A Daily Meal Plan for Exocrine Pancreatic Insufficiency

Every time you eat, your pancreas springs into action, making some of the digestive enzymes your body needs to break down the food and absorb the nutrients.e60dc2a1-f33c-4a05-9b50-8e3e8e59762911a1ab2f-bd3c-4098-9781-2b5955ccae5a These enzymes are normally secreted into the upper part of your small intestine, called the duodenum. But if you have exocrine pancreatic insufficiency (EPI) , your pancreas doesn’t make enough of these enzymes, which can result in nutrient deficiencies and symptoms such as abdominal pain , bloating, and diarrhea.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a5b80f0d-3cb9-414c-9ee9-d398f7f1460a To manage this condition, you’ll likely take pancreatic enzyme replacement therapy, or PERT, while carefully watching your diet.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a5b80f0d-3cb9-414c-9ee9-d398f7f1460a Cooking for yourself makes it easier to ensure that each ingredient is EPI diet-friendly.
Time Your Enzymes With Meals EPI is treated with PERT, which mimics the body’s natural pancreatic enzymes , says David E. Bernstein, MD , a professor in the department of medicine at the NYU Grossman School of Medicine and director of NYU Langone Health’s gastroenterology and hepatology ambulatory network on Long Island, New York. These replacement pancreatic enzymes include lipase, protease, and amylase, which are combined in pill form.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b5b4ee5b-18b8-4296-a361-edd29a310118 “How many of these pills you need to take is a bit of trial and error,” explains Dr. Bernstein. “Over time, you and your doctor will work out the best plan,” but enzyme pills always need to be taken right before every meal and snack. “Waiting until after you eat is too late,” he says. Time Your Enzymes With Meals
Eat a Healthy Diet Eat a well-balanced diet that includes whole grains, fruits, vegetables, lean meats, skinless poultry, seafood, beans, and low-fat dairy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629566e720a-dde5-4906-9bbe-b094ef0f0f69 You should also include healthy mono- and polyunsaturated fats in your diet, but try to limit your intake of foods high in saturated and trans fats, advises Alison Massey, RD, CDCES , founder of Flourish Nutrition Therapy and Wellness in Chesapeake Beach, Maryland. It’s recommended that you eat a diet that’s as close to normal as possible.e60dc2a1-f33c-4a05-9b50-8e3e8e59762942aa4b05-6a39-429c-b9cc-e69c0d3d5fb6 To make sure you’re eating the best possible foods, consider working with a registered dietitian , who can help you map out a diet strategy. Eat a Healthy Diet
Eat Smaller Meals Instead of eating three large meals, try breaking them up into four to six smaller meals over the course of the day.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915dc69a6-7681-439d-9776-043938760cb5 Massey suggests having some healthy protein at each meal and snack and limiting your total fat intake to 30 to 50 grams a day. Other tips: Bake, grill, or steam food rather than fry it. “Another important thing to remember throughout the day is to stay well hydrated,” Bernstein adds. Drink plenty of water and other clear liquids, and avoid sugary, caffeinated, and alcoholic beverages.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b43ce35e-0218-4070-9f37-37aa4139a337 Eat Smaller Meals
On the EPI Menu: Breakfast Start your day with a dose of protein, veggies, and whole grains.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292dbf4e0c-5b7b-4060-89b0-c621c91a394d Make an egg white omelet or tofu scramble filled with chopped tomatoes and peppers, and serve it with a slice of whole-wheat toast and fruit spread. Other good choices include fruit with protein-rich Greek yogurt or whole-grain cereal with low-fat milk, almond milk, or rice milk. If you drink tea or coffee, choose low-fat milk instead of cream, and stick to just one cup, as caffeine can cause symptoms, such as bloating, diarrhea, weight loss, and fatty stools.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292dbf4e0c-5b7b-4060-89b0-c621c91a394d One caveat: Monitor your symptoms when eating fiber (such as whole-grain toast) and adjust your fiber intake or PERT dosage accordingly, advises Debashish Bose, MD , medical director of surgical oncology at Mercy hospital in Baltimore. “Fiber can be irritating, especially if you’re already starting off with a bit of malabsorption,” says Dr. Bose. “If you’re effectively supplementing with PERT, fiber should be fine; it shouldn’t pose any greater problem for you than taking fiber normally. But if you’re passing a lot of fiber combined with the fat, it may make your symptoms worse.” On the EPI Menu: Breakfast
