The Health Benefits of Pancreatin

Pancreatin (Pancreatin systemic) is a digestive enzyme supplement that contains a mixture of several different types of enzymes. These enzymes are normally produced in the pancreas. Pancreatin has a primary function of helping to breakdown food and convert it into energy. The supplement is comprised of a commercial mixture of amylase (to digest starch), protease (to digest protein) and lipase (to digest fat).

Pancreatin can be derived from both plant or animal sources. The primary enzymes that comprise pancreatin include amylase, lipase, and protease. Pancreatin or pancreatic enzymes are usually made from cows or pigs, but can be derived from plant sources as well.

Pancreatin works to:

• Help break down several nutrients, including proteins, fats and carbohydrates (to be transformed into energy for the body)
• Promote healthy weight gain and maintenance of healthy weight
• Promote absorption of essential vitamins and minerals

Pancreatin may be used to treat various maladies which result in the inability of the pancreas to produce or release pancreatic enzymes, these conditions including:

• Cystic fibrosis
• Chronic (long term) pancreatitis (inflammation of the pancreas)
• Cancer of the pancreas
• Post-surgical (after surgery) conditions such as surgery on the pancreas or gut
• Steatorrhea (a condition involving loose, fatty stools)

Although some people take enzymes (such as pancreatin) for digestive problems, like heartburn or other digestive disorders, according to Harvard Health there is a lack of evidence from clinical research studies to back the effectiveness of digestive enzymes for indigestion and other digestive maladies.

Pancreatic enzymes—available in pancreatin supplement capsules—work to help the body digest food. It is particularly used to treat digestive disorders in those with pancreatic insufficiency (a condition in which the pancreas does not produce enough digestive enzymes such as amylase, lipase or protease),

One disorder that causes pancreatic insufficiency is cystic fibrosis. In cystic fibrosis, thick, sticky mucus is released, which can clog up the pancreas (and other parts of the body such as the lungs). This mucus prevents effective secretion of pancreatic enzymes. Therefore, taking pancreatin supplements has been shown in several clinical research studies to help promote the efficient digestion of nutrients for proper absorption.  

A 2012 randomized, controlled clinical research trial found that in participants with pancreatic insufficiency (due to long-term pancreatitis), six months of pancreatin administration “significantly improved flatulence [gas], abdominal pain, diarrhea and steatorrhea [the insufficient breakdown of fats resulting in fatty stools].” The study also revealed that the treatment with pancreatin was effective in treating symptoms of pancreatic insufficiency, due to cystic fibrosis.

A 2013 randomized, double-blind, placebo study (the gold standard of studies) discovered that in study subjects who had pancreatic insufficiency after pancreatic surgery, “superior efficacy of pancreatin, 25,000 [units],” over those who took placebos (sugar pills) resulted.

According to studies published by the Cystic Fibrosis Foundation (CFF), “87 percent of CF [cystic fibrosis] patients need to take enzyme replacements because their intestines lack the enzymes necessary to break down food and absorb its nutrients.“

A 2016 study, on depression and enzyme compliance, found that children with cystic fibrosis were not compliant with taking supplements when their caregivers had symptoms of depression (such as sadness, apathy and more). Caregivers of those with cystic fibrosis should be sure to seek medical/psychiatric intervention when experiencing any signs or symptoms of depression.

Although many people taking pancreatin do not experience side effects, there are some possible untoward symptoms that can occur from taking pancreatic enzymes, these may include:

• Diarrhea
• Abdominal pain (or cramps)
• Nausea
• Joint pain
• Painful (frequent) urination

Note, severe nausea, vomiting, diarrhea, or any other severe symptoms should be reported right away to the health care provider.

Symptoms of an allergic reaction (although rare) could occur as a result of taking pancreatin. Mild to severe symptoms may include:

• Hives or welts
• Headaches
• Mild abdominal pain
• Mild nausea and vomiting

Severe allergic symptoms may include:

• Difficulty breathing
• Swelling of the face, lips or eyes
• Swelling or constriction of the throat (or tongue)
• Wheezing
• Difficulty talking
• Dizziness
• Collapse

Note, severe allergic reactions are considered a medical emergency; anyone who experiences these symptoms (considered symptoms of anaphylactic shock) should seek immediate emergency medical care.

A medical contraindication is when a specific medication (over the counter or prescription drug), natural herb or supplement, procedure or surgery, should not be taken/performed because it could cause harm. It’s important to report any of these conditions to the health care provider before taking pancreatin:

• Asthma
• Gout
• Pregnancy (safety has not yet been established for pregnant women taking pancreatin)
• Breastfeeding (safety has not yet been established for nursing mothers taking pancreatin)

Other contradictions (situations in which pancreatin should not be taken without the OK from a health care provider) include:

• Antacids: Avoid taking antacids for at least an hour before taking pancreatin.
• Pork allergies: Do not take pancreatin if you are allergic to pork (because most commercial preparations are made from pigs)
• Lactose intolerance: Talk to the health care provider before taking pancreatin if you are lactose intolerant (many commercial preparations of pancreatin contain lactose).
• Other digestive enzymes: Do not take any other digestive enzymes with pancreatin (unless prescribed by the health care provider).
• Laxatives: Do not give laxatives or antacids to any children taking the higher strength preparations of pancreatin (such as Pancrease HL or Nutrizym 22) because it could increase the risk of damage to the intestines.

