Functional reasons for Low Digestive Enzymes Production

Posted by connectmayo1 @connectmayo1, Oct 1, 2023

Hi Dear Friends,

I have been suffering with Slow Digestion and weight loss issue from past 3 years. Many Tests are done. So far one thing was found. Fecal Elastase was low two times in stool test. My stool is extra soft and not in good solid shape. Many cooked veggies and other foods cause this Extra soft wettish stools. Only sometimes i get solid shape. I am 36 years old male.
Ultrasound of abdomen done two times and CT scan with contrast for chest, abdomen, pelvis is done. No issues in pancreas at all and no pain anywhere in the body.
Endoscopy EGD with duodenum biopsy done. Following is duodenum biopsy report description.

Sections show multiple fragments of small bowel mucosa with well maintained crypt villous ratio and no increase in intraepithelial lymphocytes. The lamina propria shows mild to moderate inflammation by lymphocytes and plasma cells along with few ectatic vessels and very occasional neutrophils. There is mild submucosal brunner's gland hyperplasia. No evidence of parasites, dysplasia or malignancy.
IMPRESSION:
(Method: F)
Features are suggestive of Mild Brunner's gland hyperplasia.
No evidence of organisms, increased IELs, atypia or malignancy.

Doctor said it is IBS but i don’t have any pain but my stool shape is not normal for many foods and fats are taking very longer to digest and sitting longer in stomach when i eat fats and chicken.

When i drink coffee then digestion is faster i see. I think stimulation of nervous system and enzyme production happening. Digestive enzymes pills did not work.

Symptoms:
1. Fats are taking very long to digest and empty stomach. Proteins also similar experience. If i ear fats then need to wait for 9 hours to get appetite again and it is sitting in stomach fir longer.
2. Weight loss
3. Mal Absorption (mal digestion of fats and other hard things)
3. Vitamins deficiency. So far checked B1, B2, B12, D deficient. Have not tested many other like magnesium and other
4. Sleep disturbances for no reason at 3-4am and feeling like incomplete sleep.
5. Stool is wettish and extra soft for many foods. Only little solid for few foods without fibre or sugars
6. Food intolerances started from 6 months. Whole issue of slow digestion started 3 years back.

I have been doing research on finding functional reasons of Low digestive enzymes production when pancreas has no issues at all. Found following things online but need to know of any one of these causing my issues
1. Low Melatonin harmone production
2. Any vitamin, mineral deficiency causing this entire issue? Like Thiamin B1 or Magnesium
3. PH is not strong acidic to stimulate enzymes?
4. Bacterial or fungal biofilm?
5. Amino acids deficiency?
6. Do you think any Bile Acid Malabsorption happening?
Is it Liver issue in digesting fats. Previously onetime fatty liver happened after i lost rapid weight loss but it was normal in 3 months. Blood tests of fibrosis, autoimmune hepatitis was done. All normal.

Doctor simply said IBS but my symptoms matching with Low digestive enzymes clearly but do not know how to fix. Does IBS cause low Digestive Enzymes specially for fats, proteins?

I feel like stimulation through nervous system like autonomic nervous system for motility and vitamins deficiency causing it but how to fix it. Lost lots of my body fat and muscle. Consulted four GI docs and pancreas doc but final doc said IBS but i am not convinced yet and my symptoms are not going away and not able to eat good fats like coconut oil in cooking or any other oils and other foods too. And not sure why my stool shape is not normal.

Interested in more discussions like this? Go to the Digestive Health Support Group.

I'm sorry I don't know about whether thiamine or magnesium deficiency could affect pancreas enzymes. Do you believe that you have malabsorption? Did you say that you tested as having low vitamin d also?

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@connectmayo1

Yes.
I want Thiamin (highly bio available without affecting sensitive Gut). I heard about Benfothiamine but it’s synthetic and fat soluble so want to make sure it won’t hurt liver.

Magnesium (i want)

Zinc

Currently taking low dose b-complex liquid by Pureencapsulations brand.

Does Thiamine or Magnesium deficiency affects pancreas enzymes?

Doctor is not telling why pancreas is not producing enzymes. Glucose, HBA1C, C-Peptide all normal. Blood Amylase is 88 (reference range max is 110), Lipase is not closer to high reference number and not too closer to lower reference range.

