Posted 3 weeks ago
All About EPI and PERT
Did you know that the pancreas is responsible for the digestion of many nutrients? That organ about the size of your hand has a huge impact on converting the food we eat into the energy we need to function. One of the responsibilities of the pancreas is producing enzymes that help break down the macronutrients—carbohydrates, fats, and protein—consumed in our diet into their simplest forms to be used by our body’s cells for fuel. But what happens when our pancreas cannot work properly? Certain medical conditions such as cystic fibrosis, pancreatitis, diabetes, and pancreatic cancer can lead to what is called exocrine pancreatic insufficiency (EPI). In this month’s blog, we will be focusing on EPI related to pancreatic cancer.
What is Exocrine Pancreatic Insufficiency?
Exocrine pancreatic insufficiency refers to the pancreas’ inability to produce the necessary enzymes to break down nutrients for digestion and absorption. Without these enzymes, food is then passed through the GI tract undigested and not utilized properly by the body. In individuals with pancreatic cancer, the pancreas may not function appropriately due to the tumor site and/or surgery to remove all or part of the organ. So, how can we determine if EPI is present?
Symptoms of EPI
If food is not being digested properly, especially fats, individuals may present with:
– Malnutrition
– Abdominal pain
– Gas
– Bloating
– Diarrhea
– Unintentional weight loss
– Fatty stools, otherwise known as steatorrhea (discolored, oily, foul-smelling stool that floats)
If these symptoms are present, it is very likely that intervention is required.
Treating EPI
If exocrine pancreatic insufficiency has been diagnosed, how do we treat it? One of the most used interventions used and prescribed by professionals is PERT, or pancreatic enzyme replacement therapy. PERT involves the ingestion of capsules that contain pancreatic enzymes and help with the digestion of nutrients that would be typically excreted by the pancreas. These capsules are taken within the first few bites of every meal and snack consumed so that the food is being properly used by the body. PERT also helps with the reduction of symptoms listed above.
Several brands of pancreatic enzymes exist, and luckily, all perform the same functions. Dosing for PERT is based on:
– Weight
– Clinical symptoms present
– Degree of steatorrhea (fatty, oily stools)
– Amount of fat consumed in the diet
Eating with EPI
With exocrine pancreatic insufficiency, it is important to be conscious of what you eat and ensure that the proper nutrients are present to keep you healthy and feeling well. Working with a registered dietitian can be very helpful in navigating nutrition with this condition. Here are some basic tips to consider:
– Eat small, frequent meals. Eating the traditional three meals per day can be a lot given the pancreas is not working at its optimal state. Break up meals and snacks into several small portions throughout the day to feel more comfortable.
– Consume adequate calories. If unintentional weight loss has occurred, it is pertinent to reach a healthy weight. Energy expenditure is increased, so you may need more calories than usual.
– Include lean sources of protein. Consume sources of lean protein such as chicken, turkey, fish, eggs, and dairy to meet estimated protein needs.
– Choose healthy fats. Fats are still very much essential for our health even with EPI, but the types of fats we include are important. When choosing fat-dense foods, opt for unsaturated fat sources such as oils, nuts/seeds, avocado, and fatty fish. Reducing intake of foods high in saturated fats is generally recommended for overall health.
– Use dietary supplements for fat-soluble vitamins. With the risk of fat malabsorption in EPI, the vitamins that require fat for their absorption may become depleted, potentially leading to nutrient deficiencies. Supplementing vitamins A, D, E, and K may be necessary, but always talk to your physician before starting any dietary supplement.
You are not alone when it comes to navigating EPI, PERT, and nutrition surrounding pancreatic cancer. As registered dietitians, we are dedicated to providing guidance. Please reach out to one the registered dietitians at Ironwood Cancer and Research Centers to set up a consultation.
Lauren Duda, RD
Lauren was born and raised in Scottsdale, Arizona and has lived throughout the Valley her entire life. She attended Arizona State University and graduated with her undergraduate degree in Nutrition (Dietetics) and a minor in Family and Human Development in December 2017. Lauren completed her dietetic internship through Arizona State University and became a registered dietitian in August 2020.
Lauren’s interest in nutrition peaked at the age of 14, when she experienced a personal journey in developing her relationship with food. She decided that she wanted to help people like herself and educate the general public about nutrition. Becoming a registered dietitian was a clear career path and quickly became a dream of hers at a young age. Throughout the years, Lauren began to realize how necessary nutrition is in the management of disease, especially when witnessing her family members experience major health concerns. With this deepening her desire to care for others, Lauren ultimately knew that it was her goal to provide nutrition therapy in way that also values empathy, compassion, and kindness.
When she’s not working, Lauren loves spending her free time with friends, family, and her dog, Zeppelin. She enjoys listening to music, attending concerts, styling clothes, and hiking/biking during the cooler months.