Foods that fight pancreatic cancer

Diet and inoperable pancreatic cancer

Diet and a duodenal stent

Sometimes the cancer can block the duodenum (first part of the small intestines). If this happens, you may need to have a stent (hollow tube) inserted. This unblocks the duodenum and allows food to pass through. This should also relieve symptoms caused by the blockage, such as feeling full, and feeling and being sick.

You will need to be careful what food you eat, to make sure the stent doesn’t getting blocked. The following tips may help.

  • Eat smaller meals but more often.
  • Take your time eating, and make sure you chew your food well.
  • Eat a variety of foods to make sure you get enough nutrients.
  • Sit up when eating and avoid lying down after meals. This will help to digest your food.
  • Avoid drinking too much fluid before or with your meals as this can fill you up.

You will need to eat soft and moist foods, such as:

  • porridge or cereal soaked in milk
  • soup (add cream, milk or cheese for extra nutrients and calories)
  • minced meat and poached fish
  • eggs, including boiled, poached or scrambled eggs and omelette
  • fish pie, shepherd’s pie or macaroni cheese
  • mashed potato (add butter, cream or cheese)
  • vegetables cooked until tender with no skin or pips
  • rice pudding, stewed fruit, yoghurt, mousse, custard or ice cream.

Try to avoid foods that might block the stent. These include:

  • raw vegetables or vegetables that are harder to digest, such as salads, celery and sweetcorn
  • nuts and dried fruit
  • fruit with a pith, such as grapefruit or oranges
  • tough or gristly meat
  • bread, as it expands in your stomach when it mixes with liquid.
  • wholegrain food such as wholegrain pasta or rice as they are more difficult to digest.

Speak to your doctor, nurse or dietitian for more advice about what to eat after you have had a duodenal stent put in.

More diet and pancreatic cancer information

  • Overview of diet and pancreatic cancer
  • Pancreatic enzyme supplements
  • Diet and operable pancreatic cancer
  • Diet and chemotherapy for pancreatic cancer
  • Diabetes and pancreatic cancer
  • The emotional impact of diet symptoms
  • Diet tips for pancreatic cancer
  • Questions to ask about diet and pancreatic cancer

Updated November 2017

To be reviewed November 2019

Pancreatic Cancer Diet and Nutrition

The pancreas is an important gland in the body that secretes insulin. It is near the stomach, small intestine, gallbladder, and duodenum. It plays a large role in the digestion of foods. In particular, the pancreas aids in the breakdown of carbohydrates and secretes enzymes to help in the digestion of protein and fats. Pancreatic cancer treatment includes surgery, chemotherapy and radiation therapy. Pancreatic cancer diet, however, can make the treatment process more manageable.

Pancreatic Cancer Nutrition Guidelines

Regardless of treatment type, pancreatic cancer takes quite a toll on the body, especially in the areas of diet and nutrition. Here are some tips on what to eat with pancreatic cancer on and how to optimize nutrition during and after treatment.

  • Maintain a healthy weight. Treatments such as chemotherapy, radiation and surgery for pancreatic cancer often contribute to unintentional weight loss. It’s important to avoid excess weight loss during treatment, as poor nutrition can cause a decrease in the body’s ability to fight infection.
  • Eat small, frequent meals throughout the day. Eating frequent small meals will ensure your body is getting enough calories, protein and nutrients to tolerate treatment. Smaller meals may also help to reduce treatment-related side effects such as nausea. Try eating five to six small meals or “mini” meals about every three hours.
  • Stay hydrated. Drinking enough fluids during cancer treatment is important for preventing dehydration. Aim to drink 64 ounces of fluid daily. Avoid drinking large amounts of caffeinated beverages. Too much caffeine can lead to dehydration.
  • Be observant of changes in bowel habits. Pancreatic cancer and treatments can often lead to changes in bowel habits including diarrhea, constipation, bloating and gas. It is important to communicate with your healthcare team about any changes in your bowel habits. Changes in your diet or medications may be necessary to manage these side effects.
  • Choose foods that are easy to digest. One key responsibility of the pancreas is to aid in digestion. Pancreatic tumors can impact how effective the pancreas is at digesting foods. Choose soft foods that are easy to chew. Eat slowly and chew thoroughly.
  • Choose protein-rich foods. Foods high in protein are some of the best foods for the pancreas. Protein helps the body repair cells and tissues. It also helps the immune system recover from illness. Include a source of lean protein at all meals and snacks. Good sources of lean protein include:
    • Lean meats such as chicken, fish or turkey
    • Eggs
    • Low-fat dairy products such as milk, yogurt and cheese or dairy substitutes
    • Nuts and nut butter
    • Beans
    • Soy foods

