- Exocrine pancreatic insufficiency (EPI) is a serious condition
- Many bowel-related problems may be caused by EPI
- You can take steps to ease the digestive stresses on the pancreas
- Modern chronic metabolic conditions put you at risk for EPI
- With lifestyle and dietary adjustments, you may be able to compensate for the condition and live normally with a high quality of life
- Types of pancreatic enzyme replacement therapy
- See your doctor if you have questions or suffer from weight or muscle loss
If you eat and cannot get nutrients from your food, your metabolism will slow and your health decline. That, in short, summarizes why pancreatic insufficiency is serious.
Fortunately, simple treatments and therapies can compensate for it and allow you to live with an excellent quality of life. And it’s worth noting that just because you have symptoms doesn’t mean you have this condition.
In this article, we take an in-depth look at this health issue and questions that include what pancreatic insufficiency is, what causes it, and typical treatments.
What is pancreatic insufficiency?
Pancreatic insufficiency, also called exocrine pancreatic insufficiency (EPI), is a condition in which your pancreas does not produce enough of specific enzymes needed for the digestion and absorption of carbohydrates, proteins, and fats in the small intestine.
Your pancreas plays a vital role in digestion and regulating blood sugar. Pancreatic enzymes digest food. Your pancreas also produces the hormone insulin to keep your blood sugar in balance.
The problem of exocrine pancreatic insufficiency refers to a lack of pancreatic enzymes in the small intestine during digestion. You see, the pancreas works in two ways.
- It releases digestive juices and enzymes through ducts – an exocrine function.
- It produces and releases insulin and other pancreatic juices directly into the bloodstream – an endocrine function.
The use of the term exocrine defines the medical condition whereby your pancreas fails to supply the enzymes you need.
Symptoms of pancreatic insufficiency overlap with other digestive issues, so just because you might recognize some of the symptoms below does not necessarily mean you are suffering from it. The only way to know for sure would be to consult with your doctor.
The most common symptoms of EPI are[i]:
- Gas and bloating. Unable to digest food completely, especially fats, your digestive tract becomes unbalanced, and undigested food increases unpleasant bloating and gas.
- Stomach pain. Gas and bloating can become severe enough that you feel pain after eating.
- Weight loss. You don’t want this kind of weight loss that occurs due to a lack of nutrients and fats being broken down and absorbed by the body.
- Diarrhea. Unpleasant as it may sound, undigested food may irritate your bowels and accelerate passage through your bowels.
- Foul, greasy stools. This condition, officially called steatorrhea, produces oily, bad-smelling stools and oil beads in the toilet bowl when you go.
Advanced cases of EPI can lead to severe nutritional deficiencies. As a result, individuals with conditions including osteoporosis, bone fractures that occur even with low-trauma events, and unexplained loss of muscle may also find those conditions a symptom of EPI.[ii]
What causes pancreatic insufficiency?
Any reason for your pancreas not delivering enzymes to the small intestine leads to the condition of pancreatic insufficiency.
For example, damage to your pancreas interferes with its ability to produce and get enzymes where they are needed. Damage to the intestinal wall can also prevent digestive enzymes from reaching your small intestine.
The most common causes of pancreatic insufficiency include[iii]:
- Cystic fibrosis, where the thick mucus produced by the body blocks the ducts
- Chronic pancreatitis, pancreatitis occurs when digestive enzymes become activated before leaving the pancreas, causing it inflammation and irritation of its cells
- Pancreatic cancer
- Surgery on the pancreas, intestines, or stomach, which interferes with enzyme access to the intestines
- Type I diabetes (mild to moderate EPI in up to 57% of patients)
- Type II diabetes (mild to moderate EPI in up to 36% of patients)
- Untreated celiac disease (wide variance with a presence in up to 80% of EPI patients, but often resolves on a gluten-free diet
- Irritable bowel disease (up to 74% of EPI patients have this condition)
- Shwachman-Diamond syndrome, an inherited condition where your pancreas lacks the cells needed to make enzymes
Is pancreatic insufficiency serious?
Without enough pancreatic enzymes, you will not be able to properly digest your food. In time, this leads to nutrient deficiency. Without enough nutrients, your body will not work right, your metabolism will slow, the immune system becomes weak, and you will find yourself with less energy.
How is pancreatic insufficiency diagnosed?
