Exocrine Pancreatic Insufficiency or EPI
Damage of the pancreas, especially EPI or exocrine pancreatic insufficiency, can have many seemingly unrelated symptoms. This includes issues with heart, lungs, intestines, spine, hormones, neurotransmitters, muscles, tendons, bones, nerves, mitochondria, eyes, brain, chronic fatigue, microbiome, etc. Even though the practical steps will also help those with endocrine issues of the pancreas such as diabetes, the focus of the book is on the lesser known but just as crucial exocrine pancreas side of the crucial organ.
Over a third of the US population has pre- or full-blown diabetes and some studies point to around 25-50% of those with diabetes also having exocrine pancreatic issues. Diabetes 3c sufferers will also have EPI. Officially an exocrine pancreatic insufficiency (EPI) diagnosis is done when around 90% of the function to produce and distribute the essential enzymes needed for digesting carbohydrates, proteins and fats into usable nutrients is gone.
However, exocrine pancreas damage can be much lower than 90% and thus not even get an official diagnosis, but still have devastating effects. The pancreas is the canary in the modern Western food supply, and the book brings forward the concept of pre-EPI (just like pre-diabetes) where you still digest and absorb your food, but just not as effectively due to lacking a percentage of pancreatic enzymes. Over time, people will then get specific nutrient deficiencies with its subsequent health effects and vicious cycles, as metabolic pathways and mitochondria stop functioning optimally.
Health impacts like SIBO, Candida yeast overgrowth, microbiome dysbiosis, oxidative stress, low testosterone, silent reflux, food sensitivities and premature aging are all covered as linked elements. Myalgic encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS), which can be debilitating and long lasting, is also linked as one of the lesser known but horrible downstream effects of exocrine pancreatic insufficiency (EPI).
Malabsorption, Nutrient Deficiencies, Pancreas Damage, Exocrine Pancreatic Insufficiency (EPI)
Nutrient Deficiencies
Many symptoms (in my case many dozens) can have a possible root cause in chronic nutrient deficiencies causing subsequent issues with your metabolism and mitochondrial functioning. When you have any issues with nutrient deficiencies it is worthwhile to dig deeper.
Malabsorption and maldigestion are not to be taken lightly. Issues such as low stomach acid, acid reflux, silent reflux, gastritis, bloating, excess gas, stool issues, food sensitivities, stomach and intestinal pains, small intestinal bacterial overgrowth (SIBO), Candida overgrowth, gallbladder issues, electrolyte imbalances, pancreas issues including (pre)diabetes, pancreatitis and exocrine pancreatic insufficiency (EPI), Chrohn’s, celiac, IBD, leaky gut, microbiome dysbiosis, to name a few, can all be related to malabsorption.
Of course there are many more, but here is a selection of tests to consider in this case:
Tests to Consider
- Nutrient level and Organic Acid testing such as Genova FMV or Great Plains Lab Organic Acid Test (OAT). Beside nutrient markers, there are markers that check for both bacterial and fungal dysbiosis, and malabsorption. It also has a section pertaining to neurotransmitter markers. The ‘Essential and Metabolic Fatty Acids Markers’ add-on is also very helpful.
- Comprehensive Stool test for parasites, pathogenes, dysbiosis: E.g. Genova Diagnostics – Comprehensive Digestive Stool Analysis 2.0 with Parasitology (microbiome dysbiosis indicators), and
- Fecal Fat Distribution (checks if you have issues with different types of fat intake and digestion)
- Elastase (for EPI, pancreas enzyme marker)
- Chymotrypsin (for EPI, pancreas enzyme marker).
- Doctor’s Data has similar tests.
- SIBO and Candida overgrowth: With SIBO, both methane and hydrogen ones should be tested and tackled. A breath test for SIBO and something such as Genova FMV or Great Plains Lab Organic Acid Test (OAT) can be helpful here.
