Managing Exocrine Pancreatic Insufficiency as You Age

There’s no cure for exocrine pancreatic insufficiency (EPI), a chronic condition characterized by an inability to digest certain nutrients, especially fat. But EPI can be managed with a type of medication called pancreatic enzyme replacement therapy (PERT), which consists of enzymes that aid digestion.

It’s important to keep in mind, though, that as you age, your EPI treatment plan and medication regimen may need to be adjusted. Here are five things to know about managing your EPI as you age.

1. You may be at risk for other health conditions.

Because EPI can interfere with your body’s ability to absorb certain nutrients (including vitamin D, which is important for bone health), you may be more likely to develop osteoporosis than someone who doesn’t have EPI. But people with EPI who take PERT tend to have higher bone density levels — and, therefore, maybe less likelihood of developing bone disease — than those who don’t take the medication, according to a review published in May 2020 in the World Journal of Clinical Cases.

EPI has also been associated with diabetes, although the relationship between the two conditions is still unclear.

If you’re diagnosed with another condition or add a new drug to your treatment regimen, be sure to let your doctor know.

2. Always tell your doctor if you’re experiencing any new symptoms.

As you age, it’s possible for your pancreas not to work as well as it once did. If that happens, your EPI could worsen and trigger new symptoms, such as soreness, muscle weakness, weak bones, or numbness. The problem, says Mohamed Othman, MD, a professor of medicine at Baylor College of Medicine in Houston, is that those symptoms could be mistaken for a normal part of aging and go untreated.

Don’t dismiss any new or worsening symptoms. Your doctor can help you determine the root cause and find the right solution.

3. Adjust your medication to fit your diet.

EPI can be treated with PERT, a medication that helps your body absorb nutrients. But PERT should be tailored to your individual diet — which can change as you age — to be effective.

For example, some people find that their appetite decreases as they get older and may start to eat smaller meals with less fat. If that’s the case, says Dr. Othman, your doctor will probably need to lower your dosage of PERT to match your food intake at each meal.

If you aren’t eating enough, you could lose weight and be at risk for malnutrition. So be sure to talk to your doctor if your appetite changes or you unintentionally lose weight. Your doctor can suggest ways to shore up your diet and refer you to a dietitian if you need more help.

4. Don’t stop taking your medication — even if you feel fine.

Although pancreatic enzymes can have some side effects, including abdominal pain, they are safe to take over the long term, says Othman. “We have patients taking PERT since childhood,” he says. It’s important to stick with your medication, even if you start to feel better, says Othman, because skipping doses can cause your symptoms to return.

Be sure to work with your doctor if you suspect you need your treatment adjusted. Never make changes to your treatment plan on your own.

As you age, you may also have difficulty swallowing pills. If you’re having trouble, your doctor may have suggestions for making them easier to take. For example, you may be able to open some delayed-release capsules and mix the contents with food.

5. Continue to live a healthy lifestyle.

As with all chronic conditions, it’s important to lead a healthy lifestyle if you have EPI. Try to eat a balanced diet full of nutrient-rich foods, and avoid cigarette smoke and alcohol, both of which can further harm your pancreas.

If you do drink, talk to your doctor about how much is too much. “A glass of wine every night might not seem like a lot,” says Othman, “but it adds up for a patient with EPI and can cause long-term damage.”

If your condition is well managed, it’s possible to live a healthy life as you age.