Eating After Pancreatic Cancer Surgery: Enzyme Replacement, Blood Sugar and Small Meals

Three weeks after her operation, a woman sits at her kitchen table with a plate of scrambled eggs and toast she would once have finished without thinking. She manages four bites. An hour later she is bloated, tired and quietly wondering whether she will ever enjoy food again. Her surgeon has mentioned enzyme replacement after pancreatic surgery, her nurse has talked about checking her blood sugar, and a leaflet says to eat little and often. None of it yet fits together.

That gap between the leaflet and the plate is what this article tries to close. The pancreas does two jobs, digestion and glucose control, and surgery changes both at once. Understanding why food behaves differently now makes the practical advice far easier to follow.

What follows is guideline-level information, not a substitute for your own team. Every decision about medicines, testing and diet belongs with the people who know your operation and your results.

Why eating changes so much after pancreatic cancer surgery

The pancreas is a soft, tongue-shaped organ about six inches long, tucked behind the stomach. Most people never think about it until it stops doing its work. It has two very different jobs, and pancreatic cancer surgery interferes with both.

The first job is exocrine: the pancreas makes a digestive juice rich in three enzyme families. Lipase breaks down fat, protease breaks down protein and amylase breaks down starch. The juice also carries bicarbonate, an alkaline salt that neutralizes stomach acid so the enzymes can work in the small intestine. The second job is endocrine: clusters of cells called islets release insulin, which lowers blood sugar, and glucagon, which raises it.

Which parts are removed depends on where the tumor sat. A Whipple procedure, the most common operation for cancer in the head of the pancreas, removes the head of the gland, the first part of the small intestine (the duodenum), the gallbladder and part of the bile duct, sometimes with a portion of the stomach, according to Mayo Clinic. A distal pancreatectomy removes the tail and often the spleen. A total pancreatectomy removes the whole organ.

Surgery does more than reduce tissue. It reroutes the plumbing. After a Whipple the surgeon reconnects the remaining pancreas, bile duct and stomach to the small intestine in new positions. Food, bile and pancreatic juice may no longer meet at the same spot at the same moment, so digestion becomes less efficient even when the leftover gland is healthy. That mismatch, more than any single missing enzyme, explains why a familiar breakfast can suddenly feel like a heavy meal.

How enzyme replacement after pancreatic surgery actually works

When the pancreas cannot deliver enough digestive enzymes, clinicians call it exocrine pancreatic insufficiency, or EPI. Fat is affected first and worst, because lipase is fragile and the body has few backup routes for digesting it. Undigested fat pulls water into the bowel, which is why EPI classically produces loose, pale, oily stools that float and are hard to flush, along with weight loss and a bloated, gassy abdomen, as Cleveland Clinic describes.

Pancreatic enzyme replacement therapy, usually shortened to PERT, is exactly what the name says: a replacement, not a stimulant. The capsules contain pancreatic enzymes, most commonly a preparation known by the generic name pancrelipase, derived from pig pancreas. Inside each capsule are tiny coated beads. The coating protects the enzymes from stomach acid and dissolves in the more alkaline environment of the small intestine, releasing lipase, protease and amylase where food arrives.

Timing is the whole point. Enzymes only help if they travel alongside the meal. Taken on an empty stomach, they pass through and do nothing useful. Taken long after eating, they arrive too late. This is why prescribers give instructions about taking them with food rather than at fixed clock times.

Acid matters too. After surgery, less bicarbonate reaches the intestine, so the contents may stay acidic and the beads may not dissolve on schedule. Some teams add an acid-reducing medicine from the proton pump inhibitor class to help the enzymes work. Whether that is needed, and for how long, is a judgment your prescriber makes from your symptoms and weight, not something to start on your own.

Who usually needs enzyme replacement after pancreatic surgery, and who is asked to wait

After a total pancreatectomy the answer is simple: with no pancreas, everyone needs lifelong enzyme replacement and insulin. After partial operations the picture is more individual.

People who have had a Whipple procedure very commonly need enzymes, for two reasons. The head of the pancreas contains a large share of the enzyme-producing tissue, and the rerouted anatomy means whatever the remaining gland produces reaches food less efficiently. Many surgical teams therefore start PERT soon after eating resumes, rather than waiting for weight loss to prove the point. Johns Hopkins notes that difficulty digesting food is one of the expected consequences of the operation, not a complication.

