Important Tips for Pancreatic Enzyme Replacement Therapy
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If you have exocrine pancreatic insufficiency (EPI), your pancreas doesn’t produce the enzymes you need to properly digest food and absorb its nutrients. Pancreatic enzyme replacement therapy (PERT) can help manage the condition and prevent malabsorption and gastric discomfort — but you must take it correctly, according Pancreatic Cancer Action (PCA), a U.K. nonprofit organization.
Here’s how PERT works: Pancreatic enzyme supplements are capsules that contain a mixture of digestive enzymes. They include lipase to break down fat, protease to assist with digestion of protein, and amylase for carbohydrates.
Most people take two capsules during the course of a meal. “Sometimes it’s three or more,” says Lawrence Schiller, MD, director of the division of gastroenterology at Baylor Scott and White Health in Dallas. “It depends on the product and the concentration.”
The appropriate dose of PERT also varies from person to person, says Stephen Kim, MD, a gastroenterologist with the division of digestive diseases at the David Geffen School of Medicine at UCLA Healthcare System in Los Angeles. “There are many variables to consider, including residual function of the pancreas, which can worsen over time, the size and fat content of meals, and the goal of PERT for you — whether it’s reducing bloating or eliminating diarrhea,” he says.
Doctors most often recommend that you start on a low dose of PERT and add more as needed, according to research published in the World Journal of Gastroenterology in November 2013.
Make the Most of PERT
Follow these tips to get the most from your EPI treatment:
Take medication with — not before — a meal. Your first capsule should be taken with your first bite of food, and if you’re taking multiple enzymes, the second should be taken about midway through the meal, according to OncoLink, a cancer information website from Penn Medicine, the University of Pennsylvania Health System. “For the enzymes to work, they have to be in physical contact with the food in your stomach,” Dr. Schiller explains. “If you take one capsule with the first bite of food and the second near the end of the meal, it gives the enzymes the best chance to mix with the food.” Dr. Kim adds that "taking enzymes after a meal is not as effective as the opportunity for the enzymes to mix with food is diminished."
Don’t take medication on an empty stomach.The purpose of pancreatic enzyme supplementation is to replace the digestive function of the pancreas, according to the National Pancreas Foundation. “These enzymes work best when taken with a meal because they help break down complex foods and allow absorption of nutrients," Kim says.
Don’t repeat a dose if a meal is delayed.Enzymes will work for about 60 minutes after you take them, according to the North American Societyfor Pediatric Gastroenterology, Hepatology and Nutrition. Pancreatic enzymes are generally safe and well tolerated. However, excessive doses can lead to more side effects, Kim says. This is another reason to wait until your first bite of food to take your first dose.
Take medication with every meal.If you miss a dose, just take your next capsule with your next meal or snack. Don’t double up, Kim says. Missing a dose isn’t harmful, but you may develop symptoms of malabsorption — such as bloating, flatulence, and diarrhea — after you’ve eaten.
Swallow the capsules whole.Chewing the capsules can crush their granules, releasing the enzymes in your mouth or stomach, where acid will destroy them, Schiller says. If you’re unable to swallow the capsules, open them and sprinkle the granules on fruit puree, like applesauce. Then swallow the mixture whole, don’t chew, suggests the Cystic Fibrosis Foundation (CFF).
Drink water with meals.Digestion involves a lot of water movement through your intestines. “Drinking is important,” Schiller says, “because you want sufficient water in your digestive system so the chemical processes can occur efficiently.” Drinking water helps move the capsules to the small intestines, where they do their job.
Take smaller doses with snacks.If you’re having a snack or small meal, you may need to take half a dose, the World Journal of Gastroenterology research notes. And people with mild EPI may be able to eat small meals or snacks without enzyme supplements. “The dose you’ve taken earlier may have adequate residual pancreatic function,” Kim says. But ask your doctor what’s right for you.
Store medication at room temperature.If capsules aren’t stored properly, they can be damaged by heat, the CFF says. Don’t leave them in your beach bag, a hot car, or near a toaster oven, for instance. However, they don’t need to be refrigerated, according to PCA.
Know your medications.Talk to your doctor about PERT and any other medications you take, as some medications may interact. For instance, Kim says that pancreatic enzymes can decrease the absorption of oral iron supplements. It's also important to tell your doctor if you’re allergic to pork, Kim says, because most pancreatic enzyme supplements are derived from pig glands.
Some PERT capsules have a coating that delays the release of enzymes until it reaches the small intestines. When capsules aren’t coated, Kim says, a proton-pump inhibitor is needed to prevent stomach acids from destroying the enzymes before reaching the small intestine.
Eat a Healthy Diet for EPI
Doctors used to recommend a low-fat diet to reduce EPI symptoms, but the thinking has changed, the World Journal of Gastroenterology research notes. Today the recommendation is for a diet with normal fat content, meaning that about 30 percent of your total calories should come from fat — primarily from foods with “good” fats like monounsaturated fat and omega-3 fatty acids.
Video: Foods to Heal Your Pancreas | Top 10 Natural Ways to Cure Pancreas
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