New to exocrine pancreatic insufficiency (EPI): What helps?

Posted by jewill @jewill, Dec 6, 2016

I was dignosed with e p i. Exocrine pancreatic insuffency in 2015 after having a severe reaction to premarin estergen cream then 2 weeks later i had an even more sever reaction to an infusion of reclast it is a biphosphonates l am severly allergic to phosphates, dr did not check for that. i had diarrhea lost 20 lbs destroyed 90 % of my pancreas dr gave me creon 3600 2 with each meal low fat diet that is all the information i got from him did research on web for diet and supplments .need a dr in austin tx that knows more about e p i would apprecate any info on this thank you jewill

Interested in more discussions like this? Go to the Pancreatic Disorders Support Group.

I was diagnosed with EPI in November 2023. I take ZENPEP because Medicare won’t cover anything else. Over the past month, things are getting worse again and I spend most of my time in bed with an upset stomach. I generally eat one meal a day because it’s about all I can tolerate. I am on Rebylsus to control my diabetes as well as my weight. I have lost more than 70 lbs in the past year because of EPI. My doctor did a colonoscopy to rule out Crohns or any other gastrointestinal diseases (my sister has had Crohns for more than 50 years, so we needed to make sure that was not the problem). Anyway, my doctor is not helpful at all. I have seen him on telemed twice, and then again for the colonoscopy. He hasn’t given me much feedback and doesn’t return phone calls in a timely manner. I am in Farmington Hills, Mi. Does anyone know of a good responsive doctor in this area? Your help would be well appreciated

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Profile picture for sqlgirl13 @sqlgirl13

I'm taking CREON with new diagnosis of severe EPI, sad about this and scared.

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Yes if you go to the website for Creon they have a free savings card to give to your pharmacy. It’s very cheap that way . Unfortunately it didn’t work for me ( the drug ).

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Profile picture for gardenlady1116 @gardenlady1116

New York. There is a Medicare coverage limit, I am not sure what will happen when I exceed the limit and fall into the Medicare Part D "donut hole"

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Depending upon your income, you can apply for Creon Assistance through Abbvie, the drug manufacturer. Go out to Abbvie’s website for more information.

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Profile picture for cherawgirl @cherawgirl

Thank you for this tip of Metagenic enzymes. I have used other of their products and they are good. I have order the ES version as mentioned above and plan on using them to supplement my EPI treatment of Zenpep.

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Metagenics had a lot of fillers in them . I think you can try Vitatree , a FM Dr I follow on Instagram recommends those as they have no fillers . Google it .
I have everything wrong w/ me digestive wise .
I’ve tried it all … 10 years… still chronic and horrendous.

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Profile picture for bidelmst @bidelmst

Hi, to make a long story short, my wife had a Pancreatectomy, and was left with 25% of her pancreas, back in 2011. We could not afford the Creon, she got some samples but not enough.
For a period of time we toughed it out. A few years later, her gastro dr told her about an alternative. It has been on the market for a few years and still not very many people know about it. It's a practitioners exclusive made by Metagenics, called SpectraZyme PAN 9x.

There is also a second with 2x the lipase, call Pan 9x ES
Since this is my first posting, I am not allowed to put their site up, so just do a search for Spectrazme with either the Pan 9x or Pan 9x ES and that will get you there.
As subscribers' through her dr, we received a discount. Way more inexpensive than Creon and has the same functional ingredients. To any and all who read this, go to the site, check it out. If anyone here is currently taking it, let me know. We finally were approved for Croen this year, through MyAbbvie (the direct manufacturer), so we have 2 bottles sealed of the ES (90 count each) we do not want to toss or give away to a corporation. Pix of our bottles is attached. I have had them posted online for less than half of the discounted price. So I found this site. In hopes of finding others who need it.

Questions, just inquire.

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Thank you for this tip of Metagenic enzymes. I have used other of their products and they are good. I have order the ES version as mentioned above and plan on using them to supplement my EPI treatment of Zenpep.

