When you have exocrine pancreatic insufficiency (EPI), you need to take extra care with what and how you eat. The condition means your pancreas doesn’t make enough of the enzymes you need to properly break down the proteins, fats, and carbohydrates in your food. You may not get enough nutrients.
But it is possible for you to eat and feel well when you have EPI. Work with a dietitian so you can know exactly how to get proper nutrition in your meals and snacks without making your symptoms worse. And keep a few basic tips in mind.
Eat several smaller meals throughout the day. With EPI, it may be hard to make yourself eat, much less sit down for three big meals a day. Try eating a little at a time five or six times a day. It can help you feel more comfortable.
Stick with a low-fat diet. Your body has an especially tough time digesting fat, so you need to avoid getting too much. It’s especially important to avoid saturated and trans fats. In general, you shouldn’t eat more than 20 grams of fat each day or more than 10 grams of fat at one meal. Find ways to cut it out of your diet, like eating grilled or baked foods instead of fried, using cooking spray instead of oil or butter, and choosing low-fat or fat-free dairy.
Go for lean proteins, like chicken or turkey breasts, egg whites, or tuna packed in water. This will provide your body with the fuel it needs while keeping your meals low in fat.
Avoid too much fiber. Though it’s usually part of a healthy diet, fiber can keep your pancreatic enzymes from digesting fat as well. Ask your dietitian about foods that have a lot of it, like lentils and beans.
Be careful with processed foods. Packaged snacks, frozen dinners, and the like can have partially hydrogenated oil in their ingredients, which adds more unhealthy fats. Check nutrition labels and ingredient lists before you buy.
Eat enough calories. If you take in a variety of foods with a range of nutrients and the right amounts, you have a better shot at getting what your body needs.
Take vitamin supplements. Since you can’t digest fats properly, you won’t get the vitamins that your body has to absorb through fat, called fat-soluble vitamins -- A, D, E, and K. Your doctor may give you a prescription for these.
Don’t drink too much alcohol or smoke. Both can make your symptoms worse. Too much alcohol is also a common cause of chronic pancreatitis, which in turn is the leading cause of EPI. It might be best to avoid alcohol entirely, since it can make you dehydrated and inflame your pancreas. Drinking also makes it harder for your body to absorb fat. If you need help stopping these habits, talk to your doctor. There are programs that can make quitting a little easier.
But drink plenty of fluids. It’s a good idea to keep a bottle of water with you to make sure you stay hydrated. Other liquids in your diet -- like broth, fruit juices, and drinks without caffeine -- can help, too.
Take a pancreatic enzyme replacement therapy every time you eat. This supplement, the main treatment for EPI, helps your body break down food so that you get enough nutrients.
Sometimes you need to rest. If your pancreas is acting up, your doctor may advise a break from food for a few days. If you’re having a lot of pain, they may tell you to sip just clear liquids, like broth, or apple or cranberry juice. But don’t stop eating without talking to your doctor. When you can tolerate food again, you’ll be back to eating.
If you have this genetic disorder and you also have EPI, you need a high-fat, high-calorie diet to make sure your body can work well. That might mean eating 20% to 50% more calories than people who don't have cystic fibrosis. You want a well-balanced diet that has the right amount of salt, fat, and protein. Work with your doctor or dietitian to find a meal plan that works best for you.
Each case of EPI is different, but with treatment, the right diet, and help from your doctor, you can get what you need to stay well.
The National Pancreas Foundation: “Exocrine Pancreatic Insufficiency (EPI),” “Nutrition Advice and Recipes.”
World Journal of Gastroenterology: “Exocrine pancreatic insufficiency in adults: A shared position statement of the Italian association for the study of the pancreas.”
American Journal of Managed Care: “A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities.”
American Cancer Society: “Low-Fat Foods.”
Academy of Nutrition and Dietetics: “Processed Foods: What’s OK and What to Avoid.”
NCI Dictionary of Cancer Terms: “Fat-soluble vitamin.”
Freiss, H. The Official Journal of the International Hepato-Pancreato-Billary Association, December 2009.
Medical University of South Carolina Digestive Disease Center: “Pancreatic Insufficiency.”
Lindkvist, B. World Journal of Gastroenterology, November 2013.
Cleveland Clinic: “Pancreas Function Tests,” “Diarrhea.”
Pezzilli, R. World Journal of Gastroenterology, November 2013.
Cystic Fibrosis Foundation: “Nutrition: Pancreatic Enzyme Therapy in People with Cystic Fibrosis.”
UpToDate: “Overview of the Treatment of Malabsorption.”