What You Need to Know About Pancreatic Enzymes

Deborah Gerszberg, RD, CNSC, CDN, Clinical Nutritionist at The Pancreas Center, writes regularly about nutritional issues for patients with pancreatic cancer, pancreatitis, and other pancreatic diseases, which commonly cause problems with eating or maintaining their weight. In this post, she answers frequently asked questions about the benefits and proper use of pancreatic enzymes.

What are pancreatic enzymes?

Pancreatic enzymes are pills that help you digest food. Certain medical problems can cause your pancreas to produce fewer enzymes than needed for digestion.  Some of these problems include, but are not limited to, pancreatic cancer, large pancreatic cysts, chronic pancreatitis, long-term use of a medication called Sandostatin, or cystic fibrosis. There are six FDA approved pancreatic enzymes, which are available by prescription only: Creon, Pancreaze, Zenpep, Ultresa, Viokace, and Pertzye. Health stores sell over the counter enzymes as well, but these are not FDA regulated and the amount of enzymes they contain may differ from what is advertised. If you need to take pancreatic enzymes, you should only take those prescribed by your doctor.

Who needs to take pancreatic enzymes?

If you have a medical problem affecting your pancreas that does not necessarily mean you need to take pancreatic enzymes. You may want to discuss with your doctor if you notice any of the following: yellow, floating, or greasy stools or diarrhea, excessive gas, painful cramping after eating, or weight loss despite eating your usual amount of food. Most people only experience one or two symptoms. These are all signs of malabsorption, which means you may not be making enough pancreatic enzymes to digest your food and could benefit from taking pancreatic enzymes.

How many should I be taking?

The enzymes are dosed off of the units of lipase (the enzyme that digests fat) and they come in different doses, depending on the brand. Enzymes are often dosed between 500-2500 units of lipase per kilogram (kg) per meal. Additionally, half of the meal dosage should be taken with snacks. Depending upon the brand, enzyme dosages vary. For instance, Creon comes in 3,000, 6,000, 12,000, 24,000, and 36,000 units of lipase per pill. Most people take the 24,000 dosed pills, but some people find them too large to swallow and prefer to take smaller pills. As an example of what an appropriate dose range would be, for an adult weighing 150 pounds, a range  34,100 – 170,500 units of lipase per meal is appropriate. This would be between 1-5 pills per meal of the largest available dose, 36,000. As you can see, this is a large range and you need to work closely with your provider to assure you are taking the right amount.

How should they be taken?

Always take your enzymes as directed by your provider. I recommend taking the entire dose directly before your meal, or with your first bite of food. The enzymes should be effective for up to one hour so if you eat later than one hour after taking your enzymes, you will need to take another dose.

It is important that you do not store your enzymes in a warm place such as your pocket or in direct sunlight, as this can cause the medication to become ineffective.

Does it matter if I forget to take them?

If you forget to take your enzymes and only remember after you are done eating, it may not help to take them at that point. You may derive some benefit if you take your enzymes towards the end of the meal if you forgot to take them initially, however this is not ideal. If you are consistently forgetting to take your enzymes you may notice you are losing weight, have a change in your stool, or have excessive gas or pain after eating.

Why am I still experiencing malabsorption or losing weight after I started on my enzymes?

A few things could cause your enzymes to not work effectively. Your small intestine needs to have a certain pH level, meaning the environment cannot be too acidic. If your pancreas doesn’t make enough bicarbonate (a substance that lowers the acid level in your small intestine), your pH level may be too acidic, which prevents the enzymes from working properly. Another possibility is the dose you are taking may not be effective to digest the amount of fat you are consuming. It is best to take the right amount of enzymes rather than to be overly restrictive in limiting your dietary fat. Sometimes a patient may benefit from trying a different brand, as each enzyme has slightly different ratios of all three digestive enzymes (lipase, protease, and amylase).