What are pancreatic enzyme supplements?
All enzyme supplements contain Pancreatin – a mixture of pancreatic enzymes lipase, amylase and protease. These assist the digestion of fat, carbohydrates and proteins.
In situations following surgery to remove all or part of the pancreas or where the pancreatic duct is blocked, patients may require additional enzyme supplementation to control symptoms.
The proprietary drug Creon® is by far the most common preparation used around the world (others include Panzytrat, Nutrizym, Pancrease HL, and Pancrex). Creon comes in 3 capsule sizes 10,000, 25,000 and 40,000. These values indicate how many units of liapse there are in each capsule.
Most adults take either 2 of the 25,000 capsules with a main meal and one 25,000 capsule with each snack to start with. The dosage is often adjusted according to the type and amount of food being consumed and the presence of continued symptoms. On average patients need a minimum of between 200,000 and 250,000 units of lipase a day to avoid symptoms of malabsorption.
These enzymes are extracted from pig pancreas glands and there is currently no alternative to using pork products. It is important to know that for those who have religious objections to the ingestion of pork products, special dispensation to allow these products has been granted by religious organisations as they are a medicine.
The enzyme supplement, Creon completely stopped all the digestive symptoms that he had, the burping and the reflux, all of it, it worked really well.
Wendy, wife and carer of Graeme with pancreatic cancer
How should I take enzyme supplements?
Capsules should be taken with food – i.e. with the first mouthful of food. All food includes meals, snacks and milky drinks. Your doctor and dietitian will advise you.
If you are more comfortable eating smaller, frequent meals, with for example 3 snacks a day, it may be necessary to take 1 capsule with each snack. Your doctor will tell you how many and what does capsules to take to suit your particular need.
Capsules should be swallowed with a cold drink. Swallowing them with a hot drink can make them less effective.
The capsules should be swallowed whole. If you find this difficult, you can open the capsule and mix the granules with fluid or soft food. Remember if you do this, it is important you take the fluid or food immediately, without chewing so you get the full effect of the granules.
The granules must not be crushed or chewed as they have a special coating to stop them dissolving until they have gone through the stomach and into the intestines where they work.
It is important that you try to drink plenty of fluid every day. You may find that some foods, particularly fatty foods, do not agree with you. If you are having a large meal with more than two courses, or one lasting more than half an hour, you may need to take half of your enzymes at the beginning and the other half in the middle of your meal.
If you are experiencing these symptoms, you should speak to a doctor and dietitian about taking pancreatic enzymes (Creon ©) these can ensure that nutrients break down and can be absorbed by the body.
Tips on taking pancreatic enzymes with your food:
- Large capsules containing a mixture of three different pancreatic enzymes: lipase (to digest fats), amylase (to digest carbohydrates), and protease (to digest proteins)
- Swallow the capsule whole — don’t crush or chew it. The capsule is full of tiny beads that which hold the enzymes. The capsule will be broken down in the stomach, which releases the beads containing the enzymes. The beads break open and the enzymes are activated in the small bowel. Crushing or chewing the capsule will break open the beads in the mouth, which is too early for them to be effective.
- Store the capsules carefully. Room temperature is best.
- Take them at the start of a meal or snack. If your meal or snack lasts longer than 20 minutes you will require another dose.
- Usually, enzymes are taken with meals or snacks that contain protein and/or fat
- Take the capsule with a milky cup of coffee (such as lattes, cappuccinos or flat whites)
- Do not take capsules with over-the-counter antacids that contain calcium or magnesium, such as Gaviscon® or Mylanta®.
- You may need other medication to help the pancreatic enzymes work properly. If this is the case, ask your doctor about proton pump inhibitorswhich work by stopping they work by stopping stomach cells pumping acid into the stomach
- Foods that DON’T require Creon foods or fluids that contain no protein or fat, such as fruits, vegetables, juices, jelly, lollies, black or herbal tea and non-milky drinks.
When not to take enzyme supplements
- On an empty stomach.
- With drinks that contain less than half milk – such as tea, non-milky coffee, fruit squashes and fizzy drinks.
- If you eat small quantities of fruit, vegetables, dried fruit, fat-free sweets (jelly babies, wine gums, mints).
- If you take a very small quantity of food such as an individual chocolate/square of chocolate bar or a small plain biscuit.
A dietitian can provide support when managing your diet.