Exocrine Pancreatic Insufficiency (EPI)

The pancreas is part of the endocrine system and its role is very important for digestion. When we eat the pancreas is stimulated to produce digestive enzymes needed to break down food and absorb the resulting nutrients. Most of the enzymes are produced in the part of the small intestine called the duodenum.  

EPI means the pancreas does not produce enough enzymes which can cause various symptoms and nutritional deficiencies. To help boost up enzyme’s PERT can be introduced (pancreatic enzyme replacement therapy). The treatment is in tablet form and is made up of lipase, protease, and amylase.  

Diet guidance

• eat a healthy varied diet using fresh foods
• avoid packet foods so you avoid hidden fats and sugars
• avoid solid fats and limit fat intake to 30–50g a day
• spread calories out throughout the day, so you have for example six smaller meals rather three
• choose low fat packet foods
• keep hydrated with water throughout the day
• avoid alcohol
• avoid caffeine

Breakfast ideas

Egg-white omelette filled with chopped cherry tomatoes, served on a piece of whole grain toast (no spread).

Bowl of blueberries with four tablespoons of Quark (vanilla flavour).

Whole grain muesli with ‘red’ top milk or alternative.

Cloudy apple juice as a drink.

Weetabix x2 with low fat milk or alternative, blueberries.

Baked apple with sprinkle of coconut sugar. 

Meringue nest with two tablespoons of vanilla Quark and few peach slices in juice (this is a version of Eton Mess and is so great for puddings).

Lunch ideas (use lean proteins around lunch and snacks)

Whole grain brown bread two slices, skinless roasted chicken with watercress, drizzle of lemon for flavour, very fine spread of low fat margarine or plain quark.

Home-made chicken kebab with red pepper and cherry tomatoes skewered and cooked. Make up batches so they can be snacks during the day as well.

Small jacket potato, tuna in brine, rocket leaves and baby sweetcorn.

Low fat tomato soup with two slices of wholegrain brown bread (no spread).

Dinner ideas

Cod poached in cup of water with a large squeeze of lemon juice, add chopped French beans and peas, continue to poach, stir in three or four tablespoons of plain quark to thicken, add low fat Thai paste or lemon grass to flavour. Serve with wholegrain brown rice.

Roast dinner with skinless chicken or turkey, broccoli, carrots, mashed swede and sweet potato. Use cornflour to make the gravy the old fashioned way with the vegetable water. Remember leftover chicken or turkey can be used in sandwiches.  Avoid packaged meats as these can contain hidden fats.

Tuna fish cakes (cook a couple of extra for snacks) serve with small roasted sweet potato or white potato and courgette.

Chicken mince cottage pie. Avoid packet flavourings as these often contain powdered garlic and onion.

Lean beef mince spaghetti bolognese served with wholemeal pasta. Omit any cheese toppings. Omit onion and garlic. Use chopped fennel for flavour, this is very subtle and not overpowering at all. It also helps with digestion.

Grilled salmon steak with boiled new potatoes and steamed broccoli, carrots.

Snack ideas

Snacks should be low sugar and low fat.

Low fat yoghurt (natural yoghurts are less likely to be sweetened) with a dash of orange or vanilla extract and chopped banana.

X2 Ryvita with crushed tinned mackerel (in brine).

X2 Corn thins with low fat cottage cheese.

Pear.

Apple.

Small orange (try not to eat too many oranges as they can cause loose bowels with their high vit. C content).

Fat soluble vitamins

Vitamins A, D, E, and K need fats in the diet to help with their digestion. Individuals who have EPI will therefore have difficulty absorbing enough of these vitamins. Some doctors recommend that a vitamin and mineral supplement is added to help boost these. If you do take a multivitamin it is advisable to take it in the morning.

Food to avoid

Keep saturated fats to a minimum.  Foods which are high in these fats are:

• butters
• cream
• cuts of meat which have the fatty marbled look when raw such as beef and lamb
• offal/organ meats
• skins such as chicken skin
• pastries 
• biscuits
• cakes
• cheese
• oily dressing
• onion and Garlic

Don’t mix on the same day:

• cabbage
• broccolli
• kale
• sprouts
• spinach
• cauliflower
• aubergine
• mushroom
• suggest space tomatoes out as well so not eaten every day

Useful flavours:

• fennel
• cumin
• turmeric
• lemon grass
• black pepper
• watercress
• rosemary
• marjoram
• sage
• basil
• lemon juice