If you have exocrine pancreatic insufficiency (EPI), you may assume that you have to avoid fatty foods to prevent uncomfortable digestive symptoms. But, eating adequate amounts of fat, along with protein and other nutrients, is essential to a healthy diet.
“Every part of the body needs fat to function,” says Kelly Scheller Williams, a registered dietitian with M Health Fairview in Minneapolis.
People with EPI can and should eat moderate amounts of fat from healthy sources — about 35 to 40 grams (g) a day — says Scheller Williams.
If you have EPI, Scheller Williams advises eating fat in small amounts over the course of the day and taking prescribed pancreatic enzyme replacement therapy (PERT) with meals as needed to prevent the abdominal pain, bloating, and fatty stools that can result from too much fat. Here are some foods with healthy fats that you should consider adding to your diet.
Salmon
“In terms of animal sources of fat, fish is the best,” says Scheller Williams. “Some fatty fish may actually be higher in fat than some beef, but it’s easier to digest.” Salmon offers about 4.5 g of fat for every 3 ounces (oz), according to the U.S. Department of Agriculture (USDA). Salmon, swordfish, and tuna also provide fat-soluble vitamin D, which helps keep bones healthy, according to the National Institutes of Health Office of Dietary Supplements. People with EPI have an increased risk of osteoporosis and related changes in bone density because of malabsorption of nutrients, according to a review published in February 2023 in the World Journal of Gastroenterology.
Chia Seeds
When choosing foods with fat, high-fiber options such as chia seeds are good for weight management, because the fiber helps you feel full longer. What’s more, fiber promotes healthy digestion and may help prevent constipation, according to the Academy of Nutrition and Dietetics. (That said, you don’t want too much fiber in your diet if you have EPI, so be sure to discuss with your doctor or dietitian how much fiber you are eating overall.)
An ounce of chia seeds has nearly 9 g of fat, 5 g of protein, and 10 g of fiber, according to the USDA. Chia seeds also contain omega-3 fatty acids, an essential fat that may help reduce the risk of heart disease, notes the American Heart Association. Chia seeds can be sprinkled on yogurt, hot cereal, or rice or added to drinks such as smoothies.
Avocado
A quarter cup of pureed avocado provides nearly 7 g of monounsaturated and polyunsaturated fats, according to the USDA. “Dietary fat plays a crucial role in providing energy to the body, maintaining body temperature, protecting vital organs, and allowing for the intestinal absorption of fat-soluble nutrients,” says Kristen M. Roberts, PhD, RDN, an assistant professor in the School of Health and Rehabilitation Sciences at The Ohio State University Wexner Medical Center in Columbus.
In addition to healthy fats, avocados offer fiber and other nutrients, such as vitamin E, vitamin C, magnesium, iron, folate, potassium, and beta-carotene.
Olive Oil
One of the best types of oil for cooking is olive oil, because it contains monounsaturated fatty acids, Dr. Roberts says. The 2020—2025 Dietary Guidelines for Americans recommends cooking with vegetable oils, such as olive, in place of fats that are high in saturated fat, such as butter. Olive oil has 4.5 g of fat per teaspoon, per the USDA. Canola, flaxseed, and soybean oils are also beneficial. Because certain vitamins, such as A and K, are fat soluble — meaning they’re absorbed along with fat — a small amount of oil drizzled on veggies enables your body to better use the vitamins in them.
Greek Yogurt
Greek yogurt has healthy fats, along with protein and probiotics, which can aid digestion. Eat it with fruit, in a smoothie, or even as a replacement for sour cream. Plain, whole milk Greek yogurt typically has 5 g of fat and 9 g of protein per 100 g (about 3.5 oz), according to the USDA. Roberts recommends dividing your total recommended daily fat intake over six small meals. Work with a dietitian to determine a daily goal that’s best for you.
Dark Chocolate
People with EPI are advised to cut down on refined sugars, but that doesn’t mean you can’t indulge a little and allow yourself some sweet treats, says Scheller Williams. Of all your options, she says, dark chocolate is among the best.
Aim for dark chocolate with at least 70 percent cacao for the most antioxidants and polyphenols, which are thought to benefit overall metabolic health, according to a study published in the journal Molecules.
Eggs
Most people find eggs relatively easy to digest, unlike fatty meats, Scheller Williams says. “The yolk is the source of fat, and eggs are a good source of protein,” she says. An egg offers 6 g of protein and 5 g of fat, according to the USDA. People with EPI are at risk of malnutrition, because of digestion issues, she adds, so it’s essential to find healthy sources of protein and fat that are easy to prepare and eat.
Nuts
Many people with EPI who have symptoms after eating a fatty meal often have no problem eating nut butters, Scheller Williams says. Nuts and nut butters are nutrient-rich, high-calorie foods and can be great additions to a healthy EPI diet, especially if you’re trying to gain weight. One ounce of mixed, dry-roasted nuts contains 15 g of fat and 6 g of protein, per the USDA, and provides nutrients such as vitamin E, iron, folate, selenium, and calcium. The Dietary Guidelines recommend incorporating 5 oz of nuts a week into your diet, depending on your daily calorie needs.
Additional reporting by Jessica Migala.
Ira Daniel Breite, MD
Medical Reviewer
Ira Daniel Breite, MD, is a board-certified internist and gastroenterologist. He is an associate professor at the Icahn School of Medicine at Mount Sinai, where he also sees patients and helps run an ambulatory surgery center.
Dr. Breite divides his time between technical procedures, reading about new topics, and helping patients with some of their most intimate problems. He finds the deepest fulfillment in the long-term relationships he develops and is thrilled when a patient with irritable bowel syndrome or inflammatory bowel disease improves on the regimen he worked with them to create.
Breite went to Albert Einstein College of Medicine for medical school, followed by a residency at NYU and Bellevue Hospital and a gastroenterology fellowship at Memorial Sloan Kettering Cancer Center. Working in city hospitals helped him become resourceful and taught him how to interact with people from different backgrounds.
Madeline R. Vann, MPH, LPC
Author
Madeline Vann, MPH, LPC, is a freelance health and medical writer located in Williamsburg, Virginia. She has been writing for over 15 years and can present complicated health topics at any reading level. Her writing has appeared in HealthDay, the Huffington Post, Costco Connection, the New Orleans Times-Picayune, the Huntsville Times, and numerous academic publications.
She received her bachelor's degree from Trinity University, and has a master of public health degree from Tulane University. Her areas of interest include diet, fitness, chronic and infectious diseases, oral health, biotechnology, cancer, positive psychology, caregiving, end-of-life issues, and the intersection between environmental health and individual health.
Outside of writing, Vann is a licensed professional counselor and specializes in treating military and first responders coping with grief, loss, trauma, and addiction/recovery. She is a trauma specialist at the Farley Center, where she provides workshops on trauma, grief, and distress tolerance coping skills. She regularly practices yoga, loves to cook, and can’t decide between a Mediterranean style diet and an Asian-fusion approach.