Missing Enzymes: How Pancreatic Insufficiency (EPI) Makes Eating Painful

Photo Credit: by jcomp, magnific.com

Eating is supposed to give your body the nutrients it needs. But for people with exocrine pancreatic insufficiency (EPI), even a normal meal can lead to uncomfortable digestive symptoms—and some of the nutrients in that food may pass through the digestive system without ever being properly absorbed.

EPI occurs when the pancreas doesn’t produce or deliver enough digestive enzymes to break down food effectively. It can develop as a result of conditions that damage or affect the pancreas, including chronic pancreatitis, cystic fibrosis, pancreatic cancer, or pancreatic surgery.

Cleveland Clinic explains it like this: “EPI occurs when your pancreas doesn’t make enough digestive enzymes. Sometimes the enzymes don’t work as they should. Enzymes are proteins that cause chemical reactions in your body. Digestive enzymes break down food, allowing your body to get nutrients. Children with cystic fibrosis and adults with chronic pancreatitis are most likely to have EPI.”

Symptoms of EPI can include abdominal discomfort, bloating, gas, diarrhea, weight loss, and steatorrhea, or loose, oily, foul-smelling stools caused by undigested fat.

For people with EPI, pancreatic enzyme replacement therapy (also known as PERT) can replace the digestive enzymes that the pancreas is no longer supplying in adequate amounts.

Creon (pancrelipase) is one prescription form of PERT used to help the body digest food and absorb nutrients more normally.

What Happens When Your Pancreas Doesn’t Make Enough Enzymes?

The pancreas has several important jobs, including producing enzymes that help digest the food you eat. Normally, those enzymes travel from the pancreas into the small intestine, where they help break food into smaller components that can be absorbed and used by the body.

Three enzymes are particularly important:

* Lipase helps break down dietary fats.

* Protease helps break down proteins.

* Amylase helps break down carbohydrates and starches.

According to the National Institutes of Health, “The pancreas is a large gland behind your stomach. The pancreas is both:

* an endocrine gland that makes hormones

* an exocrine gland that makes digestive juice containing enzymes

The pancreas delivers the digestive juice to the small intestine through a single duct. In the small intestine, pancreatic enzymes help digest food, breaking down carbohydrates, fats, and proteins.

You may develop EPI if

* the amount of enzymes your pancreas makes is severely reduced

* not enough enzymes reach your small intestine

* other problems prevent the enzymes from mixing with food or otherwise working well.”

In other words, when someone has EPI, there aren’t enough pancreatic enzymes reaching the small intestine to do that work efficiently. Fat is especially difficult to digest without adequate pancreatic lipase. Instead of being properly broken down and absorbed, some nutrients continue through the gastrointestinal tract undigested.

That’s why EPI isn’t simply a matter of an upset stomach; it’s much more serious than that. Over time, malabsorption can contribute to unintended weight loss, nutritional deficiencies, and inadequate absorption of fat-soluble vitamins A, D, E, and K.

Treating EPI, therefore, has two goals: helping to relieve digestive symptoms and, just as importantly, helping the body absorb the necessary nutrients in food.

Plus, the gut-brain connection matters to overall mental health and even your mood. So when your digestion and therefore physical health suffers, the rest of your body does, too.

What Is Creon (Pancrelipase)?

Creon is a prescription pancreatic enzyme replacement medication containing the enzymes lipase, protease, and amylase. Essentially, it supplies digestive enzymes to help compensate for those the pancreas is unable to provide in sufficient quantities.

Unlike medications that must enter the bloodstream and travel throughout the body to work, pancreatic enzymes perform their primary job within the gastrointestinal tract. Creon capsules contain delayed-release granules designed to protect the enzymes from stomach acid. Once the granules move from the stomach into the higher-pH environment of the small intestine, their protective coating dissolves, releasing the enzymes where they’re needed to digest food.

