Why would someone need to take pancreatic enzymes?

According to the Cystic Fibrosis Foundation, up to 90% of individuals with cystic fibrosis are pancreatic insufficient and need to take pancreatic enzymes to digest food properly. The need to take pancreatic enzymes is most commonly due to a condition called exocrine pancreatic insufficiency (EPI).

Quick Summary

Pancreatic enzymes are required when the body cannot produce or release enough of its own to digest food, a condition known as exocrine pancreatic insufficiency (EPI). This leads to symptoms like bloating, pain, and weight loss due to malabsorption of nutrients.

Key Points

• Cause is Exocrine Pancreatic Insufficiency (EPI): The primary reason for taking pancreatic enzymes is EPI, where the pancreas fails to produce or secrete enough digestive enzymes for proper digestion.

• Enzymes Aid Digestion: Pancreatic enzyme replacement therapy (PERT) provides the necessary lipase, protease, and amylase to break down fats, proteins, and carbohydrates, respectively.

• Symptoms of Malabsorption: Without enzymes, the body suffers from malabsorption, leading to symptoms like greasy stools (steatorrhea), bloating, gas, abdominal pain, and weight loss.

• Conditions That Cause EPI: Common causes include cystic fibrosis, chronic pancreatitis, pancreatic cancer, and digestive surgeries like gastrectomy.

• Proper Administration is Key: Enzymes must be taken with every meal and snack to be effective, as they need to mix with food in the small intestine. They should be swallowed whole and not with hot liquids.

• Prescription Only for EPI: Only FDA-regulated prescription pancreatic enzymes are recommended for treating EPI. Over-the-counter supplements are not standardized or proven effective for this condition.

The pancreas is a vital organ that plays two major roles: an endocrine role by releasing hormones like insulin, and an exocrine role by producing digestive enzymes. These enzymes, primarily lipase, protease, and amylase, are secreted into the small intestine to break down fats, proteins, and carbohydrates, respectively. When the pancreas is damaged or unable to function correctly, this process breaks down, leading to a condition known as exocrine pancreatic insufficiency (EPI).

Understanding Exocrine Pancreatic Insufficiency (EPI)

EPI occurs when the pancreas fails to produce or secrete enough digestive enzymes. Without these enzymes, the body cannot properly break down and absorb nutrients from food, a problem called malabsorption. A diagnosis of EPI is the primary reason why someone would need to take pancreatic enzymes, also known as pancreatic enzyme replacement therapy (PERT).

Common Causes of EPI

Several medical conditions and circumstances can lead to EPI:

• Chronic Pancreatitis: This long-term inflammation of the pancreas causes permanent scarring and damage to the enzyme-producing cells. It is the most common cause of EPI in adults.
• Cystic Fibrosis (CF): In CF, thick mucus blocks the ducts in the pancreas, preventing enzymes from reaching the small intestine. This makes EPI a significant issue for the majority of CF patients.
• Pancreatic Cancer: Tumors can obstruct the pancreatic duct, blocking the release of enzymes. Surgical removal of part or all of the pancreas (pancreatectomy or Whipple procedure) can also cause EPI.
• Digestive Surgery: Procedures that alter the digestive tract, including stomach removal (gastrectomy) and weight loss (bariatric) surgery, can impact the timing and effectiveness of pancreatic enzyme release.
• Other Conditions: Diabetes (especially Type 1), celiac disease, inflammatory bowel disease (IBD), and some rare genetic disorders like Shwachman-Diamond syndrome can also be associated with EPI.

Symptoms of Enzyme Deficiency

The symptoms of EPI result from the malabsorption of fats, proteins, and carbohydrates. If you experience these issues, a doctor may investigate your pancreatic function to see why you would need to take pancreatic enzymes.

Common symptoms include:

• Steatorrhea: Foul-smelling, greasy, or oily stools that may float and be difficult to flush.
• Bloating and Gas: Undigested food ferments in the intestines, causing uncomfortable gas and bloating.
• Abdominal Pain or Cramping: Discomfort, especially after eating, is a frequent symptom.
• Unexplained Weight Loss: The inability to absorb sufficient nutrients leads to calorie deficiency and weight loss, even with a normal appetite.
• Fat-Soluble Vitamin Deficiencies: Poor fat absorption can lead to deficiencies in vitamins A, D, E, and K, potentially causing related health issues like osteoporosis or anemia.

Pancreatic Enzyme Replacement Therapy (PERT)

PERT involves taking prescription medications that contain a mixture of lipase, protease, and amylase derived from pigs. This therapy is crucial for allowing individuals with EPI to digest their food and absorb essential nutrients. Because PERT needs to be in the small intestine at the same time as food, proper timing and technique are essential for effectiveness.