After a distal pancreatectomy, where the head is left intact, some people digest food well and are monitored rather than treated. Others develop insufficiency later, especially if the remaining pancreas was already damaged by a blocked duct or chronic inflammation before surgery.

Clinicians look at several things when deciding: how much gland was removed, how healthy it looked, whether stools are oily or frequent, whether weight is falling despite reasonable intake, and blood levels of fat-soluble vitamins. A stool test called fecal elastase, which measures an enzyme the pancreas releases, can help, though it is less reliable when stools are watery and many teams rely on clinical judgment after surgery.

Who is asked to wait? Usually people whose remaining pancreas appears to be coping, those not yet eating by mouth, and those whose symptoms have another likely cause, such as an infection or a medicine side effect, that needs sorting first. Waiting is a monitored decision, revisited at each clinic visit, not a closed door.

When to take pancreatic enzymes: timing with meals and snacks

The single question dietitians answer most often is not how much but when. The consistent guidance from major centers is that enzymes belong with food: taken at the start of a meal so the beads mix with the first mouthfuls, and, for a long or large meal, spread across it rather than swallowed all at once. Cleveland Clinic advises taking them with every meal and snack that contains fat, protein or starch.

Think of the enzymes as a passenger who has to board the same train as the food. If the meal lasts forty minutes and every capsule went in at minute one, the last part of the plate travels alone. Splitting the prescribed amount between the beginning and middle of the meal keeps the passenger on board. How the prescribed amount is divided, and whether a particular snack needs enzymes at all, is set by your prescriber and dietitian and adjusted as your intake changes.

A few practical points recur across guidance. Capsules are swallowed whole with a cool drink; heat can damage the enzymes, so they should not be taken with hot liquids or stirred into hot food. If someone cannot swallow capsules, some preparations can be opened and the beads placed on a spoonful of soft, slightly acidic food such as applesauce, then swallowed without chewing; the beads should not be crushed, and residue should be rinsed from the mouth because enzymes can irritate the gums.

Plain water, black tea or coffee, and clear broths generally do not need enzymes. A milky latte, a handful of nuts or a slice of cheese usually does. When unsure, ask, and write the answer on the fridge until it becomes second nature.

Pancreatic enzyme side effects: what they usually mean

Most people tolerate enzyme replacement well. The commonest complaints are mild and often temporary: stomach cramps, gas, nausea, constipation or, less often, looser stools. Cleveland Clinic lists these as the usual reactions. Many settle within the first weeks as the gut adjusts and the amount is matched to meals.

Some symptoms blamed on enzymes are really signs of too little enzyme for the meal in front of you. Oily stools, urgent bowel movements shortly after eating and persistent bloating point in that direction. Constipation and hard stools may point the other way. Neither should be corrected by guesswork; the useful step is to record what you ate, what you took and what happened, and bring that log to your next appointment.

Rarer effects deserve honest mention. A bowel scarring condition called fibrosing colonopathy has been reported in children with cystic fibrosis taking very large amounts over long periods. It is the main reason prescribers set an upper ceiling and why more is not always better. Enzyme preparations can raise uric acid levels, which matters for people with gout or kidney stones. Because the enzymes come from pig pancreas, anyone with a pork allergy, or religious or dietary objections to pork products, should raise this with the prescriber so alternatives or accommodations can be discussed.

Allergic reactions such as hives, facial swelling or wheezing are uncommon but need same-day medical attention. Mouth soreness usually means beads were chewed or held in the mouth rather than swallowed promptly.

Keep the perspective: the untreated alternative, ongoing fat malabsorption, brings its own harms, including weight loss, vitamin deficiency and fatigue.

Can the pancreas regenerate enzymes after surgery?

People ask this hoping the answer is yes, and it deserves a careful reply. Pancreatic tissue that has been surgically removed does not grow back. Unlike the liver, the pancreas has very limited ability to regenerate lost bulk in adults. What was taken out stays out.

Yet enzyme needs are not fixed, because the remaining pancreas is a living organ whose output can change. Before surgery, a tumor in the head of the gland often blocks the pancreatic duct, so the whole organ upstream is inflamed, swollen and underperforming. Once the blockage is gone, the leftover tissue may recover some function over the following months. Some people find their digestion improves and their team reduces their enzymes; others find little change.

