Whipple’s surgery (pancreatoduodenectomy) is usually performed on pancreatic cancer patients to remove tumors at the head of the pancreas. Whipple’s surgery effectively reorganizes the body’s digestive system as aside cutting away parts of the pancreas, it removes the bile duct, and in some cases, portions of the digestive system like the small intestine and even parts of the stomach. This means that the body has to learn to adapt to its new digestive set-up, which can cause patients varying degrees of digestive discomfort depending on how radical the surgery has been.
General Diet Tips for Post-Whipple Patients:
Unfortunately because every patient is different, there is no one specific diet recommended for post-Whipple patients. They are often advised to eat whatever they can, which can feel distressingly vague, especially if issues do arise such as favorite foods becoming difficult to eat or digest.
Although the goal is for Whipple patients to be able to eat the same diet high in fruits and vegetables, whole grains and lean proteins recommended to all cancer patients, some will unfortunately struggle with diet issues while others will have no problems at all. There are however some general diet tips and recipes for post-Whipple patients, which we give here along with some more specific recipe ideas to help those struggling with side effects.
- Focus on eating little and often– think six small meals per day, and remember to chew your food well.
- Focus on eating enough protein and calories, as this will help the body to recover after the surgery. Good sources of protein include lean meat such as chicken, turkey and fish, eggs, dairy products, beans and nuts
- Avoid foods high in insoluble fiber, such as whole grains, as many find them hard to digest immediately post surgery. Until your system settles down, eat ‘white’ foods and peel all fruits and veggies.
- You may have trouble digesting your foods, particularly fatty foods, which may need to be managed by correct use of pancreatic enzymes. Your pancreas makes enzymes needed for the digestion of protein, fat and carbohydrate, so post-Whipple surgery, you may need to take pancreatic enzymes with your meals and snacks to help with your digestion. Your medical team should be able to advise you about this. If you are having issues absorbing fat, speak to your MD or RD about pancreatic enzyme supplements, and make sure to follow their guidance regarding the best way to take them.
- Drink enough fluids. Fluids are very important for patients to avoid dehydration, but it’s best to avoid filling up on them too much before meals. Drink liquids either 30 minutes before or after a meal, and only sip enough liquid with your meal to help the food go down.
- As you recover, it is a good idea to focus on adding back the foods you enjoy, one at a time. Keep a food diary to help you identify potential trigger foods, and let your RD know about any adverse effects you experience, and the foods connected to them.
- Malabsorption of vitamins can be an issue post-Whipple. Ask your doctor if he would recommend taking a daily multivitamin.
Recipe Ideas: (Recipes available at CookForYourLife.org)
- Ditch the idea of 3 squares and aim to eat little and often, around 5-6 times per day. Eat small, nutritious snacks in between meals and drink nutritious drinks. Try creamy lemon yogurt, boiled eggs, mocha chocolate mousse, pears poached with vanilla, high protein hot chocolate or our apple pie smoothie. This miso peanut honey spread is also a really delicious treat to spread on some plain crackers.
- Some high protein mains and sides that are quick to prepare: poached chicken pot au feu, twice baked potatoes, chicken rice congee, fish en papillote, simple poached white fish, spinach and ricotta scrambled egg.
- If you are experiencing the taste changes that often come with chemo, try using different herbs to give food more flavor. For example a cilantro marinade can transform plain broiled chicken into something totally delicious. Other tasty options include tuna with herbs, coconut lime twice-baked sweet potatoes, grilled chicken in rosemary marinade, soy poached salmon or our amazing miso lime sauce which can be eaten with your favorite protein or drizzled over veggies for great flavor. If you are having taste issues with water, try Mint Water, Pomegranate Water, Ginger Tea, Fennel tea, or Canario.
Dealing with Common Post-Whipple Problems:
- Lactose Intolerance
- Lactose intolerance can develop due to the parts of the digestive system that were removed. If you notice that you have gas, bloating or diarrhea after eating or drinking dairy, try a lactose-free product to see if that helps.
- Dumping Syndrome
- This is triggered by foods high in sugar, such as confectionary or sodas so these should be avoided. To satisfy your sweet cravings, try some of these dishes which are lower in sugar and will provide you with nutrients to help your recovery: leftover rice pudding, banana pudding, grilled apricots with mint yogurt.
- Delayed Stomach Emptying
- Choose lower fiber, lower fat foods and continue to focus on eating little and often. Some tasty options include potato chive cakes, tarragon & lemon chicken soup, baked turkey meatballs, risotto with grilled radicchio or pea couscous with poached egg.
- Taking Pancreatic Enzymes the Right Way
- As mentioned above, pancreatic enzymes may need to be taken with your meals and snacks. Enzymes help you digest proteins, fats and carbohydrates in your foods, however fatty foods in particular can cause a lot of discomfort. If you find that you are having issues digesting foods after your Whipple, it’s important that you speak to your doctor about taking pancreatic enzymes and learning to take them at the right time, rather than altering your diet. Most patients will lose weight after surgery, and since fat is an excellent source of calories to help gain it back, it is better to try to manage any fat digestion issues medically rather than by simply cutting back on it. Malnutrition can be an unsought-for side effect.
In the end these are all just rough guidelines. Listen to your body, and experiment with different foods and flavors until you find what works for you and your new GI system.
Your food diary will help you to keep track. If you need more inspiration, head to the CookForYourLife.org for more great meal ideas. You’ll find our unique search filter will help you find easy, tasty recipes even for clinical diets like bland or low fiber, and will generally help get you through all stages of your cancer treatment.