Include whole grain foods. Whole grain foods provide a good source of carbohydrate and fiber, which help keep energy levels up. Good sources of whole grain foods include:

  • Oatmeal
  • Whole wheat bread
  • Brown rice
  • Whole grain pasta

Eat a variety of fruits and vegetables every day. Fruits and vegetables offer the body antioxidants, which can help fight against cancer. Choose a variety of colorful fruits and vegetables to get the greatest benefit. Aim to eat a minimum of five servings of whole fruits and vegetables daily.

Eat healthy fats

Choose sources of healthy fat. Avoid fried, greasy and fatty foods. Instead, choose baked, broiled or grilled foods. Healthy fats include:

  • Olive oil
  • Avocados
  • Nuts
  • Seeds

Limit sweets and added sugars. It is not uncommon for individuals with pancreatic cancer to have more difficulty digesting foods high in sugar. Desserts and sweets may have adverse effects. These foods provide little nutritional benefit and often take the place of other foods that are better for you. These foods may also lead to high blood sugar or blood glucose levels.

Practice good food safety. Wash your hands often while preparing food. Use different knives and cutting boards for raw meat and raw vegetables. Be sure to cook all foods to their proper temperature and refrigerate leftovers right away. Talk to your healthcare team before taking any vitamins or supplements. Some medications and cancer treatments may interact with vitamins and supplements. Choose food as the main source of nutrients.

Pancreatic enzyme supplement

Take pancreatic enzymes if prescribed by your healthcare team. Your cancer may affect the functionality of your pancreas, which may affect your ability to digest food properly. Your doctor may prescribe pancreatic enzymes to take with meals. Pancreatic enzymes can aid in better digestion and help improve any digestive discomfort or problems you may be having.

Eat as healthy as possible

  • Nutrient-dense foods are foods that contain protein, complex carbohydrates, healthy fat, vitamins and minerals, all needed by the body to function optimally.
  • Fruits, vegetables, lean protein and whole grains are all nutrient dense foods.
  • Consult a registered dietitian for specific recommendations based on your level of food tolerance.

Try to eat with others when possible

  • Typically this makes meal times more enjoyable and may encourage you to eat more than eating alone.

Eat slowly and chew food well

  • Digestion begins in the mouth. Smaller food particles are much easier to digest and are less likely to cause discomfort during the digestion process.

What to do after you eat

  • Lying down after eating encourages acid from the stomach to flow back into the esophagus leading to symptoms of heartburn.
  • Stay in an upright position while food digests. This will keep the acid from the stomach in the stomach.
  • Ask a registered dietitian for guidance on which foods to avoid to prevent heartburn, gas, bloating and belching.

Be as active as possible

  • Exercise may help to stimulate appetite and endorphin production. Physical activity will provide a sense of well-being, which will make treatments more bearable and allow you to eat more.

