@sara53 Pancrealipase should not be taken before meals and all the manufacturers and their information make this very clear. Pancrealipase is to be taken with food at the start of a meal and then take any additional capsules spaced out through the duration of the meal. The objective is to mimic how the pancreas functions when it is healthy…that is it produces and secretes the digestive enzymes in response to food entering the small intestine where a hormone is secreted into the circulation and picked up by receptors on acinar cells of the pancreas.

When you take pancrealipase ahead of the meal without the presence of food, it gets activated immediately. It doesn’t remin in your GI tract waiting for food to bind to and digest. The enzyme activity begins getting depleted leaving less enzymes for when they are needed to digest food. This is why you take enzymes through the course of the meal so they adequately mix and digest the food.

Optimization of pancrealipase is key and the amount for each meal will differ based on the amount of carbohydrates, fats nd protein contained in the meal. To make this process easier and accurate, use the pancrealipase dosing optimization calculator at pertcalculator. org. If Zenpep is not listed, use the closest concentration of Creon for calculating the amount of Zenpep to take, If you take 40K Zenpep, select Creon 36K.

If high gastric acid is an issue, a Proton Pump Inhibitor like Omeprazole will suppress gastric cid secretion and result in the pancrealipase working better. This is because enzymes work most efficiently in an alkaline pH, not an acidic environment. When a pancreas is impaired, not only is its ability to produce digestive enzymes is effected, but also the process of producing carbonate that flushes the pancreatic ducts and making the small intestine alkaline for the enzymes to activate and work.