The opposite can also happen. The remaining gland can shrink over years, a process called atrophy, or the surgical join between pancreas and bowel can narrow, reducing the flow of juice. Additional treatments such as chemotherapy can also affect appetite and digestion. Needs that rise a year or two after surgery are not a sign of failure; they are a signal for reassessment.

This is why enzyme replacement after pancreatic surgery should be reviewed rather than set once and forgotten. A sensible cadence, used by many teams, is to revisit symptoms, weight and vitamin levels at each oncology or surgical follow-up, repeating a fecal elastase test where it will change the decision. If your prescriber offers a trial of reduced enzymes, it is a supervised experiment with a clear plan to return to the previous amount if symptoms recur. Stopping on your own to see what happens is not the same thing.

Blood sugar after pancreatic surgery: why it can swing both ways

The same gland that digests your lunch also decides what happens to the glucose it releases. Removing part of it can push blood sugar in either direction, which surprises many people.

Diabetes that develops because of pancreatic disease or surgery is sometimes called type 3c or pancreatogenic diabetes. After a total pancreatectomy it is universal and requires insulin from the start. After a Whipple or distal operation it may appear immediately, months later, or never, depending on how many islets remain and how healthy they are. NHS guidance on pancreatic cancer treatment notes that some people will need to manage diabetes after surgery.

Type 3c diabetes behaves differently from type 2. Because glucagon-producing cells are lost alongside insulin-producing ones, the body’s brake against low blood sugar is weakened. Hypoglycemia can arrive faster and with less warning, especially after a total pancreatectomy or when meals are skipped. Teams often prefer slightly more relaxed glucose targets in this setting to reduce that risk, a decision made individually.

Two other factors muddy the readings. First, starting enzyme replacement improves absorption, so blood sugar can rise simply because more of the meal is now reaching the bloodstream; a person whose diabetes seemed mild may need a medicine review once digestion improves. Second, some chemotherapy regimens include steroids, which raise glucose for a day or two afterward.

Pre-existing diabetes can improve after surgery if a tumor had been squeezing the gland, or worsen if the resection removed many islets. Either way, glucose monitoring in the early months is information, not judgment, and any change to a glucose-lowering medicine sits with the prescribing clinician.

Diet after Whipple surgery: why small meals win

The advice to eat little and often sounds like folk wisdom. After a Whipple it is mechanics. Part of the stomach may have been removed, the valve that regulated its outflow may be gone, and the small intestine now receives food more directly. A large plate that once sat comfortably can overwhelm the new arrangement, producing early fullness, nausea or a rapid, uncomfortable emptying into the bowel.

Mayo Clinic’s guidance for people with post-surgical dumping syndrome offers a template that translates well: five or six smaller meals a day instead of three large ones, eating slowly, chewing thoroughly, and drinking fluids between meals rather than with them so liquid does not flush food through too quickly.

Protein deserves the first bites. Recovery from major surgery raises protein needs, appetite is unreliable, and if you only manage half the plate it is better that half was eggs, fish, yogurt, beans or chicken rather than toast. Dietitians often suggest building each mini-meal around a protein source and adding starch and vegetables around it.

Fat is the misunderstood one. People with oily stools instinctively cut fat, but on adequate enzyme replacement most can and should keep moderate fat in their diet, because fat carries calories and the vitamins A, D, E and K. The goal is matching enzymes to what you eat, not stripping fat out. Very sugary foods and drinks, by contrast, are often the real culprits behind sweating, cramping and diarrhea an hour after eating.

Temperature, texture and timing all matter more now. Many people find warm, soft, savory food easier than cold, sweet or fried, and that eating something every two to three hours prevents the vicious cycle of skipped meals, low energy and further weight loss.

Dumping, early fullness and slow emptying: what is happening and what usually helps

Several distinct problems can hide behind the single word discomfort. Sorting out which one you have changes what helps, so the table below sets them side by side using descriptions from Mayo Clinic and Johns Hopkins.

