Tag: exocrine pancreatic insufficiency

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Pancreas Damage and Exocrine Pancreatic Insufficiency (EPI)

There are 2 major areas that this little and sensitive organ, that I did not even know existed before my life had ground to a halt, is crucial for:

  1. Endocrine. The side which handles the management of blood sugar levels in the body. It is very much in the news due to the massive (pre-) diabetes rates.
  2. Exocrine: The rarely mentioned, but just as important side which produces the enzymes necessary to break down proteins, fats and carbs into usable nutrients. Without these we would starve to death.

Exocrine pancreatic insufficiency (EPI) is a condition which occurs when the acinar cells in the pancreas are damaged or the organ is unable to deliver pancreatic juice in sufficient quantities, and at the right time, into the small intestine. The main enzymes the pancreas produces are:

● Lipase: enzymes that break down fats

● Protease: enzymes that break down proteins

● Amylase: enzymes that break down carbohydrates

EPI causes maldigestion and malabsorption of food. This causes microbiome dysbiosis, malnutrition and nutrient deficiencies, which in turn impact mitochondria, metabolism and metabolic pathways in the body. Subsequently, this can cause a great many downstream health effects, including ME/CFS symptoms.

An official EPI diagnosis is often done when around 90% of the exocrine functionality has been impacted, in part due to the difficulty in determining gradations of damage. However, your health can still be impacted through nutrient deficiencies even if a much smaller portion of the functionality is not optimal. Anything between 1 to 90% pancreatic enzyme insufficiency is something I have called pre-EPI (like pre-diabetes for the endocrine side of the pancreas).

Most doctors, especially family practice or primary care physicians, who are often the ‘gatekeepers’ to the specialists, are not experienced in recognizing the huge range of symptoms, and have no idea how to properly test for it. Even if you are eventually diagnosed by a specialist, potentially many years of suffering and further damage later, there is little practical comprehensive help.

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Often Overlooked and With Recovery Actions to Consider

For those struggling with Chronic Fatigue Syndrome (ME/CFS) and ailments that are wide ranging and difficult to diagnose, pancreas dysfunction and malabsorption are hardly ever considered as a possible link to many symptoms, both by doctors and sufferers.

Everyone is aware of the diabetes crisis, but the pancreas has another crucial but far lesser known function, the exocrine side, which produces the enzymes we need to digest and absorb our food. Any level of pancreatic enzyme dysfunction can cause nutrient deficiencies and subsequent health issues affecting the functioning of, for example, heart, lungs, intestines, brain, nerves, bones, muscles, neurotransmitters, hormones, immune system, mitochondria and microbiome, as it did with me.

Pancreas damage, specifically exocrine pancreatic insufficiency (EPI), causes malabsorption, nutritional deficiencies, and often related issues such as small intestinal bacterial overgrowth (SIBO), Candida yeast overgrowth, acid or silent reflux which exacerbate the situation. Over time your metabolism struggles, and metabolic pathways no longer function properly. The body’s mitochondria have a tougher time generating energy (ATP). This can subsequently have an impact anywhere in the body, cause vicious cycles, and hence be an underlying source of a wide variety of seemingly unrelated symptoms.

The long lasting impact of EPI and malabsorption on metabolism and mitochondrial functioning from chronic nutrient deficiencies is often overlooked.

Root causes and bodily insults that cause oxidative stress, mitochondrial dysfunction, microbiome imbalances and pancreatic damage are frequently not addressed comprehensively, to the detriment of the sufferer.

With EPI you have to look at the situation in an integrative and holistic way. There can be too broad a range of symptoms, all with their own medical specialties, so that the overal picture and root cause is lost. This can lead to many years of unnecessary suffering and a diagnosis that is established much, much later.

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Treatment Part 2 – Deficiency Rebalancing

There are a few areas which may require specific supplementation attention for those with pancreas damage, especially for exocrine pancreatic insufficiency (EPI) sufferers. This was needed to help me heal and start functioning again. A few key groupings of nutrient rebalancing which helped me, not just with EPI, but also many of the downstream effects of exocrine pancreatic insufficiency are:

1. Deficiencies Rebalancing:

● Macronutrients

Calories for energy through carbohydrates, proteins, fats.

● Micronutrients

Vitamins, minerals, trace elements.

● Phytonutrients

Plant based chemicals such as carotenoids or flavonoids.

● Fatty Acids:

Essential omega-3, -6, and nonessential omega-9.

