
Strength through Nutrition
The following video provides insight from clinicians and patients on experiences with diet and nutrition when living with pancreatic cancer. This video was produced by WCMICS (Western & Central Melbourne Integrated Cancer Service) with the support of Pancare Foundation and NeuroEndocrine Cancer Australia, to enable patients living with pancreatic cancer improve their quality of life.
Pancreatic cancer diet & nutrition changes
Pancreatic cancer and the associated treatments change how your pancreas functions. Managing these changes is important for your nutritional health, your recovery, and to make you feel better in general. Treatments can affect people differently. You may have no side effects, some, or all of them, but there are plenty of things you can do to improve your general wellbeing. We will explain the side effects of cancer treatments, and how to manage them.
Pancreatic cancer may impact:
- your nutritional requirements and what you need to eat
- how much you eat
- your appetite
- your ability to digest and absorb foods
- your blood sugar control
- your ability to maintain your weight and muscle mass
- your energy levels and general wellbeing.
Common side effects that impact diet and nutrition
A common side effect of treatment is feeling extreme and constant tiredness (fatigue).
Fatigue can be caused by treatment side effects that reduce the number of red blood cells (anaemia)
Tips on fatigue:
- Plan ahead for when you feel too tired to cook. Prepare food in advance and store in the freezer.
- Cook when you have more energy
- Shop online for groceries
- Ask and accept offers of help with shopping and cooking from family and friends
- Do regular exercise to help improve fatigue and appetite
- Keep snacks handy e.g. in your bag or car
- Use services such as Meals on Wheels or other home delivery meal companies that bring pre-prepared food to you.
- Eat with others
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.
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.
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.
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.
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 ©
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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
Recovering from surgery
Surgeries used to treat pancreatic cancer may result in a variety of side effects, including weight loss and diarrhoea. The side effects usually only last for a short period of time, but you may have to make some changes to your diet to ensure that you are getting enough nutrition and maintaining your weight.
Your body needs good nutrition after surgery, and it is an important part of your recovery process. If you are struggling to eat or drink, the hospital may prescribe nutrition supplements, or recommend tube feeding, to help you to maintain weight and provide you with the nutrients you need for speedy recovery.
Tips on maintaining weight after surgery:
- Monitor your weight – weigh yourself once or twice a week to monitor for any weight loss
- If you are losing weight, tell your doctor and get a referral to see a dietitian
- eat small, frequent meals after surgery so your digestive system only has to deal with a small amount of food at a time
If you have had a Whipple procedure, you may have had the lower part of your stomach removed. This may include the valve, or sphincter, that helps control the flow of food from your stomach to your small intestine. Removal of this valve can result in a condition called Dumping syndrome.
Dumping syndrome can occur when food moves from your stomach into your small bowel too quickly.
There are several symptoms of dumping syndrome:
- cramps and
- diarrhoea approximately 10-30 minutes after eating or sweating and
- dizziness 1-3 hours after eating
Be sure to speak to your doctor or dietitian if you are experiencing any of these symptoms.
Some tips to prevent Dumping Syndrome include:
- Avoid large meals
- Avoid sugary drinks and sweet
- Choose meals high in protein to slow the digestion of carbohydrates
- Keep drinks separate to meals.
Malabsorption and pancreatic enzyme replacement therapy
Changes to your pancreas, from either the cancer or the treatment, can mean that your body does not produce enough, or any, pancreatic enzymes. This can lead to poor digestion and absorption of food and is known as pancreatic exocrine insufficiency (PEI).
There are several symptoms of malabsorption:
- floating, pale, foul smelling stools
- more frequent or loose bowel movements
- bloating or pain (because the large bowel is not used to dealing with these undigested nutrients)
- excess flatulence (farting)
- stools that are oily in appearance
- stools that are difficult to flush and stick to the toilet bowel
- not gaining weight or losing weight, even if you feel you are eating enough
- fatigue and weakness.
If you are experiencing these symptoms, you should speak to a doctor and dietitian about taking pancreatic enzymes (Creon ©) these can ensure that nutrients break down and can be absorbed by the body.
We recognise that dietary changes have a huge impact on everyone with cancer. It can take a while to get used to changes to your diet and lifestyle. But finding ways to manage your diet and symptom can help you feel more in control of the situation. If you are struggling at all, speak to your dietitian, doctor or nurse. Or call our support team.