Drink plenty of fluids to avoid dehydration

  • A good starting point is to strive for eight eight-ounce glasses per day.
  • Only take small sips with meals to avoid excessive bloating, gas or feeling too full to eat.
  • The best time to drink fluids is an hour before or after a meal.
  • Choose beverages that contain calories and nutrients such as juices, smoothies and liquid nutrition supplements.
  • A registered dietitian can provide you with recommendations for a liquid nutrition supplement and how much is best for you.
  • Drink alcohol in moderation, if at all. Alcohol provides no beneficial nutrients and may contribute to dehydration, which can lower the abilities of your immune system.

Be observant of changes in bowel habits

  • You may experience symptoms of fat malabsorption by the frequency of bowel movements and the appearance of stools. Fat-containing stools are often bulky, frequent, foul-smelling and have an oily appearance.
  • These symptoms warrant the need for vitamin A, D, E and K supplements as well as a multivitamin. You may also need a calcium supplement.
  • Your healthcare team can advise you on choosing these as well as the correct dosage.
  • Ask your oncologist about vitamin B12 injections and iron to avoid becoming anemic.

Stay on top of your weight

It is normal to lose some weight after being diagnosed with pancreatic cancer and beginning treatment. Consult a registered dietitian immediately if you are losing more than one or two pounds a week. A registered dietitian can provide recommendations on how to increase calorie intake.

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Pancreatic cancer

Having cancer of the pancreas will affect your eating and drinking habits, whatever your stage of cancer or treatment. 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.

Blood sugar

If you are on insulin or tablets to regulate your blood sugar, your doctor will ask you to check your urine for sugar. Too much sugar in the urine indicates that the sugar balance of your body is not yet right.

If you are on insulin, you will probably also have to test your blood sugar levels. You will have to prick your finger and squeeze a drop of blood onto a test strip. This will show how much sugar is in your blood. You will then know how much insulin to take.

It takes time to get used to doing these tests. You will be shown how to do it before you leave hospital.

You may also have a nurse to visit you at home to help you and answer your questions.

Enzyme supplements

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 types of enzyme supplement. Creon is the most commonly used. The 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.

How to take them

You swallow the enzyme capsules whole, immediately before your meal. 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 dietician 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.

Snacks and small meals

You may find it easier to have lots of small meals through the day, rather than sticking to the traditional three 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 may 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 supplement between meals throughout the day can really boost your calorie intake. Again, ask your doctor or dietitian.

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Cancer of the pancreas used to be considered relatively rare, but its incidence has been slowly increasing, likely because of the rising numbers of older adults in the U.S. (this kind of cancer is more common with advancing age; most cases develop after the age of 60). In fact, pancreatic cancer is now the fourth leading cause of cancer death, and it is expected to move up to second place, possibly as soon as 2015, according to the Pancreatic Cancer Action Network.

The disease is more common among men than women and occurs more often among African-Americans than among any other group. The risk of developing it triples if your mother, father, sister or brother had the disease. A family history of colon or ovarian cancer also increases risk. In addition, smokers are two to three times more likely to develop the disease than nonsmokers. Diabetes and being overweight are also risk factors, as is, possibly, excessive alcohol consumption. Bear in mind, however, that most people with these risk factors do not develop pancreatic cancer. And many people who do get the disease have no risk factors at all.

A recently published National Cancer Institute (NCI) study found that a healthy diet – along the lines of the 2005 federal dietary guidelines which emphasize eating a variety of fresh fruits and vegetables daily – reduced the risk of pancreatic cancer by 15 percent among the more than 500,000 participants ages 50-71. In addition to focusing on fruits and vegetables, lean meats and low-fat dairy products, the guidelines call for limiting consumption of saturated and trans fats, cholesterol, added sugars, salt and alcohol. While the study didn’t prove that the diet was responsible for the decreased risk, it did show an association between adhering to a healthy diet and a lower risk of pancreatic cancer.

Study leader Hannah Arem was quoted in news reports as saying that the researchers also tested the influence of education, smoking history, physical activity and vitamin use, plus other factors, but noted that the 15 percent reduction in risk could be due to healthy behaviors that the investigators didn’t ask about. The NCI researchers also found that the association between diet and a lower risk of pancreatic cancer was stronger in overweight or obese men, but not in overweight or obese women. The study was published online on August 15, 2013 in the Journal of the National Cancer Institute.

