Your diet and pancreatic cancer

How pancreatic cancer causes diet problems

The pancreas is part of the digestive system. It produces insulin and digestive enzymes. These enzymes help break down the food you have eaten, so your bowel can absorb it.

Having pancreatic cancer or surgery to remove the cancer, can affect how well your digestion works. If your pancreas doesn’t work properly it is called pancreatic exocrine insufficiency (PEI). You would then need to take enzyme supplements when you eat. This is to help you to digest your food.

You may also need to take insulin or tablets. This is because your body may not be able to make any or enough insulin. Insulin is responsible for keeping sugar levels (glucose) in your blood at a steady level. You have diabetes if you are not making enough insulin.

If your doctor puts a stent in your small bowel to treat or prevent a blockage, your dietitian may speak to you about having a low fibre diet. This helps stop the stent from blocking..

You usually see a dietitian who gives you information and support on how to manage your diet.

Replacing enzymes to help you digest food

PERT works in the same way as the pancreas by replacing the digestive enzymes to break down fats, carbohydrates and proteins in your food.

Without enough enzymes you may have loose poo (diarrhoea) or floating poos. The poo can also look pale, yellow or orange in colour, and smell offensive. This is due to the undigested fat in it. You may also get:

• a bloated tummy (abdomen)

• abdominal pain or cramps after eating

• indigestion

It can also cause weight loss. Or make it 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 surgery to remove the cancer, you need to take enzyme supplements to reduce these effects. Doctors call this treatment pancreatic enzyme replacement therapy (PERT).

Your dietitian will advise you on how to take PERT.

Types of pancreatic enzyme replacement therapy (PERT)

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

• Creon - this comes in different amounts (doses)

• Nutrizym 22

• Pancrex

Allergies

These enzyme supplements are made from pork products, so cannot be given to anyone with a pork allergy.

Jewish and Muslim faiths

Jewish and Muslim leaders agree to the use of PERT as there aren’t any alternatives that aren’t made from pork.

How to take the enzyme supplements

They are capsules that must be taken every time you eat. This includes meals, snacks and milky drinks. You take them just before you begin eating or with the first few mouthfuls of food. They need to be swallowed with a cold drink.

Your doctor or dietitian tell you how many to take. A normal starting dose is 2 capsules with meals (breakfast, lunch and dinner), and 1 capsule with snacks and milky drinks. But this depends on:

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

• how much food, how often and what you eat

It can take a bit of time to get the right dose of enzymes to reduce the symptoms of poor digestion and weight loss. Sometimes you might need to take more enzymes, such as if you are about to eat a large or fatty meal, but your dietitian will explain about this.

If you find it difficult to swallow capsules

You can open the capsules and mix the granules in soft acidic foods such as yoghurt, apple sauce or fruit juice. The foods need to be cold or at room temperature and easy to swallow.

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

Diabetes and pancreatic cancer

The pancreas contains cells that make insulin. This is a hormone that controls your blood sugar. Pancreatic cancer and surgery to remove the cancer may mean you don’t have enough insulin making cells. Or these cells can stop working. So your doctor might ask you to take medicine to keep your blood sugar stable. This might be:

• insulin as an injection that goes under your skin (subcutaneous injection)

• tablets such as metformin

If you do need to take medicines to control your blood sugar, your healthcare team refer you to a specialist diabetic nurse.

Testing your blood sugar

If you do develop diabetes, you will be advised to test your blood sugar regularly to make sure it doesn’t go too high or low. You do this by either:

• pricking your finger and squeezing a drop of blood onto a test strip

• having a small device on your skin which continually measures your sugar levels - the device has a small sensor that sits just beneath the skin

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

• how and when to test your blood sugar

• what to eat and drink to keep your blood sugar steady

• how to give yourself insulin injections

• how much insulin to take

• what to do if your blood sugar level drops too low and the symptoms to look out for

It takes time to get used to doing these tests. Contact your healthcare team if you have any questions or problems.

Your diet after having a stent in your small bowel

In some people pancreatic cancer can block the first part of the small bowel (duodenum). Doctors call this bowel obstruction and it can make you feel very unwell. Any food or drink you swallow can't pass through to the bowel in the normal way. It collects in your stomach and you need to vomit it back up again.

Treatments for bowel obstruction include putting a small metal tube (stent) into the duodenum to keep it open. This means food can then pass through your body as normal.

If you have a stent you need to make some changes to your diet. This is to help stop the stent from becoming blocked. You should eat foods that are moist and soft. They should also be easy to chew.

It helps to:

• have lower fibre foods

• eat little and often

• add extra sauces and gravy to your food

• eat slowly

• chew your food thoroughly

• eat sitting upright and don’t lay down after eating

Read more about having a stent for a blockage in your duodenum

Snacks and small meals

Managing diarrhoea

Diarrhoea might be due to:

• not making enough digestive enzymes

• side effects of cancer treatments such as chemotherapy or radiotherapy

Diarrhoea can also be caused by the cancer if it is advanced.

Tell your doctor, nurse or dietitian if you have diarrhoea. They may ask you to give a poo (stool) sample to check how your pancreas is working. And they might give you some medicines to control your symptoms.

If you're taking enzyme supplements, your dietitian may suggest you alter the dose. They can also suggest some changes to your diet that may help.

Find out more about coping with diarrhoea