● Amino Acids:

Essential and nonessential building blocks of protein.

2. Mitochondrial and Chronic Fatigue Syndrome (CFS) Support

Mitochondria are essential organelles in animal and plant cells which are, simply put, the energy power plants of our cells. ATP (adenosine triphosphate) is the energy storage that they produce. They are in almost all our cells, and the heart, liver, pancreas, kidneys and muscles contain large amounts due to their high energy demand. Any dysfunction in the mitochondria can have a large impact on your health. Due to the long-term nutrient deficiencies, the energy producing mechanism was possibly no longer functioning optimally. ATP production in cells needs to be supported as much as possible during the healing and recovery time, and beyond. In my case the downstream effects of nutrient deficiencies also caused chronic fatigue symptoms. Providing additional supplementation beside a very healthy balanced diet helped resolve many of my symptoms. Some of the supplements I used included:

● Amino acids

● Antioxidant support

● Intestinal healing support

● Methylation support

● Mitochondrial support

● Neurotransmitter support

● Omega-3

● SIBO, Candida yeast overgrowth resolution support

● Vitamins and minerals

It is important to note that I did do a lot of nutrient testing as well to keep track of improvements and of areas that required more focus. Supplements were cycled in and out, fine-tuned, and after imbalances were resolved taken out of the mix. I now sporadically take supplements if I feel or see an imbalance either through test results or symptoms, as you will learn to listen to your body better through the whole process.

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Treatment Part 1 – PERT or Pancreatic Enzyme Replacement Therapy 

Maldigestion is an impaired breakdown of nutrients through either lack of digestive enzymes and/or gastric acid production issues. This in turn causes malabsorption, as nutrients are not broken down into useful absorbable components, which then causes malnutrition. With EPI, you are slowly and painfully starving to death, first nutritionally and eventually completely. Your muscle tissue and bones are used up internally as nutrient fuel. This is when pancreatic enzymes come into the picture.

Pancreatic enzymes are absolutely crucial for survival and to improve quality of life when you have EPI. The generic term for these enzyme pills is Pancrelipase. I have been prescribed Pancrelipase pills called Creon as well as Pancreaze, which are some of the few prescription brands of pancreatic enzyme replacement pills. They are essentially pancreatic enzymes such as lipase, amylase and protease from a pig’s pancreas in tightly controlled quantities.

PERT or Pancreatic Enzyme Replacement Therapy is getting a prescription of one of the available Pancrelipase medications and start dialing in the quantities you need for your personal situation and diet. This will take a bit of trial and error in the beginning, but many doctors start with 36,000 units of lipase, which is how the pill sizes are noted as. They all contain amylase and protease as well at different quantities, and in addition many are enteric coated.

Enteric coated

Importantly, the Pancrelipase pills need to be able to get through the stomach acid bath into the duodenum where the pancreatic enzymes are needed for further digestion, therefore many of them are enteric coated.

There are also many over the counter digestive and vegetarian type of enzyme supplements containing, e.g., bromelain and papain. But, this will not be sufficient because of how crucial it is to get very specific and controlled amounts of enzymes for each meal, as well as likely not being enteric coated.

Some FDA approved Pancrelipase medications that are available are:

● Creon®

● Pancreaze®

● Pertyze®

● Ultresa®

● Viokace®

● Zenpep®

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Causes of Exocrine Pancreatic Insufficiency (EPI)

EPI causes maldigestion and malabsorption of food. This causes malnutrition and nutrient deficiencies, which in turn impacts the metabolism and metabolic pathways in the body, and subsequently can cause many downstream health effects.

Some known causes of EPI are:

● Pancreatitis

● Infections

● Cancer

● Cystic fibrosis

● Duct obstructions

● Surgery

● Pancreas atrophy

● Alcohol abuse

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What is EPI or Exocrine Pancreatic Insufficiency?

Exocrine pancreatic insufficiency (EPI) is a condition which occurs when the acinar cells in the pancreas are damaged or the organ is unable to deliver pancreatic juice in sufficient quantities, and at the right time, into the small intestine. The main enzymes the pancreas produces are grouped as follows:

● Lipase: enzymes that break down fats, such as pancreatic lipase, cholesterol esterase, and phospholipase.

● Protease: enzymes that break down proteins such as elastase, carboxypeptidase, trypsinogen and chymotrypsin.

● Amylase: enzymes that break down carbohydrates.

error: Primal Pancreas
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