WebMD explains it this way: “Creon is made up of a mixture of enzymes (pancreatic enzymes), including lipases, proteases, and amylases. These enzymes help break down fats, proteins, and sugars from food in the small intestine. This helps the body digest and absorb important nutrients.”

Creon comes in different strengths, and dosing is based primarily on the medication's lipase content. The appropriate dose varies from person to person and may depend on factors including age, body weight, diet, symptoms, and the severity of pancreatic insufficiency.

A healthcare provider determines the appropriate dose and may adjust it according to how well symptoms and malabsorption are controlled. Always consult a qualified health care professional before taking Creon or any prescription drug.

How to Take Creon Correctly

Timing and handling matter with pancreatic enzyme replacement therapy. The enzymes need to reach the digestive tract at roughly the same time as the food they’re intended to help digest.

A few practical rules can help patients get the intended benefit from their medication:

* Take Creon with food. Creon should be taken during or immediately after meals and snacks. Taking pancreatic enzymes without food means there is little for them to digest. Follow the specific timing and dosing instructions provided by your doctor or pharmacist.

* Don’t crush or chew the granules. The protective coating of Creon helps keep the enzymes intact until they reach the intestine. Crushing or chewing the granules can damage the coating and irritate the mouth.

* If swallowing capsules is difficult, ask about opening them. Creon capsules may be carefully opened and the granules mixed with a small amount of soft, acidic food that does not require chewing. For example, applesauce is a commonly recommended option. The mixture should be swallowed immediately without crushing or chewing the granules. Patients should follow the instructions for their particular Creon product rather than experimenting with other foods.

* Don’t mix Creon into hot food or drinks. Heat can affect pancreatic enzyme activity. Follow the medication’s storage and administration instructions carefully.

* Remember snacks, too. EPI doesn’t switch off between breakfast, lunch, and dinner. If your healthcare provider has prescribed Creon with snacks, those doses are important as well.

If you miss a dose, don’t double the next one to compensate. Take your next prescribed dose with your next meal or snack.

How Should Creon Be Stored?

Because Creon contains enzymes, proper storage is important.

Most Creon products are advised to be stored at temperatures not exceeding 25°C (77°F) in a tightly closed container protected from moisture. That makes places exposed to heat or humidity—such as a hot car or a steamy bathroom—poor choices for medication storage.

Check the storage directions supplied with your specific prescription, as recommendations can differ by product and country of origin.

What Side Effects Can Creon Cause?

Like any prescription medication, Creon can cause side effects. Reported gastrointestinal effects can include abdominal pain, bloating, constipation, diarrhea, nausea, and vomiting, although some of these symptoms can also result from EPI itself.

More serious reactions are uncommon but possible. Very high doses of pancreatic enzyme products have been associated with fibrosing colonopathy, a rare condition involving narrowing of the colon, particularly in patients with cystic fibrosis. Allergic reactions are also possible.

Patients should take Creon exactly as prescribed and contact their healthcare provider if they experience severe, persistent, or unusual abdominal symptoms or signs of an allergic reaction.

Making Meals Work for You Again

EPI can turn something as ordinary as eating into a source of discomfort and frustration rather than a source of joy, satisfaction, and fulfillment. But the problem isn’t necessarily the food itself: when the pancreas can’t supply enough digestive enzymes, the body may lack some of the tools it needs to process that food effectively.

Pancreatic enzyme replacement therapy helps restore those tools. By supplying lipase, protease, and amylase at mealtimes, Creon can help people with EPI digest fats, proteins, and carbohydrates and absorb the nutrients they consume more effectively.

If your healthcare provider has prescribed Creon, we have good news: Canadian Pharmacy World offers Creon in multiple strengths. A valid prescription is required, and prescriptions can be uploaded through your online account or submitted according to Canadian Pharmacy World’s prescription-ordering instructions. Always follow the dosing and administration directions provided by your healthcare professional and the instructions supplied with your medication.

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