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

Posted by steveskolnick @steveskolnick, Nov 13, 2023

I had whipple surgery 3 months ago. Fortunately, I was able to keep 1/2 my pancreas. I continue to have digestive issues (frequent trips to the bathroom) because I can not process the fat. I have lost 35 lbs since the surgery. I understand that there is Rx medication which can address this issue but it is very expensive. Has anyone had the issue just go away over time (3 months is still early in the healing process) or been successful in taking an over the counter (OTC) enzyme supplement? I have ordered an enzyme supplement and will try it. I plan to post my results here but if anyone has already tried this, I am interested as to how it went or is going and what brand you tried.
Thanks for reading and thanks in advance for responding.

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@steveskolnick

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.

Jump to this post

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.

REPLY

Thank you very much for your detailed explanation. I will start my enzyme regimen by following your suggestions while using the calculator. No sense blindly navigating a road many have already been down. Thanks again for providing me with a starting point.

REPLY
@stageivsurvivor

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.

Jump to this post

Appreciate your detailed explanation. Question, my husband had the Whipple in February and finished his Chemo treatments at end of September. We still cannot get his bowel movements to return to some normalcy. His Dr. finally agreed to have his enzyme levels tested through stool samples. His were less < 40, well below normal. They have increased his Zenpep to six capsules with meals and 3 with snacks (40,000 units each cap). He was directed to take 3 at start of meal and 3 in the middle. Snacks - 1 at start and 2 in the middle. Would you feel this is the best way to approach things based on all your findings.
Also, do you know how we could watch the Seminar if recorded? Thanks for your help.

REPLY
@stageivsurvivor

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.

Jump to this post

One more question. I did go to the “Digestthis.ca”. However, after registering the site does not offer Zenpep for calculating. Any suggestions, thanks again.

REPLY

Hello steveskolnick!
I took Creon (36k units) 5-7 months after surgery, then tried OTC papaya enzymes and they worked fine. Abbvie does have a generous program where probably most people would fall under their financial assistance program and ended up getting Creon for free. Now I take no enzymes, though for Thanksgiving meal which has many foods, I found I did need to take some. Generally, I eat small meals at a time since I'm diabetic now.
I became a "hard" diabetic type 1 following my surgery, which requires me to eat healthy (though I do have occasional sweets) and stay low on the carbs. Obviously, with pancreatic issues all we need to stay away from a high fat diet as fats are difficult to digest and exercise (even walking in great) regularly, but maybe you are already doing this.

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Thank you so much for your reply. I am on Creon right now and I've gained 5 lbs in 2 weeks so they are working. I am walking and will try the papaya enzymes in a few months. Fingers crossed. My oncology surgeon told me that it may take some time for the pancreas to wake up after shocking it by removing half of it. It may start to create the digestive enzymes on its own over time but there is also a chance it does not. Everyone is different.

REPLY

I’m amazed you gained 5 pounds in two weeks. How did you do it? I’m stuck at the same weight for months. Did you increase your Creon.? I’m on Zenpep and have no diabetic issues as I don’t eat anything with sugar. No one has told me to increase my Zenpep but I did it on my own. I wonder if I didn’t go high enough. I take 40,000 units with each oversized snack. I don’t eat meals as I’m small and my system won’t tolerate too much food. Any suggestions, anyone, especially if you’re on Zenpep.
Thank you.

REPLY

I have stayed on 25,000 units of Creon per meal since i started it. I am a creature of habit. I have a bagel with margarine and lots of cream cheese for breakfast. 2 hours later I scramble 3 eggs. For lunch I usually have some leftovers from the night before. Mid afternoon I have a shrimp cocktail (5 large - shrimp is all protein and water). Then I'll have dinner and usually a couple of cookies or ice cream a couple of hours after dinner. So let's look at the data - I weighed 200 before Whipple surgery. 3 weeks in the hospital with little to no food. When I arrived home I weighed 172. Then proceeded to continue to lose weight and got down to 165. Then I started Creon and my weight has come up to 170 after 2 weeks. I was not getting any nutrients out of what I was eating before Creon. Now my system is processing the food better and I can see the difference in my stool.

REPLY
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