Confused about how to start taking PERT? To help you better understand what this therapy involves and how it works, here are some answers to the frequently asked questions about the medication.
1. What is PERT?
“The idea is to replace the enzymes that your own pancreas isn’t making,” says Lawrence Schiller, MD, former director of the division of gastroenterology at Baylor University Medical Center, which is part of Baylor Scott & White Health in Dallas. “An analogous idea is if you have diabetes and aren’t making enough insulin, you take insulin shots to replace the missing insulin. With EPI, the pancreas isn’t making enough enzymes, so you take replacement enzymes.”
2. How does PERT work?
Enzymes are molecules that the body makes to help with chemical reactions, Dr. Schiller explains. “Much of the food we eat is composed of big molecules that have to be broken down into smaller molecules in order to be absorbed,” he says. “For instance, proteins are made up of strings of hundreds of amino acids. These strings need to be broken down into one, two, or three amino acid fragments in order to be absorbed. Enzymes are what allow that process to happen.”
3. Does PERT have side effects?
Typically not, says Timothy B. Gardner, MD, director of pancreatic disorders, medical director of the islet cell transplant program, and professor of medicine at the Geisel School of Medicine of Dartmouth University in New Hampshire. However, there is one exception: People with cystic fibrosis who take very high doses of PERT over a very long period of time can develop narrowing in the colon called fibrosing colonopathy. “It’s a very rare side effect,” Dr. Gardner says.
4. Will PERT throw off my metabolism?
No. “If anything, PERT will help your metabolism,” Gardner says. “Think of it as getting it back to normal.”
5. How long will I have to take PERT?
“It’s usually a permanent treatment because most of the diseases that cause EPI cause permanent damage to the pancreas,” Schiller says. “Your pancreas doesn’t recover with time. If you’re taking enzymes to treat EPI, then you’ll always have to take them.”
6. How do I know how much to take?
The dose you’re prescribed typically depends on how much you eat and your body size. “We often treat people with a standard dose to start with, and then we see how well that’s meeting their needs,” Schiller explains. “Usually there’s an initial period of adjusting the dose, but typically, once you find a dose that works, people stay on it for years and years.”
7. When should I take my medication?
PERT “has to be taken with food,” Schiller says. “The enzyme has to come into physical contact with the food that it’s digesting, so you have to take the enzymes as you’re eating — not hours before or hours after.” Your doctor will help you work on an exact timing for your medication based on how many pills you’ve been prescribed to take with each meal and snack. (The general rule is to take the medicine with the first bite of food.)
8. Can my dose be reduced as my symptoms improve?
No. The reason you’re feeling better is because you’re on the therapy, says Lisa Ganjhu, DO, a clinical associate professor in the department of medicine at NYU Langone Medical Center in New York City. Although you might adjust the dose and drop it down in the case of a temporary problem, that’s rare, Gardner says.
9. Does it matter what I eat?
Eating healthy is important for everyone, but especially for people with EPI. In the past, experts used to tell people with EPI to eat a low-fat diet, but now that’s no longer the case. According to StatPearls, you should try to eat a normal diet that contains healthy fats — this can help you avoid nutritional deficiencies, particularly of vitamins D, A, E, and B. Work with your doctor and dietitian on a plan. You may choose to eat smaller meals more frequently and avoid foods that are high in fiber and in saturated and other unhealthy fats.
10. Should I adjust my medication if my meal is larger or smaller than usual?
Yes. “You can adjust the enzymes as you eat your meal — for smaller meals you can take fewer enzymes, and for larger meals you can take more,” Gardner says. That said, PERT dosages vary from person to person, so be sure to talk to your doctor about your individual medication needs.
11. What happens if I take my medication but don’t eat right away?
As noted above, it’s best to take your pill just before your food is served. But if you take your pill and don’t eat right away, it shouldn’t be a problem, Gardner says. Enzymes are very safe, so it’s okay if you’ve already taken your pill. That said, you may need to take more enzymes since the ones you took may have been already digested.
12. What happens if I forget to take the enzymes with a meal?
“You’re probably not going to digest that meal very well, and you may experience diarrhea or changes in the stool due to incomplete digestion,” Schiller says. But don’t take a make-up dose hours later. “If you eat at 8 a.m. and 10 minutes later you realize that you forgot your medication, there’s no problem taking it then,” he says. “But by 10 a.m., the food will have left the stomach and there won’t be a chance for the enzymes to mix with the food to help digest it.”
