Diet and pancreatic cancer
This section looks at the impact of pancreatic
cancer on diet and nutrition. It contains information on managing
dietary related symptoms and signposts to sources of
support.
How does pancreatic cancer affect diet and
nutrition?
The pancreas plays an important role in the
digestion of food. It produces enzymes and hormones that help to
break down food and regulate blood sugar. Pancreatic cancer
can affect the functioning of the pancreas and its ability to
produce these enzymes and hormones. This has an impact on
digestion and the absorption of nutrients from food. Surgery for
pancreatic cancer where all or part of the pancreas is removed will
also affect the functioning of the pancreas.
It is common for people diagnosed with pancreatic
cancer to have diet related symptoms. These can include changes in
appetite, smell and taste, weight loss, nausea and vomiting, a sore
mouth and changes to your bowel habits. Some people may also
develop diabetes.
Lipase, a pancreatic enzyme, breaks down fat in
food. f the body does not produce enough lipase it can
lead to the development of steatorrhoea which is caused by the
presence of undigested fat in stools. It is characterised by clay
coloured stools, which can be oily in appearance, float, be
difficult to flush, and have an offensive smell. It can lead to
weight loss because nutrients from food are not absorbed
properly.
Some people with pancreatic cancer will develop
jaundice. This can also affect diet as it can cause loss of
appetite, taste changes, vomiting and nausea. These symptoms
usually resolve once the jaundice is treated.
What dietary support is
available?
The dietitian is a key member of your multi-disciplinarycare
team at the hospital. You may require
support from a dietitian as part of your care, if so they will
assess your dietary related needs. Dietitians can offer
expert advice to help you manage dietary symptoms related to the
pancreatic cancer or your treatment. They will give advice on
getting the nutrition you need and provide tips on boosting your
calorie intake. In particular they may suggest the use of
pancreatic enzyme supplements and nutritional
supplements.
Finding ways to manage your dietary related symptoms
will help your overall wellbeing. If you have not seen a dietitian
you should ask your care team or GP to refer you to one if you are
experiencing problems with your nutrition.
What are pancreatic enzyme supplements
and how can they help?
Pancreatic cancer or the removal of all or part
of the pancreas through surgery can affect the ability of the
pancreas to produce enzymes which help to break down fat, protein
and carbohydrate. Lipase is responsible for the
digestion of fat, protease is responsible for the digestion of
proteins and amylase is responsible for the digestion of
carbohydrate.
If you are experiencing weight loss, steatorrhoea, diarrhoea, abdominal
discomfort, bloating or flatulence it can be a sign that you are
not digesting and absorbing nutrients properly. These
symptoms can often be controlled by the use of pancreatic enzyme
supplements which help to break down food. There are different
types of enzyme supplement available; Creon is the most commonly used type in
the UK. Other types include Pancrease, Nutrizym, and Pancrex. Your
consultant will usually prescribe the pancreatic enzyme
supplements but your dietitian can also provide advice on starting
to use these enzymes or altering the dose. The dosage prescribed
will vary between individuals due to differences in pancreatic
function. You may also be advised to alter the amount you take
based on the size of the meal or whether it contains a lot of
fat. Larger meals and more fatty foods need more enzymes to
be digested and you should alter your pancreatic enzyme dose
accordingly.
Your dietitian can provide advice on how to work out
the best dosage of enzymes for you. When you first start taking the
enzymes you may need to alter the amount you take until you find
out what works best. Signs that you are taking enough include
stools returning to normal, weight gain, and less gas/wind. Some
people find they have to restrict the amount of fat in their diet
despite taking the tablets. If you continue to have dietary
related symptoms while using the enzyme supplements or are losing
weight you should consult your dietitian.
How should I take the enzyme
supplements?
It is important to understand how to take the
supplements to make sure they work well. Pancreatic enzyme
supplements come in a capsule form or as granules. They
should be swallowed with water whenever you have a meal or snack
and you should take the supplements immediately before you eat. For
larger meals you can take half of the capsules just before you eat
and half during the meal. It is best not to drink a whole
glass of water with the tablets as this will flush them through
your system too fast and it can make you feel full
quicker.
Fatty foods may require more enzymes, for example
fried foods, curries, doughnuts, pastries, puddings, oily dressings
and sauces.
You should not take the supplements without food as
they will not have a helpful effect and could be harmful. The
capsules should not be chewed or crushed as this will destroy the
enzymes. Ideally the capsules should be swallowed whole. However,
if you find this difficult you can empty the capsules and take the
microspheres they contain with a teaspoon of jam, but again you
must not chew.
Some people experience bloating when taking an
enzyme supplement. It can help to try a different brand of
the enzyme as the manufacturers use different coatings or you can
try a different type of enzyme. If you are experiencing problems
seek advice from your dietitian, healthcare team or
GP.
Nutritional
supplements
If you have lost weight, have a poor appetite or can
only eat small amounts of food you may find it helpful to take a
nutritional supplement. These supplements can help make sure you
are getting enough calories, protein, vitamins and minerals. They
are available on prescription through your GP, hospital or
dietitian.
There are different types of nutritional supplement
products available including milk-based, juice-tasting, powder,
yogurt style and soups. You may need to try different products
until you find one you prefer or tolerate better. Some people find
they prefer a savoury to a sweet product.
There are four main companies that make nutritional
supplements. They are:
- Abbott Nutrition (Ensure® range of productse.g.
Ensure®Plus milkshake style, Ensure Plus Juice).
- Nutricia (Forti range of products e.g. Fortisip,
Fortijuice).
- Fresenius (Fresubin range of products e.g. Fresubin
Energy Drink).
- Nestle (Resource range of products e.g. Resource
Shake, Complan, Build-up)
Macmillan Cancer Support has more detailed information on
the products produced by these companies on their
website. You may want to try products from
different companies to find one you like. The company websites also
contain tips on using the products in recipes.
If you are finding it hard to eat or drink you may
find it easier to take a nutritional supplement drink as small
'shots' (50ml doses) throughout the day.
If you are diabetic you should be aware that these
supplements can be high in sugar (in particular glucose). This does
not mean you cannot use them as it is important to get enough
calories but you should seek advice from your dietitian before
taking them and you may need to monitor your blood sugar
closely.
Further information on diet and pancreatic cancer
in this section:
Real life stories - diet and pancreatic
cancer
The real life stories section of our website contains case
studies of people experiences of managing their diet and dietary
related symptoms following a diagnosis of pancreatic cancer. Click
here to read these
stories.