An earlier study from the University of California at San Francisco, published in September 2005, found that eating five or more servings per day of yams, corn, carrots, onions, and similarly colored vegetables is associated with a lower risk of pancreatic cancer. Eating spinach, kale and other dark green leafy vegetables, as well as cruciferous vegetables such as broccoli and cauliflower, also lowers the risk.

The researchers asked 2,233 men and women, including 532 pancreatic cancer patients, how much produce they ate. Then, they looked at the eating habits of the cancer patients compared with the eating habits of the others.

Tomatoes and other vegetables also were beneficial but not as protective as the yellow vegetables mentioned above or the dark green leafy vegetables. Eating citrus helped somewhat but not as much as vegetables. And overall, raw vegetables seemed to provide more protection than cooked vegetables. The study was published in the September 2005 issue of the journal Cancer Epidemiology Biomarkers & Prevention.

Andrew Weil, M.D.

Friday Fix: Foods Pancreatic Cancer Patients Should Avoid

The nutrition goal for people with pancreatic cancer should be to consume an adequate amount of fluids, calories, protein, vitamins and minerals each day to maintain a healthy weight and feel their best.

Making the healthiest choices possible to maintain good nutrition can help patients minimize the side effects of treatment, recover from surgery and maintain the best quality of life. However, certain foods can lead to discomfort among pancreatic cancer patients.

Foods that pancreatic cancer patients should consider avoiding include:

  • High-fat foods, including whole or 2 percent milk (reduced fat), high-fat meats or cheeses, rich desserts
  • Many fast foods, fried foods and foods with added oil, butter, margarine, sour cream, cream cheese or full-fat salad dressing
  • Spicy foods, especially those containing garlic, onions or hot peppers
  • Refined/simple carbohydrates, such as those containing high fructose corn syrup, or sucrose, especially if the patient is experiencing dumping syndrome
  • High-fiber foods
  • Milk and dairy products, if lactose intolerant
  • Caffeine (coffee, tea, soft drinks)

“For individuals with multiple side effects it can be complicated to figure out what is best to eat. It can be helpful to keep a diary of food intake and symptoms to review and look for patterns of what foods make symptoms worse, better or are neutral,” said Maria Petzel, senior clinical dietitian at MD Anderson Cancer Center and a member of the Scientific and Medical Advisory Board at the Pancreatic Cancer Action Network (PanCAN). “Due to these factors, it is important for pancreatic cancer patients to have the support of a registered dietitian.

Patients with pancreatic cancer often have many questions and concerns about nutritional care. MyPlate and American Institute for Cancer Research can be used as a resource for healthy diets; however, patients and caregivers should understand that each patient has individualized nutritional needs. Therefore, it is important to consult with a registered dietitian or doctor before making any dietary changes.

Contact Patient Central for comprehensive disease information – including our diet and nutrition booklet, nutrition tips and information on dietitians in your area.

Come back to our blog each week for a new installment of the Friday Fix.

As the source of insulin that helps in the regulation of blood sugar and of enzymes that help break down fats, carbohydrates, and proteins, the pancreas is a key part of the digestive system.

So it’s not so surprising that cancer of the pancreas can bring with it significant nutritional challenges. Successfully addressing these challenges, however, brings multiple rewards: it can enable and enhance treatment, boost day-to-day well-being, and support healthy recovery.

A Dietitian’s Training and Experience Matters

When assembling a team to tackle your pancreatic cancer, a dietitian should be one of your first recruits, according to Maria Petzel, RD, CSO, LD, CNSC, a senior clinical dietitian at the MD Anderson Cancer Center. Ideally, he or she should have a CSO after their name, signifying they have received oncology nutrition certification, with more than 2,000 hours of clinical oncology experience under their belt. That experience comes in handy when assessing the needs of each patient, which differ from person to person, based on factors such as their body type, treatment history, surgical history, and amount of fat in their diet.

