Exocrine Pancreatic Insufficiency (EPI)

EPI occurs when your pancreas does not make enough digestive enzymes.  Sometimes the enzymes don't work as they should.  Enzymes are proteins that cause chemical reactions in your body.  Digestive enzymes break down food, allowing your body to get nutrients. 

The pancreas is part of your digestive system.  It makes enzymes that aid digestion and help your body absorb nutrients.  When you have EPI, you don't have enough digestive enzymes.  Foods pass through your intestines in a more complete (undigested) state.  As a result, your body doesn't get the nutrients it needs from foods.

There are differently types of pancreatic enzymes.  Amylase, which breaks down carbohydrates.  Lipase, which breaks down fats.  Protease and elastase, which break down proteins.

Causes:  Chronic pancreatitis is the main cause of EPI in adults.  Other causes are Celiac disease, Diabetes, Inflammatory bowel disease, Pancreatic cancer, and surgery on the digestive tract.

Some autoimmune diseases (like Hashimoto’s, celiac, Crohn’s) can cross-react with pancreatic tissue.  After age 60–65, enzyme output can naturally decrease a bit — though usually not to deficient levels unless something else is going on. A very low-fat diet or long-term nutrient deficiencies (especially of zinc, B12, and fat-soluble vitamins) can affect enzyme production.

People with EPI have a particularly difficult time absorbing fats from foods.  This leads to uncomfortable digestive problems such as:  abdominal pain, gas and bloating, constipation, diarrhea, fatty stools (pale, oily, foul-smelling poop that floats), and unexplained weight loss.

Testing & Diagnosis:

Fecal Elastase test (FE1) to check stool for the presence of the elastase enzyme that helps digest proteins.  Little or not elastase can indicate EPI.

Fecal fat test to measure the amount of fat in stool.  A high fat volume may be a sign of EPI.

Secretin pancreatic function test to test how the pancreas responds to secretin, a hormone that triggers the release of digestive enzymes.  

You may also get a CT scan, abdominal ultrasound or other imaging.  These test can spot pancreas problems that can lead to EPI.

People with EPI can't absorb

 enough fats, proteins and carbohydrates from foods.  This problem is called malabsorption.  Your body needs these nutrients for energy and to maintain organ function.  Malabsorption of nutrients can lead to malnutrition.

Signs of malnutrition:  dry skin, brittle nails and hair loss, depression, edema, fatigue or dizziness, feeling cold all the time, irritability, memory and concentration issues, and muscle loss.

EPI is a lifelong condition.  Treatment focus on getting your body the nutrients it needs to maintain good health.  Treatments include:  pancreatic enzyme replacement therapy, high-calorie, high fat diet, vitamins,

February 2023, my pancreatic elastase was 155.  A Pancreatic Elastase level of 155 µg/g in stool is below the normal range, which typically looks like this:

  • Normal: >200 µg/g

  • Mild to moderate pancreatic insufficiency: 100–200 µg/g

  • Severe pancreatic insufficiency: <100 µg/g

So, a value of 155 suggests mild to moderate exocrine pancreatic insufficiency (EPI). This means your pancreas may not be producing enough digestive enzymes, especially elastase, which helps break down proteins.  

My latest pancreatic elastase test done May of 2025 was 529. Well above normal, meaning my pancreas is functioning fine now.  I am thinking when I had the inflammation from a flare up of the lymphocytic microscopic colitis, that played a role in the lower number.

Prescription enzymes usually made from pig pancreas

Creon (enzyme medication)

24,000 contains:

24,000 USP units of lipase

76,000 USP units of amylase

120,000 USP units of protease

If You Want a Vegan-Friendly Alternative:

There are over-the-counter digestive enzymes that are plant-derived and vegan, though they are not FDA-approved for EPI treatment and are generally less potent than prescription PERT. Still, they can help in mild to moderate EPI or as a starting point.

Look for:

Lipase (at least 5,000–10,000 LU per serving)

Protease

Amylase

Optionally: Bromelain, papain, cellulase, lactase, ox bile (non-vegan)

How to Use:

Take one capsule right before or with your main meals.


