By Elisabeth Geier
Diseases like pancreatic cancer and pancreatitis impact the body’s ability to digest food and absorb nutrients. For people struggling with gastrointestinal symptoms and reduced appetites, figuring out what to eat can be a big challenge.
At the Pancreas Center, a team of nutritionists is on hand to help patients find foods to enjoy and get the nutrients they need. One of those nutritionists is Sabrina Toledano, a digestive disease dietitian who is passionate about working with people with pancreatic disease, helping them manage their pancreatic enzymes, and develop individualized meal and snack plans.
In this article, Toledano walks us through some of the common myths about pancreatic diets and shares holistic measures that work alongside medical management of pancreatic diseases.
Pancreatic nutrition 101
The pancreas is an oblong organ located behind the stomach in the upper left abdomen. It is responsible for two main functions: endocrine (producing hormones to regulate blood sugar) and exocrine (producing enzymes to aid in digestion). Diseases like pancreatitis and pancreatic cancer impact the body’s ability to digest food and absorb nutrients.
In general, a pancreatic diet emphasizes small, frequent, nutrient-dense meals including lean protein, fruits and vegetables, and whole grains, and discourages alcohol and greasy foods. In practice, every patient is unique. That’s why working with a nutritionist can be so helpful: Toledano and other pancreatic nutritionists offer a supportive, individualized approach to food to help patients enjoy food and maintain proper nutrition.
Common myths about pancreatic nutrition
In her decade-plus of practice, Toledano says she has most frequently fielded questions about the ketogenic diet, the pH diet, and whether or not sugar “feeds” cancer.
Let’s start with the sugar thing: does sugar feed cancer? In short, the answer is no. However, chronic pancreatitis can lead to diabetes, so patients should avoid large quantities of refined sugar and simple carbohydrates.
As for fad diets, “If we had something that was going to help improve outcomes and help [patients] in any way possible,” Toledano says, “we would be shouting it from the rooftops...but there’s really not all that much evidence to support eating [specific foods] to help with their outcome.”
Severely restricted diets like the keto diet (which strictly limits carbohydrates) and alkaline or pH diets (based on the misconception that replacing acid-forming foods with alkaline foods can fight disease) can prevent patients from getting the nutrients they need. Pancreatic patients are already at high risk of malnutrition, and research definitively documents that malnutrition can lead to treatment breaks that worsen patient outcomes. It’s most important for patients, especially those with pancreatic cancer, to consume enough calories to maintain weight.
Toledano recommends a varied diet of densely caloric, nutrient-rich meals throughout the day—and not placing strict limits on what those meals contain, including fat. “One of the biggest misconceptions I come across is pancreatic patients being scared of fat,” Toledano says, “and it's really unfortunate because...they need to eat fat. Fat is their friend. Issues digesting fat is a sign a patient needs to be on enzymes.”
Foods that ease gastrointestinal symptoms
While no one food or trendy diet has been proven to improve outcomes for pancreatic patients, there are some foods that can help patients feel better and get the nutrients they need. These include:
- Healthy fats with anti-inflammatory properties like avocado, nut butters, and salmon
- Anti-inflammatory herbs like turmeric
- Ginger to ease nausea
- Peppermint tea to aid in digestion
In general, Toledano says it’s most important to find foods that your body is able to digest and supplement with doctor-recommended vitamins as needed. “A lot of the fruits and vegetables that have been shown to be great sources of antioxidants and micronutrients can be more difficult to digest,” she explains, “so I don’t like to put pressure on patients of ‘you have to have this in order for you to get adequate nutrition.’”
Enzymes, vitamins, and supplements
Pancreatic disease prevents the pancreas from secreting enough digestive enzymes to break down food, causing symptoms like pain, bloating, and diarrhea. Gastrointestinal discomfort discourages patients from eating, which can then lead to malnutrition. In order to ease symptoms and aid in digestion and nutrient absorption, the majority of pancreatic patients take prescription-based enzymes.
In addition, pancreatic disease impacts the body’s ability to absorb fat-soluble vitamins. Toledano recommends patients get their vitamin levels checked and then supplement what is needed, either in prescribed “repletion doses” or over-the-counter vitamins, depending on your levels and your practitioner’s recommendation.
Many pancreatic patients need to replenish electrolytes due to chronic diarrhea. This is initially addressed through diet with foods high in potassium and magnesium, and then rehydration drinks like Gatorade or Pedialyte. If a patient’s potassium or magnesium levels are very low, an additional supplement may be added.
Exercise and mindfulness make a difference
When it comes to a holistic approach to health care for pancreatic patients, Toledano says, “Mental health is everything.” Living with pancreatic disease can be uncomfortable, isolating, and stressful; finding opportunities for self-care, mindfulness, and gentle movement can help.
For pancreatic cancer patients in particular, Toledano explains, “there’s a lot of research around the benefits of exercise.” It helps with physical health, mental health, increasing energy, and improving sleep. She recommends low-impact exercise like yoga, stretching, and short walks, and says to start slow: “Put on your favorite podcast...and go for a little walk, or walk for two of your favorite songs.”
Make the most of every bite
Above all, Toledano stresses the importance of “making the most of every bite of food.” For patients with reduced appetite and gastrointestinal distress, nutrient-dense foods—high in calories, fat, and protein—can go a long way even in smaller amounts. “If you’re not that hungry,” she suggests, “instead of having applesauce, have a full-fat Greek yogurt.” If yogurt doesn’t sound good, work with your nutritionist to find nutrient-dense foods that you find palatable.
“Food is a very personal decision for people,” Toledano says. “Especially for pancreas patients, [their diagnosis] is completely out of their control. But the one thing they can control is the food they put into their mouth.” A pancreatic nutritionist can help identify the overlap between what you want to eat based on personal and cultural preferences, and what you can eat to maximize nutrition and minimize discomfort.
- The National Pancreas Foundation Nutrition Advice & Recipes
- The Pancreatic Action Network ‒ Diet and Nutrition