For pancreatic cancer patients it is important that the dietitian is well-educated in enzymes. Pancreatic enzymes help break down fats, proteins, and carbohydrates. A deficit of pancreatic enzymes can affect digestion, cause uncomfortable side effects, and weight loss. Symptoms of inadequate enzyme production include excessive gas, bloating, or indigestion after meals and changes in bowel movements such as light colored or yellow stools or stools that are frequent, floating, oily, or loose.

Fun Fact: A normally functioning pancreas secretes about eight cups of enzyme-containing pancreatic juice into the duodenum daily.

“Inadequate enzyme production can be fixed with pancreatic enzyme replacement therapy (supplementing with prescription enzymes), but it’s not a one-size-fits-all solution,” Petzel says. “Pancreatic cancer patients need to have someone on their healthcare team who can help individuals figure out what brand and dose works best to help minimize symptoms and get maximal digestion and absorption.”

Combating the Side Effects of Treatment

Weight loss due to pancreatic cancer is common, but its causes can be complicated. Some are related to the tumor itself, in which case surgery, chemotherapy, or radiation treatment can help. Others, however, are a result of such treatment.

Nausea, loss of appetite, or the change in taste that often accompany chemo or radiation therapy can be combated through diet and pharmaceutical strategies. These are most successful when tailored to each patient, Petzel explains. One person’s diarrhea could be caused by fat malabsorption due to pancreatic enzyme insufficiency, while another may be suffering the effects of lactose intolerance, bacterial overgrowth, chemotherapy, or dumping syndrome from surgical resection. Enzyme replacement may solve the problem for some patients, while a low-fat, low-fiber, and/or dairy-free diet might do the trick for others.

Maintaining a healthy weight for pancreatic cancer patients can be critical to the success of their treatment. “We know that patients who are able to maintain weight are more likely to get their scheduled doses of treatment,” Petzel adds.

Here is some general advice Petzel offers for patients:

  • Consume small, frequent, balanced meals (not just snacks), six to eight per day, to help combat fatigue and weight loss. Schedule these meals for specific times. “Depending on your body to tell you it’s hungry is often not sufficient,” Petzel says.
  • Avoid high-fat foods that are hard for your already taxed pancreas to handle.
  • Watch your fiber. High intake of insoluble fiber food sources (whole grain breads/cereals, raw fruits with thick peels, raw vegetables, and nuts) can make foods move faster through and draw more water into the intestines, exacerbating diarrhea. Foods that contain soluble fiber, such as oat fiber, and high-pectin foods like applesauce and bananas, can help.
  • Avoid sugary foods and portion out your carbs, mixing them with protein sources like low-fat dairy, beans, fish or seafood, poultry or lean red meat, to help with blood sugar stability.
  • If your sense of taste has been altered due to treatment, experiment with different foods, textures, and flavors to determine what is most appealing.
  • Keep hydrated by drinking clear beverages like water, juice, electrolyte replacement beverages, or broth. Beverages that contain calories, nutrients, and protein, such as smoothies or nutritional supplement drinks, can also be helpful for those who cannot stomach a meal.
  • Stay active. “Even 5, 10, 15 minutes of physical activity, two or three times a day, can stimulate the appetite and promote the emptying of the stomach,” Petzel explains.
  • Keep a daily diet journal recording foods eaten, weight, pancreatic enzymes used (and when, in relation to meals), frequency and consistency of bowel movements, and blood glucose readings, if applicable.

Additional nutritional advice can be found on the Academy of Nutrition and Dietetics Oncology Nutrition website. The American Institute for Cancer Research also provides some culinary inspiration in its recipe archives.

For other dietary suggestions, read the Managing Pancreatic Cancer article “How to Eat After a Whipple Procedure.”

