What many people don’t realize is that the pancreas — and the enzymes it produces — are essential for digestion, says Kristi King, RDN, MPH, a clinical instructor at Baylor College of Medicine in Texas; senior pediatric dietitian at Texas Children’s Hospital in Houston; and spokesperson for the Academy of Nutrition and Dietetics. “Pancreatic enzymes are used to digest all three macronutrients: carbohydrates, proteins, and fats,” she explains. “Without adequate amounts of the enzymes, malabsorption of the macronutrients are bound to occur.” Your body may also have difficulty absorbing the fat-soluble vitamins A, D, E, and K. The good news is that eating a healthy diet tailored to your needs, as well as taking pancreatic enzyme replacement therapy (PERT), can help you manage the symptoms of EPI. Use this A to Z guide to learn exactly which foods, nutrients, and lifestyle habits can help you manage your symptoms — and what to avoid. A: Vitamin A People with EPI have trouble absorbing vitamin A (aka retinol), a nutrient that helps keep your vision, reproductive system, and immune system healthy. Because of its antioxidant properties, vitamin A may also help stave off heart disease, cancer, and other diseases, according to the Mayo Clinic. You can find vitamin A in leafy green vegetables, such as spinach; dairy products; and some fish, such as salmon. B: Vitamin B12 EPI also puts you at risk for vitamin B12 deficiency, says King. According to the National Institutes of Health Office of Dietary Supplements (ODS), B12 keeps your nerves and red blood cells healthy. To up your intake, focus on eating chicken, meat, fish, and dairy products. Some breakfast cereals are also fortified with B12. C: Carbs EPI can interfere with your body’s ability to break down carbohydrates. The good news is that PERT can help. It contains a mixture of digestive enzymes — including amylase, which breaks down carbs — to help you properly digest your food, according to Pancreatic Cancer Action (PCA), a charity based in Hampshire, England, that focuses on early diagnosis of pancreatic cancer. D: Vitamin D If you have EPI, you’ll also have trouble absorbing vitamin D, a nutrient you need for strong bones, because it helps your body absorb calcium, ODS. Not many foods contain vitamin D naturally. The best sources are fish — salmon, tuna, mackerel — and milk, which is fortified with vitamin D in the U.S. E: Vitamin E Vitamin E, another nutrient people with EPI have trouble absorbing, is crucial for keeping your eyes and reproductive system healthy. It also helps keep your blood, brain, and skin in top shape, according to the Mayo Clinic. You can find vitamin E in vegetable oils (sunflower, safflower), nuts (peanuts, almonds), and seeds (sunflower). Leafy greens (spinach) also provide some vitamin E. Although fiber is usually part of a healthy diet, people with EPI need to avoid getting too much of it, because it can inhibit pancreatic enzymes from digesting fat, says King. Talk to a nutritionist if you’re unsure about which foods to avoid. (For example, beans have a lot of fiber.) G: Gluten Some people with EPI may also have celiac disease, a condition where the body can’t properly digest gluten, according to a study published in May 2010 in the journal Digestive Diseases and Sciences. If that’s you, you’ll need to eliminate gluten from your diet. That means avoiding grains that contain gluten, such as wheat, barley, and rye. H: High-fat diet Try to avoid high-fat meals if you have EPI. “The best rule is, if it’s greasy, let it be!” says King. That said, your body does need some fat to function. Focus on getting healthy, unsaturated fats from foods such as salmon, avocado, chia seeds, and nuts. I: IBS Some of the symptoms of EPI — stomach pain, gas, bloating — can be similar to those of irritable bowel syndrome (IBS). In fact, one study published in May 2010 in the journal Clinical Gastroenterology and Hepatology found that as many as 6 percent of people who have been diagnosed with IBS may actually have EPI. Talk to your doctor if you have questions about your diagnosis. J: Join a support group If you’re feeling discouraged about your diet or EPI symptoms, consider joining a support group. Chatting with other people who have EPI can go a long way in helping you feel better. To get started, check out the National Pancreas Foundation’s (NPF) online community. K: Vitamin K If