Many people never recognize they suffer from exocrine pancreatic insufficiency, meaning the condition goes undetected. Typically, a doctor will make a clinical diagnosis based on the symptoms and presence of any other conditions. Your doctor might ask:
- How often do you have pain in your stomach after eating?
- Does your stool look oily, smell bad, or float?
- Have you had any bouts of diarrhea? How often?
Your doctor will likely also check your weight and do a visual evaluation. If you have lost muscle mass, you should mention it to your doctor.
Depending on the concern, your doctor may ask you to:
- Have some blood tests
- Measure vitamin levels, especially vitamins A, D, E and K
- Measure your pancreatic enzyme levels.
If your doctor is concerned about the pancreas itself, he may ask you to get a CT scan, MRI, or endoscopic ultrasound to get a clearer picture of your pancreas’ health.[iv]
Treatment for pancreatic insufficiency
If you are diagnosed with exocrine pancreatic insufficiency, there is good news. With a few lifestyle modifications, dietary adjustments, and digestive aids determined in consultation with your doctor, you can address the issue and improve your health and quality of life.
Steps you can take to ease the stress on your system include:
- Reduce alcohol consumption. Alcohol can interfere with the absorption of fats, and as a sugar, alcohol stresses the pancreas by increasing the need for greater insulin production.
- Stop smoking. Smoking increases the risk of chronic pancreatitis, the inflammation of the pancreas that interferes with the delivery of enzymes to the small intestine.[v]
- Increase the amount of fresh, sprouted, raw fruits and vegetables you eat. Sprouted, raw fruits and vegetables contain higher levels of natural plant enzymes that support the digestion of the food you eat.
- Chew your food completely. Chewing is the first part of digestion. As you chew, you introduce the first digestive enzymes which start to break down your food. By chewing your food completely, making it easy to swallow, you reduce the stress on your stomach and small intestine to break down your food.
- Eat smaller but more frequent meals. Big meals mean more food. That requires more digestive enzymes to break down and absorb your food. By eating smaller meals more often, you regulate the flow of food, allowing your body to keep up with digestion.
- Get more vitamins or take a vitamin supplement. With pancreatic insufficiency, there is a good chance you aren’t getting enough of the vitamins and minerals from your food. Making it a priority to add nutrient-rich foods to your diet can help. A multivitamin can help too. Depending on the severity of your condition, your doctor may recommend speaking with a nutritionist for a personalized plan.
- Add probiotics to your diet, or take a probiotic supplement. Probiotics support digestion by promoting overall gut health. You can eat foods that contain probiotics or take a supplement. You can read more about probiotics in our article, “Probiotics: How and When to Take Them.”
Treating pancreatic insufficiency with digestive enzymes
Your doctor may recommend digestive enzyme replacement therapy to help with digestion. There are several prescription digestive enzymes available to support your pancreatic enzyme levels. You can also speak to your doctor about plant-based digestive enzyme replacement therapy with supplements like Digest Infused, which may offer an alternative.
If you find a plant-based digestive enzyme supplement works, you gain several advantages. You don’t need to contact your doctor for a prescription when you need more. You can manage how much you take. It’s plant-based, so it is a non-animal way to deal with the condition.
Ultimately, you need to work with your doctor to find the best solution for you.
Is there an exocrine pancreatic insufficiency diet?
There is not a specific pancreatic insufficiency diet. As noted above, eating a diet based on raw, sprouted fresh fruits and vegetables can help, depending on other symptoms and conditions you may experience. (For example, if you suffer from irritable bowels, you may find fiber-rich foods need to be avoided until that issue is addressed.)
The following foods have higher levels of digestive enzymes and may be worth consideration to help with your diet:
- Pineapple. It contains bromelain, a highly effective protein-digesting enzyme.
- Papaya. The enzyme papain found in papaya is often used as a meat tenderizer, for its powerful protein-digesting enzymes.
- Avocados. Being high in omega-3 fatty acids, avocados have higher amounts of enzymes for digesting fat (lipases).
For more information about foods that are rich in digestive enzymes, check out “Digestive Enzymes: The Key to Healthy Digestion.”
A Few Final words about EPI
Exocrine pancreatic insufficiency is a serious condition in the way it deprives you of the nutrients you need. Untreated, it can become a downward slide as you don’t get the nutrients you need to support your immune system, give you the energy you need, expel waste, and otherwise maintain good health. Fortunately, with proper lifestyle, dietary, and digestive support therapies, you can overcome it and enjoy great health and excellent quality of life.