Introduction

Author: JoAnn Coleman, RN, MS, ACNP, AOCN

Nutrition can be a major focus for patients diagnosed with pancreatic cancer and subsequent treatment. Questions about diet arise along with physical activity, dietary supplement use, and nutritional complementary therapies. Patients may receive dietary advice from a variety of sources including family, friends, and health care providers, as well as from the media, health food stores, magazines, books, nutritional supplement industry, etc. In addition, many claims about the use of dietary and nutritional supplements as alternatives to standard therapy abound. Making an informed choice can be difficult.

Pancreatic cancer and its treatment can place extra demands on the body, greatly increasing nutrient and caloric needs. Weight loss can contribute to fatigue, delay and lengthen recovery, and adversely affect quality of life. Choosing one’s own course of treatment and disease management is extremely important for enhancing quality of life. Feeling comfortable with personal choices made and confidence in the health care professionals involved is also important.

American Cancer Society Guidelines

There is scientific evidence on many issues regarding nutrition and cancer. But there are also many gaps and inconsistencies in the scientific evidence on the effects of nutrition after cancer diagnosis. The American Cancer Society’s Guidelines on Diet, Nutrition, and Cancer Prevention should be regarded as a basis for a healthy diet.

  1. Choose most of the foods you eat from plant sources.
    • Eat five or more servings of fruits and vegetables each day
    • Eat other foods from plant sources, such as breads, cereals, grain products, rice, pasta, or beans several times a day
  2. Limit your intake of high fat foods, particularly from animal sources.
    • Choose foods low in fat
    • Limit consumption of meats, especially high-fat meats
  3. Be physically active–achieve and maintain a healthy weight.
    • Be at least moderately active for 30 minutes or more on most days of the week
    • Stay within your healthy weight range
  4. Limit alcoholic beverages, if you drink at all.

Dealing with Dietary Complications

Some of the changes that occur as a result of pancreatic cancer are unintentional loss of body weight and loss of lean body mass (muscle). Problems with eating, digestion and fatigue can also occur. Any treatment for pancreatic cancer(surgery, radiation therapy, and chemotherapy) can alter nutritional needs and interfere with the ability to eat, digest, or absorb food. This is often due to side effects such as nausea, vomiting, changes in taste or smell, loss of appetite or bowel changes. At the same time, caloric intake needs are increased during any of these treatments.

When problems occur, usual food choices and eating patterns may need to be adjusted. Eating small, frequent meals or snacks may be easier to tolerate than three large daily meals. Food choices should be easy to chew, swallow, digest, and absorb. Choices should also be appealing, even if they are high in calories or fat. If it is not possible to meet nutritional needs through regular diet alone, nutritious snacks or drinks may be advisable. Commercially prepared liquid nutritional products (such as Boost, Ensure, Resource, or NuBasics) can also be helpful to increase the intake of calories and nutrients.

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Sensory Changes

Patients with pancreatic cancer may complain of sensory changes that interfere with food intake. The sense of smell may be affected. Sensitivity to food odors can occur. Serving foods cold instead of hot may be helpful in decreasing unpleasant aromas. Using covered pots, boiling bags, or a kitchen fan can minimize cooking odors. Taste changes are also common. The use of plastic eating utensils and nonmetal cooking containers can help alleviate this problem.

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Insulin

The pancreas may not be able to function adequately to produce insulin (endocrine function) to help regulate blood glucose or to produce pancreatic enzymes (exocrine function) to help the body digest certain foods. Patients may need to be followed by their primary care physician or an endocrinologist to assist with controlling their blood glucose. In addition, assistance with diabetic management, including insulin use and administration, diabetic diet, and related health maintenance, can also be accomplished with the help of a diabetic educator and a registered dietitian.

