Subscribe
Share
Share
Embed
The PancChat Podcast is a collaborative effort from Let’s Win Pancreatic Cancer and the Pancreatic Cancer Action Network (PanCAN), inspired by the long-running #PancChat Twitter/X chat.
Hosted by award-winning journalist Alisyn Camerota, each episode features conversations with leading researchers, clinicians, patients, and advocates who are shaping the future of pancreatic cancer care and research. Together, we deliver expert insights, personal journeys, and the latest breakthroughs—bridging the gap between science and lived experience.
Whether you’re a patient, caregiver, healthcare professional, or simply want to learn more, join us to connect, be inspired, and learn how you can help to accelerate progress in the fight against pancreatic cancer.
Cindy Gavin: Hello everybody, and welcome back to episode 17 of the PancChat Podcast. I'm Cindy Gavin, CEO and co-founder of Let's Win Pancreatic Cancer. On today's episode, we are discussing managing nutrition and pancreatic cancer with Audrey Caspar-Clark. Take it away, Alisyn.
Alisyn Camerota: Thank you, Cindy. I want to welcome our listeners to episode 17 of PancChat. I'm Alisyn Camerota, your host. Today's episode focuses on nutrition and how patients can stay healthy during treatment.
We also want to thank our sponsor, Revolution Medicines.
Our guest today is Audrey Caspar-Clark. Audrey is an outpatient oncology dietitian specializing in pancreatic cancer at the Hospital of the University of Pennsylvania and the Abramson Cancer Center in Philadelphia. She provides nutrition-related education at oncology conferences, patient support groups, and community health programs. Welcome to the podcast, Audrey.
Audrey Caspar-Clark: Thank you. I'm happy to be here.
Alisyn Camerota: Great to have you here. Okay. So as we know, nutrition during pancreatic cancer treatment can be very challenging because the cancer itself complicates eating, and then the treatment can affect your digestive system, which makes it harder to absorb nutrients. So what are the biggest challenges as you see it?
Audrey Caspar-Clark: Well, I think there are probably at least five. I'll try to simplify, though. One, as you mentioned, is the cancer itself. So if the tumor is pressing on the abdomen, which is pretty common, it makes people feel full and very uncomfortable. And when they lie down, and they have food in their stomach, it often makes pain really intense.
So they have pain. They have this limited feeling of — they feel full quickly, and it's very uncomfortable. Then, if they are going through chemotherapy, that itself comes with a wonderful array of side effects, including nausea, vomiting, maybe constipation, maybe diarrhea, possibly some mouth sores and taste changes, and also sensitivity to extreme temperatures, particularly cold temperatures. And often, people are just flat-out tired. Cancer makes you tired.
Treatment makes you tired. And so you may just not have very much energy and interest in eating. Food doesn't seem very appealing. And if your brain is associating eating with feeling uncomfortable, it kind of turns off those hunger signals. So those hunger signals get all messed up, and we don't get that reminder that we need to eat.
So I think sort of starting from the top down, the most important thing is to identify if there's pain that can be managed appropriately, symptoms from the chemo side effects that need to be managed very optimally. And then working closely with a dietitian to figure out what is going to give you the biggest bang for your buck. What is a small amount that you can comfortably eat that is as nutritionally dense as it needs to be? And then making sure that you are working really closely with your oncology care team so that those symptoms are managed and not rearing their head, maybe over the weekend. And you're just sort of totally wiped out and not eating.
Alisyn Camerota: Yeah. I mean, Audrey, the way you've spelled it out, it's just so daunting. That whole laundry list of things that make it complicated, I can understand why patients would be like, it's not worth it. Eating is just not worth it. Between the nausea, the mouth sores, the exhaustion, the pain, the digestive issues, it's just — I'd rather skip meals.
When you have a patient come in who's encountering any or all of those, what are the tips that you give him or her to start?
Audrey Caspar-Clark: So first off, I make sure that we communicate what's happening really clearly to that person's oncology care team. Because without getting those symptoms controlled, I could give you 100 different suggestions for things to eat, and that's just not going to work. So that's the first place we start — a little bit of better living through science, chemistry. We need those medications to help us feel better. And then what we do is we figure out where are you? Like, what is happening today? What can you do today? What can you get in? What can you use as a reminder? And how about thinking about taking your calories in in liquid form?
