Diet and the whipples procedure

How will my diet be affected by the Whipple's procedure?

Before surgery

You may have your nutritional status assessed before surgery and receive dietary support.  If you have lost weight and there is time before surgery takes place your dietitian may advise eating a 'build up' diet using regular food. This diet will aim to increase the energy, protein, vitamins and minerals in your diet. While eating this diet you will need to monitor your stools because an increase in high fat food could make steatorrhoea (fatty stools) worse which can reduce the absorption of nutrients.

Tips for a build up diet:

• Try to eat 3 small meals and 3 snacks a day,

• Eat more protein rich foods (e.g. meat, fish, milk, cheese, eggs, beans and lentils, nuts, yogurts). It is important to include at least one rich source of protein at each of your meals.

• If you can only eat small amounts enrich your food. For example enrich milk by taking a pint of full cream milk and mixing in 3-4 tablespoons of dried milk powder. Then use this enriched milk instead of ordinary milk in tea and coffee, to add to cereals or milk based puddings, to add to soup and to make sauces.

• Try to drink 6-8 cups of fluid a day but avoid drinking at mealtimes as this can make you feel full. Have drinks such as milk, fruit smoothies, hot chocolate and fruit juice.

• Have some fruit and vegetables each day.

After surgery

Immediately after surgery you will be 'nil by mouth' as the gut needs to rest. You will initially be fed through a tube either directly into the stomach or bowel (enteral feeding) or into a vein (parental feeding). You will usually be fed in this way for around 5-7 days, although it can be longer if needed.

After this period you will slowly start to take liquid and food orally again. You will begin by drinking clear fluids such as water, black tea, black coffee and squashes. You can then move on to fluids in any form including fruit juice, milk and nutritional supplements. Next you can try a soft or light diet which involves eating softer foods which you should chew well. Once you are managing this diet you can gradually build up your intake of normal food.

You are likely to feel full more quickly than before because of a reduced stomach capacity. It will help to eat little and often to make sure you get the calories and protein you need. Try having three small meals and three snacks a day.

You may receive an assessment from a dietitian in the hospital once you start taking food orally again. They can provide advice on managing any symptoms from the surgery and gaining weight if needed. They will also give tips on helping you improve your food intake in a form you can manage.

After the Whipple's procedure most people find that they have a small appetite and cannot manage big portions. This may last for several months or be a long term effect of the surgery. You may also experience heartburn and steatorrhoea (greasy stools).

Having all or part of the pancreas removed during surgery will affect the functioning of the pancreas and your ability to digest food. Your dietitian or surgeon may advise you to take pancreatic enzyme supplements to help you absorb the nutrients you need from food. They may also advise you to take nutritional supplements to help you gain weight.

It is also very common to find favourite foods do not taste the same after surgery. Taste can take some weeks to return to normal. Often citrus flavours such as grapefruit or pineapple, or perhaps strong flavoured crisps or snacks can stimulate taste buds. After surgery some people find they have difficulty with some foods and you may have to experiment to find what you can tolerate and enjoy eating.

It is possible that you will have lost weight both before and after surgery, and it may take 3-6 months for you to begin to gain weight, in some cases up to 12 months. This is a normal effect of surgery and the changes to your eating pattern that have occurred. You may find that your weight stabilises at a certain point and you do not gain any further weight. You should monitor your weight and request a review by a dietitian for advice on how to increase your weight if you are having difficult gaining weight.

Six months after surgery the majority of people will be able to maintain weight and experience minimal gastrointestinal symptoms.

If you are having chemotherapy following the Whipple's procedure you should seek advice from a dietitian to help make sure any nutritional problems will not delay the start of chemotherapy treatment.

Diabetes and blood sugar

The removal of all or part of your pancreas, during surgery can lead to the development of diabetes. This is because the cells that produce insulin have been removed.

You may need to start having insulin injections or taking tablets to regulate your blood sugar. You may also need to make changes to your diet to help manage the diabetes.

Your diabetes will need to be managed in the context of the pancreatic cancer.  For example if you have lost weight it may be a priority to stabilise your weight using a build-up diet and monitor the diabetes around this. This will help you to recover from surgery, preserve your physical function and enable you to carry out normal daily activity.

You should seek advice from a dietitian or diabetes nurse for advice on managing your diabetes. After a total pancreatectomy close monitoring of the diabetes will be important.

It is important to be aware that some nutritional supplements are high in glucose and you should seek advice before taking these if you are diabetic.

You can find more information on managing diabetes from Diabetes UK. They have information on different types of diabetes, eating well and and recipes.