Why we eat this way

Two policies, one strategy

Anchor runs two dietary playbooks and switches between them based on your weight and appetite. The dashboard tells you which one is active.

• Low-carb when weight is stable and appetite is good — protects lean mass and limits glycaemic load.Wolpin 2009Cohen 2018
• Energy-dense when weight is dropping or appetite is poor — calories first, composition second.JPCC Nutrition Guide, p. 9Hendifar 2019

The four priorities

1. Protein ≥ 1.2 g/kg/day. Sarcopenic loss is the main driver of ECOG drift on chemo. Lean mass protects function for daraxonrasib eligibility.Mueller 2014
2. Energy density. Olive oil, avocado, fatty fish, eggs, full-cream milk. In energy-dense mode, also cream, honey, cheese, milky desserts (the JPCC “adding principle”).JPCC Nutrition Guide, p. 21
3. PERT (Creon) with every meal containing protein or fat. The pancreas can't make enough lipase. Untreated steatorrhoea = malabsorption + accelerated weight loss.JPCC Nutrition Guide, p. 19
4. Hydration. ~2 L/day, more on chemo infusion days and when nauseated. Bone broth, electrolyte drinks count.JPCC Nutrition Guide, p. 13

Why low-carb when stable

Hyperglycaemic spikes correlate with worse pancreatic-cancer outcomes.Wolpin 2009 A relaxed-keto pattern (≤ 50 g net carbs) reduces glycaemic load without the strict-keto compliance burden during chemo, and stabilises energy through long infusion days.Cohen 2018

Why energy-dense during cachexia

85% of pancreatic cancer patients lose weight at diagnosis; 80% develop cachexia.JPCC Nutrition Guide, p. 6Hendifar 2019When weight is dropping, calories trump composition. The JPCC adding principle: full-cream milk in porridge instead of water, cream in soups, honey in drinks, cheese on sandwiches, olive oil on cooked vegetables.JPCC Nutrition Guide, p. 21

PERT (Creon) — the JPCC rules

• Take with the first mouthful of any meal or snack containing protein or fat.JPCC Nutrition Guide, p. 19
• No PERT needed for fruit, jelly, soft drink, juice, water, black tea, black coffee.JPCC Nutrition Guide, p. 19
• Split the dose if the meal lasts > 30 minutes.JPCC Nutrition Guide, p. 19
• Forgot at the start? Take it halfway through. Remembered after the meal? Skip until next meal.JPCC Nutrition Guide, p. 19
• Standard initial dose: 25,000–50,000 units lipase with main meals; half that with snacks. Titrate with Dr Ananda / dietitian if steatorrhoea continues.
• Store away from heat (out of sunlight, away from ovens).

Red flags

• ≥ 5% weight loss in a month → tell the team.JPCC Nutrition Guide, p. 25
• ≥ 2 days of "couldn't eat anything" → tell the team.
• Persistent oily/floating stools despite PERT → re-dose with team.

Local source of this advice

Most of this page is drawn from the JPCC Nutrition Guide, written by Ryan Surace, Senior Dietitian, Epworth Richmond. If anything is unclear or you want personalised advice:

03 9426 8880