Diet & Nutrition

Diet, Nutrition & Managing Symptoms

People with pancreatic cancer have many nutritional challenges to overcome, therefore it is important to keep a diet that contains a wide variety of nutrients so you can maintain your weight and have energy to remain active.
Here are a few general diet tips:
  • Drink plenty of fluids each day to combat dehydration and improve appetite
  • Eat five to six small meals each day
  • Avoid consuming unhealthy calories found in sweets and junk food
  • Your diet should be rich in protein and calories.
  • Eat fish and lean meat
  • Eat red meat only sparingly
  • Milk products can be a good source of protein
  • Eat plenty of fresh fruit and vegetables as long as they do not trigger diarrhea
A dietitian can be a valuable resource for patients living with pancreatic cancer. They will work with you to develop an eating plan catered specifically for your needs that will typically involve keeping fat intake low and carbohydrate intake high. In addition, it is important to develop meal plans that incorporate a broad range of foods, and to eat small nutritionally balanced meals frequently.

Coping with Loss of Appetite and Nausea

Nausea is a common symptom of pancreatic cancer that may occur for many different reasons including chemotherapy drugs, radiation therapy, and other prescribed medications. Diet should focus on easily tolerated foods that are usually bland, low in odor, and low in fat and fibre content. Getting enough fluids is important to prevent dehydration. If nausea is severe, please see your doctor.
Here are some tips if you are experiencing loss of appetite and nausea:
  • Eat small, frequent meals of easily digestible food
  • Try to avoid rooms that are too warm or stuffy, as they may make nausea worse
  • Try dry starchy foods such as crackers or dry toast, especially if it has been several hours since your previous meal or snack
  • Choose foods that are cold or room temperature. They can have fewer odors and be more easily digested
  • Avoid greasy, spicy, hot, or very sweet food
  • Avoid your favourite foods when you are nauseated to prevent permanent dislike for these foods
  • Slowly sip cold, clear juices, ginger ale, or other carbonated beverages
  • Restrict fluids with meals
  • Try peppermint or ginger tea or sucking a candy flavored with peppermint, wintergreen or lemon. These can help, especially if you have unpleasant tastes in your mouth
  • Try high calorie medical nutritional supplements
  • Try relaxation techniques
  • Wear loose clothing
  • Talk to the doctor about antiemetic (antinausea) medications

Helpful Tips for Caregivers

  • Offer small amounts of food and beverages often
  • Allow your loved one to say “no” but make sure they stay hydrated
  • Keep track of the amount of fluid they take each day
  • Consult a doctor if they continue to vomit when taking fluids
  • Cook when your loved one is not home so they are not exposed to odors. If this is not possible try opening a window
  • If friends or family offer to help, have them cook a meal at their home
  • Remove all garbage as it may contain odors that can make nausea worse

Diarrhea

Diarrhea is a common problem with pancreatic cancer patients. If it is posing a serious issue, the diet should be limited to simple, easy-to-digest food, then expanded as the diarrhea subsides. A diet consisting of bananas, rice, applesauce, toast (called the BRAT diet), and clear liquid can help with severe diarrhea. Imodium® (loperamide) can also be easily obtained at a pharmacy. This drug slows the gastrointestinal system and reduces the amount of fluid lost in the stool.
Helpful tips if you are experiencing diarrhea:
  • Eat 5-6 small meals a day
  • Talk to a dietitian about enzymes or antidiarrhea medication
  • Avoid or try to limit the amount of fatty, greasy, or fried foods including high fat meats or cheeses, whole or 2% milk, rich desserts, fast food, and foods with added oil, butter, margarine, sour cream, cream cheese, or salad dressing
  • Limit use of hot spices
  • Eat fewer fruits or vegetables and choose juices instead. High intake of insoluble fiber food such as whole grain breads/cereals, raw fruits with thick peels, raw vegetables, and nuts can increase intestinal motility
  • Avoid gas-forming foods, including vegetables in the cabbage or onion family, dried beans, corn, popcorn, and chewing gum
  • Cut back your usage of carbonated beverages. It is suggested that they be left open for at least 10 minutes prior to drinking
  • Choose beverages that are decaffeinated versions of your favourite beverages including tea
  • Drink lots of fluids to prevent dehydration. It is recommended to drink an additional cup of fluid after each bowel movement. Good choices include broth, jello, and popsicles
  • Watery diarrhea may occur after eating foods high in sugar, like rich desserts, or if symptoms of high blood sugar are present. Symptoms of high blood sugar include increased thirst and urination
  • Keep a diary of your diet and bowel movements as it may identify trigger foods for you
Staying hydrated is very important in the management of diarrhea. It is essential to consume enough clear liquids to make up for the volume of fluid lost due to the diarrhea. This amount is in addition to the usual daily intake. If the diarrhea is severe, 12 to 16 cups or more of fluid per day is recommended. In addition to plain water, you should include beverages that contain some sugar and electrolytes, such as over-the-counter formulations for diarrhea or Gatorade. If diarrhea persists, it is important to seek medical attention.

