Specifically, the right diet can help ease EPI symptoms and prevent nutritional deficiencies. One of the best ways to ensure your diet meets your specific needs is to work with your doctor and a registered dietitian.

How EPI Affects Your Body

To understand why working with a dietitian is essential, it helps to first know how EPI affects your body, especially your pancreas. The pancreas is a small organ, but it plays a big role in digestion. Part of its job is to produce enzymes necessary to break down food so the body can absorb essential nutrients. Damage to the pancreas impairs the release of these enzymes. EPI is most often the result of another medical condition, such as cystic fibrosis (CF), chronic pancreatitis, pancreatic cancer, inflammatory bowel disease, or diabetes, or surgeries to the pancreas or stomach, says Bridget Doyle, a registered dietitian at Loyola University Medical Center in Chicago. “EPI is a condition where there is poor digestion and absorption of nutrients,” she says. Fat is the nutrient most affected. If your body is unable to digest foods properly, you may experience uncomfortable symptoms, such as stomach cramps, nausea, and diarrhea. This can also lead to unintentional weight loss and malnutrition. People with CF, for example, may need to eat 1.5 to 2 times the number of calories compared with people who don’t have CF, notes the Cystic Fibrosis Foundation. This often means eating a diet where 40 percent of calories come from fat. “Type 1 or 2 diabetes can also lead to EPI,” notes Kristi L. King, a senior dietitian at Texas Children’s Hospital in Houston. For people with both diabetes and EPI, carbohydrate and fat intake may be limited. A dietitian can also help tailor your eating plan to the severity of your EPI. People with mild EPI, for example, may benefit from a lower-fat diet, while more severe insufficiency may require a higher fat diet “to optimize calories to maintain or gain weight,” says Doyle.

Working With a Dietitian to Design a Balanced Diet for EPI

One key benefit to working with a registered dietitian to make adjustments to what you eat is that it can help ease EPI symptoms such as bloating, abdominal pain, and diarrhea. Aim for a balanced diet with healthy, unsaturated fats alongside lean protein, fruits and vegetables, and whole grain carbohydrates, Doyle recommends. Based on your individual needs, a dietitian can help you understand what foods you should be eating and why. They can also give you specific meal suggestions and tips on how to prepare them. For instance, King advises those with EPI to avoid fried foods and cream sauces, because they can cause digestive discomfort. (Moderate amounts of healthy fats can and should be a part of a healthy diet, though, if you have EPI.) “People with EPI may be very underweight and malnourished,” King says. “So we focus on all the health conditions patients are facing and design a plan they can follow that will help them feel better.” To create a balanced diet for EPI, here are six tips that a dietitian may suggest.

  1. Choose fats wisely. The amount of fat you should eat depends on your height and weight, as well as your symptoms. “We really stress that fat is still an important component of the diet, so we discourage avoiding fat. Fat is an essential nutrient needed for cell growth, protecting organs, and regulating body temperature,” says Doyle. These fats should come from unsaturated sources, such as unsaturated oils, avocados, nuts, seeds, and fatty fish, she advises. Your doctor or a registered dietitian will help you determine how much fat is appropriate for you.
  2. Add in vitamins. Most people with EPI need some type of vitamin supplementation, particularly fat-soluble vitamins, King says. Low levels of vitamin D can boost the risk of bone disease, for example. You’ll want to make sure you’re consuming foods higher in the fat-soluble vitamins A, D, E, and K, Doyle advises. “Eat more dark green leafy vegetables for vitamins A and K and nuts like almonds and peanuts for vitamin E.” This is where management by a care team is so critical. “We screen for vitamin deficiency, and many times we do need to recommend oral supplementation,” says Doyle. Your dietitian or doctor can advise you on which vitamins you should take and in what doses.
  3. Boost omega-3s. People with EPI also tend to have insufficient levels of essential fatty acids. This puts you at higher risk for high triglycerides, which can affect heart health. “An omega-3 fatty acid supplement may be needed,” King says.
  4. Think small. It’s also important to have four to eight small meals a day, rather than three big meals, says King. Eating more frequent, smaller meals can aid in nutrient absorption and may lead to less digestive distress.
  5. Hydrate often. Drink plenty of water and avoid alcohol, which can lead to dehydration and tax your digestive system. A good rule of thumb is eight 8-ounce glasses of water a day. Other beverages, such as tea or 100 percent fruit juice, count, too.
  6. Consider enzyme replacement therapy. You may also benefit from pancreatic enzyme replacement therapy (PERT). “These enzymes are prescribed by a physician and taken with meals and snacks to help break down fat and reduce uncomfortable gastrointestinal symptoms,” King explains. Your dietitian will help you manage PERT and teach you how to adjust the dose of enzymes based on the fat content of your meal, says Doyle. For example, you may need to take two enzyme pills with a turkey sandwich but four with something fattier like pizza. Weight loss is also a concern for people with EPI. If you’re losing weight despite PERT, and symptoms (fatty, foul-smelling stools, for example) indicate that you’re not absorbing food well, you may be advised to adjust your PERT doses accordingly, she says.

How to Find a Registered Dietitian

Working with a registered dietitian experienced in EPI can be helpful, and King suggests starting that search with the Academy of Nutrition and Dietetics and talking with your doctor. “Gastroenterologists and endocrinologists usually have dietitians they refer their patients to,” she says, “so it’s important to actually take that step and ask for help.” How long you will need to work with a dietitian depends on the extent of the changes you need to make and how comfortable you are with your treatment plan. “The goal is to make sure people have the confidence to continue on the path that is keeping their condition in check,” King says. A virtual doctor appointment (conducted over a telehealth platform on your computer or phone) may also be an option for you. “In my experience, EPI is a condition that I feel [appointments] can be just as effective virtual as face-to-face,” says Doyle. “Over the past two years, I’ve seen many patients virtually, and we’re able to manage their diet and enzymes.” The additional benefit is that you may be able to work with a dietitian more frequently, especially if you live farther away from the office and time and transportation are issues. And if you’re making any lifestyle or dietary changes, you should talk to your doctor. “The physician, patient, and registered dietitian can make a very powerful team,” King says. “Keeping your doctor and dietitian in the loop about what you’re doing and any changes you’re making helps ensure you get the best possible care.” It may take a little work to find a balanced diet that addresses your needs, but the effort is well worth it. Talk to your doctor and a registered dietitian to find a diet that works for you. Additional reporting by Jessica Migala