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10/29/2014Nutrition and Pancreatic Enzymes for Side Effect ManagementPresented byPancreatic Cancer Action Networkwww.pancan.orgOctober 28, 2014If you experience technical difficulty during the presentation:Contact WebEx Technical Support directly at: US Toll Free: 1-866-229-3239Toll Only: 1-408-435 -7088orSubmit a question to the Event Producer via the Q&A PanelFor international support numbers rs.htNutrition and Pancreatic Enzymesfor Side Effect ManagementOctober 28, 2014Maria Petzel, RD, CSO, LD,CNSC, FANDJeannine Mills, MS, RD, CSO, .org1
10/29/2014Nutrition Therapy Goals Prevent or reverse poor nutrition Maintain dose and schedule of cancertreatments Manage symptoms Maintain or improve weight andstrength Maximize quality of lifeRole 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
10/29/2014Pancreatic EnzymesFatty Acids ProteinFatCarbohydrate GlucoseAmino AcidsEnzymes Maria Petzel3
oseGlucose InsulinInsulinGlucoseInsulinCell Maria PetzelCommon Side Effects DiarrheaPancreatic exocrine insufficiencyGlucose intolerance, diabetesNausea and/or vomitingLoss of appetite, weight loss4
10/29/2014Common Side Effects (continued) Taste changes Early satiety ConstipationPancreatic Enzymes5
10/29/2014Symptoms of Pancreatic ExocrineInsufficiency Feelings of indigestionCramping after mealsLarge amounts of gasFoul smelling gas or stoolsFloating stools or greasy/fatty stoolsFrequent stoolsLoose stools/diarrheaUnexplained weight lossNarcotic Constipation Malabsorption DiarrheaNormal Bowel Function6
10/29/2014How 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.The 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 snack7
10/29/2014Enzyme 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)What 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 10,0008
10/29/2014Pancreatic 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.)Symptom Management9
10/29/2014Common Side Effects DiarrheaConstipationNausea and/or vomitingEarly satietyExcessive gasTaste ChangesPoor appetiteDiarrhea Work closely with medical team(multiple causes of diarrhea):–Treatment Induced–Lactose Intolerance–Bacterial Overgrowth–Pancreatic/Digestive Insufficiency–Dumping syndrome (after Whipple orgastric bypass)10
10/29/2014Nutrition Therapy for DiarrheaIndependent of causeLimit or avoid: Lactose (or add lactase) Insoluble fiber Foods sweetened with sugar alcohol Sugar sweetened beveragesNutrition Therapy for DiarrheaIndependent of causeIncrease: Soluble fiber Fluids11
10/29/2014Probiotics for Diarrhea Sources of probiotics:– Foods– Dietary SupplementsConstipation Hot fluids Include high fiber foods Limit gas forming foods,carbonated beverages, straws,chewing gum Bowel regimen may be warranted12
10/29/2014Nausea/Vomiting Eliminate offending odors Dry crackers/toast Avoid overly sweet, greasy/fried, orhighly spiced foods Use room temp foods Oral care Eliminate stress MedicationEarly Satiety Alleviate gas and bloatingLiquids between mealsSmall servings, more oftenLimit high fat or fried foodsHigh fiber foods may be problematicMedications13
10/29/2014Excessive 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 strawsTaste Changes Rinse mouth Metallic taste: use plastic utensils andserving ware Enhance dull taste use tart flavors Try new foods or foods previouslydisliked14
10/29/2014Poor Appetite Eat small amounts frequentlySchedule meals/snacksUse liquid supplements/smoothiesLight exerciseAlcoholic beverage before mealMay benefit from medicationLiquid 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, cottagecheese15
10/29/2014What to Eat?General 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 active16
10/29/2014Protein Poultry, fish, meatBeans, peas, lentilsNuts and seedsEggsYogurt, milk, cheeseVegetarian alternatives: soy milk, tofu,veggie burgers, protein powders, etc.Complex Carbohydrate Bread, pasta, rice, cereal, etcFruitsVegetablesDairy products17
10/29/2014Fat (as tolerated)Nuts and seedsAvocadoOlivesOil: canola, olive, peanutOther fats to use sparingly: Butter, stick margarine, hydrogenated oils(or foods that use these as ingredients)FluidsMost 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 alternativesBrothGelatin18
10/29/2014Glucose Intolerance/Diabetes MedicationCustomize dietLimit refined carbohydratesEat carbs in combination with protein,fiber, and fatsFinding 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 (PanCAN)– Contact The Academy of Nutrition andDietetics www.eatright.org19
10/29/2014Cookbooks 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 ResearchReminder: Next WebinarNutrition After Surgery and Long TermManagementTuesday, November 11th, 2014Ready to answer questions 20
10/29/2014Thank you for your participation.Pancreatic Cancer Action Networkwww.pancan.orgIf you have questions, please contact ourPatient and Liaison Services (PALS) programat(877) 272-6226 or e-mail pals@pancan.org.21
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
