Pancreatic Insufficiency: Therapy

General measures

  • Alcohol restriction (abstaining from alcohol), for life!
  • Nicotine restriction (abstaining from tobacco use).
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised program for the underweight.
    • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following special dietary recommendations in exocrine pancreatic insufficiency (EPI; inability of the pancreas to produce sufficient digestive enzymes):
    • If steatorrhea (fatty stools) is present, it must be taken into account that patients with chronic pancreatitis (inflammation of the pancreas) and exocrine pancreatic insufficiency often have malnutrition (malnutrition) in the advanced stage and thus cannot do without fat as an energy source. Therefore, a substitution of digestive enzymes* (“ferment substitution”) should be carried out first and only then a reduction of fat consumption to 50-75 g/day should be considered. When selecting dietary fats, it must be remembered that the lower the melting point, the better the digestion (e.g., vegetable oils; butter has a higher melting point).
      • * At main meals, pancreatin is recommended at a dosage of 20,000-40,000 units, and at snacks of 10,000-20,000 units.
    • In rare cases, steatorrhea does not improve sufficiently with reduction of fat in combination with pancreatic ferment substitution. Then, partial replacement of dietary fat (LCT fats = fats with long-chain fatty acids) with MCT fats (fats with medium-chain fatty acids) should be performed:
      • The transition to MCT fats should be gradual, otherwise abdominal (stomach) pain, vomiting and headaches may occur.
      • MCT margarine – as a spread or after cooking add to the still warm food; is not suitable for frying, stewing, braising, grilling, etc.
      • MCT cooking oils – can be used as cooking fat; however, they can not be heated as high as usual vegetable oils (do not heat too long and never above 70 ° C, at temperatures above 120-130 ° C smoke development occurs).
      • Long keep warm or reheat the food prepared with MCT should be avoided, because a bitter aftertaste can arise.
    • If there is a risk of insufficient energy and nutrient supply, the additional administration of a chemical-defined formula diet is indicated. A deficiency supply mainly affects the fat-soluble vitamins (especially vitamin A and E) and vitamin B12.
    • Other measures are:
      • Distribute food evenly throughout the day.
      • Consume small portions.
      • Gentle preparation of food (steaming, cooking).
      • Avoid: foods that are difficult to digest, high in fiber.
      • Prefer: carbohydrate-rich food with adequate protein content.
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Endocrine pancreatic insufficiency (inability of the pancreas to produce hormones such as insulin) ultimately leads to diabetes and may require insulin therapy. Nutritional recommendations for this can be found under Diabetes mellitus under “Further therapy“.