Having Digestive Problems? – It Could Be EPI!

by | Jul 26, 2016

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. It has become an epidemic because of an industrialized diet.

Chronic pancreatitis is the most common cause of EPI and affects thirty percent of North Americans.  EPI is caused by a progressive loss of pancreatic cell function or cell death that leads to reduction of digestive enzymes causing maldigestion and malabsorption of nutrients.  Metabolic syndrome, irritable bowel and Type 2 Adult Onset Diabetes are also linked with EPI. Severe EPI is found in people afflicted with cystic fibrosis.


dreamstime_xxl_10909953EPI can affect macronutrients (eg, proteins, carbohydrates, fats), micronutrients (eg, vitamins, minerals), or both, causing excessive fecal excretion, nutritional deficiencies, and GI symptoms. Malabsorption may be global, with impaired absorption of almost all nutrients, or partial (isolated), with malabsorption of only specific nutrients. Loss of Pancreatic enzymes leads to maldigestion and malabsorption which may be the underlying cause of:

  • steatorrhea (fatty or oily stool)
  • fatigue
  • flatulence and abdominal gas(bacterial fermentation of unabsorbed food)
  • edema (hypoalbuminemia – low protein in the blood)
  • anemia (B-12, Iron, folic acid deficiency)
  • bleeding disorders (vitamin K malabsorption)
  • Metabolic bone disease (Vitamin D deficiency)
  • neurologic manifestation (inflammation transferred to brain by dendrites in bowel)

You might also lose weight and get other nutrient deficiency problems, because your body doesn’t absorb enough vitamins. For instance, you could develop a bleeding disorder if you’re not getting enough vitamin K. Or you could get bone pain if you don’t get enough vitamin D.

Your Pancreas Gets Inflamed Often.

Doctors call this chronic pancreatitis. It happens when the enzymes made by the pancreas start working while they’re still inside it, before they get to the small intestine. You’re at risk for this if you use alcohol regularly (1 beer raises CPR in many people), though there can be other causes as well. For instance, your pancreas could get inflamed if some passageways in it are blocked or if you have very high levels of triglycerides (a type of blood fat) or an immune system disorder such as allergies or food sensitivities.  EPI can sometimes result if you have had surgery on your gall bladder, stomach, or intestines.

Irritable Bowel Disorders

The symptoms of EPI may be a contributor to other gastrointestinal disorders, like Crohn’s disease, celiac disease, irritable bowel syndrome (IBS), and ulcerative colitis, which often have EPI as an underlying cause.  In my practice I have seen patients who have taken antacids, broad spectrum plant digestive enzymes with partial relief but when a full functional GI test was performed on stool and saliva we often discovered insufficient pancreatic enzymes and a diagnosis of EPI was made.  There are dozens of commercial pancreatic enzyme preparations however, I have only found a few that work sufficiently with EPI sufferers.

Things To Do

Christine Gerbstadt, MD, RD, a spokeswoman for the Academy of Nutrition and Dietetics and author of Doctor’s Detox Diet: The Ultimate Weight Loss Prescription,says that a diet tailored to your specific needs is the best way to manage EPI and ensure you’re getting proper nutrition.  Diet recommendations may be different depending on what’s causing your condition, if you have food sensitivities or if you are severely malnourished. Generally, these strategies can help ease the symptoms and pain of exocrine pancreatic insufficiency in most people:

Drink plenty of fluids.

Proper hydration is an important dietary key.  Dehydration puts severe stress on the body and can contribute to symptoms of pancreatic insufficiency. “Hydration is best for prevention and treatment and usually considered the first step before all others,” she says. An easy rule to remember is to drink eight 8-ounce glasses of fluid a day, which can include water, tea, coffee, and even soup broth, because all liquids count toward the daily total. Check with your natural doctor for more details.

Eat a low-fat diet. 