Problem	What is happening	Typical pattern	What teams commonly suggest
Early dumping syndrome	Food rushes into the small bowel, pulling in fluid	Cramping, nausea, sweating, faintness 10–30 minutes after eating (Mayo Clinic)	Smaller meals, fluids between rather than with meals, less simple sugar, more protein
Late dumping syndrome	A sugar surge triggers excess insulin, then low glucose	Shakiness, sweating, confusion 1–3 hours after eating (Mayo Clinic)	Limit sugary foods and drinks, pair carbohydrate with protein, discuss glucose checks
Delayed gastric emptying	The stomach is slow to move food onward after surgery	Early fullness, bloating, vomiting undigested food, common in the first weeks (Johns Hopkins)	Small soft meals, low residue foods, walking after eating, sometimes a prescribed motility medicine
Fat malabsorption	Too little lipase reaching the meal	Oily, pale, floating stools; urgency after fatty food; weight loss	Review enzyme timing and amount with the prescriber; do not simply cut fat

Two of these can coexist, and both can be mistaken for each other. Late dumping and true hypoglycemia from diabetes medicines feel identical from the inside, which is why anyone with post-surgical diabetes should have a glucose meter and a plan agreed with the team.

Delayed emptying is usually a problem of the early weeks and tends to improve as swelling at the surgical joins settles. Dumping and malabsorption are more likely to persist and to respond to habits. A food and symptom diary kept for a fortnight is often more revealing than any single test.

What the first days and weeks after surgery usually look like

Expect a staged return to eating rather than a switch flipped on. In hospital, most people start with sips of clear fluids, progress to full liquids and soft foods, and move toward a regular but modest diet as bowel function returns. Mayo Clinic describes a hospital stay of roughly a week after a Whipple procedure, though this varies with complications and with the type of operation.

Appetite is usually the last thing to recover. It is common to feel full after a few bites for several weeks, to find that favorite foods taste different, and to lose weight in the first month despite everyone’s best efforts. Dietitians expect this and plan for it; the goal in the early weeks is to stop the slide, not to regain everything at once.

Enzyme replacement after pancreatic surgery typically begins as soon as meaningful amounts of food are eaten, often before discharge. The first two to four weeks at home are usually spent matching enzymes to meals, learning which snacks need them, and noticing whether stools are becoming more formed and less oily. Blood sugar checks may be requested during this period if diabetes is present or suspected.

Johns Hopkins and Mayo Clinic both describe full recovery in terms of weeks to months rather than days. Energy tends to return before weight does. Many people feel able to eat close to normal portions by two to three months, while others take longer, particularly if chemotherapy begins during recovery.

Follow-up usually includes a surgical review, a dietitian appointment and blood tests for vitamins and glucose. Bring your food diary, your list of questions and, if possible, a recent weight from the same scale each time.

Weight, protein and vitamins: the nutrition targets that matter most

If you track only one number after pancreatic surgery, track your weight. Stable or gently rising weight is the most reliable sign that digestion and intake are keeping pace with your body’s needs. Unexplained ongoing loss, even when stools look better, is the earliest warning that something is off.

Protein comes next. Healing tissue, rebuilding muscle lost during illness and tolerating chemotherapy all consume protein. Because portions are small, protein density matters: adding eggs, dairy, fish, poultry, tofu or beans to every mini-meal usually achieves more than any supplement powder, though oral nutrition drinks have a place when appetite fails, and a dietitian can advise which suit someone with dumping symptoms.

Vitamins are the quiet casualty of fat malabsorption. Vitamins A, D, E and K dissolve in fat, so when fat is poorly absorbed they are too. Low vitamin D affects bone; low vitamin K affects clotting; low vitamin A affects vision and immunity. Cleveland Clinic lists deficiencies of these vitamins among the consequences of untreated exocrine insufficiency, which is why blood levels are usually checked and why supplements are often prescribed alongside enzymes rather than left to chance.

The duodenum is where much iron, calcium and folate are absorbed, and removing part of the stomach reduces the intrinsic factor needed to absorb vitamin B12. People who have had a Whipple are therefore commonly monitored for anemia and for B12 and iron status over the long term. Bone density can be affected by years of poor absorption, so your team may raise bone health well after the cancer itself is behind you.

Take supplements only as prescribed; some, particularly the fat-soluble ones, can accumulate if taken beyond what a blood test supports.

What people often get wrong about enzyme replacement after pancreatic surgery

Enzymes are a crutch you should try to get off quickly. They are a replacement for something the body no longer makes in sufficient quantity, closer to glasses than to a painkiller. Needs can be reviewed, but stopping to prove independence usually costs weight and energy.