Because a lot of times, that is just much easier. It's going to empty out of your stomach more quickly and you don't have to spend a lot of energy sitting there staring at a plate full of food and chewing your way through it. So that might be something that we talk about for maybe a couple of days. And then as the side effects of the chemo start to wear off and your energy starts to get better, then you start adding back in more things and making sure that you are keeping on a schedule as far as staying hydrated and getting that nutrition in.
Alisyn Camerota: When you say liquid form, you mean those like high-density caloric Ensure drinks?
Audrey Caspar-Clark: It can be the commercial over-the-counter products. Ensure and Boost are the ones that we most commonly hear about. But there right now are probably at least 20 different products out there. But you can make your own smoothies if you have access to a blender. You can certainly think about having soup. In summer, you might not necessarily want something hot, but if it's cold out or it's kind of cool temperature-wise, you can have a soup that is just as nutritious as one of those Boosts or Ensures. And that's where working with a dietitian can really help you figure out what would be the best fit for you right now in this moment.
It's a great point. Are there myths about diet and nutrition and pancreatic cancer that you encounter?
The question is not are there myths, but how many myths are out there? And boy, oh boy, they just — it's like whack-a-mole. They just keep rearing up and it's very hard to help people understand that if they go on the internet and start Googling nutrition and pancreatic cancer, that algorithm is probably going to start pulling in a whole lot of stuff that is very scary and not very true. So what we probably most frequently hear is people have been told by the internet or by somebody who's well-intentioned that sugar is probably the thing that they need to stay away from.
Alisyn Camerota: I did hear that. I did. So are you about to tell me that's not true? I do believe that.
Audrey Caspar-Clark: So of course. So what is sugar? Sugar is what happens after we eat carbohydrates. So that could be coming from a Snickers bar or it could be coming from a bowl full of strawberries and blueberries or it could be coming from a sweet potato. Now, that sugar is what is the main currency of energy in our body. But it also can be a problem if your pancreas is not operating the right way and you have blood sugars that are starting to go up. So there is a little kernel of truth there that sugar should be avoided. But let's think about what do we mean by sugar. And we know that carbohydrates are pretty important for most people in terms of being able to provide energy. So we have to think about — is that final product of sugar, is that actually promoting cancer or is it just keeping all of your cells going?
Alisyn Camerota: But is it fair to say refined? Should pancreatic cancer patients avoid refined sugar?
Audrey Caspar-Clark: Well, I would not go so far as to say avoid anything in particular while you're going through cancer treatment because what we really want to think about is maintaining somebody's weight and hopefully preventing them from losing a lot of muscle, which is what tends to break down really quickly. And sometimes when you are tired and your taste buds are off and you just really need something that's calorically dense, you might want to have something like a milkshake. And that is a fair amount of refined sugar. But in the short term, that is certainly not going to be a problem. If you are diabetic, if you need to watch your blood sugars and if you're not on insulin, then you do need to make sure that you're being conscientious to have some fiber, some fat, some protein. All of that needs to be along with your carbohydrate, with your sugar.
Alisyn Camerota: Tell me some other myths that might be out there.
Audrey Caspar-Clark: There's one that sort of pops up every now and then, which is that cancer cells thrive in an acidic environment, and therefore we need to alkalize our bodies and that we do that with diet. Well, that is very much of a myth.
Our body has an acid-alkaline sort of ratio or level. And if it goes too far to one extreme or the other, that's a very, very serious condition and requires hospitalization. We cannot alkalize our cells through diet. If we did that, that would be a medical emergency. But the thing that is probably a little bit of a truth in that is that the foods that are more likely to have an alkaline profile would be plant foods, fruits and vegetables, which we happen to know are pretty darn good for us. So that's the little kernel of truth in there, but you cannot kill cancer cells by trying to make your diet more alkaline. So that's another big myth.
I think one that is not necessarily a myth, but one that people get very interested in is a ketogenic diet. And that is therapeutically evidence-based for controlling seizures in children. It is a very low-carbohydrate diet. And that kind of goes back to that sugar-feeding-cancer idea — can we slow down cancer cells from proliferating if we starve them? And following a ketogenic diet is so challenging that for somebody going through cancer treatment, I think it would be nearly impossible and would put a tremendous amount of burden on that person and possibly their family who's also trying to support them.
We don't have enough strong evidence to show that a ketogenic diet is beneficial for people who have cancer. We do know that, as I mentioned, it can be used in treating children with seizures. So we just don't want to go outside the box with some of this stuff.
