How does nutrition affect pancreatic cancer?


The November #PancSM Twitter chat for Pancreatic Cancer Awareness Month 2015 focused on nutrition and pancreatic cancer.

The first Thursday of each month, I spend my evening online with physicians, dietitians, and curious people from across the country to discuss insights and facts about pancreatic cancer. We participate in the #PancSM Twitter chat to help increase awareness about risk factors, symptoms, and treatment options.

The November chat for Pancreatic Cancer Awareness Month 2015 focused on nutrition and pancreatic cancer. In case you missed the chat last week, here’s a recap of the bigger questions we discussed and the answers provided by local and national experts.

Can nutrition play a role in the development of pancreatic cancer?

Although nutrition is critical, there is no clear evidence that poor nutrition causes pancreatic cancer. But diet can play a significant role after diagnosis. Nutrition is important for general health and can make a difference in how the body reacts to any insult, including cancer. There’s no miracle diet for cancer.

A lifetime of poor nutrition and inactivity can lead to obesity, which is a known risk factor for pancreatic cancer. Pancreatic cancer can cause weight loss and/or cachexia, which is a weakening of muscle tissue due to chronic illness. However, weight loss doesn’t cause pancreatic cancer. 

Heavy alcohol use can cause chronic pancreatitis and cirrhosis, which can lead to pancreatic cancer. Chronic inflammation in any organ can lead to cancer – pancreas inflammation is no different.

Nutrition gives patients and caregivers a sense of control in a time where they have little control. It’s one of the few things that a patient can do for themselves in the midst of a difficult diagnosis.

How can patients diagnosed with pancreatic cancer optimize nutrition in the midst of symptoms?

Many patients with pancreatic cancer face jaundice, worsening diabetes, nausea, and weight loss, which makes it hard to think about nutrition. Nutrition is very important, but recommendations often get lost amid all of a patient’s medical appointments and tests. It can be a relatively easy fix, but often providers don’t think of this early enough.

Make sure to see a cancer center dietitian in addition to discussing nutrition with your doctors. Unfortunately, Medicare often does not cover visits with a dietitian, but some cancer centers and oncologists provide this service for free. This is a big issue – essential care that’s not valued makes it harder to provide that care.

Some patients need slight diet changes to help with side effects. Simple things like frequent, small meals and high nutrition, high protein foods can really help. We always emphasize eating frequent, small meals and not restricting the diet.

The pancreas makes enzymes that digest fatty foods. A tumor can block these enzymes, and sometimes patients need replacements. It’s important for doctors to prescribe enzyme replacement if cancer is compromising pancreatic exocrine functions such as digestion. Many patients benefit greatly with the prescription of pancreatic enzymes.

Both the cancer itself and treatments can alter taste. It’s important to experiment with different foods to see what works. What works for food choices one day may not work the next.

The worst thing we see is when patients intentionally decrease calorie intake to avoid “feeding the cancer.” This just worsens cachexia. We see people going on the Atkins diet to avoid “giving the cancer sugar,” but tumor cells are capable of anaerobic glycolysis (turning glycogen to glucose, or sugar). There’s a fear of making the cancer worse. Good nutrition does not make the cancer worse – it only helps!

Are there basic principles of cancer nutrition every patient can benefit from?

Eating healthy after a cancer diagnosis won’t reverse the growth of cancer, but it can help you feel better during treatment. Here are four tips to follow: 

  1. Eat small, frequent meals that include lean protein
  2. Choose high-impact foods (high calorie and high protein)
  3. Keep it bland – avoid spicy, rich, and fatty foods
  4. Experiment to see what works for you

Lean proteins include: Fish, skinless poultry, beans, lentils, low-fat dairy, eggs, and lean cuts of red meat (on occasion). Remember, sugar is not the enemy. For nutrition, join a gym, maintain a healthy weight, and be careful with supplements that have lofty claims.

As far as nutritional shakes, there’s no “magic shake.” Whatever you use should be a blend of carbohydrates, protein, fats, and sugar. Balance is key! There is no such thing as a perfect anti-cancer diet or supplement, so beware. Certain vitamins and supplements can interfere with medications or cause easy bleeding, so check with your physician if you take dietary supplements.

Anything nutrition-related to focus on before surgery and during chemotherapy?

Patients shouldn’t feel guilty about “suboptimal diets.” Often they just need counseling on proper nutrition.

Good nutrition can help the body better tolerate cancer treatments such as surgery and chemotherapy. Malnutrition can lead to poor outcomes. Sometimes poor nutrition makes surgery more risky. It’s tricky. It’s best to optimize nutrition before surgery whenever possible. You can start by avoiding spicy/greasy/junk food (even though it tastes so good!).

During chemotherapy, nausea, poor appetite, reflux, and altered taste are major issues. To counter nausea, be aggressive with nausea medications, ginger, and bland, crunchy foods. Tart foods such as pickles, lemons, vinegar can help reduce symptoms. Some patients have found peppermint tea to be calming for an upset stomach. The Pancreatic Cancer Action Network has a great booklet on diet and nutrition.

Getting professional help from a dietitian is critical. Talk to your provider about nausea medication and try not to get discouraged if some of your favorite foods don’t appeal to you anymore. You may want to take a break from your favorite restaurants if you’re experiencing nausea and vomiting. Associating getting sick with your favorite restaurant could lead to a long-term aversion. We want your favorite restaurant to remain your favorite! 

Keep experimenting with your diet – it’s a moving target. Include complex carbohydrates, fruits, vegetables, and healthy fats (as tolerated) to round out meals. Healthy fat is not an oxymoron. You can find healthy fat in avocado, nuts, seeds, and olive oil. Every bite counts!

Still curious about nutrition and pancreatic cancer? Join us the first Thursday of each month at 8:00pm CT for the Pancreatic Cancer Twitter chat.