Stomach acid PH or Bile quality from liver might not be enough to stimulate pancreas to produce enzymes.

Not sure why i got deficiency is B1, B2, B12 —— these are water soluble vitamins. I need to fix this malabsorption issue first so vitamins and minerals may help pancreas to produce enzymes. No physical issue in pancreas at all.

Jump to this post

Does peristaltic movement affect stimulation of pancreas for digestive enzymes?

What are high quality and very good multivintamin or individual vitamins brand in usa.

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@scolio

I'm sorry I don't know about whether thiamine or magnesium deficiency could affect pancreas enzymes. Do you believe that you have malabsorption? Did you say that you tested as having low vitamin d also?

Jump to this post

Yes. Vitamins deficiency of B1, B2, B12. Vitamin D also.

not sure why B vitamins deficiency there, these are water soluble right. fats take lots of time to digest and sit longer in stomach. Doctors said it is Functional issue but i want to know what is causing it. I don’t know how these doctors were trained. Help less.

I feel like Harmones, nervous system and peristalic movements on intestines are causing this low enzymes and slow digestion issue. I lost lots of weight. Doctors tested all except colonoscopy. All r good except Fecal Elastase but pancreas has no damage.

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Hi "connectMayo1": When my B-12 was below normal and not diagnosed, I felt absolutely horrible! It worsened my IBS SYMPTOMS, sleep, mental focus, and resulted in above normal methymalonic acid and homocysteine levels.
You can easily get your B-12 levels normalized via B-12 shots initially and B-12 supplements (which you may have to continue taking indefinitely) as touched on by other folks posting here so please do a search on B-12. Are you being treated for low B-12 and if not, why? I am sorry I cannot comment about your other deficiencies.

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@connectmayo1

Yes. Vitamins deficiency of B1, B2, B12. Vitamin D also.

not sure why B vitamins deficiency there, these are water soluble right. fats take lots of time to digest and sit longer in stomach. Doctors said it is Functional issue but i want to know what is causing it. I don’t know how these doctors were trained. Help less.

I feel like Harmones, nervous system and peristalic movements on intestines are causing this low enzymes and slow digestion issue. I lost lots of weight. Doctors tested all except colonoscopy. All r good except Fecal Elastase but pancreas has no damage.

Jump to this post

I have had chronic problems for years. Stomach pain nausea, so much diarrhea. Blaming it on IBS.
Now my Gastro dr does this test Stool Elastase. WoW surprise I’m Pancreatic Insufficient. Now I need to take expensive medication Zenpep.

REPLY
@connectmayo1

Yes. Vitamins deficiency of B1, B2, B12. Vitamin D also.

not sure why B vitamins deficiency there, these are water soluble right. fats take lots of time to digest and sit longer in stomach. Doctors said it is Functional issue but i want to know what is causing it. I don’t know how these doctors were trained. Help less.

I feel like Harmones, nervous system and peristalic movements on intestines are causing this low enzymes and slow digestion issue. I lost lots of weight. Doctors tested all except colonoscopy. All r good except Fecal Elastase but pancreas has no damage.

Jump to this post

You said you lost a lot of weight? May I ask, was that on purpose?

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SIBO? Small Intestinal Bacteria Overgrowth You might want to do the breath test for this.

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https://clearpassage.com/blog/what-to-know-before-accepting-an-ibs-diagnosis/
I ran across this internet link and thought some of it may be helpful even though you may not have scar tissue or adhesions.

REPLY
@denisehigby

I have had chronic problems for years. Stomach pain nausea, so much diarrhea. Blaming it on IBS.
Now my Gastro dr does this test Stool Elastase. WoW surprise I’m Pancreatic Insufficient. Now I need to take expensive medication Zenpep.

Jump to this post

I too have been diagnosed with EPI although there is no blockage in the pancreas duct. I do not understand how this is possible or what the "cause" is. The enzymes are thousands of dollars and my insurance only covers a tiny percentage. Not sure what to do!

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Have you had the test stool elastase? You said two tests showed low something? If your pancreas isn’t working properly and not producing the enzymes needed than that is called EPI. That would explain you digestion issues and stool problems.
If that is the case once the pancreas breaks like that it can’t be fixed. You will need replacement enzymes, usually prescribed medication. Then you will see improvement in your stool symptoms.

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