you have EPI, your body will have trouble absorbing vitamin K, a nutrient that promotes healthy blood clotting and helps build strong bones, according to the ODS. To ensure you’re getting enough K, stock up on green veggies (spinach, kale, broccoli) and fruits (blueberries, figs). Vitamin K is also found in eggs, cheese, meat, and soybeans. L: Lipase Lipase is an enzyme that helps break down the fat in food so it can be absorbed in the stomach, according to the Mount Sinai Health System. If you’re taking PERT, it’s part of the mix of digestive enzymes you’ll take at every meal to assist with proper digestion. M: Medication The medication you’ll take to treat EPI is called PERT. The supplement capsules contain a mixture of digestive enzymes that will help your body break down food so you get enough nutrients, according to PCA. N: Nutritionist When it comes to managing EPI, what works for one person may not work for the next, notes King. A registered dietitian nutritionist can help tailor your diet to your needs. “You are unique, and therefore your symptoms will be unique,” says King. “It may take a little trial and error to find the right balance for your body, but a nutritionist can help you get there.” O: OTC supplements If you have EPI and are considering taking over-the-counter supplements, a few words of warning: “Any vitamins or supplements should be discussed with a physician and/or registered dietitian nutritionist prior to use,” says King. Supplements could overlap with the medications you’re taking, which is why it’s important to talk to your doc first. P: Pancreatitis Chronic pancreatitis is the most common cause of EPI in adults, according to the NPF. Pancreatitis causes inflammation and damage to the pancreas, which can affect its ability to produce digestive enzymes. Q: Quit smoking According to the American Cancer Society, smoking cigarettes is a big risk factor for pancreatic cancer, which can lead to EPI. A study published in January 2020 in the journal Digestive Diseases found that EPI occurs in more than 80 percent of people who need surgery for pancreatic cancer. R: Research Learning more about EPI can help you cope with your symptoms and learn healthy eating habits. Exploring information from The NPF is a good place to start. S: Steatorrhea The most common symptom of EPI is steatorrhea (fatty stools), according to the Canadian Society of Intestinal Research. It occurs because the digestive system can’t absorb fat. Consuming healthy fats and taking PERT with every meal can help you avoid this issue. T: Tests To diagnose EPI, your doctor will likely have you take a stool test. There are two types: the fecal elastase test measures how much elastase (a digestive enzyme) you have in your stool, and the fecal fat test measures how much fat is in your stool, according to the Canadian Society of Intestinal Research. Testing the levels of both will let your doctor know how well your body is absorbing fats and nutrients. U: Ulcerative colitis If you have an inflammatory bowel disease, such as ulcerative colitis or Crohn’s, you may also be at risk for EPI. In fact, EPI affects an estimated 14 percent of people with Crohn’s and 22 percent of people with ulcerative colitis, according to a research review published in October 2018 in the Journal of Clinical Medicine Research. V: Vitamins Your doctor may write you a prescription for vitamins since your body can’t absorb the fat-soluble vitamins A, D, E, and K. Not everyone needs an Rx though, so talk to your doctor if you’re unsure. W: Water If you have EPI, it’s important to stay hydrated. Keep a water bottle with you to make sure you’re getting enough fluids — and avoid alcohol, which can lead to dehydration, says King. X: X-ray In addition to stool tests, your doctor may order an X-ray of your pancreas to check for damage — an indicator of EPI. Y: Yogurt Yogurt is a great choice if you have EPI. It contains healthy fat and probiotics, which can help keep your digestive system healthy. Z: Zollinger-Ellison syndrome A study published in February 2018 the International Journal of Clinical Practice shows that EPI can result from Zollinger-Ellison syndrome. This is a rare condition where tumors form in your pancreas or the upper part of your stomach, according to the Mayo Clinic. The tumors cause your stomach to produce too much acid, which can lead to diarrhea and other stomach issues.
