In this bulletin we will discuss dietetic recommendations to manage common digestive issues that happen after a Whipple surgery according to the Academy of Nutrition and Dietetics and the Pancreatic Network.
Slow Stomach Emptying
Slow stomach emptying after eating can cause nausea, vomiting of undigested food, bloating, early fullness, and abdominal pain.
• Eat small but frequent meals
• Chew foods well
• Liquids work better than solids
• Low fat, low fiber and soft foods work better than high-fat, high-fiber, tough foods.
• Take a walk after eating to help iwth digestion
• Ask your doctor if you will need medication to help your stomach empty faster
Dumping Syndrome may occur 30 to 60 minutes after eating and is occurs when food from the stomach (especially sugar) passes too quickly into the intestine. Symptoms include dizziness, sweating, fast heart rate, bloating, nausea and diarrhea. Some symptoms occur 2 to 3 hours after a meal and include feelings of weakness, hunger, and fast heart rate.
• Avoid foods high in sugar (no more than 12 grams per serving)
• Drink fluids 30 minutes before or after meals
• Eat 5 to 6 small meals a day
• Lie down for up to 30 minutes after meals to delay stomach emptying
• Try foods high in soluble fiber such as apples, apricots, bananas, blackberries, nectarines, oranges, grapefruit, pears, plums, strawberries, tangerines, asparagus, broccoli, Brussel sprouts, carrots, kale, okra, spinach, mustard greens, sweet potato, oatmeal, oat bran, beans (only if tolerated), or commercial fiber supplements
Decreased Pancreatic Function
Pancreatic enzymes help break down fats, proteins and carbohydrates. A normal functioning pancreas secretes about 8 cups of pancreatic juice into the duodenum, daily. This fluid contains pancreatic enzymes to help with digestion and bicarbonate to neutralize stomach acid as it enters the small intestine.
Decreased pancreas function can happen due to partial or total removal of the pancreas and symptoms include feelings of indigestion, cramping after meals, large amounts of gas, stool changes (foul smelling, oily, frothy, very light in color), loose stools, and weight loss even though you are getting plenty of calories. In this case your doctor may prescribe digestive enzymes to improve your digestion and control your symptoms. If the enzymes are well administered, a low-fat diet is usually not needed. Below are some hints to maximize the benefits of the digestive enzymes:
• Take enzymes with every meal, fat-containing snack, meat, bread and desserts
• Spread your enzymes throughout the meal
• High fat meals will need more enzymes than low fat meals
• Most snacks will require fewer enzymes than a meal but be cautious as some snacks are very fatty and can require more enzymes than a meal
• Be flexible with the dosage and timing of enzymes
• Enzymes do not need to be taken with fruit, jelly, sorbet, boiled, chewy or jelly sweets, squash, fizzy drinks or fruit juices
Sometimes people over produce stomach acid and this can make pancreatic enzymes less effective. Talk to your doctor if your symptoms don't improve with the dose that you are receiving.
This can cause gas, bloating or diarrhea after eating or drinking dairy products.
• Choose lactose free foods
• Try using Lactase enzyme tablets
• Yogurt and cheese are usually well tolerated by most people with lactose intolerance
Bacteria Growth in the Small Intestine
Symptoms include nausea, gas, bloating, diarrhea, low vitamin B12 and high folate in the blood. Make sure to talk to your doctor about treatment with antibiotics.
If you develop diabetes after a Whipple surgery, be aware to monitor your blood sugar, take your medications, and follow a healthy diet. Visit a Registered Dietitian Nutritionist or a Diabetes Educator for more details about your ideal diet.
Finally remember everybody is different and certain foods may be not be ideal for some patients. Food tollerance usually improves over time. If you can’t tolerate one specific food, try again a few weeks later. With patience and time you might be able to tolerate your favorite foods again. Keeping a journal of what you eat, how much you eat, your symptoms, and how much enzymes you are using could help you find out your individual tolerance to certain foods and personalize your diet.