Pancreatin is available in several forms, including:

• Tablets
• Granules
• Powder

Because there are many different variations of pancreatin available commercially (each type of supplement containing a different amount of the enzymes), it’s important to consult with a health care professional about which type of pancreatin is best for you.

Pancreatin capsules are coated with a special coating called enteric coating; this allows the enzymes to reach the small intestine before being absorbed. The small intestine is where nutrients are absorbed in the body. Without the enteric coating, pancreatic enzymes would be rendered ineffective in the stomach by hydrochloric acid (HCI). What this means is that pancreatin should never be crushed, but rather, swallowed whole.

Pancreatic enzymes work best when taken before a meal because it takes 45 to 60 minutes before they go to work in the body.

Other tips for taking pancreatic enzymes include:

• Take pancreatin before each meal or snack (this includes formula or breast milk for infants)
• Some foods (such as popsicles, hard candy or fruit juices) do not require pancreatic enzymes to digest.
• Keep extra pancreatin capsules handy at all times for when you decide you want to eat a snack or a meal, or have milk (or other food containing beverage).
• Pancreatin capsules should be swallowed whole (do not crush or chew)
• Giving pancreatin to small children who cannot swallow pills may work best by sprinkling the beads (without crushing them) on a small amount of acidic, soft foods that do not require chewing (such as applesauce).
• It’s best to take pancreatin with a full glass of water.
• Do not mix digestive enzymes with milk or foods that are milk-based (such as pudding) because lactose may break down the enteric coating on the beads.
• If meals take longer than 30 minutes to complete, it may be beneficial to split the enzyme dose in half. Take half at the beginning of a meal, and the other half, in the middle of the meal.

Many studies have shown that the minimal dose of pancreatin is 25 000–50 000 U, however, the therapeutic dose can vary quite a bit, depending on a person’s condition, age, symptoms and many other factors.

Although many people who take pancreatin for conditions such as cystic fibrosis may take a specific number of capsules with a meal, and a smaller number with each snack, others are instructed to adjust their dose according to the amount of fat content in their meal.

Note: Studies have found that taking too many pancreatic enzymes can potentially cause damage to the intestines; be sure to consult with a health care provider before taking pancreatin (or any other type of enzymatic supplement).

To discover the exact amount—in units— of lipase, protease and amylase in a specific brand of enzyme supplements, see the side of the supplement bottle label.  Note, for those with cystic fibrosis, seborrhea and other conditions involving lack of normal fat digestion, the health care provider will primarily consider the amount of lipase in the supplement prescribed because lipase is the enzyme that breaks down fat.

Avoid skipping dosages and interchanging various brands (as each has a different amounts of the enzymes).

It's best to store pancreatin at room temperature and keep the supplements away from heat (don’t store near the stove or in a hot car) because heat can destroy the therapeutic action of enzymes.

Unlike many other dietary supplements, the U.S. Food and Drug Administration (FDA) began regulating pancreatic enzymes in 1991. This was because of the wide range of various mixtures of enzymes that were being formulated in different brands of pancreatic enzyme preparations (PEPs). It's important to note that today there are only six out of a total of 30 different band names of pancreatic enzymes that are FDA approved, these include:

• Creon
• Zenpep
• Pancreaze
• Ultresa
• Viokace
• Pertzye

How do I know that pancreatin is working?

Sometimes there is no outward change in symptoms after taking digestive enzymes, but your doctor or other health care provider may perform blood tests, or take a stool sample, to find out if pancreatin is working. the health care provider will use the lab test results to evaluate the dose and duration that the enzymes should be given.

What should I do if my symptoms get worse after taking pancreatin?

Inform your health care provider if symptoms do not improve, or they get worse while taking pancreatin.

Why am I experiencing itchiness on my hands when handling pancreatin beads to mix with applesauce for my child?

A rash, or itchiness that occurs upon contact of pancreatin is common in some people. If this occurs, wearing thin gloves may be needed when handling pancreatin.

How can I learn more about the side effects, and other information about pancreatin?

To learn more about the side effects, action and other information about pancreatin, visit the National Library of Medicine’s website, DailyMed and search for pancreatin in the search bar. This website provides general information about medication and certain supplements, but to learn about specific information (such as the best dosage for you), always consult with the health care provider. 

For those with pancreatic insufficiency, forgetting to take enzymes regularly with each meal or snack (or taking the wrong dose of digestive enzymes) can result in poorly digested nutrients. When undigested food stays in the intestines too long, it can cause an adverse reaction, such as flatulence (gas), abdominal pain, greasy frequent stools, constipation, and other symptoms.

If pancreatin does not seem to be working, never increase the dose on your own. Taking too much pancreatin could result in damage to the intestines. Always consult with the healthcare provider before adjusting the dose of digestive enzymes.
According to the Cystic Fibrosis Foundation (CFF) taking enzymes—such as pancreatin—helps with the assimilation of nutrients (which promotes weight gain). A higher body weight has been linked to better lung function, so taking enzymes with each meal and snack is important.