On the EPI Menu: Lunch Build your lunch around lean protein, such as skinless sliced turkey or chicken or tuna packed in water. Toss it into a salad or layer it with tomato and lettuce on whole-grain bread. And skip the high-fat condiments, such as salad dressing and regular mayo; instead, use mustard, flavored vinegar, or light mayo. On the EPI Menu: Lunch
On the EPI Menu: Dinner Keep your dinner portions small, such as 3 ounces of broiled fish with a half-cup of brown rice or couscous and sliced carrots or peas. Experiment with different whole grains to add variety to side dishes: Try quinoa , polenta, or kasha. For dessert, eat fresh fruit or, for something sweeter, fruit-based frozen yogurt, ice, or gelatin. On the EPI Menu: Dinner
On the EPI Menu: Snacks Eating snacks throughout the day will help boost your energy levels and provide you with some additional calories and nutrients. (Bonus: You’ll also be more likely to eat smaller meals.) Shelve the chips and dip and whip up a fruit smoothie made with almond or soy milk ; low-fat yogurt with a dash of vanilla extract and a banana; or a small cup of low-fat cottage cheese with fresh fruit. As with your main meals, remember to take your enzymes before each snack. On the EPI Menu: Snacks
Take Your Vitamins If you have EPI, your body can’t break down fats to absorb fat-soluble vitamins A, D, E, and K.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290f438c64-bdb2-4da5-8cec-9f1ff4729793 To make up for these losses, your doctor or dietitian may prescribe supplements. “The best time to take these vitamins is in the morning,” Bernstein says. In particular, vitamins A and E may help reduce inflammation, which can be present in your pancreas if you have EPI.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d96a9a1-c2b4-4ede-8b98-631c870fc041e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b4ba91c-3fc1-407c-9c88-49938cced58be60dc2a1-f33c-4a05-9b50-8e3e8e597629e9599b8f-b4bc-4b0f-9381-092fa41cebfa (Keep in mind, however, that you can have too much of a good thing — be sure to work with your doctor or dietitian to find out how much and which of these vitamins you may need.) Take Your Vitamins
Avoid These Foods In general, try to limit the amount of fat you eat — especially saturated fats from animal-based foods, such as butter, cream, fatty cuts of red meat, organ meat, and poultry skin.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cc3936bd-a623-4bff-b683-e39f8fe82681 Avoid fried, creamy, or cheesy foods. You’ll also want to avoid trans fat — a particularly unhealthy fat that’s often found in packaged food in the form of partially-hydrogenated oils, says Massey.e60dc2a1-f33c-4a05-9b50-8e3e8e59762985525190-c5cc-4d7b-abe1-6ef81b55d85f While it may take some planning, it’s possible to eat a healthy, satisfying diet. If you’re having problems putting together a meal plan, ask your doctor for advice or enlist the help of a dietitian. Avoid These Foods
The Takeaway Planning meals can be challenging when you have exocrine pancreatic insufficiency (EPI), a condition in which your body can’t produce enough of the digestive enzymes that break down foods. Treatment for EPI includes taking digestive enzymes in pill form whenever you eat to enable your body to break down foods and absorb sufficient nutrients. Eating a well-balanced diet that includes whole grains, fruits, vegetables, lean protein, and healthy fats is key, as is avoidance of triggers such as saturated fats, high fiber foods, and drinks that are high in sugar, caffeine, or contain alcohol. It can be tricky to figure out the right dose of enzymes for your diet, and you may need to take nutritional supplements, but working with your doctor and a registered dietitian can help.