Learning About Taking Pancreatic Enzymes for Cystic Fibrosis (CF)

Enzymes are substances that start or speed up processes in your body. When you eat and drink, the body releases pancreatic enzymes (also known as digestive enzymes) to help digest food.

For people who don't have cystic fibrosis (CF), these enzymes travel through small passages (ducts) to the small intestine. There they break down food so that the body can absorb nutrients.

If a person has CF, it’s common for thick mucus to block the ducts to the small intestine. These blockages make it hard for the body’s pancreatic enzymes to reach food.

People with CF often take prescription pancreatic enzyme supplements to treat this problem. This treatment is called pancreatic enzyme replacement therapy (PERT). It helps the body break down food and absorb nutrients.

Most pancreatic enzyme supplements come in capsule form. Inside each capsule are many small beads that contain the enzymes. The beads are covered with a coating that keeps them whole until they reach the small intestine, where they dissolve. If you can't swallow the capsules whole, open them and sprinkle the enzyme beads into a small amount of applesauce that you can swallow. Don't crush or chew the beads.

The enzymes used in these supplements usually come from pig pancreas. If you’re part of a religion that doesn’t allow the use of pork products, you may want to talk with your doctor and faith leader. If you have a pork allergy, you should talk with your doctor about your options.

When the beads in the capsules dissolve, the enzymes are released in the small intestine to break down food. Enzymes work for about 45 to 60 minutes after taking them.

By breaking down the food you eat, these enzymes help your body absorb calories from protein, carbohydrates, and fat. They also help you absorb vitamins and minerals. This makes it easier for you to gain weight if needed, maintain a healthy weight, and have good vitamin and mineral levels.

Weight gain is usually a good sign that the enzymes are working. If you’re not gaining weight or you have any symptoms of malabsorption, talk to your dietitian or doctor.

If your doctor recommends pancreatic enzyme supplements and you don’t take them, your body might not be able to absorb the nutrients it needs. This is known as malabsorption. This might cause you to:

• Struggle to gain weight or grow, even if you’re eating a lot of food.
• Feel hungry all the time.
• Have frequent gas or large bowel movements.
• Feel belly pain or cramps.
• Often feel bloated or full.
• Have rectal prolapse (when the rectum falls through the anus).

Malabsorption leads to malnutrition. This can cause serious health problems like stunted growth, serious infections, and weakness.

Most people with CF need to take pancreatic enzyme supplements before they have any foods and drinks that have fat and protein. There are only a few foods and drinks that don’t need enzymes. Ask your dietitian or doctor for a list.

It’s important to take the enzyme dose that your doctor recommends. Taking too many enzyme capsules can cause serious intestinal problems.

• Know the recommended dose for each food. The dose may vary depending on what food you’re eating.
• Keep your enzymes with you. You will take them throughout the day with meals and snacks. Use a small portable pill case to keep a supply with you.
• Store them safely. Keep the capsules in a cool, dry place (not the refrigerator or car). Keep the bottle tightly closed.
• Track the expiration date on the bottle. Get a refill before the enzymes expire.

You may need to split your enzyme dose if you are eating a meal that lasts longer than 30 minutes, such as a holiday meal. For example, you may be instructed to take half of your enzyme dose at the start of the meal and the other half partway through the meal.

Pancreatic enzyme supplements are considered safe. But you may have some side effects, especially when you first start taking them. Side effects include:

• Constipation.
• Diarrhea.
• Nausea.
• Stomach pain or discomfort.

If you continue to have these side effects, contact your doctor. You may need to change your dose or switch to a different brand.