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Pancreatic Enzymes

Pancreatic enzymes, which contain amylase, lipase, and trypsin can be supplemented to counteract any malabsorption of food. Malabsorption syndrome is characterized by a patient’s inability to digest fat or protein. The symptoms include bloating, indigestion, diarrhea, constipation, steatorrhea, and muscle weakness. Steatorrhea is characterized by stools that look oily, frothy, are foul smelling and may float in the water. To correct this problem oral tablets can be taken with or meals or snacks. The dosage is different for each person. It may take several adjustments before the most appropriate dosage is determined.

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Vitamins

The use of dietary supplements is a topic of considerable controversy, especially in the cancer treatment phase. These dietary supplements include nutrients, vitamins, and minerals that are essential for human health, as well as a wide variety of non-essential nutrients, such as phytochemicals, hormones, and herbs. As a general rule, dietary supplements should never replace whole foods and are best when used in moderate doses. The use of vitamin and mineral supplements at doses higher than recommended levels can raise safety concerns as can the intake of high doses of herbal and botanical supplements.

There have been many questions regarding the benefit of vitamin supplements that contain higher levels of antioxidants (vitamins C and E) than those established by the Dietary Reference Intakes. Vitamin supplements that contain high levels of folic acid, or eating fortified food products that contain high levels of folic acid may be counterproductive when taken during the administration of certain chemotherapy agents. There are still many unanswered questions regarding the benefits and risks that may or may not be associated with these supplements. It is recommended that patients undergoing chemotherapy or radiotherapy should not exceed the upper intake limits of the Dietary Reference Intakes for vitamin supplements. Patient should also avoid other nutritional supplements that contain antioxidant compounds during chemotherapy or radiotherapy treatment.

A reasonable health recommendation for a patient with pancreatic cancer is to use a balanced multiple vitamin and mineral supplement (once or twice a day) to correct possible deficiencies. Multivitamin supplements of this type are manufactured by a wide variety of companies, with levels of nutrients at approximately the levels recommended for daily consumption , formerly known as the Recommended Daily Allowance.

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Herbal Supplements

The belief that an herbal or botanical supplement is “natural” and therefore can be only beneficial, even in high doses, is incorrect. Many vitamins and herbal compounds are toxic at high levels. There is currently no regulatory oversight of herbal supplements, which has led to hazardous doses and contaminants in marketed products. Consumers should be warned about the use of high-dose supplements of any type. There is not evidence that any nutritional supplements can reproduce the apparent benefits of a diet high in vegetables and fruits. It is always advisable for patients to inform their health care providers about any vitamin, herbal or botanical supplement use. There are many uncertainties about the effects of vitamin, herbal or botanical supplements and their interactions with other treatments, including surgery, radiation therapy, and chemotherapy.

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Complimentary and Alternative Nutritional Therapies

Complementary and alternative nutritional approaches are very popular and many people consider these substances to be safe. But not much is known about the safety and efficacy of the active ingredients found in many of these substances/compounds.

Complementary therapies are supportive methods used to complement evidence-based treatment. Examples include meditation to reduce stress, acupuncture for pain, and ginger for nausea. Complementary methods are not given to cure disease, rather they may help control symptoms and improve quality of life.

Alternative therapies are promoted as cancer cures. They are unproven because they have not been scientifically tested, or were tested and found to be ineffective. Nutritional methods used within complementary and alternative medicine generally encompass vitamin and mineral supplements, herbal and botanical supplements, and dietary regimens. It is important for you to discuss any use of complementary or alternative therapies with your health care provider so that everyone is informed and open discussion about possible benefits and risks can occur.

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Conclusion

Health information is extremely useful and can empower patients to make important health decisions. The search for information can be confusing, as there may be differences in information given regarding the best way to treat pancreatic cancer. Patients should seek out information and consult with a number of different health care providers specializing in the care of patients with pancreatic cancer to help formulate decisions on the use of supplements or complementary and alternative therapies. Patients are strongly encouraged to communicate all decisions involving complimentary/ alternative therapies with members of their health care team. This is important so that the entire team can be aware of any potential interactions that may interfere with conventional medical treatment.

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