If my stools look normal, I do not need them. Some people malabsorb fat without obvious oily stools, and lose weight or vitamins silently. Stool appearance is one clue, not the whole verdict.

A low-fat diet is the answer. Cutting fat reduces oily stools but also cuts calories and fat-soluble vitamins, and it does nothing for protein and starch digestion. The evidence-based approach is adequate enzyme matching with a moderate-fat diet.

Once a day is fine. Enzymes work only in the presence of food. A single daily capsule cannot cover meals it never meets.

Health-store digestive enzymes do the same job. Over-the-counter enzyme products vary widely and are not standardized or regulated as medicines for exocrine insufficiency. They are not interchangeable with prescribed pancrelipase, and no evidence supports them as a substitute.

Sugar feeds the cancer, so I should avoid it entirely. All cells use glucose. Mainstream cancer guidance does not support starving a tumor through diet, and under-eating during recovery is a documented harm. Limiting sugary drinks is sensible for dumping symptoms and glucose control, not as cancer treatment.

Weight loss is just part of having had cancer. Some early loss is expected; continuing loss is a problem to be investigated, not accepted.

Diabetes after surgery is my fault. It reflects how many islet cells remained, not lifestyle. Managing it well is possible; blaming yourself helps no one.

Questions to ask your care team about eating and enzymes

Clinic time is short and questions evaporate under fluorescent light. Writing them down beforehand, and bringing someone to take notes, changes the quality of the conversation. These are the questions dietitians and surgical nurses say they wish more people asked.

• How much of my pancreas was removed, and how healthy did the remaining tissue look? This shapes both enzyme and blood sugar expectations.
• Which of my meals and snacks need enzymes, and how should I split them across a long meal?
• What signs would tell you my enzyme amount needs adjusting, and how do I report them between visits?
• Do I need an acid-reducing medicine to help the enzymes work, and if so, for how long is it likely to be reviewed?
• Should I be checking my blood sugar, how often, and what readings should prompt a call?
• Which vitamin and mineral levels will you monitor, and when is the first blood test?
• What weight would concern you, and what is the plan if I keep losing?
• Is what I am feeling after meals more likely dumping, slow stomach emptying or malabsorption, and how do we tell?
• Can I see a registered dietitian who works with pancreatic surgery patients, and how do I reach them directly?
• If chemotherapy is planned, how might it change my appetite, digestion or glucose, and who coordinates that?
• Are there foods or drinks I should avoid for now, and is that restriction temporary?
• How will you know whether my remaining pancreas has recovered function, and when might we reassess my enzymes?

Ask, too, who to contact on a weekend. Knowing the phone number for the surgical ward or oncology line before you need it is worth more than any recipe.

When to call your doctor: red-flag signs after pancreatic surgery

Most eating problems after pancreatic surgery are uncomfortable rather than dangerous and can wait for a scheduled call. Some cannot. Contact your surgical team or emergency services the same day if you notice any of the following.

• A fever, shaking chills, or a wound that becomes red, swollen, hot or leaks fluid. These can signal infection or a leak at a surgical join.
• Yellowing of the skin or eyes, dark urine or pale clay-colored stools appearing or returning after surgery, which can indicate a blocked bile duct.
• Severe or worsening abdominal pain, especially with a rigid or very tender abdomen.
• Repeated vomiting, inability to keep down fluids for more than a day, or vomiting blood.
• Black, tarry or visibly bloody stools.
• Signs of dehydration: very little urine, dizziness on standing, a racing heart, extreme thirst.
• Blood sugar readings that stay very high, or any episode of low blood sugar with confusion, drowsiness or difficulty waking, particularly after a total pancreatectomy.
• Sudden calf pain or swelling, chest pain or breathlessness, which can indicate a blood clot.
• Hives, facial or throat swelling or wheezing after taking a new medicine, including enzymes.

Call within a few days, rather than waiting for the next clinic, if you are losing weight week on week despite eating, if stools remain oily and frequent after enzyme adjustments, if you cannot manage more than a few mouthfuls at most meals, or if fatigue is worsening rather than easing.

Every one of these judgments, from adjusting enzymes to changing a diabetes medicine or investigating a symptom, sits with the team that operated on you and knows your results. This article can help you ask better questions; it cannot answer them for your particular body.

