While PERT is an effective and safe treatment for EPI, determining the ideal dosage of this prescription medication can be a challenge and take time, according to an article published in November 2019 in the Journal of the Pancreas, because response to the treatment can vary widely from person to person. The article notes that the main reason PERT may initially seem to be ineffective in some cases is that the dose is inadequate or ill timed, meaning more enzyme is needed or the drug isn’t being taken at the right moment to work as it should. “When pancreatic enzyme replacement therapy is started, the dose prescribed is often similar for adults across the board. But the biggest factor that influences the necessary enzyme amount is the degree of pancreatic insufficiency,” says Julie Stefanski, RDN, national spokesperson for the Academy of Nutrition and Dietetics. That can vary based on size, sex, and medical conditions, she says. Because trial and error can be a part of PERT treatment (and missed doses are a fact of life, no matter which medications you take), eating well is critical. “Fewer pancreatic enzymes or an insufficient PERT dose can lead to poor nutrient absorption, which means it’s important to maximize the quality of the foods you eat to prevent deficiencies and malnutrition,” Stefanski adds. That said, when the meds you’re taking aren’t accurately calibrated or you’ve missed a dose, your first priority is to ease your symptoms, rather than focus on overall nutritional quality. Your best bet: Pick easy-to-digest foods that are low in fat, fiber, and lactose, says Stefanski. Here are some easy-on-your-gut foods to reach for when your EPI symptoms are at their worst. Greek yogurt Skip regular cow’s milk yogurt and opt for lactose-free plain varieties. Or choose rich and creamy Greek yogurt, which is easier on the digestive system; it contains less lactose, thanks to the fermentation and straining methods used during production. Stefanski suggests trying Greek yogurt with fresh or frozen fruit, such as peaches, mixed in. White rice and pasta It’s not often that the more refined versions of grains are recommended, but in this case they’re best. The reason, says Stefanski, is that too much fiber from whole grains may block the activity of digestive enzymes and contribute to excessive bowel movements, painful gas, or bloating. Options here might include noodles with a bit of olive oil or cream of rice cereal with low-fat, lactose-free milk. Lean protein High-fat red meat and processed meats are no-gos when you’re trying to ease symptoms of EPI. Instead, your best bet is to choose lean meats, such as chicken or turkey breast, or broiled white fish, such as haddock, says Stefanski. When midday rolls around, pair some lean cooked chicken or turkey and a slice of lactose-free cheese in a tortilla for a portable lunch that’s also fast and tasty. Low-fiber fruits Lean hard on fruits with lower fiber content, such as cans of fruit cocktail or pears. Or try some canned pumpkin puree as a topping for hot cereal, such as instant oatmeal, in the morning. “It’s a good idea to experiment with different forms of fruits, vegetables, and grains to determine which combination helps you achieve the fewest symptoms,” says Stefanski. Egg substitutes Yolks are a source of healthy fat, but when you’re dealing with active EPI symptoms, it’s best to go with an egg substitute made with egg whites. “There’s really no such thing as ‘good fats’ when it comes to malabsorption, but rather the quantity of fat consumed will be the greatest influence on how someone feels after eating,” she says. Once your symptoms are in check, you can increase the amount of monounsaturated fats in your diet, such as those found in salmon and avocado, she adds.
