I think the difference in diet recommendations are likely a result of the physician's experience with the disease and what has and has not worked for their patients. A compromised pancreas makes it more difficult to digest all food and fat is the most difficult of the three types of food we consume to digest. If you have had no problems with consuming fat, I am envious. Even with digestive enzymes (I have also taken Zenpep at near the level you do as well as pancrealipase (sp?) and another generic enzyme before they were removed from the market), most of us with EPI are racked with pain after eating large amounts of fat. I don't try to get to zero grams, but something below 40 grams works best for me. I also try to avoid large meals instead opting for 4-6 of 300 calories or less. My total calorie goal is about 1600/day unless I have an unusually long exercise session or golf when I am losing lots of fluids.

Wow, totally different. I have no pain after eating, even larger meals. Sorry.

How about your weight? Did you lose weight? Etc.

I have no idea how I got EPI. Never have had pancreatitis or nor was I a heavy alcohol drinker.

I read someplace that only 8 out 100,000 have EPI. Knowing that, I am not certain how much experience any GI doctor could have.

Gman007 Thank you for your reply and the information on supplements.I take all of these and a lot of antioxIdants alphs lipoic acid, N A C,acetyl.-l-cartinine ,vit a ,e selenium . A lot of the ones i take help with brain function.I like to be able to think clearly,and at almost 80 that takes more working at.I agree with bobinthevillages about the lack of experience any GI Dr has.here is a web sight on dosing of creon wwwcfhcp/dosingguide. I think that is the one that says Too high dose of creon is associated with FIBROSING COLONOPATHY. i have less pain if i have smaller meals and control my stress.I am going to try to contact the collage here in Austin to try to find a Dr with more experience treating EPI any information on that would be good

Bob, my experience has been that major pancreatic treatment centers are where you find docs who have the most experience with anything pancreatic. I live in upstate SC, about a three hour drive to the Medical Univ. of SC and they have some amazing doctors there who treat everything related to the pancreas and in large amounts. My surgeon is recognized as one of the best in the US and also does a lot of work in the Hollings Cancer Center there with patients who have pancreatic cancer. They also have some great endoscopy therapist's who have given me tremendous relief with stents to help pancreatic drainage and a balloon therapy that has removed pancreatic stones. I think it is likely to be these type of high volume centers where the best doctors for less common illnesses are to be found. I know the May Clinic facility in Jacksonville, FL has some very prominent pancreas docs as well as one of the top surgeons.
My weight has gone up since I was dx'ed. Some of that is related to constant inflammation of my pancreas and stomach in general (pancreatic issues have led to the discovery, if not the cause, of IBS-C, a very peptic stomach, highly acidic, some minor colon issues, etc., etc., etc...) and some is related to a lot lower level of activity due to simply not having the energy to exercise, and the fact that my pain meds make me hungry which is the reverse of many folks reaction. I am also insulin dependent as a result of lower insulin production in my pancreas as I have lost at least a third of my beta cells, if not closer o a half. I gained about ten pounds over the first several weeks of insulin use. My weight can also vary by ten pounds over 2-3 days depending on the level on inflammation around my pancreas. During my longest hospitalization for an acute attack I went from about 225 lbs. to 255 and back down to 205 within three weeks. That is comparable to a gestation period of pregnancy with the weight changes in 3 weeks instead of 37.
Sorry, I tend to be overly verbose. How did you discover you had EPI and does that mean you are insulin dependent? Is the primary result of your disease being a lack of digestive enzymes? How long have you been dx'ed with EPI?

Thank you for this excellent information. I currently live in Central Florida, The Villages, a massive retirement community. However, it is likely I will be moving to Amelia Island in April, so your suggestion to go to the Mayo Clinic in Jacksonville is a great resource.

I was having urgent diarrhea in the middle of the night 3-4 times a week. Earlier this year after seeing my family doctor and a urologist I finally got to GI doctor. He did a colonoscopy and ordered some stool tests. All the tests came back normal except for 1, the elastase was severe. I have never had GI issues before this, I am 66.

Once I went on 12 Zen Pep a day the urgent diarrhea virtually stopped making the doctor feel as though he had the correct diagnosis. However, I am still not sure as I never had any of the conditions (pancreatitis or alcohol issues or cystic fibrosis) which seem to cause it.

My concern is my weight as I am the lowest weight since being a teenager and I cannot gain any weight no matter what I eat. I am also anemic so I just started taking iron supplements. Also, I have had Cat scans, MRI's and endoscopy procedures and thankfully no cancer has been detected.

I am really appreciative of this website as this has been my only opportunity to discuss my EPI issue with anyone who understands it.

Once you are closer to Jacksonville, I would look into a second opinion just for your peace of mind. If you are digesting everything it would seem you could add weight if that was your goal. The GI you saw may have been spot on, but no reason not to be completely comfortable with what you are doing. Do you have a pretty well balanced diet with veggies and fruits, etc... I have to try to get a lot of my calories from protein because I am so limited on fts and carbs, so that may have some impact on my weight maintenance.

The thinking clearly is a chore for me as well. I am a bit more than 2 decades younger, but have been on heavy doses of opiates for the pain that I have chronically from my pancreas, scar tissue, phantom pain from missing an organ and parts of others, and various other stomach ailments. I do pretty well if I am focused on a discussion, but my wife often says remember, "we talked about that" and I have no memory of it because I was busy writing a reply to someone online. I will have to look into your other supplements.