Adding digestive enzyme supplements: What's your experience?

I had horrible stomach pains the next morning when I first took creon. Now I won’t take it cause it hurt so bad. What to do now

@valerina30 That's no fun. Did you consider any of the suggestions from @stageivsurvivor?

@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.

@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.

@valerina30 That's no fun. Did you consider any of the suggestions from @stageivsurvivor?

@tomrennie
Zenpep seems to be helping my husband.

Hi @djfone - sorry to hear your husband is having trouble with food post his surgery. I have been using Creon for almost seven years now since having a total pancreatectomy in 2019. I use three 36,000 unit Creon capsules with meals and one for snacks and has really worked out well for me.

Sometimes I will take an extra one with a meal if it is a higher fat content but generally can eat anything I want as long as I watch my carb load since the resultant diabetes from the surgery. I will tell you that Creon is expensive but AbbVie, who makes Creon, offers support and discounts at https://www.creonhcp.com/patient-support if you would like to learn more about their offerings.

Take care,
- Matt

@matt2024
Hi Can you please share what state was your tumour when you have total pancreatectomy and did you have chemotherapy?

I had total pancreatectomy 7 weeks ago and is waiting for my chemotherapy.

My husband, diagnosed with pancreatic cancer November 1, 2025 and hopefully having a Whipple in the next month, has been on Creon since that time. It has allowed him to eat and digest food MUCH better. He takes one capsule at the beginning of a meal and one in the middle of the meal. His tumor is in the head of his pancreas and his billiary duct was clogged so he has a stent in place.

@joeseah - Hi there! Hope you are recovering well from surgery! It is a major one and took me a bit to get back into the swing of things.

I had 4 pNET tumors ranging from 2.5 cm to 4.5 cm with many small tumors present. I had 13 lymph nodes removed and only one showed malignancy so I did not require chemotherapy. I was home after 6 days in the hospital and went back to work remotely after two weeks.

The biggest challenge was balancing the diabetes with the pancreatic enzyme supplements. How are you doing with your recovery? Happy to share my experiences if it helps.

Take good care of yourself

- Matt