Start slowly and monitor for:

Less bloating

Better stool consistency

Fewer post-meal symptoms

Pancreatic elastase test:

2/3/2023 results were 155, borderline, consistent with slight to moderate pancreatic insufficiency

If your new result is still <200, that confirms EPI.

If it’s <100, that indicates severe EPI.

If 150–199, that confirms moderate EPI (same range as before).

Even if it comes back slightly improved, symptoms and clinical picture still matter — especially since your past result was already low and your autoimmune conditions are your risk factors.

Having Hashimoto’s can absolutely be a legitimate risk factor for developing mild or early exocrine pancreatic insufficiency (EPI) — even if you don’t have other common causes like cystic fibrosis, chronic pancreatitis, or heavy alcohol use.

Here's how Hashimoto's can be connected to EPI:

1. Autoimmune Link

  • Hashimoto’s is autoimmune — and people with one autoimmune condition are more likely to develop others.

  • Autoimmune pancreatitis or subtle immune-mediated damage to the pancreas can affect enzyme production over time.

  • Even without full-blown autoimmune pancreatitis, the pancreas can be functionally sluggish.

2. Low Thyroid Slows Digestion

  • Hypothyroidism (even if well-controlled) can reduce gut motility and affect pancreatic secretions.

  • It may impair your body’s signaling for proper enzyme release.

  • Bloating, gas, and stool changes in this context can overlap with EPI.

3. Common Overlaps

People with Hashimoto’s often also develop:

  • SIBO (Small Intestinal Bacterial Overgrowth)

  • Microscopic colitis or IBS

  • Low stomach acid (hypochlorhydria)
    These all increase the burden on digestion — and may reveal borderline EPI symptoms more clearly.

So even without classic EPI risk factors like:

  • Chronic pancreatitis

  • Alcohol abuse

  • Diabetes

  • Cystic fibrosis

  • GI surgeries
    You can still develop mild to moderate pancreatic insufficiency, especially if you have long-standing autoimmune thyroid disease.

Comments

Post a Comment

Popular posts from this blog

  A little bit more about myself.  I am 65 years old and passionate about living an active healthy lifestyle.  I have followed a plant-based diet since 2006.  Being a retired nurse, I have always been interested in nutrition and how it impacts the body.   I believe that eating the right foods, exercise, and lifestyle choices are the key to feeling strong at any age.  Let's stay strong and feel great together.
Read more

Calcium

  It is very important to get enough calcium in our diet to maintain good bone health and reduce the risk of osteoporosis.  For women 50 and older it is recommended to get 1200 mg per day along with Vitamin D to help with the absorption.  For me eating a plant-based diet, my calcium comes from leafy greens like kale, tofu, tempeh, chia seeds, beans, legumes, and nuts.  I started eating a little cottage cheese for a snack, but I have to take Lactaid pills since I have some lactose intolerance.  I downloaded an app from the Playstore (My Net Diary) to help me track my calcium and protein intake (we will talk about protein another day).  Needless to say,  I am only getting about 800 mg of calcium from my diet, which is not enough.  I do supplement with Citralcal Maximum Plus daily which contains 650 mg of calcium, vitamin D 1000 units, Zinc 5.5 mg, Copper 0.45, Maganese 1.15 mg.  I also take Vitamin K2 100 Mcg daily.  Vitamin K2 helps direc...
Read more

Sugar

Consuming too many added sugars can contribute to health problems such as weight gain and obesity, type 2 diabetes, and heart disease. Sugar  contributes to tooth decay and gum disease. Eating excessive amounts of sugar may increase your risk of developing certain cancers. Diets high in sugar increase inflammation in the body, may cause insulin resistance, both of which increase cancer risk. Consuming sugary products might give you a brief energy boost that is quickly followed by a sharp drop in blood sugar, leading to major fluctuations in energy levels. The American Heart Association recommends the following daily added sugar limits: Women : No more than  25 grams (6 teaspoons or about 100 calories) Men : No more than  36 grams (9 teaspoons or about 150 calories) These limits apply to  added sugars  (like those in processed foods, sugary drinks, and sweets), not naturally occurring sugars found in whole fruits, vegetables, and dairy. Cutting out sugar can lead...
Read more