REPLY
Profile picture for vuk @vuk

I began Creon last Fall for EPI. I too lost 30# in a period of about 16-18 months thru which I stabilized @ 165 then started going down until I reached 145 @ which time Gastro's PA tested stool and found fatty stool indicating EPI
I THINK(?) I started on Ensure OTC drinke then went to 12000 Creon 4 x daily. I gained 2-3 pounds by Xmas but asked Dr if I could cut back Creon to see what happens and he said try 3 x day after which I seemed to lose the 3# that I gained plus went to 140#.
I found an EPI diet and tried it but I gained no weight so I went to Gastro and told him what was oging on as I had been eating EVEYRYTHING when I began the Ensure and Creon w/o a 'diet.'
He said he DID NOT WANT ME ON A DIET but to eat everything I felt like eating just to see if I could gain some weight and go back to the 4 Creon.
I went back to 'no diet' and have gained about 2# in last 4-6 wks tho I have little appetite as I did last Fall. I usually have oatmeal in AM w/ Banana, some kind of meat for lunch (even bologna sandwich on whole wheat once or twice!) and 4 oz burgers at times for lunch/supper or Aldi's braised pork pieces, etc. Pizza too if I want. IE I have no 'diet per se.'
I don't always eat a 4th 'meal' but was told by PA it was OK to take piece of toast w/ 3 table spoons room temperature apple sauce for last 'meal' of day.
I will eat green beans with 3-4 oz of meat at a 'meal' or sweet potatoes and am thinking fruit cocktail might be OK also. I do eat eggs and bacon or sausage patties at times for 'lunch' but basicall brkfst is Quajer Oatmeal usually w/banana. I also like Kashi cinammon wheat with coconut almond milk which I bought today.
I don't know if I'm helping anyone. I am thinking however, 'Did I gain the first few pounds on the Ensure????

Creon has 'seemed' to have increased my normal pulse rate (usually in mid 70's but for sometime now in mid 80's 90's and a few times 100) which I read Creon can do tho my BP is in safe range for 80 y.y. Also lately lots of gas. (Then again, I did eat 3-4 tsps Potato salad for 3-4 days w/some meals so that might have contributed!)

I know I have lost much muscle as well and can understand the concern others may have when they hear"Pancreas" but the fact that the Gastro wanted me to eat everything I wanted to see if I could absorb some calories seemed to alleviate the severity of the EPI at least at present.

Then again, there is always the thot of 'What if I quit Creon (which my BC pays all but $82 for) and try the Assure (which is actually MORE expensive per 'dose' than the Creon!) to see if I gained more weight from the Assure than the Creon in the first place????????

And what about my resting heart rate IF I wanted to go to health club and start walking in a pool lane and trying to swim a little in between lengths of walking?

Will kicking up that pulse rate be dangerous?

Seeing the Gastro day after tomoro and will report anything interesting. Also seeing heart Dr Aug 1 to ask question I posed above re: Creon and pulse rate. (Had 75% intense heart ischemia 5-6 yrs ago but it collateralized self and swimming 1/2 mile per day at that time induced no negative effects.

So many questions / concerns. Weeks to see one doctor and more weeks to see the next and few if any seem to have the time to listen to your recent histories and make any diagnosis before just sending you off to another type Dr in their system.

And that might be the most troubling part of seeing Drs at all. 🙁

Take care - Look for sunshine - I also believed that nature Herself is one of the greatest 'healers' since it goes IME right to one's soul/

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Correction - I DID NOT take the Ensure and Creon together tho it may read like that. The lengths of time of weight loss and taking the additives is also estimated.
Sorry for any confusion.

REPLY

I began Creon last Fall for EPI. I too lost 30# in a period of about 16-18 months thru which I stabilized @ 165 then started going down until I reached 145 @ which time Gastro's PA tested stool and found fatty stool indicating EPI
I THINK(?) I started on Ensure OTC drinke then went to 12000 Creon 4 x daily. I gained 2-3 pounds by Xmas but asked Dr if I could cut back Creon to see what happens and he said try 3 x day after which I seemed to lose the 3# that I gained plus went to 140#.
I found an EPI diet and tried it but I gained no weight so I went to Gastro and told him what was oging on as I had been eating EVEYRYTHING when I began the Ensure and Creon w/o a 'diet.'
He said he DID NOT WANT ME ON A DIET but to eat everything I felt like eating just to see if I could gain some weight and go back to the 4 Creon.
I went back to 'no diet' and have gained about 2# in last 4-6 wks tho I have little appetite as I did last Fall. I usually have oatmeal in AM w/ Banana, some kind of meat for lunch (even bologna sandwich on whole wheat once or twice!) and 4 oz burgers at times for lunch/supper or Aldi's braised pork pieces, etc. Pizza too if I want. IE I have no 'diet per se.'
I don't always eat a 4th 'meal' but was told by PA it was OK to take piece of toast w/ 3 table spoons room temperature apple sauce for last 'meal' of day.
I will eat green beans with 3-4 oz of meat at a 'meal' or sweet potatoes and am thinking fruit cocktail might be OK also. I do eat eggs and bacon or sausage patties at times for 'lunch' but basicall brkfst is Quajer Oatmeal usually w/banana. I also like Kashi cinammon wheat with coconut almond milk which I bought today.
I don't know if I'm helping anyone. I am thinking however, 'Did I gain the first few pounds on the Ensure????

