9 Supplements You May Need If You Have EPI

PERT is the most important supplement for people with EPI, because it directly treats the condition. It’s important to take your enzymes with every meal, as well as spread your dose out as much as possible during the meal, according to Joshua S. Forman, MD, a gastroenterologist at the University of Maryland St. Joseph Medical Center in Towson.

“Most people with EPI are currently treated with a prescription pancreatic enzyme replacement rather than over-the-counter enzymes,” says Dr. Forman. In rare cases, with patients who can’t afford prescription enzymes, he’s worked to develop a regimen of over-the-counter options, but they can be less reliable.

If you still experience unpleasant symptoms despite taking enzymes diligently, you may need to ask your doctor about increasing your dose, Forman says. “Many people with EPI tend to be underdosed.”

Forman says that because people with EPI have trouble digesting fat, they’re especially at risk for deficiencies in fat-soluble vitamins — including vitamin A — if the condition isn’t adequately treated. According to an article published in the journal Pancreas, as many as 35 percent of people with both chronic pancreatitis and EPI are deficient in vitamin A.

Vitamin A is important for eye health, helps your body maintain healthy teeth and bones, and helps keep your immune system strong. It can be found in beef, liver, fish, eggs, fortified dairy products, carrots, squash, mangoes, and dark green leafy vegetables.

If your doctor recommends vitamin A, stick to the suggested dosage. Too much vitamin A can be harmful to your health; the daily intake for an adult should not exceed 3,000 micrograms, according to the Office of Dietary Supplements (ODS).

The good news? “[Fat-soluble] vitamins are also stored in our fatty tissues in the body, so it takes much longer for the stores to be used up,” Stefanski says.

Because vitamin D is another fat-soluble vitamin, people with EPI are more likely to be lacking in it than in other nutrients. The same study in Pancreas found that 63 percent of people with both chronic pancreatitis and EPI were deficient in vitamin D.

Vitamin D is vital for bone health, because it helps your body absorb and maintain levels of calcium. Vitamin D also helps your body use vitamin K, ensures healthy blood levels of phosphorus, and, as an antioxidant, helps ward off tissue damage throughout the body.

The best way to get vitamin D is through direct skin exposure to sunlight for about 15 minutes three times a week, according to the National Library of Medicine. Most food sources don’t naturally contain much vitamin D, but you can find some in fatty fish, fortified cereals, and dairy products. Supplements, if recommended by your doctor, can also help you get adequate amounts.

Vitamin E is another fat-soluble vitamin likely to be lacking in people with EPI. It helps strengthen the immune system so that it can fight off bacteria and viruses and helps blood vessels stay wide and reduce the risk of blood clots from forming.

If you’re taking vitamin E supplements, be sure not to take more than 1,000 milligrams/day since high doses can put you at risk for bleeding and other dangerous health issues, according to ODS.

Good food sources of vitamin E include avocados, nuts, seeds, plant oils, and dark green vegetables. If test results show you have a vitamin E deficiency, your doctor will likely tell you to take a supplement.

Vitamin K, also a fat-soluble vitamin, helps heal wounds by triggering blood clotting and is often lacking in people with EPI. A study published in September 2019 in the journal Nutrition in Clinical Practice found that up to 63 percent of people with chronic pancreatitis and EPI had a vitamin K deficiency and needed to take a supplement.

Food sources of vitamin K include dark green and leafy vegetables — kale, spinach, collard greens, Brussels sprouts, broccoli, asparagus, cabbage — as well as cauliflower, beef, liver, fish, and eggs.

Vitamin B12 is sometimes lacking in people with EPI as well. If that’s the case for you, your doctor may prescribe a vitamin B12 supplement.

The vitamin plays an important role in your metabolism, as do other B vitamins. It helps red blood cells form and keeps your nervous system running effectively. You can find it in red meat, poultry, shellfish, eggs, dairy products, and fortified foods such as cereal and soy milk.

According to StatPearls, the trace mineral zinc is second only to iron in its concentration in the body. If you have a disease such as EPI, though, you may have a zinc deficiency. Although a study published in the Journal of Gastroenterology and Hepatology Research found that people with EPI may be at high risk for zinc deficiency, the researchers stopped short of recommending routine supplementation with zinc for everyone.

Zinc plays a role in the growth of cells, the healing of wounds, and the breakdown of carbohydrates in your diet. Good food sources include red meat, dark poultry meat, nuts, whole grains, and legumes, such as beans and peas.

Calcium helps strengthen your bones and teeth. But because it’s regulated by vitamin D — a fat-soluble vitamin — people with EPI can have trouble absorbing it. This lack of both calcium and vitamin D means that people with EPI can be at high risk of decreased bone mineral density, which could develop into osteoporosis or osteopenia, according to a study published in November 2019 in F1000 Research.

Calcium is often lacking in people’s diets. Food sources include leafy green vegetables, salmon and other fatty fish, and dairy products. Calcium supplements can help bridge the gap between how much your body needs and how much it’s able to absorb through diet.

Probiotics fall into the category of “shouldn’t hurt, may help,” Forman says. These supplements contain “good” bacteria intended to promote digestive health and support your immune system.

People can respond differently to probiotics, so it’s important to make sure you’re taking a type and dose that’s right for you. As with other supplements, be sure to talk with your doctor before taking any probiotics.

And don’t assume all probiotics are the same — many strains may be beneficial, but the effectiveness can vary based on the health condition they’re being used for, according to a study published in Frontiers in Medicine. Since very little is known about probiotics and how they impact gastrointestinal disorders such as EPI, don’t just switch from one staring to another without discussing it with your doctor first.

If you’ve recently been on antibiotics, you may especially want to take a probiotic. Probiotics may help replenish the beneficial bacteria in your digestive tract that were killed off along with the harmful, infection-causing bacteria.

Additional reporting by Elizabeth Yun.