Bloating, stomach cramps, and loose stools are three signs of pancreatic exocrine insufficiency. (also known as PEI or EPI). Pancreatic insufficiency affects up to 80% of people with pancreatitis and celiac disease and commonly occurs in conjunction with other disorders like autoimmune disease, cystic fibrosis, and more.

Pancreatic exocrine insufficiency can result in disorders like malnutrition, osteoporosis, and muscle wasting if left untreated. Thankfully, a functional medicine approach to pancreatic exocrine insufficiency can effectively relieve symptoms of PEI and even treat the root cause. Here’s what you need to know.

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What is Pancreatic Exocrine Insufficiency

The pancreas is a small digestive organ located under the stomach that helps to produce digestive enzymes like amylase, lipases, and proteases. These enzymes break down food into particles small enough to be absorbed.

When the pancreas doesn’t produce enough enzymes, food is not adequately broken down, and optimal amounts of nutrients cannot be absorbed. This condition is called “Pancreatic Exocrine Insufficiency” (PEI) or “Exocrine Pancreatic Insufficiency” (EPI).

Pancreatic Exocrine Insufficiency Signs & Symptoms

PEI / EPI causes noticeable issues with digestion, including:

• Diarrhea
• Foul-smelling, loose stools
• Greasy, fatty stools that float
• Flatulence
• Bloating
• Stomach discomfort and cramping

Due to the malabsorption of nutrients associated with PEI / EPI, people with this condition can also develop other disorders; as a result, including:

• Weight loss
• Muscle wasting
• Nutrient deficiencies, including those deficiencies of
• Fat soluble vitamins like vitamins A, D, E, and K
• Minerals like magnesium‍
• Total cholesterol
• Total protein

What Causes Pancreatic Exocrine Insufficiency

People with other medical disorders are likely to suffer from PEI / EPI due to the damage these disorders can inflict on the pancreas. For example, 90% of people with cystic fibrosis will experience PEI, and up to 80% of people with chronic pancreatitis or who’ve undergone abdominal surgery may also experience pancreatic exocrine insufficiency.

Much of the data we have on pancreatic insufficiency treatment comes from studying people with chronic pancreatitis. Common causes of PEI / EPI include:

• Excessive Alcohol consumption
• Malabsorptive disorders like Celiac disease and IBD
• Diabetes, including Type 1 and Type 2 Diabetes
• Small intestinal bacterial overgrowth is associated with PEI / EPI

Other less common risk factors for the development of PEI include

• Abdominal surgeries, including Gastric bypass surgery, Small bowel surgery, Abdominal lymph node dissection
• Pancreatic duct obstruction
• Bone marrow disorders
• Hemochromatosis and iron-storage disorders which can cause the accumulation of iron and other heavy metals in the pancreas

What are The complications of Pancreatic Exocrine Insufficiency?

Because the major consequence of PEI is inadequate digestion, the significant complications associated with pancreatic exocrine insufficiency result from the nutrient deficiencies it can induce. These include things like

• Osteopenia and osteoporosis
• Vitamin D deficiency
• Vitamin A deficiency
• Vitamin E deficiency
• Magnesium deficiency
• Phosphorus and protein deficiency

These deficiencies can cause poor night vision, impaired immune function, dry skin, muscle tension, muscle wasting, and more.

Functional Medicine Labs to Test for Root Cause of Pancreatic Exocrine Insufficiency

Fecal Elastase

Fecal Elastase-1 values under 200 are considered diagnostic for pancreatic exocrine insufficiency. This test detects the amount of pancreatic elastase in a stool sample. It can be run independently or as part of a comprehensive stool test like the GI Effects.

Tests to Rule Out Root Causes of PEI

• Celiac disease testing
• SIBO testing
• Liver enzyme testing
• Iron and ferritin to rule out iron storage diseases like hemochromatosis that can impact pancreatic function
• A1C to assess for blood sugar regulation and screen for diabetes
• Fecal or serum calprotectin, Fecal lactoferrin, and serum C-reactive protein (CRP) can help to identify IBD if it is present.

Functional Medicine Treatment for PEI

PERT

The primary treatment for pancreatic exocrine insufficiency is to supplement pancreatic enzymes while working to heal the root cause. This is called PERT, or pancreatic enzyme replacement therapy. Supplemental enzymes should include lipase, protease, and amylase.

Lifestyle and Root Cause Medicine

• People with pancreatic insufficiency should not smoke or drink alcohol.
• People with inflammatory bowel disease (IBD) should treat their disorder
• People with celiac disease should adopt and stay on a 100% gluten-free diet
• People with SIBO should find and heal their root cause
• People with liver disease should address it using approaches recommended by their doctor
• If you have blood sugar issues, managing them can reduce the amount of stress put on pancreatic tissues.
• Chewing food thoroughly increases the chances that pancreatic enzymes will successfully break down the proteins, carbohydrates, and fats contained within each meal. People with PEI should make sure to chew mindfully at meals before swallowing.

Summary

Pancreatic exocrine insufficiency can cause symptoms like stomach pain, bloating, and diarrhea. A functional medicine approach to PEI includes finding and treating the potential root causes and supplementing with digestive enzymes (known as PERT or pancreatic enzyme replacement therapy). With proper treatment and care, you can improve the symptoms of PEI and live a life where you finally enjoy good digestion and improve your symptoms.