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4/20/2015Nutrition and Pancreatic Enzymesfor Side Effect ManagementApril 16, 2015Jeannine Mills, MS, RD, CSO, LDNutrition Therapy Goals Prevent or reverse poor nutrition Maintain dose and schedule of cancertreatments Manage symptoms Maintain or improve weight andstrength Maximize quality of life1
4/20/2015Role of the Pancreas Produce enzymes to help digest food to betransported in blood stream Produce insulin to help transfer glucosefrom the blood to the cells where it is usedfor energy.2
4/20/2015Pancreatic EnzymesFatty Acids ProteinFatCarbohydrate GlucoseAmino AcidsEnzymes Maria lucose InsulinInsulinGlucoseInsulinCell Maria Petzel3
4/20/2015Common Side Effects DiarrheaPancreatic exocrine insufficiencyGlucose intolerance, diabetesNausea and/or vomitingLoss of appetite, weight lossCommon Side Effects (continued) Taste changes Early satiety Constipation4
4/20/2015Pancreatic EnzymesSymptoms of Pancreatic ExocrineInsufficiency Feelings of indigestionCramping after mealsLarge amounts of gasFoul smelling gas or stoolsFloating stools or greasy/fatty stoolsFrequent stoolsLoose stools/diarrheaUnexplained weight loss5
4/20/2015Narcotic Constipation Malabsorption DiarrheaNormal Bowel FunctionHow to Optimize Enzymes: Take at the beginning and throughoutthe meal/snack Don’t take at the same time asantacids or iron supplements If prescribed by your doctor, take acidreducing medication daily.6
4/20/2015The Right Enzyme and howmuch to take Find the brand and the dose thatworks for you and stick with it. Start:–Meals: 20,000-40,000 units oflipase per meal–Snacks: 10,000-20,000 units oflipase per snackEnzyme Dosage: Titration Increase until pancreatic insufficiencysymptoms are minimized/eliminated Maximum: 2500 units of lipase perkilogram per meal (or 10000 units oflipase per kilogram per day)7
4/20/2015What does that really mean? 60 kg (130 lb) woman Max daily dose weight x 10,000 L.U.60 x 10000 600,000 lipase units/day 48 capsules Creon 12,000Or 60 capsules Zenpep 10,000Pancreatic Enzymes:Side effects of too many Constipation (most common) Nausea Abdominal Cramps Diarrhea(Careful not to confuse with symptoms ofinadequate enzyme use or chemotherapyor radiation treatment.)8
4/20/2015Symptom ManagementCommon Side Effects DiarrheaConstipationNausea and/or vomitingEarly satietyExcessive gasTaste ChangesPoor appetite9
4/20/2015Diarrhea Work closely with medical team(multiple causes of diarrhea):–Treatment Induced–Lactose Intolerance–Bacterial Overgrowth–Pancreatic/Digestive Insufficiency–Dumping syndrome (after Whipple orgastric bypass)Nutrition Therapy for DiarrheaIndependent of causeLimit or avoid: Lactose (or add lactase) Insoluble fiber Foods sweetened with sugar alcohol Sugar sweetened beverages10
4/20/2015Nutrition Therapy for DiarrheaIndependent of causeIncrease: Soluble fiber FluidsProbiotics for Diarrhea Sources of probiotics:– Foods– Dietary Supplements11
4/20/2015Constipation Hot fluids Include high fiber foods Limit gas forming foods,carbonated beverages, straws,chewing gum Bowel regimen may be warrantedNausea/Vomiting Eliminate offending odors Dry crackers/toast Avoid overly sweet, greasy/fried, orhighly spiced foods Use room temp foods Oral care Eliminate stress Medication12
4/20/2015Early Satiety Alleviate gas and bloatingLiquids between mealsSmall servings, more oftenLimit high fat or fried foodsHigh fiber foods may be problematicMedicationsExcessive gas Optimize pancreatic enzymesUse simethicone (Gas-X) liberallyConsider Bean-OAvoid gas-producing foods:– Broccoli, cauliflower, cabbage– Onions– Beans– Carbonated beverages (beer, soda) Avoid chewing gum Avoid drinking through straws13
4/20/2015Taste Changes Rinse mouth Metallic taste: use plastic utensils andserving ware Enhance dull taste use tart flavors Try new foods or foods previouslydislikedPoor Appetite Eat small amounts frequentlySchedule meals/snacksUse liquid supplements/smoothiesLight exerciseAlcoholic beverage before mealMay benefit from medication14
4/20/2015Liquid Nutritional DrinksRegular Boost Orgain Ensure EnuDiabetic Glucerna Boost Glucose Control Home made smoothies Mix in blender Liquid: juice, yogurt, milk, soymilk, etc Fruit and/or cooked vegetables Protein: protein powder, tofu, cottagecheeseWhat to Eat?15
4/20/2015General Nutrition Tips Eat small frequent meals (6-8/day)Plan meals/snacks the day beforeGet plenty of fluidsLimit use/portions of fat containingfoods Choose nutrient dense foods Be activeProtein Poultry, fish, meatBeans, peas, lentilsNuts and seedsEggsYogurt, milk, cheeseVegetarian alternatives: soy milk, tofu,veggie burgers, protein powders, etc.16
4/20/2015Complex Carbohydrate Bread, pasta, rice, cereal, etcFruitsVegetablesDairy productsFat (as tolerated)Nuts and seedsAvocadoOlivesOil: canola, olive, peanutOther fats to use sparingly: Butter, stick margarine, hydrogenated oils(or foods that use these as ingredients)17
4/20/2015FluidsMost patients require 6 to 12 cups per day ofnon-alcoholic fluid per day to maintainadequate hydration. (8 oz. 1 cup)WaterTeaJuice (100%)Sports drinksMilk or dairy alternativesBrothGelatinGlucose Intolerance/Diabetes MedicationCustomize dietLimit refined carbohydratesEat carbs in combination with protein,fiber, and fats18
4/20/2015Finding a Dietitian How to Find a Registered Dietitian:– Request a consult at your cancer center– Commission on Dietetic Registration Search: List of Board Certified Specialists inOncology Nutrition by State- www.cdrnet.org– Contact the Pancreatic Cancer ActionNetwork– Contact The Academy of Nutrition andDietetics www.eatright.orgCookbooks Betty Crocker’s Living With Cancer Cookbook (2011) What to Eat During Cancer Treatment: 100 Great-Tasting,Family-Friendly Recipes to Help You Cope (2009) by JeanneBesser The Cancer-fighting Kitchen: Nourishing, Big-Flavor Recipes forCancer Treatment and Recovery (2009) by Rebecca Katz One Bite at a Time (2009) by Rebecca Katz Eating Well Through Cancer: Easy Recipes &Recommendations During & After Treatment (2006) by HollyClegg The New American Plate Cookbook: Recipes for a HealthyWeight and a Healthy Life (2005) by The American Institute forCancer Research19
The Cancer-fighting Kitchen: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery (2009) by Rebecca Katz One Bite at a Time (2009) by Rebecca Katz Eating Well Through Cancer: Easy Recipes & Recommendations During & After Treatment (2006) by Holly Clegg The New American Plate Cookbo
