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Exocrine pancreatic insufficiency (EPI) is a lifelong condition that keeps the body from making enzymes to help absorb fats, carbohydrates, and proteins from foods. If you have this condition, you may have bloating, gas, stomach pain, constipation, unexplained weight loss, and diarrhea.

Managing daily life with these symptoms can be easier with an EPI diary. The diary lets you plan and process what is happening to your body. That can help lessen any anxiety about your condition. 

Why Is an EPI Diary Important?

An EPI diary allows you to take an active role in managing your symptoms. Having an EPI diary helps you keep track of what you eat and how your body reacts without having to rely on your memory. 

It can help you figure out which foods keep your symptoms the same, or make them worse or better. Having a way to actively keep track of how your body reacts can give you some sense of control. An EPI diary is also a record that you can bring to your doctor’s office when you talk about what will help you most. 

Having a handy way to see daily, weekly, and monthly patterns not only helps you keep an eye on your symptoms, but it can also lessen the anxiety and panic that may happen when you get a flare-up. 

What Do You Track in Your EPI Diary? 

You’re motivated to get a journal and start tracking, but you may wonder what you need to jot down to understand patterns of your EPI. Consistency is important in keeping an EPI diary. Note in your EPI journal what is happening to you every day – a few entries won’t be enough to see patterns. 

Here are some guidelines on what to track: 

  • What foods are you eating? It is important to track fast foods, foods that are high in fat, your dairy intake, and how much caffeine you have.
  • How often are you skipping meals?
  • If you’re drinking alcohol, how often do you have wine, cocktails, or beer? And how many drinks do you have in one sitting?
  • When are you eating?
  •  When are your symptoms better, the same, or worse?
  • When do flare-ups happen? And what are the symptoms of these flare-ups?
  • What are your glucose levels?
  • How often do you exercise? What kinds of exercise are you doing? How do you feel when you exercise? 
    • Write down any symptoms you might have after exercising. 
    • Although exercise is a good tool for weight control, a high-intensity workout may trigger a flare-up for some people. 
  • What stress do you face every day? And how do you think it affects your EPI? 
    • You should note your everyday stresses and any out-of-the-ordinary events that may worsen your EPI symptoms. 
  • What supplements or vitamins are you taking to help with your EPI?
  • What medications are you taking? When are you taking them? 
  • If you have multiple symptoms in one day, what did you do differently that day? 

Why Your Diary Can Help Your Medical Team 

James Farrell, MD, a gastroenterologist at Yale Medicine, says keeping a diary helps you not only track your EPI, but it's also a good way to keep your medical team informed about your specific symptoms. Looking back at your journal is a good way to let your doctors know what your symptoms are, when they happen, and how intense a flare-up is. Based on what is happening to you and how your body is reacting, you can jot down questions in real time in your journal, instead of trying to remember them at your next doctor’s appointment. Also, the diary can make it easier to ask questions about the best treatment options and any changes you might make to your diet. 

Your EPI diary is a great reference tool for your dietitian or nutritionist, too. By reviewing the foods you’ve eaten in the past and identifying why your body reacted in the way that it did, the dietitian can suggest cutting back on certain foods and substitutions to make for certain ingredients.

If you’re seeing a therapist to manage your mental health because of your EPI, you can use the journal to track your moods and situations that cause you stress every day. Therapists can offer ways to help you deal with frustrations and low points as you navigate the disease. 

Most importantly, a journal can be a helpful way to track your medications or supplements and monitor how you take pancreatic enzyme replacement therapy (PERT) – capsules that contain digestive enzymes to help you absorb nutrients you may lose because of your EPI. You can track your dosage options for meals and snacks. “Maintaining an EPI diary will help identify which components of a patient's symptoms are related to EPI and may be helped through dietary changes and PERT,” Farrell says. 

An EPI diary makes it easier to approach your EPI from all the important angles. It helps eliminate the guesswork in trying to manage your disease. Because you’re sharing this information with your medical team, you can work more efficiently and effectively to find ways to live with EPI. 

Show Sources


Cleveland Clinic: “Exocrine Pancreatic Insufficiency (EPI).” 

James Farrell, MD, gastroenterologist; director, Center for Pancreatic Diseases, Yale School of Medicine, New Haven, CT. 

Nutrition Issues In Gastroenterology: “A Practical Guide to Nutritional Management of Chronic Pancreatitis.” 

PanCAN: “Friday Fix: Foods Pancreatic Cancer Patients Should Avoid,” “Moments Matter: Maryann Grau.”