The Whipple procedure respects the head of the pancreas-the section which contains the vast majority of acinar cells which produce and secrete the digestive enzymes amylase, lipase and protease. In many patients, it causes Exocrine Pancreas Insufficiency (EPI) also referred to as Pancreas Enzyme Insufficiency (PEI). The result is inability to digest food leading to diarrhea, loose stools, excessive malodorous gas, cramping, urgency of bowel movements, leakage, floating stools, greasy sheen on toilet water surface. Malabsorption and weight weight loss result and it has a significant impact on quality of life.

The condition is treated by Pancreatic Enzymes Replacement Therapy (PERT). In the US, there are five Rx brands (Creon, Zenpep, Viokace, Pertzye and Pancreaze. A physician will suggest a starting dosage on the number to take for a meal or a substantial snack. In most patients, they will need to optimize the dosage and this is is now more easily accomplished using an on-line dosing calculator at https://digestthis.ca.

The different brand of enzymes do not always perform exactly the same in a single patient. This is due to differences in manufacturing processes. If the desired results are not achieved with a specific brand, the manufacturers and registered dietitians suggest evaluating another brand. Capsules are to be taken with a meal, not before as the enzymes have a limited time of activity. When multiple capsules are required, they are to be taken staggered through the meal.

I went through all the symptoms you described after my Whipple as I was not prescribed a pancrealipase. Eventually I figured out what was going on and advocated for a Rx pancrealipase. The effects for me were immediate. It ameliorated all the symptoms. No more urgency, no leakage, stopped the malabsorption and I gained weight and it stabilized at a healthy BMI. If you were prescribed a pancrealipase, then it is likely ineffective and another brand should be evaluated.

Pancreatic Enzymes

PANCAN WEBINAR ON DIET, NUTRITION AND TAKING ENZYMES