8 Things to Know About Your Diet After a Pancreatic Neuroendocrine Tumor

The majority of pancreatic cancers are adenocarcinomas, but about 7 percent of pancreatic cancers are neuroendocrine tumors, according to the Pancreatic Cancer Action Network (PANCAN). This type of tumor is also called a PNET, and grows from islet cells in the pancreas.

Because these tumors are typically slow-growing and less aggressive compared with adenocarcinoma, PNETs can often be surgically removed — and fortunately, this may cure the cancer. The type of surgery you receive depends on the size of the tumor and its location in the pancreas, according to the American Cancer Society.

During surgery, a portion of your pancreas may be removed, as well as other nearby organs (like the spleen). In rare cases, the entire pancreas is removed.

All of these changes — cancer, and major surgery that affects your GI system — can present added and unique challenges to the way that you eat, says Amanda Bryant, RD, a clinical oncology dietitian with OHSU Knight Cancer Institute in Portland, Oregon. Here are eight tips for managing your diet after a PNET:

1. Eat Smaller, More Frequent Meals to Lessen the Risk of Digestive Distress

The procedure for PNET removal can increase the risk of malabsorption, and a full plate of food can be overwhelming afterward. “Patients often tell me that looking at a plate filled with food gives them anxiety because they feel like it’s too much food for them to eat at once, but they don’t want to let family members down,” says Bryant. You don’t need to eat large amounts in one sitting, she says. A better strategy is having mini meals and larger snacks throughout the day — a hard-boiled egg with ½ cup of a smoothie and a small amount of avocado, for instance — can help you get in the calories and nutrients you need.

2. Don’t Go Low-Fat if You Need to Gain Weight

Following surgery, weight loss is common, so the calorie-density of your food matters. While high-fat foods may trigger digestive problems, swinging the other way to low-fat isn’t the answer either. “If you need to gain weight, eating a modest amount of fat will increase the energy — or calorie density — of your diet,” says Bryant. A greasy cheeseburger might not sit well, for instance, but a full-fat Greek yogurt may be more tolerable.

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3. Focus on Easy-to-Digest Fruits and Vegetables

Believe it or not, during recovery, fruits and vegetables are low priority, says Bryant. “They’re more bulking and irritating in someone who is already having digestive issues like discomfort and pain after eating or diarrhea,” says Bryant. Choose high-fiber foods that are more easily digested, like cooked vegetables or canned or well-ripened fruits, such as bananas, melons, or canned peaches or pears. Blending fruits and vegetables into a smoothie can also make them more tolerable, she says.

4. Stress Less About the Specific Foods You Choose

It’s okay to focus on the foods that sound appetizing right now, like a piece of white toast with jelly, instead of trying to force something you know is more nutritious, like a nine-grain bread with almond butter. “I don’t want to see people drinking cola and eating doughnuts all the time, but I also don’t want patients to feel anxiety around food choices,” says Bryant.

5. Take Your Digestive Enzymes for a More Comfortable Meal

According to Columbia Surgery, the pancreas produces enzymes needed for digestion, and having surgery that removes some or all of the pancreas means you may need to (or must) take prescription digestive enzymes before eating meals, says Bryant. Your doctor and the registered dietitian on staff can help you navigate this, as well as provide pointers on developing helpful reminders to take them.

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6. Watch Certain Foods, as These May Trigger Diarrhea

A rarer form of PNET, a carcinoid tumor, can lead to carcinoid syndrome. Symptoms of carcinoid syndrome include facial flushing, diarrhea, and wheezing, according to the National Organization for Rare Disorders. For patients with a carcinoid tumor, specific foods may trigger these symptoms, says Bryant. “The foods that are more likely to trigger this response are those that are higher in compounds called amines, which are present in aged cheeses, alcohol, fermented foods like tofu, miso, and soy sauce, and any smoked, pickled, or salted fish or meats,” she says. You may not have to avoid them completely, as you might find that you are okay when smaller amounts are eaten. Keeping a food log with symptoms can help you identify the likely offenders.

7. Fill Up on Protein-Rich Foods to Build Muscle Mass

When you have cancer, it’s important to get adequate protein for muscle preservation. “The amino acids in protein are utilized for many different cellular processes. If you don’t consume sufficient protein, your body will pull from stores — and that comes from your muscle,” says Bryant. Lean proteins, like chicken, fish, turkey, and eggs, fit the bill, as well as dairy options like yogurt, cheese, and cottage cheese, if you can tolerate them. If you can’t, then go for protein-enhanced nut milks. Plant-based options include beans, legumes, and tofu. An oncology dietitian on staff can help you set a goal for how much protein you need.

8. Drink Up, Especially if You’re Visiting the Bathroom Often

Diarrhea is common after this surgery, and if you’re running to the bathroom throughout the day, remember to sip fluids often to stay hydrated. “You don’t need to only drink water, especially if you have diarrhea. In that case, electrolyte beverages can help replace fluids and lost electrolytes,” says Bryant.