Taking replacement digestive enzymes will help you digest your food, but it’s also good to be on the lookout for symptoms of malnutrition and check your vitamin levels on a regular basis.

When you eat, the food travels to your stomach, where enzymes break down larger food pieces into smaller ones that can be used by cells for energy and nutrition. “Most digestion occurs as a result of exocrine pancreatic secretions,” says Steven D. Freedman, MD, PhD, a professor of medicine at Harvard Medical School and the director of the Pancreas Center at Beth Israel Deaconess Medical Center in Boston. “When food enters the stomach, the pancreas secretes enzymes as a liquid that digests fat, protein, and carbohydrates.” EPI occurs when the pancreas is unable to produce enough of these digestive enzymes or the enzymes get stuck in clogged ducts in the pancreas and aren’t released. EPI is a chronic condition that can occur in people with cystic fibrosis, diabetes, and pancreatic cancer, among other health issues. Symptoms of EPI include weight loss, stomach pain, diarrhea, and other digestive changes. Dr. Freedman says many other gastrointestinal disorders can cause similar symptoms, so EPI is often misdiagnosed. He says the best way to diagnose EPI is by identifying a particular symptom and seeing if it responds to treatment. “The most characteristic symptom of EPI is pale, oily, and greasy stools, and when we give a person with EPI pancreatic enzyme capsules, those symptoms go away,” he says. A lab test that measures the amount of a certain pancreatic enzyme in the stool can also help with diagnosing EPI. In a study of 91 patients with EPI published in September 2018 in the journal Pancreas, researchers found that vitamins D and A were the most common deficiencies. The study also found that 30 percent of the patients suffered from malnutrition. General symptoms of malnutrition include feeling tired and irritable, bone or joint pain, slow wound healing, and infections. The malnutrition associated with EPI can lead to more serious conditions, such as sarcopenia — a muscle disorder — cardiovascular disease, and a reduced ability to have a normal immune response, according to a study published in October 2020 in the journal Medicina. Those with malnutrition may have other symptoms related to specific vitamin deficiencies. “Vitamins A, D, E, and K are often needed by people with exocrine pancreatic insufficiency, because the body isn’t capable of breaking them down,” says Vandana Sheth, CDCES, a Los Angeles–based dietitian. Besides supplementing with these fat-soluble vitamins, she says, people with EPI should avoid high-fiber foods, because they interfere with the replacement enzyme activity that breaks down these nutrients. Possible symptoms of vitamin deficiency include:

Vision problems Vitamin A is critical to eye health, and symptoms of deficiency include night blindness, which is trouble seeing in poor light or at night. Also, a lack of vitamin E can lead to diminished sight.Osteoporosis Vitamin D helps the body absorb calcium and plays a role in preventing osteoporosis. Symptoms of vitamin D deficiency can be vague and difficult to spot at first, so regular testing is recommended for people with digestive disorders such as EPI.Bruising and bleeding Vitamin K plays a role in blood clotting, and symptoms of deficiency include bruising and bleeding easily.Muscle weakness Vitamin E is an antioxidant that protects cells and boosts immunity. One symptom of vitamin E deficiency is muscle weakness.

Reducing the Risk for Malnutrition

Sheth recommends consulting your doctor or a dietitian for a complete nutritional screening to check for potential malnutrition and vitamin deficiencies. Once your vitamin and mineral levels have been assessed, they can help tailor your diet and recommend the necessary supplements to correct any vitamin deficiencies. Regular checkups to assess your pancreatic enzyme levels are also recommended to make sure you’re getting the right dose of replacement enzymes to digest food properly and maintain good nutrition. Each person with EPI has different nutritional needs. For example, a person with diabetes will need to watch their carbohydrate intake, but a person with cystic fibrosis needs a high-calorie diet. By working with your doctor or a dietitian, you can find the right nutritional approach for you: a diet and supplement plan that will help keep EPI symptoms in check and help you avoid vitamin deficiency. Additional reporting by Nina Wasserman