Because your pancreas doesn’t secrete the enzymes needed to digest nutrients in the food you eat, that food passes through your body. “Although you’re eating a normal amount of food, you can be malnourished,” explains R. Martin Bashir, MD, a gastroenterologist at Holy Cross Health in Fort Lauderdale, Florida. It’s essential to address this lack of nutrient absorption. Left unchecked, EPI can worsen your overall health and even lead to an increased mortality rate, according to some research. “We all pass some nutrients through without absorbing them, but when you have EPI, you do more of that, and that kind of malabsorption syndrome can manifest also as diarrhea,” says Debashish Bose, MD, medical director of The Center for Hepatobiliary Disease at Mercy Medical in Baltimore. But eating more to compensate for this nutrient loss when you have EPI can also cause waves of nausea and cramping, a vicious cycle that leads to unwanted weight loss. In addition, undigested food stays in your small bowel, where it draws in water and causes oily stools, according to Pancreatic Cancer Action (PCA), a nonprofit group based in the United Kingdom that is dedicated to improving pancreatic cancer survival rates. To alleviate such symptoms and avoid malnutrition, doctors and nutritionists often recommend nutritional support through both pancreatic enzyme replacement therapy (PERT), which are prescription supplements that contain digestive enzymes, and dietary counseling. Take enzymes as directed. PERT improves your body’s ability to absorb nutrients and gain weight. “You take pancreatic enzyme supplements before you eat a meal or a large snack to aid digestion,” says Dr. Bashir. “They will provide the enzymes that your pancreas is no longer producing.” Be aware that over-the-counter enzymes aren’t recommended, because they aren’t regulated and are often ineffective, according to Mission: Cure, a nonprofit dedicated to finding a cure for pancreatitis. Your doctor will give you a prescription for PERT and help you determine the right dose, which is usually proportional to your body weight and the amount of fat in your meal. You might take one or two capsules when you start eating and then more later in the meal, if it’s a long or multicourse meal, according to PCA. Eat less, but more often. Have several smaller meals throughout the day rather than larger meals three times a day. Eating small amounts of food at a time is easier on your stomach and your pancreas, according to Pancreatic Cancer Action Network, a nonprofit dedicated to fighting pancreatic cancer. In addition, smaller meals may aid nutrient absorption. Consume a moderate amount of healthy fats. “A healthy diet is a balance of protein, fat, and carbs,” Dr. Bose explains. Your body needs fat to absorb certain vitamins, including vitamins A, D, E, and K, according to research. The amount of fat you should eat, though, depends on your tolerance, he says. “Continuously monitoring your symptoms when you eat fat is really important.” If you’re getting gassy or cramped when you eat fat, you need to lower your fat intake or adjust your PERT dosage to compensate. Children with cystic fibrosis are an exception. They need to eat a high-fat diet to meet their greater energy needs, according to a study published in Nutrition in Clinical Practice in September 2019. Bose also recommends focusing on your protein intake. “A protein-rich diet with some fat is good, because that helps you maintain your muscle mass. And muscle mass is really what your metabolism and healthy weight are based on,” he says. Don’t drink with meals. It’s better not to drink while you’re eating solid foods, because liquids push food through your stomach faster, Bashir says. Also, drinking with your meal could make you feel full too quickly. Staying hydrated is important to your health, but save the beverages for between meals. Practice good lifestyle habits. Smoking or drinking alcohol can make it harder to maintain a healthy weight. In addition to increasing your risk for certain cancers, heart disease, and lung disease, the nicotine in cigarettes can reduce your appetite, according to a review published in Appetite in September 2021. Smoking is also a risk factor for pancreatitis, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Alcohol can also be taxing on your pancreas, according to The National Pancreas Foundation (NPF). If you need help quitting smoking or drinking, talk to your doctor.
Maintaining a Healthy Weight
Even if you don’t return to your previous weight, your overall goal should be to keep your weight stable. Your doctor can help you determine a target weight. Few people with EPI are likely to gain too much weight, even after they find a combination of foods they can tolerate. Even after you reach a healthy weight, your doctor will continue to monitor you for any vitamin deficiencies. Your biggest concerns are likely the fat-soluble vitamins A, D, E, and K, according to the NPF. Fat-soluble vitamins are broken down by fats in the liver, as opposed to water-soluble vitamins, which break down more easily during digestion. Along with your PERT, you may need to take vitamin supplements to replace those you can’t absorb. A combination of an optimal diet and enzyme replacement therapy should help you feel better and enable you to eat enough to maintain a healthy weight.