Loss of Pancreatic Digestive Enzyme Production

Patients with pancreatic cancer, especially after surgery, may have digestive enzyme deficiencies. This means that it is difficult to break down one or more types of food components into absorbable forms. The undigested food, therefore, provides no nutrient or caloric value to the patient, and unintentional weight loss may result. The diarrhea that commonly accompanies digestive enzyme deficiencies further contributes to weight loss. To treat this problem, supplemental digestive enzymes may be prescribed and should be taken with your meals or snacks.

Coping with Weight Loss and Cancer Cachexia

Side effects or symptoms such as loss of appetite, malabsorption, nausea and vomiting can cause a patient to consume fewer calories than the body needs to maintain an appropriate weight. Weight loss and malnutrition can have a significant impact on quality of life, daily functioning, response to treatment, length of hospital stays and complications such as infections. Tumor-induced weight loss, also known as cancer cachexia, is a complex problem that affects the way the body uses calories and protein. Cancer cachexia can cause the body to burn more calories than usual, break down muscle protein and decrease appetite.

If a person is consuming regular meals and snacks but is losing weight, they may be experiencing cancer cachexia. The following tips may help increase appetite, improve interest in eating and assist in controlling weight loss:

  • Get plenty of rest
  • Exercise lightly before meals to stimulate appetite. Even a short walk may help
  • Select enjoyable foods and foods that have a pleasant aroma
  • Aim for 6-8 small meals and snacks per day
  • Eat meals and snacks at scheduled times, even if not hungry
  • Substitute a meal with a nutritional supplement drink or a homemade smoothie made with protein powder. If you have been prescribed pancreatic enzymes, be sure to take them with these drinks
  • Take anti-nausea medication at the first sign of queasiness or nausea. Delay eating favorite foods if feeling nauseous
  • Consult with a registered dietitian for nutrition counseling
  • Eat calorie-rich, nutrient-dense foods and try not to consume foods or liquids with little nutritional value, such as soft drinks
  • Restrict or avoid any foods that may cause or worsen diarrhea
  • Ask the doctor or dietitian whether pancreatic enzymes may be helpful
  • Check with the doctor to see if medications to stimulate appetite would be helpful in controlling weight loss
If poor appetite and weight loss persist, speak to your doctor as they may prescribe medication to increase your appetite.

Helpful Tips for Caregivers

  • Peel fruits and vegetables
  • Keep track of the amount of fluid they take each day
  • Consult a doctor if they continue to vomit when taking fluids
  • Stock snack foods such as crackers, applesauce, soups, Jell-O or drinks like Gatorade that will help replace lost sodium and potassium.
  • Bananas can help replace lost potassium
  • Use broths to flavour and moisten food
  • Avoid deep fried foods

TIP: Keep a daily journal of diet. In addition to the foods and the amounts eaten, also record daily weight, amount of pancreatic enzymes used, frequency and consistency of bowel movements, and blood glucose readings (if applicable). This information can be useful in tracking nutritional progress and can help the doctor or dietitian make further recommendations.

Special thanks to our friends and partners at the Pancreatic Cancer Action Network for sharing this information with Pancreatic Cancer Canada and our community.

Additional Resources

In our partnership with Wellspring we have collaborated on a series of helpful videos specifically geared towards pancreatic cancer patients, caregivers and family members. These videos offer more information about day to day diet and nutrition considerations for pancreatic cancer patients.

With thanks to Servier for their support of our patient community through an unrestricted educational grant.

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