Your diet and pancreatic cancer

Having cancer of the pancreas will affect your eating and drinking habits. Many people with pancreatic cancer lose weight. The pancreas is not only close to the stomach and bowel, it produces insulin  and enzymes which help to digest food.

If you've had all or part of your pancreas removed, you may need to take insulin or tablets to regulate your blood sugar. You may also need to take enzyme supplements when you eat to help your digestion.

Diabetes

Insulin is responsible for keeping sugar levels (glucose) in your blood at a stable level. Having diabetes means you don’t make enough insulin.

You might be on insulin or take tablets such as metformin to regulate your blood sugar.  

To keep track of your blood sugar levels you’ll have to test it regularly. You do this by pricking your finger and squeezing a drop of blood onto a test strip. This shows how much sugar is in your blood. Or you might have a small device on your skin which continually measures your sugar levels. The device has a little sensor that sits just beneath the skin. 

Your nurse, doctor and dietitian will follow you closely. They will teach you:

• how and when to test your blood
• what to eat and drink
• how to give your insulin injections
• how much to take of your insulin
• what to do if your blood sugar level drops too low and the symptoms to look out for

You might also see a specialist diabetic nurse.

It takes time to get used to doing these tests. You may have a nurse to visit you at home to help you at first and answer your questions.

Contact your healthcare team if you have any questions or problems.

Pancreatic enzyme replacement therapy (PERT)

Digestive enzymes help your body to break down and absorb fats and proteins. Without enough enzymes, you may have diarrhoea or your poo (stools) may float, look pale and smell offensive. This is due to the undigested fat in the stool. 

It might be difficult to put on weight as you are unable to absorb the nutrients from your food. If your pancreas is not working properly due to the cancer or you've had all or part of your pancreas removed, you may need to take enzyme supplements to reduce these effects.

Types of enzyme supplements

There are several different brands of enzyme supplements available. These include:

• Creon - the most commonly used
• Nutrizym
• Pancrex
• Pancrease

The amount (dose) depends on:

• how well the remaining part of your pancreas is working
• your diet 

You might need to take more enzymes if you are about to eat a large or fatty meal. 

You usually take the supplements with main meals, snacks or with a milky drink.

How to take the enzyme supplements

You swallow the enzyme capsules whole, with your meal or snack. If you find it difficult to swallow capsules, you can open them and mix the granules in soft acidic foods that are at room temperature and easy to swallow. This can include apple sauce or mashed banana.

You must not chew or crush the granules. Have a drink of water afterwards to make sure none of the granules stay in your mouth as they can irritate the lining and cause mouth ulcers.

Your dietitian will give you a diet plan to suit you and advise you on taking the supplements. It can take a bit of time to get the right dose of enzymes for you.

Jewish and Muslim faiths

These enzyme supplements come from pigs. Jewish and Muslim leaders agree to the use of PERT as there aren’t any alternatives.

Snacks and small meals

You may find it easier to have lots of small meals through the day, rather than sticking to the traditional 3 meals a day.

It is a good idea to have plenty of nutritious snacks to hand that you can have whenever you feel like eating. If you can manage it, it's best to choose full fat versions of yoghurts and puddings, so that you get the most calories.

You could try:

• yoghurts or fromage frais
• other soft puddings such as trifle or chocolate mousse
• dried fruit
• stewed or fresh fruit (bananas are high in calories)
• nuts
• cheese
• instant soups (make up with milk to boost calories)
• cereal
• milky drinks
• flapjacks

Some of these ideas may not suit your digestion but they might be worth a try. If in doubt, check with your dietitian.

Try to think of quick ways of having the things you like to eat. If possible, get someone to prepare your favourite foods in advance and freeze them in small portions. A microwave makes defrosting and heating easier and quicker.

Managing diarrhoea

If you have diarrhoea after pancreatic surgery, it is probably related to difficulty digesting fat. Avoid very high fibre foods (such as cereal and dried fruit) for a time as these may make things worse. Tell your doctor, nurse or dietitian.

You might need to give a poo (stool) sample to check how your pancreas is working. You might need some medicines to control your symptoms. If you're taking enzyme supplements, your dietitian may need to alter the dose. They can also suggest some changes to your diet that may help.

Nutritional supplements

If you are finding it hard to eat, there are plenty of nutritional supplements available on prescription. Some are powders you sprinkle on your food and some are drinks that are complete meals in themselves.

Sipping a nutritional supplement between meals throughout the day can really boost your calorie intake. Again, ask your doctor or dietitian about what would be best for you.

If you have diabetes, some nutritional drinks or supplements may affect your blood sugar levels. Your dietitian or specialist nurse can advise you about this.