The Sol Goldman Pancreatic Cancer Research Center


Nutrition

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 [now expressed on labels as the % Daily Value (DV)], 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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