Exocrine Pancreatic Insufficiency and Vitamins

If you are a person diagnosed with exocrine pancreatic insufficiency, or EPI, you’re most likely familiar with the gastrointestinal (GI) symptoms of the condition: gas, bloating, frequent diarrhea, and oily stools.

EPI can also trigger other problems because without medication, people with EPI have trouble properly digesting nutrients, especially fat. Not only is fat an essential part of a healthy diet, but it also helps the body absorb certain key vitamins, including A, D, E, and K.

When people do not get enough of these vitamins, they can experience a whole host of problems, including vision trouble, bone weakness, fatigue, and more. Here are a few non-GI symptoms of EPI that may occur, plus what you can do to manage them.

1. Bone weakness and pain

This is the most common — and often the first — sign that you have a vitamin deficiency. Our bodies need vitamin D to absorb calcium. Together, the nutrients help support bone health and ward off osteoporosis. Without enough D and calcium, our bones can become thin and brittle, causing pain and weakness. The pain will generally be like a deep, generalized ache, and some people may also experience muscle weakness and become fatigued easily.

2. Muscle cramps

Getting too little calcium can cause muscle cramping in people with EPI, according to research published in the November 2013 in the World Journal of Gastroenterology. Additionally, dehydration, which can be triggered by a bout of diarrhea, can cause muscle cramping.

3. Depression

Vitamin D deficiency has also been linked to depression. A research review published in January 2017 in the Journal of Affective Disorders found an association between the conditions: It suggested that vitamin D supplements might help treat depression in people who are deficient. Talk to us at Palmetto Endocrinology before starting any new supplements, and if you start taking one, be sure to take it at the same time you take your EPI medications.

Many people have trouble getting enough vitamin D because the chief source of D is sunlight, but people are generally cautioned to protect their skin from the sun. It’s also available in only a few foods, such as fatty fish and fortified milk, which makes people with EPI at even higher risk of deficiency because of their problems with digestion.

It is also true that managing any kind of chronic condition can take a toll on your mental health. In fact, it’s estimated that one-third of people living with a chronic health condition also show signs of depression. If you suspect you’re experiencing depression, talk to us about whether you should see a therapist or other specialist.

4. Vision problems

If you are lacking vitamin A, you may experience nighttime blindness. Vitamin A helps with light absorption in the retina and keeps the cornea healthy. The most well-known form of the vitamin, beta-carotene, may also help prevent or treat age-related macular degeneration, the leading cause of vision loss in people over 50.

5. Gastroenteritis

Vitamin A plays an important role in boosting the health of the immune system; a severe lack of A can lead to frequent infections such as gastroenteritis, which is commonly known as the stomach flu. You can protect yourself against viruses by washing your hands frequently. If you’re already sick, make sure you stay hydrated.

Preventing Symptoms of EPI

The best way to ward off these deficiencies is to treat the cause of your EPI and take pancreatic enzyme replacement therapy, or PERT. Because EPI occurs when something is wrong with the pancreas, it’s important for people to understand what’s causing the pancreas to malfunction and to treat that root cause.

Also, if we suggest you take vitamin supplements, always take them at the same time you take your enzymes, because the enzyme replacements help your body absorb these vitamins. It’s a good idea to have your vitamin levels checked regularly (or have vitamin deficiency-related tests done) when you come in for your regular visit.

Try to eat a diet that’s high in nutrients — one that contains plenty of fruits and vegetables — and limit or avoid alcohol, which researchers estimate is involved in nearly half of all cases of EPI. Finally, stop smoking; research suggests that lighting up is a risk factor for EPI.

Finally, we know how difficult and important it is to manage a chronic illness. Please see us at Palmetto Endocrinology to help.

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.