Nutrition Guidelines Following a Whipple Procedure

The pancreas is an essential gland in the body that secretes insulin. It is located near the stomach, small intestine, gallbladder, and the duodenum. The pancreas plays a large role in the digestion of foods. In particular, the insulin that is secreted by the pancreas aids in the digestion of carbohydrates. The pancreas also secretes enzymes that help in the digestion of protein, carbohydrates, and fats. Pancreatic cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination. The most common surgical procedure performed to remove cancer from the pancreas is called a Whipple procedure. A Whipple procedure involves the removal of the head of the pancreas, duodenum, gallbladder, and part of the bile duct. Regardless of treatment type, pancreatic cancer takes quite a toll on the body in terms of diet and nutrition. 

If you had a Whipple procedure or other surgery to remove any part of your pancreas as part of your cancer treatment, follow these guidelines after your surgery:

  • Pancreatic Enzymes
    • Your doctor will write you a prescription for pancreatic enzymes. Take pancreatic enzymes as prescribed. 
    • These enzymes are designed to take the place of the enzymes that your pancreas would normally produce to digest protein, carbohydrates, and fat.
    • If you have questions about your pancreatic enzymes, consult a registered dietitian.
  • Solid Food
    • Gradually increase food intake until eating a normal solid food diet.
    • The progression will most likely be from clear liquids to full liquids, and eventually to soft solids. This progression will vary from person to person.
  • Fat
    • Avoid fried, greasy and fatty foods. These foods are hard to digest with an altered pancreas. 
    • Choose baked, broiled, or grilled foods instead.
    • After a Whipple procedure, it is often recommended to limit fat intake to no more than 40-60 grams per day.
  • Nutrient Dense Foods
    • Eat as healthy as possible as allowed by the digestive system.
    • Nutrient dense foods are foods that contain protein, complex carbohydrates, healthy fat, vitamins, and minerals all needed by the body to function and heal.
    • Fruits, vegetables, lean protein, and whole grains are all nutrient dense foods. 
    • Consult a registered dietitian for specific recommendations based on your level of food tolerance.
  • Meal Frequency
    • Eat small, frequent meals. Try to eat something every 2-3 hours. Smaller amounts of food are more easily digested and nutrients are better absorbed. 
    • Smaller meals have less potential to cause gas or bloating.
    • A common side effect from a Whipple procedure is a delay in stomach emptying called gastroparesis. Smaller meals reduce the feeling of excessive fullness.
    • Include a protein source with each meal and snack. Protein can be found in the form of meats, dairy products, nuts, or beans.
  • Fluid Intake
    • Drink plenty of fluids to avoid dehydration. 
    • A good starting point is to strive for 8 8-ounce glasses per day.
    • Only take small sips with meals to avoid excessive bloating, gas or feeling too full to eat. 
    • The best time to drink fluids is an hour before or after a meal.
    • Choose beverages that contain calories and nutrients such as juices, smoothies, or liquid nutrition supplements.
  • Alcoholic Beverages
    • Avoid all alcoholic beverages.
  • Management of Nausea
    • Limit liquids and choose dry, easy-to-digest foods such as crackers, toast, dry cereal, oatmeal or a plain baked potato. 
    • Liquids should be sipped 1 hour before or after food is eaten.
    • Your doctor can also prescribe a medicine to help with managing your nausea.
  • Management of Diarrhea
    • Limit or reduce excess fiber and gas forming foods such as beans, whole grains, raw vegetables, and fruit.
    • Avoid sweets and foods containing a lot of sugar.
    • Increase fluid intake to avoid dehydration.
    • Strive for 5-6 small meals of low fiber foods such as applesauce, bananas, white toast, oatmeal, crackers, or a plain baked potato.
    • Avoid dairy products other than yogurt containing live cultures called probiotics.
  • Loss of Appetite
    • This is a common occurrence after a Whipple procedure.
    • Foods also may not taste that same as before.
    • Be patient and re-introduce easy-to-digest foods slowly.
    • You may also need to eat when you are not feeling hungry in order to meet the nutritional needs of your body. This will help you recover faster.
    • Appetite typically improves 4-6 weeks after surgery.
  • Food Journal
    • Keep a journal of eating times, foods consumed, and if the food caused any digestive problems. This will help you determine which foods are best tolerated.
  • Liquid Nutrition Supplements
    • Due to altered digestion, absorption, and limitations on solid food intake, a liquid nutrition supplement may be an appropriate addition to help you meet your nutritional needs. 
    • Consult a registered dietitian for the best recommendation and the amount of supplement needed by your body.
  • Vitamins and Mineral Supplements
    • You may experience symptoms of fat malabsorption which can be determined by the frequency of bowel movements and the appearance of stools.
    • Fat containing stools are often bulky, frequent, foul smelling, and have an oily appearance.
    • These symptoms warrant the need for vitamin A, D, E, and K supplements as well as a multivitamin. You may also need a calcium supplement. 
    • Ask your oncologist about vitamin B12 injections and iron to avoid becoming anemic.
    • Your healthcare team can advise you on choosing vitamins and supplements as well as the correct dosage.
  • Weight Loss
    • It is normal to lose up to 5-10% of your body weight after having a Whipple procedure.
    • If you are continuing to lose weight exceeding 5-10% of your pre-surgery weight, consult a registered dietitian for recommendations on increasing your calorie intake.

Related Resources

Nutrition Guidelines for Pancreatic Cancer

Understanding Pancreatic Cancer: An Introduction

Pancreatic Cancer Survivors Handbook