Frequently asked questions

What are the potential side effects of pancreatic enzyme replacement therapy?

The most common side effects are mild: stomach cramps, gas, nausea and constipation, which often ease within the first weeks. Oily stools or bloating while taking enzymes usually mean the amount does not yet match the meal rather than a reaction to the medicine. Rarely, very large long-term amounts have been linked to bowel scarring in children with cystic fibrosis, which is why prescribers set upper limits. Allergic reactions are uncommon but need same-day care.

How much does pancreatic enzyme replacement cost?

This article does not cover prices, because costs vary widely between countries, insurance arrangements and individual prescriptions, and any figure quoted here would mislead more people than it helped. What matters clinically is that enzyme replacement is a long-term prescribed treatment for many people after pancreatic surgery. If affordability is a concern, raise it early with your prescribing clinician or oncology nurse so it can be factored into the plan.

What is the best time to administer pancreatic enzyme replacement?

Enzymes work only when they are in the small intestine at the same time as food, so guidance from major centers is to take them at the start of each meal and with snacks that contain fat, protein or starch, spreading them across a long meal. They are swallowed whole with a cool drink, not hot liquids. How your prescribed amount is divided between the beginning and middle of a meal is set by your prescriber and dietitian.

Can the pancreas start producing enzymes again after surgery?

Tissue that was surgically removed does not regrow, so the pancreas cannot fully return to its previous output. What remains, however, can recover some function once a blocking tumor is gone and inflammation settles, which is why some people’s enzyme needs fall over months. Others find needs rise later as the remaining gland shrinks. Any reduction should be a supervised trial with your team, not a self-directed experiment.

When to take pancreatic enzymes if I only have a drink or a light snack?

Plain water, black coffee or tea and clear broth generally do not need enzymes because they contain almost no fat, protein or starch. A milky coffee, nuts, cheese, yogurt or a biscuit usually does. Because the line is not always obvious, dietitians often suggest asking about your specific regular snacks and writing the answers down until they become habit. Your prescriber decides whether snacks require enzymes in your case.

What does a good diet after Whipple surgery look like?

The pattern most teams describe is five or six small meals a day, each built around a protein source, with fluids taken between meals rather than alongside them and sugary foods and drinks kept low to limit dumping symptoms. Moderate fat stays in the diet when enzymes are matched properly, because fat supplies calories and vitamins A, D, E and K. Warm, soft, savory foods are often easier than cold, sweet or fried ones early on.

Why has my blood sugar changed after pancreatic surgery?

The pancreas makes insulin and glucagon, so removing part of it can push glucose up if many insulin-producing islets were lost, or make readings less stable because the glucagon brake against low sugar is weaker. Starting enzymes can also raise readings simply because more of each meal is now absorbed. Diabetes after pancreatic surgery is managed individually, and any medicine change belongs with your prescribing clinician.

Will I need enzyme replacement for the rest of my life?

After a total pancreatectomy, yes, because there is no pancreas left to make enzymes. After a Whipple or distal pancreatectomy it depends on how much healthy tissue remains and how digestion performs over time. Some people need enzymes indefinitely, some see their needs fall as the remaining gland recovers, and some develop a need years later. Regular review of weight, symptoms and vitamin levels guides the decision.

Are over-the-counter digestive enzymes the same as prescribed pancreatic enzymes?

No. Health-store digestive enzyme products vary widely in content and strength, are not standardized or regulated as medicines for exocrine pancreatic insufficiency, and have no supporting evidence as a substitute after pancreatic surgery. Prescribed pancrelipase is a standardized, coated preparation designed to survive stomach acid and release in the small intestine. Swapping one for the other without your team’s knowledge risks untreated malabsorption and weight loss.

How long does it take to eat normally again after pancreatic cancer surgery?

Mayo Clinic and Johns Hopkins describe recovery from a Whipple procedure in weeks to months rather than days, with a hospital stay of roughly a week in uncomplicated cases. Appetite is usually the last thing to return, small portions and early fullness are common for several weeks, and many people approach normal portions by two to three months. Chemotherapy during recovery can extend the timeline, and individual experiences vary widely.

References

• NHS: Pancreatic cancer treatment
• MedlinePlus: Pancreatic Cancer

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.