Anyone tried over the counter enzymes to help digest fat post whipple?

Thank you for your reply. After the attending the EATING & NUTRITION w/PANCREATIC CANCER seminar, I called my Dr. He has just put in the script for Creon. I should get it in a few days. We are starting on the low end 24,000 units. We may increase the dosage based on how things go. As was stated in the webinar, what concerns me about the over the counter enzyme supplement is the filler they use. Since this is not regulated, one doesn't really know what is in the capsules with the enzymes. That makes me nervous.

Some tips on taking enzymes-every brand differs and requires it be optimized for each meal specific to the contents of the meal. Until not long ago, it was a process of trial and error of keeping a daily food journal noting what the meal consisted of, the number of capsules taken and then noting symptoms and characteristics of the stool 24-40 hours later which is the time for digestion and passage of food in most adults.

Now there is an on-line dosing calculator at https://digestthis.ca. After registering on the site, you input your weight and the brand of pancrealipase. Next you select meal type and ingredients and portion size for the meal are listed. Select all the food items in the meal and press calculate and it will determine the number of capsules required.

One of the most common mistakes I see in people taking digestive enzymes is taking the capsules before the meal. The first capsule is taken immediately before or after the first bite of food. When more than one capsule is required, they should be staggered throughout the course of the meal. Then Rx brands are enteric coated for timed release. When the capsule reaches the alkaline pH of the small intestine, the first batch of microspheres become immediately activated. A second batch is activated 15 minutes later and the third at 30 minutes. That is what enteric coatings are designed to do. As a result, it assures a consistent amount of enzyme available to digest food throughout the meal.

In a normal pancreas, enzymes are released in response to food entering the small intestine and a hormone released that binds with receptors in the pancreas to produce and secrete amylase, lipase and protease followed by the pancrease then making bicarbonate HCO3 which increased the alkalinity where enzymes perform best. This is combined with water to flush the pancreatic ducts into the intestine.

The goal of the patient is to take enzymes to mimic how the pancreas would supply them to the intestine. Taking a capsule or all well ahead of the meal defeats the purpose. They start activating and their activity is depleted over a short period of time. If you take a capsule 30 minutes before a meal, then 66% of the enzyme activity is depleted before ever encountering food. The last 33% having the enteric coating to prevent activation until 30 minutes after swelling is all that is left and likely not enough for the size of the meal. This leads to malabsorption and GI tract issues.

So for best results, take the first capsule immediately at the start of the meals and when more than one capsule is required, stagger by taking the remaining at even intervals to ensure a consistent level of enzyme is available to combine with the food to throughly digest.

On the subject of vegetables, the high fiber vegetables like peas, corn, beans, broccoli, cauliflower, cabbage, Brussels sprouts and others are comprised of complex carbohydrates called oligosaccharides. In a healthy person, these vegetables are hard to digest because the human pancreas does not produce the enzyme needed to digest oligosaccharides called alpha-d-galactosidase. Pancrealipase does not contain alpha-d-galactosidase. To digest these vegetables and prevent gas from forming at its source, the OTC product Beano is alpha-d-galactosidase. Taken with meals containing oligosaccharides will prevent gas from forming.

Flatulence
https://flatulencecures.com/vegetables-that-cause-gas/
https://www.beanogas.com/
Regarding differences between the Rx and OTC brands, the main difference is the Rx brands use enteric coating. They also have a higher amount of lipase. Whether Rx or OTC, the purity of the binders and fillers are regulated by the FDA. OTC brands are required to adhere to FDA regulations just as the Rx brands. Another difference is that the Rx brands have a more rigorous quality control regarding concentration. The manufacturers titrated the enzymes to match the concentrations within +/-10% of the stated value. The OTC brands can vary considerably more. This is a more important parameter for those on a very strict diet and infants then the average patient.

Some tips on taking enzymes-every brand differs and requires it be optimized for each meal specific to the contents of the meal. Until not long ago, it was a process of trial and error of keeping a daily food journal noting what the meal consisted of, the number of capsules taken and then noting symptoms and characteristics of the stool 24-40 hours later which is the time for digestion and passage of food in most adults.

Now there is an on-line dosing calculator at https://digestthis.ca. After registering on the site, you input your weight and the brand of pancrealipase. Next you select meal type and ingredients and portion size for the meal are listed. Select all the food items in the meal and press calculate and it will determine the number of capsules required.