Eating less fat may help normalize your stools. In EPI, undigested fat is passed in the stool, causing greasy, foul-smelling, loose stools. In a small Japanese study published in the journal Digestion,researchers found that a low-fat diet decreased the frequency of such bowel movements in people with chronic pancreatitis (inflammation of the pancreas).

However, you’ll still need to include some healthy fats in your diet to help  absorb vitamins A, D, E, and K. Only a couple of tablespoonsful of olive, avocado or coconut oil per day is adequate to initiate a tolerable response. Apart from what you’re eating, having smaller, more frequent “high protein mini meals” throughout the day instead of fewer large meals may also improve digestive pain,

Take your supplements. 

Replacing lost pancreatic enzymes with oral supplements can improve pain and cut down on loose stools early in the course of exocrine pancreatic insufficiency. Make sure to take the correct type and dose of enzymes for your specific needs.  Alfalfa naturally contains 8 mild digestive enzymes, the detoxifier called chlorophyll, vitamin K for blood and bone well being and more than a dozen minerals for metabolic stability and hormonal health.

People with exocrine pancreatic insufficiency often need supplements of the fat-soluble nutrients found in carotenoids vitamin  D3, vitamin E, and  antioxidants like vitamin C, and a resveratrol polyphenol mixture may also be suggested because they could help decrease inflammation.

Be careful with a high-fiber diet. 

The digestive and heart benefits of a high-fiber diet have been known for years. But for those who need to follow a pancreatic insufficiency diet, getting less fiber may actually be the better choice. In one small study published in the American Journal of Clinical Nutrition, researchers found that a high-fiber diet led to more gas and flatulence in people with exocrine pancreatic insufficiency caused by chronic pancreatitis. Dietary fiber also appeared to contribute to fattier stools. If a low-fiber diet works for you it, it is still important to eat fruits and vegetables.  Generally, tender-steamed vegetables like carrots, beets, and spinach are lower in fiber. Be careful with berries, raw vegetables, and prune juice.

Stop drinking alcohol and quit smoking.

Alcohol is a waste product of bacterial and fungal fermentation in the bowel.  Humans do not need to supplement alcohol in their diet!   Eliminating alcohol entirely helps reduce inflammation of the pancreas.

Along with countless benefits to your lungs, heart, and overall health, quitting smoking can also improve the health of your pancreas. Researchers in Denmark recently combed through 20 years of data from more than 17,000 people to see if smoking was linked to either acute (sudden) or chronic (long-term) pancreatitis. In all, 257 cases of pancreatitis were reported. The researchers found that smoking was independently linked to 46 percent of the cases. “Smoking is a risk factor for the development of pancreatic cancer, which can occur after chronic pancreatitis.

I have found that dietary and lifestyle changes are the only sure ways to improve symptoms of exocrine pancreatic insufficiency once it has started.  Following the above guidelines may be preventive in EPI as well.

Get Tested

If you are over 25 years of age and have a problem with your digestion or absorption, get tested. The stool and saliva test measure the exocrine pancreas (the part that does not make insulin or glucagon) which is the portion  that contains clusters of ducts  producing bicarbonate,  as well as several digestive enzymes that together empty by way of the common bile duct into the duodenum (upper small intestine). The hormones gastrin, cholecystokinin and secretin are secreted by the stomach and duodenum in response to distension and the presence of food, and in turn stimulate the production of digestive enzymes by the pancreas.  The alkalization of the duodenum neutralizes the acidic juices produced by the stomach that is passing into it; the digestive enzymes serve to catalyze the breakdown of complex foodstuffs into smaller molecules for absorption. The enzymes tested include proteases (trypsinogen and chymotrypsinogen), hydrolytic enzymes that cleave lipids (the lipases phospholipase A2 and lysophospholipase, and cholesterol esterase), and amylase to digest starches. EPI results from progressive failure in the exocrine function of the pancreas to provide its digestive enzymes, often in response to a genetic condition or other disease state, resulting in the inability of the person to properly digest food.

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