Alisyn Camerota: Audrey, what about red meat? I remember hearing that cancer loves red meat.
Audrey Caspar-Clark: Well, again, this one actually has some evidence behind it. We know that colon cancer — the incidence of colon cancer does correlate with intake of red meat, but it's primarily processed red meat. So we're talking about hot dogs, lunch meats, bacon, sausage, those types of meats. And we don't have a strong correlation for pancreatic cancer in terms of red meat.
I think the general advice is to limit your red meat intake, but that does not mean that you have to avoid it altogether. And if you are somebody who loves a hot dog — if you're at a baseball game, a hot dog every now and then is really not a big deal. It's cumulative. It's, as we say, the dose makes the poison. So if you're eating hot dogs every day, probably a good idea to back it down to maybe once a month.
Alisyn Camerota: Who doesn't love a hot dog at a barbecue or a baseball game? It would be horrible to live without, I would say. So, agreed — moderation. Are there some foods that slow down the spread of cancer? I know you said that fruits and vegetables are good. Is there any magical food that has been shown to slow it down?
Audrey Caspar-Clark: Don't we wish? If we had that — boy, oh boy, that would just be such an amazing thing. No, we don't really have that, but we do know very much that people who are able to maintain their weight, who are able to minimize muscle loss, who are able to be active and stay well hydrated and eat a sufficient amount of a well-balanced diet do better. We also know that from a prevention standpoint, diets that are high in fruits and vegetables, beans, nuts, seeds, whole grains, and have smaller, lesser amounts of processed foods, lesser amounts of red meat, focus more on fish as a protein source — that those are people who are less likely to develop cancer. But once you do have cancer, I would say that you'd want to do the best you can when you are feeling up to it.
So I always say to folks, how can we squeeze in or sneak in some more fruits and vegetables while you're feeling not so great? We can put them in a soup or a smoothie, depending on where your taste buds are. But I don't want people to be burdened with the guilt of thinking that if they don't eat this perfect way as they're going through cancer treatment, that it's going to be sort of the deciding factor whether or not they do well. That's just not the case.
Alisyn Camerota: That's really good to know. Explain the role of pancreatic enzymes and what they do in terms of diet and nutrition for patients.
Audrey Caspar-Clark: So our pancreas is a very important organ, and it does a couple of things. One, it produces insulin, which is why it's very common for people who have a tumor in their pancreas to start to have some hyperglycemia, some new diabetes. But the pancreas — especially the head of the pancreas — is also where the digestive enzymes are created and then secreted into the small intestine. And those enzymes are essential for breaking down the components in our food that we then need to absorb and use for all the different things that we use those nutrients for. So those enzymes break down fat, protein, and carbohydrate.
And so if you don't have enough of those enzymes, or if you have a timing issue where those enzymes maybe aren't getting to the food as it's emptying from the stomach, you will have some degree of what we call malabsorption or exocrine pancreatic insufficiency. And you may be losing weight even though you're eating really well. But more frequently, what people notice is that they have some really bad gas and bloating, and their bowel movements may be more frequent, or they may be very loose, kind of floating, pale in color, very stinky. And that is because the food is actually not being broken down by those enzymes. Therefore, it's not getting absorbed. Therefore, you're actually not getting those nutrients. And over time, you will start to lose weight, and you can develop some fat-soluble vitamin deficiencies.
So it's really, really critical that if you experience any of that, that you have a conversation with the doctor and get started on the pancreatic enzyme replacement, which has a couple of brands that are pretty well known. Creon and Zenpep are the two that are most commonly found on people's prescription plans. And you have to take them with your food. They have to act along with your food as you're eating it in order to work.
Alisyn Camerota: I have guilt nowadays about how I pressured my husband when he was losing weight. Like, you have to eat. Have to eat. Do you want me to get you a cheeseburger? Do you want me to go get you a milkshake? You have to force it down. Keep eating. And I now think how silly. Like, it's not that easy. I thought that if he could just keep his weight up, he'd be doing better. And I guess — I mean, what should caregivers do when they see their loved one losing weight?
Audrey Caspar-Clark: I think that is the hardest, hardest role to be in — being the caregiver. And often the patient feels really badly, too. But what you have to think about is what are some strategies that work for both of you so that you don't end up being in this tug of war?