One of the most common mistakes I see in people taking digestive enzymes is taking the capsules before the meal. The first capsule is taken immediately before or after the first bite of food. When more than one capsule is required, they should be staggered throughout the course of the meal. Then Rx brands are enteric coated for timed release. When the capsule reaches the alkaline pH of the small intestine, the first batch of microspheres become immediately activated. A second batch is activated 15 minutes later and the third at 30 minutes. That is what enteric coatings are designed to do. As a result, it assures a consistent amount of enzyme available to digest food throughout the meal.

In a normal pancreas, enzymes are released in response to food entering the small intestine and a hormone released that binds with receptors in the pancreas to produce and secrete amylase, lipase and protease followed by the pancrease then making bicarbonate HCO3 which increased the alkalinity where enzymes perform best. This is combined with water to flush the pancreatic ducts into the intestine.

The goal of the patient is to take enzymes to mimic how the pancreas would supply them to the intestine. Taking a capsule or all well ahead of the meal defeats the purpose. They start activating and their activity is depleted over a short period of time. If you take a capsule 30 minutes before a meal, then 66% of the enzyme activity is depleted before ever encountering food. The last 33% having the enteric coating to prevent activation until 30 minutes after swelling is all that is left and likely not enough for the size of the meal. This leads to malabsorption and GI tract issues.

So for best results, take the first capsule immediately at the start of the meals and when more than one capsule is required, stagger by taking the remaining at even intervals to ensure a consistent level of enzyme is available to combine with the food to throughly digest.

On the subject of vegetables, the high fiber vegetables like peas, corn, beans, broccoli, cauliflower, cabbage, Brussels sprouts and others are comprised of complex carbohydrates called oligosaccharides. In a healthy person, these vegetables are hard to digest because the human pancreas does not produce the enzyme needed to digest oligosaccharides called alpha-d-galactosidase. Pancrealipase does not contain alpha-d-galactosidase. To digest these vegetables and prevent gas from forming at its source, the OTC product Beano is alpha-d-galactosidase. Taken with meals containing oligosaccharides will prevent gas from forming.

Flatulence
https://flatulencecures.com/vegetables-that-cause-gas/
https://www.beanogas.com/
Regarding differences between the Rx and OTC brands, the main difference is the Rx brands use enteric coating. They also have a higher amount of lipase. Whether Rx or OTC, the purity of the binders and fillers are regulated by the FDA. OTC brands are required to adhere to FDA regulations just as the Rx brands. Another difference is that the Rx brands have a more rigorous quality control regarding concentration. The manufacturers titrated the enzymes to match the concentrations within +/-10% of the stated value. The OTC brands can vary considerably more. This is a more important parameter for those on a very strict diet and infants then the average patient.

Pancrealipase Use Tips for Thanksgiving and other festive occasions

I meant to post this ahead of the Thanksgiving holiday but hope it reaches and benefits those that see this post……

With Thanksgiving upon us, those with Exocrine Pancreas Insufficiency (EPI) can take a few measures to prevent discomfort when eating large meals. There will be many ingredients that can challenge one’s digestive tract. Meals containing lots of fats, sugar, protein, carbohydrates, high-fiber vegetables and beans composed of complex carbohydrates called oligosaccharides will be encountered.

To enjoy the Thanksgiving meal, I have found the following tips helpful:

Don’t skimp on taking extra capsules of pancrealipase (Creon, Zenpep, etc).

Take small portions of items and a pancrealipase at the start.

Eat slowly and chew all ingredients thoroughly.

Take an extra capsule for items of higher fat content and stagger taking additional capsules throughout the meal. Each time you refill your plate, take another capsule.

Take a pause before going back for extra helpings. Spread out the servings and avoid overeating.

By slowing down my ingestion, smaller meal portions spread out over time and taking an ample amount of pancrealipase has been very effective for me without any digestive discomfort during and after Thanksgiving. I generally take 6-10 capsules of Creon throughout the Thanksgiving meal with satisfactory results.

Vegetables such as corn, peas, asparagus, broccoli, cauliflower, cabbage, Brussels sprouts, beans, etc., are composed of oligosaccharides. They require the enzyme alpha-d-galactosidase to be digested. This enzyme is not blended into any Rx or OTC pancrealipase capsule. It is available as the OTC product Beano. Taking a capsule of Beano with vegetables and beans will digest food items without the formation of gas, bloating or cramping.

Should gas and bloating form after the meal, simethicone-based OTC medications Phazyme and Gas-X will break up pockets of gas making it easier to expel.