- Fasting blood sugar tests: e.g. HbA1c, triglycerides, c-peptide, insulin, ketones, glucose. These are also a good indicator of diet quality and excess carbohydrates and sugars in the diet.
- Lactose intolerance: Easy to test yourself.
- Food sensitivities: Any food allergy and sensitivity tests as well as gluten allergy tests
- Stool test pancreatic elastase: A standard test for exocrine pancreatic insufficiency
- Blood test fasting trypsin: to see if you produce enough enzyme for protein breakdown
- Stool test chymotrypsin: similar to, but not as accurate as elastase
- Intestinal permeability: Intestinal permeability (a.k.a. leaky gut) is worth checking.
- Cyrex Laboratories – Intestinal Antigenic Permeability Screen. It measures intestinal permeability to large molecules, which can cause autoimmune reactions, inflammation, food sensitivities, malabsorption, etc.
- Gallbladder function: Yet another element that is important in breaking down food and thus any gallbladder issues can cause malabsorption. For example MRI of the abdomen with MRCP.
- MRI of the abdomen with MRCP with contrast: It gives a 3D picture of the gallbladder and high resolution liver, pancreas, gallbladder, ducts, stomach intestines. Amazing test.
- Stomach acid: Is your pH low enough to start digesting food? If it is too high this will exacerbate any SIBO, candida overgrowths, and malabsorption. Are you taking antacids or PPI as these only cover symptoms, do nothing about root cause, and can make things much worse. Have you tried the following simple selftest:
A simple unscientific test to approximate acid level is by drinking a quarter teaspoon of baking soda (sodium bicarbonate) mixed in a glass of water on an empty stomach in the morning. This creates bubbles within two to three minutes when mixed with the hydrochloric acid in your stomach. If after five minutes nothing happens, there is a very good chance the pH of your stomach acid is too high (i.e., low stomach acid).
Food and Drink Quality
nd of course, with any nutrient or malabsorption issues, an honest and hard look has to be taken at everything that is put into your mouth. I always thought I ate healthily, but little did I know until many years of slow creeping damage ended with my pancreas damaged beyond repair, SIBO and Candida overgrowth, acid reflux, gastritis, systemic inflammation, nutrient deficiencies, and an endless list of symptoms.
It is one of the few things you have complete control over, yet it is very difficult to navigate through the noise, marketing power, pseudo medical organization messages, pseudo research news, blatant misinformation, lack of affordable access, chemical, herbicide, hormone, pesticide exposure, poor nutrition education (that includes doctors b.t.w.) starting from the food pyramid (tainted by the food industry) taught to children onwards, and just sheer lack of knowledge. Add to that your own personal sensitivities (which can take a while to determine) and preferences, and it turns out it is not that easy.
Some questions to ask yourself are:
- Have you kept a food diary for a while and note how you feel and whether there are correlations?
- Do you still eat in restaurants or cafes as there is no control on quality and ingredients that could be impacting you?
- How many grams of carbs do you eat and drink per day and per meal?
- Do you consume a lot of processed, refined, packaged, canned, non-organic food and drinks?
- What is the quality of the protein?
- Do you eat enough healthy fats?
- How much starch, potato, rice, legumes, pasta, grains, cereals, bread, etc. do you eat?
- Do you east highly processed, partially hydrogenated GMO oils (canola, corn, soy, etc.) and trans-fats?
- Do you drink any calories? If so, any sugar of any kind, chemicals, or unrecognizable ingredients in them?
- Of course smoking and alcohol are no-brainers when you are not doing well.
- What is the quality of your water? Are you drinking, e.g. mineral, well, tap, bottled (plastic or glass), chlorinated (all US tap water), fluoridated (all US tap water), reverse osmosis, reverse osmosis with minerals added back in, filtered (what kind?), restaurant or cafe water, etc.?
Exocrine Pancreatic Insufficiency (EPI) and Pancreas Damage Book
