Ask the Nutritionist
Q: My mom recently underwent the Whipple procedure for pancreatic cancer. She can't seem to keep food in her long enough to pull any of the nutrients from them. She is only two months out, and we are told her eating will be trial-and-error and to just stick to giving her six small meals a day. Are there any foods that would be essential for her to try and eat — foods in which she'll get the most nutrition and won't cause her horrible gas pains or diarrhea? She's a vegetarian, but does eat fish. She can't eat green vegetables because they are so hard to digest, yet they contain the iron she needs for energy. She's so tired all the time. She can't digest fat, so that won't help her put on weight. Her sugar is all over the place so we don't want her to eat too many carbohydrates. I'm just looking for a little guidance or some suggestions, if possible. Any insight would help.
Kyle, Boston, Massachusetts
A: It sounds like your mom could benefit from some diet modifications to help her symptoms and promote weight gain since her surgery.
We recommend that your mother speak with her doctor about a prescription for digestive enzymes.
Many of the digestive problems you describe, such as diarrhea and malabsorption of nutrients, could be helped by using prescription digestive enzymes. These enzymes are usually taken with meals and snacks to help the body break down food and increase the amount of nutrients being absorbed. They will particularly help with fat digestion and absorption.
Because she is not eating much fat now, your mother may be deficient in fat-soluble vitamins, such as vitamin D. Your mother should ask to have her vitamin D levels checked with a blood test called "25 OH D."
As far as diet recommendations go, your mother should be eating protein, fruits and vegetables, and complex carbohydrates. These kinds of foods will help promote healing and help her feel better.
Diarrhea and gas pains can be caused by foods that contain too much fat or too much fiber, and making different diet choices may help prevent or treat these problems.
Protein is essential for your mother to try and eat. Vegetarians sometimes have a hard time getting enough protein, but there are ways to get protein into her diet without causing gas pains or diarrhea.
Eggs are a great source of protein and a good source of iron. They also should not cause diarrhea or gas pains.Depending on the type of vegetarian your mother is, eggs may be a great addition to her diet.
For protein, she should continue eating white fish and should try small amounts of tofu and smooth/creamy peanut butter. These are both protein sources that won't cause diarrhea.
Sometimes lactose found in dairy products may cause diarrhea, so trying out products such as soy milk, rice milk, almond milk, and low-fat yogurt without fruit will provide some protein.
The kinds of fruits that are easiest to digest are cooked or peeled and do not have skins or seeds. These include applesauce, ripe bananas, fresh melon, canned peaches, oranges and fruit cocktail in "lite" or natural syrup.
The kinds of vegetables that are recommended are cooked vegetables with the skins and seeds removed, such as winter squash, sweet potatoes, baked potatoes, green beans, carrots, beets, asparagus tips, peeled summer squash or zucchini. These vegetables are easy to digest. Cooked asparagus tips and green beans are also are a fair source of iron.
Most cereals are fortified with iron. Your mother should try eating a small portion of low-fiber cereals such as Cheerios, Rice Krispies, or Corn Flakes. Just make sure to check the labels for iron fortification and low fiber (should be less that 3g of fiber per serving).
Some pastas are also fortified with iron.
She may also need an iron supplement and should speak with her doctor about checking her blood iron levels. To prevent diarrhea and gas, stick to boiled, enriched noodles or pastas instead of whole wheat pastas.
Adding cereals and pastas to your mother's diet may also help with her fatigue. These carbohydrates will keep her energy up and small portions eaten frequently will not spike her blood glucose.
The best way to eat all this food is in small frequent meals. Eating too much at once will cause too much food to be "dumped" into the small intestine and the food will move very quickly causing her diarrhea and gas pains.
Small meals will move more easily through the GI tract and allow for more digestion to occur, which can result in better absorption of nutrients. Eating slowly and chewing foods thoroughly will also help her prevent this "dumping" from happening.
Finally, we recommend you ask your mother's doctor for a referral so she can see a Registered Dietitian who will create a personalized diet plan for her.