What Is EPI?
According to UpToDate, Exocrine Pancreatic Insufficiency (EPI) means the pancreas either does not make enough digestive enzymes to break down food, the enzymes aren’t working as well as they should, or not enough enzymes are getting from the pancreas to the small intestine.
As a result, fats, proteins, and carbohydrates are not absorbed well, leading to symptoms like:
- Oily or floating stools
- Gas, bloating
- Abdominal pain and/or cramping
- Weight loss
- Vitamin deficiencies
Pancreatic enzyme replacement therapy (PERT)—taken with every meal and snack—helps your body absorb nutrients.
Key Daily Habits
- Always take enzymes with food (including snacks) exactly as prescribed.
- Eat small, frequent meals (4–6 per day) for better digestion.
- Stay hydrated with plenty of water or other non-caffeinated drinks.
- Include protein at each meal to support muscle and immune health.
- Take all prescribed vitamins/minerals.
- Avoid alcohol and tobacco/nicotine
“Good” Foods for EPI
These foods are usually easier to digest and can help meet your nutritional needs:
Lean Proteins
- Skinless chicken or turkey
- White fish and seafood
- Eggs and egg whites
- Lean cuts of pork or beef (trimmed)
Low-Fiber Fruits & Vegetables
- Bananas, applesauce, peeled peaches or pears
- Well-cooked carrots, green beans, zucchini, peeled potatoes
Whole Grains & Starches (choose lower-fiber if symptoms flare)
- White or sourdough bread, white rice, pasta
- Oats (well-cooked), low-fiber cereals
Healthy Fats (with enzymes)
- Olive oil, avocado oil
- Nut butters (smooth)
- Soft margarines made with healthy oils
Dairy (if tolerated)
- Lactose-free milk or yogurt
- Hard cheeses
*Ask your healthcare provider about any recommended dietary modifications. Working with a dietician may be helpful. This document is not meant to be prescriptive, but rather informational. Always check with your healthcare provider before making any dietary changes, trying anything new, etc.
Foods to Limit or Avoid
Certain foods can make symptoms worse or reduce enzyme effectiveness:
- High-fat fried foods (fast food, deep-fried snacks)
- Greasy meats (sausage, bacon, fatty cuts of beef or pork)
- Creamy or heavy sauces (alfredo, rich gravies)
- Full-fat dairy if lactose intolerant (whole milk, cream, ice cream)
- High-fiber raw vegetables (broccoli, cauliflower, cabbage) during flare-ups
- Alcohol (can worsen pancreatic damage)
- Sugary desserts and sweetened drinks (which can spike blood sugar)
*Ask your healthcare provider for any specific foods that you should limit or avoid.
Practical Tips
- Take enzymes with the first bite of food. If a meal lasts longer than 30 minutes, a second small dose may be needed (check with your provider).
- Keep a food & symptom diary to track how foods and enzyme timing affect you.
- Eat balanced meals: aim for a mix of protein, carbohydrates, and healthy fats with every meal.
When to Call Your Healthcare Team
- Sudden weight loss or ongoing diarrhea
- Stools that are oily, pale, or hard to flush
- Persistent bloating, gas, or abdominal pain
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care
Key Takeaways
- EPI requires daily enzyme replacement and consistent nutrition habits.
- Good food choices and enzyme use help your body absorb nutrients, maintain weight, and reduce symptoms.
- Regular follow-ups with your care team are essential to adjust enzyme dosing and monitor vitamin levels.
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.