Pancreatic Enzymes
Pancreatic insufficiency occurs when the pancreas cannot make or transport enough digestive enzymes needed
to break down the food in the intestine for use by the body. Pancreatic enzymes are natural chemicals that
help break down fats, proteins, and carbohydrates. There are three common pancreatic enzymes – lipase,
protease, and amylase used to break down fats, proteins, and carbohydrates, respectively. Malabsorption of
nutrients can occur as a result of pancreatic insufficiency, since consumed foods are unable to be properly
broken down and used by the body.
Symptoms
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Stomach bloating and distention
Cramping following meals
Feelings of indigestion
Excessive gas and belching
Foul smelling gas or stools
Frequent stools after meals
Fatty(greasy) or floating stools
Diarrhea or loose stools
Weight loss
Types of enzymes
When the pancreas does not produce enough enzymes to break down food, pancreatic enzyme products are
needed. Pancreatic enzyme products are also known as pancrealipases. There are two categories of
pancrealipase products:
! Prescription or Food and Drug Administration (FDA) approved enzymes
! Non-prescription or Over the Counter (OTC) enzymes
Some brand name prescription enzymes are the following: Zenpep®, Creon®, Ultresa™, Viokace™, and
Pancreaze®, and Pertzye®.
It is recommended to use prescription enzymes since they are better regulated than over the counter products.
The FDA ensures that the manufacturing process of prescription enzymes is consistent and that products are
safe and effective. Non-prescription enzymes, on the other hand, are labeled as dietary supplements by the
FDA, and follow a different set of regulations. Contamination is a cause for concern with over the counter
enzymes due to inconsistencies in the manufacturing process.
Side effects
The most common side effect is constipation. Other less common side effects include abdominal cramps,
nausea or diarrhea.
Discontinue the use of pancreatic enzymes if any signs of hypersensitivity or allergic reaction appear. Pork is
used in the preparation of prescription enzymes and therefore individuals with allergies to pork or pork
products should work with their medical team to find an appropriate enzyme preparation.
Dosing
Recommended dosage varies on an individual basis. In general, 8,000-12,000 lipase units are consumed with
snacks and 16,000-36,000 lipase units with meals. Some individuals adapt to different doses of enzymes
throughout their care. As meal size increases, more pancreatic enzymes may be needed. It is important to
discuss with a doctor or dietitian the appropriate type and dose of pancreatic enzymes at regular visits.
Administration
• Enzymes must be taken at the start of every fat-containing snack or meal. When taking multiple
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enzymes, take some at the beginning of the meal and the rest at various points throughout the meal.
Enzymes generally do not work well if forgotten and only taken at the end of the meal.
Begin by taking the smallest dose required to minimize or completely eliminate symptoms.
Adjustments can be made at regular intervals, if necessary, after consulting with your dietitian and
doctor.
Swallow the capsules or tablets whole with liquid at the beginning of every meal. Do not chew or
crush.
Tips for best results
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Once a suitable brand is found, it is recommended that the same brand be continued.
Ensure the capsule or tablet is promptly swallowed once placed in mouth to avoid getting oral sores
that can occur if enzymes are held in the mouth for long period of time.
If size of capsule is difficult to swallow, empty contents of capsule onto a spoonful of soft food that
does not require any chewing (eg. applesauce) and consume immediately.
Capsule contents should not be added to dairy products as the high pH of such foods can damage
enzyme activity before reaching the stomach.
For ideal functioning of enzymes, do not take with calcium or magnesium containing antacids such as
Maalox®, Mylanta®, Tums® or Rolaids®.