And one of the things to think about is just small amounts. Make it a really small bowl, a small plate. Don't heap it on there. So if a cheeseburger does sound good to somebody, that cheeseburger probably could be cut up into at least two pieces, maybe four pieces. And the other piece of this is that what used to taste really great and be somebody's favorite food may no longer taste the way it's supposed to taste. And so when you're offering these foods that were favorite foods, and they turn that person off, it's a horrible experience.
So the other piece of it is to find things that are either kind of neutral or just don't take a whole lot of work, which is where I go back to using liquids. Those commercial products may be too sweet. Boost and Ensure are pretty sweet. So what could you add to that to maybe make it more appealing? And maybe you could use some ice cream or some plain milk, or maybe you just make something on your own with a blender and some ice cream and some peanut butter and some chocolate syrup or whatever. But try not to push and really try not to feel responsible if something does not appeal to that person who's the one with the cancer.
Alisyn Camerota: Gosh, in listening to you, I'm remembering that my husband at one point was forcing me to drink Ensure because I was losing weight. Obviously, as a caregiver and with all of the devastation of the diagnosis, I too wasn't eating. And so he was forcing me to drink those Ensures, which are not always the most palatable thing in the world. And so I remember he came out of a doctor's appointment one day, and I had said, I'll just be around the corner. I'm going to go grab a coffee. But when he came — it was breakfast — but when he came around, I was eating a filet of fish. I was at McDonald's. I got a glass-front window at a McDonald's, eating a filet of fish sandwich, french fries, and a milkshake. Like, that's what—
Audrey Caspar-Clark: — when you want to eat, you just have to eat. Like, an incredibly high-fat meal because there's just not a lot of eating. Well, you bring up a good point, too, Alisyn. I think something that we forget about is ourselves — taking care of ourselves if we're the caregiver.
But the other piece of it too is the person with cancer, the person going through all of this, wants to just feel like themselves. They want to be back to before they got this diagnosis. They want to feel normal.
So I think one of the things that really helps is actually sitting down together and eating a meal together. I don't care what it is. Share a sandwich. Whatever it is, but actually eating together can, I think, be helpful.
Alisyn Camerota: That's nice. Audrey, what have we missed? Any other tips that you want to share?
Audrey Caspar-Clark: Well, I'll tell you, I have a couple of real short ones. If you are having a hard time finding things that taste right and you don't want to have to either be doing all of this cooking on your own or burdening somebody else, a couple of ideas. One is if people ask, oh my gosh, what can I bring you food-wise? Ask them if they're going to make a casserole, could they please divide it up into very small, maybe one-cup servings and freeze them? Just label them really well — put what's on there, put the date, but put them into really small containers.
Because if you arrive at somebody's doorstep with a big old lasagna, they may be able to eat one small piece of that, and then the rest of that is sitting in the refrigerator and going to waste. The other thing that I think is really helpful is go to the freezer section in your grocery store and look for the frozen appetizers and hors d'oeuvres. There are little mini quiches, little egg rolls, and all sorts of small portions of things. And you could just take out one or two at a time.
The other thing I like — and it does sound a little weird — but those pouches that little toddlers like to use, you know, that have applesauce and some other stuff in them, throw them in your bag or keep them handy. They're actually pretty tasty, and they're shelf-stable. You don't have to refrigerate them. You can do the same thing with cereal bars, protein bars. And you don't have to feel like it's a big chore to get something like that in.
Alisyn Camerota: That's excellent. Audrey, thank you very much for all of those tips. I think that they will really help people. And thanks so much for being on PancChat.
Audrey Caspar-Clark: My pleasure. Thank you very much.
Alisyn Camerota: Thanks, everybody, for listening. I also want to thank our sponsor, Revolution Medicines. I'm your host, Alisyn Camerota, and I'll see you next time.
Julie Fleshman: Hi. I'm Julie Fleshman, president and CEO of PanCAN. If you or a loved one has been diagnosed with pancreatic cancer, navigating this journey can feel overwhelming, but you don't have to do it alone. Be sure to explore resources available to patients and caregivers on nutrition and healthy eating habits. You can find PanCAN at pancan.org and Let's Win at letswinpc.org.
Together, PanCAN and Let's Win are committed to guiding you through every step of the pancreatic cancer journey, offering support, information, and hope. In our next episode, we'll be speaking with Dallas Lawry about pancreatic enzymes and the critical role they play during cancer treatment. Don't forget to follow PancChat to get new episodes delivered twice a month right in your podcast feed. PancChat is available on all major platforms wherever you get your podcasts.