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By Karen Alexander, Oncology Wellness Specialist


Dietary Recommendations for Pancreatic Cancer after a Whipple Surgery (Part 1)

According to the American Cancer Society, it is estimated that in 2019 about 56,770 people (29,940 men and 26,830 women) will be diagnosed with pancreatic cancer. This accounts for about 3% of all cancers in the US. The average lifetime risk of pancreatic cancer for men is about 1 in 63 and for women it is about 1 in 65. Each person’s chances of getting this type of cancer can be affected by certain risk factors.

Although scientists don’t know exactly what causes pancreatic cancer, they have found several risk factors that can make a person more likely to get this disease. Those risk factors include being over 45 years old, family history (inherited genetic syndromes), race (African Americans are slightly more likely to develop pancreatic cancer than whites), diabetes, cirrhosis of the liver, H. pylori stomach infection, and chronic pancreatitis. There are also some potentially modifiable risks factors for pancreatic cancer such as workplace exposure to certain chemicals, physical inactivity, tobacco use, heavy alcohol use, and being overweight or obese. 

For information about signs, symptoms, diagnosis and treatment of pancreatic cancer click here.

Depending of the location and extension of the tumor, pancreatic cancer may interfere with the body’s ability to digest and absorb foods. In an attempt to cure the disease, some patients can undergo a Whipple surgery. This procedure usually removes part of the pancreas, intestine, stomach, bile duct, and all of the gall bladder. As a result of a typical Whipple surgery, and due to the importance of the organs involved in the surgery, the amount of food the patient can eat at one time and how the body handles food will change. Patients typically experience trouble with the stomach emptying after eating, trouble digesting some foods, weight loss, changes in bowel habits, and may develop diabetes. Below are some dietetic recommendations after a Whipple surgery:

Short-term post-surgical nutritional guidelines
- Start oral diet with clear liquids and advance to solid foods.
- Avoid greasy and fried foods.
- Limit consumption of raw fruits and vegetables, initially.  Gradually increase as tolerated.
- At first, it is common to have trouble tolerating fatty foods. Depending on the type of surgery, the doctor might prescribe digestive enzymes to help with digestion.
- It is important to eat small, frequent meals (5 to 6 meals per day) since the patient will feel full quickly and will be able to eat only small amounts at a time. 
- Eat slow and chew your food very well.

Long-term post-surgical nutritional guidelines
- After the surgery, patients are encouraged to gradually introduce solid foods. 
- Small, frequent meals may help tolerate foods. Don’t push; stop eating when you feel full.
- For the first few weeks, avoid drinking large amounts of fluid with meals. Small sips are ok. Drink most fluids 30 minutes before and after meals. Drink 48 to 64 ounces (6 – 8 cups) of fluids throughout the day. 
- Try to maintain your weight, even if you are overweight, because it can make you feel weaker and can delay healing. 
- Choose a variety of foods that contain a wide variety of nutrients so you can maintain your weight and have energy to be active.
- Some patients might need to take a daily vitamin/mineral supplement, or extra calcium, or vitamin D.  Talk with your doctor to find out if you need any extra supplements.
- Include foods high in protein in order to promote healing (meats, fish, dairy, poultry, eggs, peanut and nuts butters). Oral nutrition supplements such as Ensure ®, Kate Farms ®, Boost ®, Orgain ®, Carnation Instant Breakfast ®, etc. are good source of protein as well.
- Caffeinated drinks cause dehydration, so avoid these. If nausea is a problem, avoid eating meals with strong odors, high fat greasy fried and spicy foods. Eating dry crackers will help when feeling nauseated. 
- Consume fat (as tolerated) from healthy sources such as olive oil, canola oil, peanut oil, nuts, seeds and avocados.
- You may eat plenty of fresh fruit and vegetables as long as they do not trigger diarrhea. A goal of at least 2.5 cups of fruits and vegetables per day is recommended.
- Take pancreatic enzymes if needed.
- Take acid reducing medications as prescribed.
- Engage in physical activity for at least 30 minutes per day.  Under the advice of the surgeon, weight training may be considered.
- Choose beverages that contain calories, nutrients and protein, such as juices, smoothies or nutritional supplement drinks.  It is acceptable to drink small amounts of these at mealtimes or to use nutritional supplement drinks or protein smoothies as meal/snack replacements.
- Avoid alcoholic beverages.

Source: Academy of Nutrition and Dietetics. Nutrition Care Manual. Whipple Surgery Nutrition Therapy. http://www.nutritioncaremanual.org. Accessed February 27, 2019.

In the next bulletin we will discuss the dietetic recommendations to manage some common digestive problems that may happen after a Whipple surgery.

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