Proper Administration of PERT

Following a doctor's instructions for taking PERT is critical to managing EPI effectively:

• Take the capsules with the first bite of each meal and snack.
• Do not chew or crush the capsules or their contents, as this can damage the enteric coating and irritate the mouth.
• If swallowing capsules is difficult, open them and sprinkle the contents on a small amount of acidic, soft food like applesauce.
• Swallow the mixture immediately and follow with cold or room-temperature liquid. Hot liquids can inactivate the enzymes.
• For long meals, your doctor may suggest splitting the dose, taking some at the start and some partway through.

Prescription vs. Over-the-Counter (OTC) Pancreatic Enzymes

It is important for patients with EPI to use only FDA-regulated prescription pancreatic enzymes. OTC supplements are not an effective alternative and are not recommended for serious conditions.

Feature	Prescription Pancreatic Enzymes (e.g., Creon, Zenpep)	Over-the-Counter (OTC) Supplements
FDA Regulation	Fully regulated, with consistent and standardized enzyme amounts.	Not regulated by the FDA, leading to potential inconsistency.
Effectiveness	Clinically proven to treat EPI and improve nutrient absorption.	Generally contains insufficient or unstable enzyme amounts for treating EPI.
Source of Enzymes	Sourced from the pancreas of pigs.	Can be sourced from plant, microbial, or animal products, often with no stated quantity of active enzymes.
Cost & Coverage	Often expensive, but may be covered by insurance or patient assistance programs.	Typically cheaper, but coverage is not available for a dietary supplement.

Potential Risks and Side Effects

Side effects of PERT are usually mild and may include abdominal pain, bloating, or changes in bowel movements. A very rare but serious side effect, particularly linked to high doses in children with cystic fibrosis, is fibrosing colonopathy, which involves scarring of the colon. Allergic reactions, while rare, can also occur, and individuals with pork allergies should inform their doctor, as most products are pork-derived.

Conclusion

Understanding why someone would need to take pancreatic enzymes is key to managing a chronic digestive condition like exocrine pancreatic insufficiency. By replacing the enzymes the body can no longer produce, PERT effectively combats malabsorption, reduces digestive symptoms, and prevents malnutrition. As the treatment is lifelong for most individuals, close collaboration with a healthcare provider to ensure proper dosage and administration is vital for a good quality of life. For more information on EPI and its treatment, consult resources like the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Conclusion

Understanding why someone would need to take pancreatic enzymes is key to managing a chronic digestive condition like exocrine pancreatic insufficiency. By replacing the enzymes the body can no longer produce, PERT effectively combats malabsorption, reduces digestive symptoms, and prevents malnutrition. As the treatment is lifelong for most individuals, close collaboration with a healthcare provider to ensure proper dosage and administration is vital for a good quality of life. For more information on EPI and its treatment, consult resources like the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Frequently Asked Questions

What is Exocrine Pancreatic Insufficiency (EPI)?

Exocrine Pancreatic Insufficiency (EPI) is a medical condition where the pancreas does not produce or release enough digestive enzymes (lipase, protease, and amylase). This prevents the body from properly breaking down and absorbing fats, proteins, and carbohydrates from food.

What are the most common causes of EPI?

The most common causes of EPI include chronic pancreatitis (long-term inflammation), cystic fibrosis (CF), pancreatic cancer, and surgical procedures involving the pancreas or digestive tract.

What happens if you don't take pancreatic enzymes when you have EPI?

If you have EPI and don't take pancreatic enzymes, your body cannot properly digest food. This leads to malabsorption of nutrients, causing symptoms like bloating, abdominal pain, fatty stools (steatorrhea), and unintended weight loss. Over time, it can result in malnutrition and vitamin deficiencies.

How do you know if you need to take pancreatic enzymes?

You may need to take pancreatic enzymes if you have symptoms of malabsorption, such as unexplained weight loss, floating or oily stools, frequent gas, or discomfort after eating. Only a doctor can provide an accurate diagnosis of EPI through specific tests.

Should I take pancreatic enzymes with every meal?

Yes, pancreatic enzymes should be taken with every meal and snack that contains fats, proteins, or carbohydrates. This ensures the enzymes are present in the small intestine at the same time as the food you need to digest.

Are over-the-counter pancreatic enzymes effective?

No, over-the-counter pancreatic enzyme supplements are not recommended for treating EPI. They are not regulated by the FDA, lack standardized enzyme content, and are generally not strong enough to effectively treat the condition.

What are the side effects of pancreatic enzyme replacement therapy (PERT)?

Most people experience few side effects with PERT. Potential mild side effects include abdominal pain, gas, or diarrhea. In rare cases, high doses over a long period can lead to fibrosing colonopathy, a serious bowel disorder.

What should you avoid when taking pancreatic enzymes?

You should avoid chewing or crushing the capsules, as they can irritate your mouth and damage the enteric coating. Also, do not take enzymes with hot liquids, as high temperatures can inactivate the enzymes.