Creon has 'seemed' to have increased my normal pulse rate (usually in mid 70's but for sometime now in mid 80's 90's and a few times 100) which I read Creon can do tho my BP is in safe range for 80 y.y. Also lately lots of gas. (Then again, I did eat 3-4 tsps Potato salad for 3-4 days w/some meals so that might have contributed!)

I know I have lost much muscle as well and can understand the concern others may have when they hear"Pancreas" but the fact that the Gastro wanted me to eat everything I wanted to see if I could absorb some calories seemed to alleviate the severity of the EPI at least at present.

Then again, there is always the thot of 'What if I quit Creon (which my BC pays all but $82 for) and try the Assure (which is actually MORE expensive per 'dose' than the Creon!) to see if I gained more weight from the Assure than the Creon in the first place????????

And what about my resting heart rate IF I wanted to go to health club and start walking in a pool lane and trying to swim a little in between lengths of walking?

Will kicking up that pulse rate be dangerous?

Seeing the Gastro day after tomoro and will report anything interesting. Also seeing heart Dr Aug 1 to ask question I posed above re: Creon and pulse rate. (Had 75% intense heart ischemia 5-6 yrs ago but it collateralized self and swimming 1/2 mile per day at that time induced no negative effects.

So many questions / concerns. Weeks to see one doctor and more weeks to see the next and few if any seem to have the time to listen to your recent histories and make any diagnosis before just sending you off to another type Dr in their system.

And that might be the most troubling part of seeing Drs at all. 🙁

Take care - Look for sunshine - I also believed that nature Herself is one of the greatest 'healers' since it goes IME right to one's soul/

REPLY
Profile picture for sunlover @sunlover

I'm an active grandma who was diagnosed with EPI in May 2023. GI doctor was vague about diet and I'm looking for any help. His advice was low fat (how low?), bland (how boring?), low fiber (what a change for me) and I'm trying but need something more specific. I've read and printed lists of food to avoid which MIGHT be helpful, pretty much everything! Nutritionist is not covered by insurance but I will pay the $50 a virtual session for a few visits if they can help - when I can get an appointment. So very thankful that Creon is covered! I think it is helping and now big problem is terrible gas. Diarrhea is much better but the gas! I understand keeping weight on is important and that seems difficult with low fat. I'd appreciate any suggestions and must say that life is still good, just frustrating.

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I too have a lot of bloating and gassiness, and have not found a reliable solution. I'm wondering what others have found that works.
I have discovered that a small amount of real sugar is much better than stevia which makes the gas and bloating ever so much worse.

REPLY
Profile picture for laker67 @laker67

I'm an active grandpa diagnosted wiht EPI in 2016. I also was diagnosed with Type 2 Diabetes around the same time, so I had already modified my diet to watch carbohydrates and sugar. I lost 35 lbs before EPI was diagnosed. After about a year my GI doc said I probably don't need to worry about fat any more and haven't had any issues. My weight has been pretty stable since the dignosis.
I also wanted to speak with a nutritionist and asked my GP doc for a referral. The insurance co denied paying, and I called them to explain my situation and that it was after a doctor referral, not simply a request. It did get covered.

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Thanks, laker 67. It sounds like you are doing well and that encourages me. I will definitely try to get insurance to reconsider. They do cover for diabetes so there's hope! I'm so thankful that they cover the Creon - what a shock to see the full price.

REPLY
Profile picture for sunlover @sunlover

I'm an active grandma who was diagnosed with EPI in May 2023. GI doctor was vague about diet and I'm looking for any help. His advice was low fat (how low?), bland (how boring?), low fiber (what a change for me) and I'm trying but need something more specific. I've read and printed lists of food to avoid which MIGHT be helpful, pretty much everything! Nutritionist is not covered by insurance but I will pay the $50 a virtual session for a few visits if they can help - when I can get an appointment. So very thankful that Creon is covered! I think it is helping and now big problem is terrible gas. Diarrhea is much better but the gas! I understand keeping weight on is important and that seems difficult with low fat. I'd appreciate any suggestions and must say that life is still good, just frustrating.

Jump to this post

I'm an active grandpa diagnosted wiht EPI in 2016. I also was diagnosed with Type 2 Diabetes around the same time, so I had already modified my diet to watch carbohydrates and sugar. I lost 35 lbs before EPI was diagnosed. After about a year my GI doc said I probably don't need to worry about fat any more and haven't had any issues. My weight has been pretty stable since the dignosis.
I also wanted to speak with a nutritionist and asked my GP doc for a referral. The insurance co denied paying, and I called them to explain my situation and that it was after a doctor referral, not simply a request. It did get covered.

REPLY
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