A Whipple surgery (pancreatoduodenectomy) is usually performed on pancreatic cancer patients to remove tumors at the head of the pancreas. Whipple surgery effectively reorganizes the body’s digestive system.

Aside from 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 isn’t one specific diet recommended for post-Whipple patients. These patients 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. However, there are general diet tips and recipes for post-Whipple patients. Here are five of the most basic along with some recipe ideas to help get you through.

• 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. Remember to chew your food well. Try these small plates for small appetites
• The focus should be 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. Here are some protein powered breakfasts to start your day right, and suggestions to get in some high-calorie
• Initially avoid foods high in insoluble fiber, such as whole grains, as many patients find them hard to digest immediately post-surgery.
• Choose lower fiber, lower fat foods, and continue to focus on eating little and often.  Although counterintuitive, this means choosing ‘white’ refined foods and peeling all fruits and veggies.  Here are some easy ideas to get you through this stage.
• Drink enough fluids for the first month after surgery. Fluids are very important for patients to avoid dehydration, but it’s best to avoid filling up on them too much before meals. Drink between 48 to 64 ounces of fluid throughout the day. Try warming teas and summery coolers
• 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.
• Eat slowly and chew your foods well before you swallow. Stop eating when you feel full.

Common post-Whipple problems

There are some problems that need watching out for after Whipple regardless of how well you may feel you’re doing:

Digesting foods

The pancreas makes enzymes that help digest protein, fats, and carbohydrates. After having a Whipple surgery, many patients find that they have difficulty digesting foods the way they used to. If you find that you are having issues, it’s important that you speak to your dietitian or doctor about taking pancreatic enzymes and how to take them at the right time. Ongoing weight loss after surgery can be a sign of becoming malnourished which can prolong the recovery process.  If you continue to lose weight after surgery talk with your dietitian.

Delayed stomach emptying:

This can happen in the first few days after surgery and usually improves within a few weeks. If it persists, it can cause an infection. Some symptoms to watch out for would be nausea, vomiting, bloating, feeling full soon after you start eating, and abdominal pain. To help alleviate these symptoms, choose lower fiber, lower fat foods, and continue to focus on eating little and often, aiming for 5-6 small meals per day. Make sure to chew your food well.  Try taking a walk after a meal to help encourage digestion. Some tasty low-fiber options for you.

Pancreatic Insufficiency

The pancreas releases enzymes that help breakdown carbohydrates, proteins, and fats, but after Whipple surgery, these nutrients can be improperly broken down or even fail to be broken down. This can result in a change of stools that can be foul-smelling, oily, frothy, or lightly colored. These changes in stools can also be accompanied by weight loss. If you’re experiencing any of these symptoms talk with your doctor or dietitian who may recommend pancreatic enzymes.

Malabsorption

Malabsorption of vitamins can be an issue post-Whipple. Ask your doctor and dietitian if they would recommend taking a daily multivitamin. This may become especially important if there is continued weight loss.

Dumping Syndrome

Dumping Syndrom is triggered by foods high in sugar, such as candy, cookies, or sodas, so these types of sugary treats 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.

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.

Diabetes

This can occur after a Whipple surgery due to the pancreas producing less insulin. Signs to look out for are feeling very thirsty and hungry accompanied by an increased need to urinate. Other symptoms include an increased feeling of being tired and weight loss.

In summary, it is best to follow these guidelines for the first 4-6 weeks after surgery.  After 6 weeks of following these guidelines, begin to experiment with different foods and flavors until you find what works for you and your new GI system. Many people are eventually able to consume regular-sized meals.  Your food diary will help you to keep track. Consult your medical team before making any changes.