Pancreatic and digestive enzymes are indicated for all cancers and in particular pancreatic cancer, both the optimize nutritional intake and to help minimize cancer’s anti immune-surveillance network.
What are pancreatic enzymes?
Pancreatic enzymes help break down fats, proteins and carbohydrates. A normally functioning pancreas secretes about 8 cups of pancreatic juice into the duodenum, daily. This fluid contains pancreatic enzymes to help with digestion and bicarbonate to neutralize stomach acid as it enters the small intestine.
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Types of Pancreatic Enzymes and Their Effects
Lipase works with bile from the liver to break down fat molecules so they can be absorbed and used by the body.
Shortage may cause:
- Lack of needed fats and fat-soluble vitamins.
- Diarrhea and/or fatty stools.
Proteases break down proteins. They help keep the intestine free of parasites such as bacteria, yeast and protozoa.
Shortage may cause:
- Allergies or the formation of toxic substances due to incomplete digestion of proteins.
- Increased risk for intestinal infections.
Amylase breaks down carbohydrates (starch) into sugars which are more easily absorbed by the body. This enzyme is also found in saliva.
Shortage may cause:
- Diarrhea due to the effects of undigested starch in the colon.
Reasons to Take Pancreatic Enzymes
Pancreatic insufficiency is the inability of the pancreas to secrete the enzymes needed for digestion. Having an insufficient amount of pancreatic enzymes is very common among people with pancreatic cancer. When the pancreas does not produce enough enzymes to break down food, pancreatic enzyme products are needed. Doctors sometimes prescribe digestive enzymes, including pancreatic enzymes, to patients who have conditions that cause poor absorption. These products help improve digestion and absorption of food.
Some of the conditions that may cause pancreatic insufficiency include surgery (Whipple procedure or total pancreatectomy), blockage or narrowing of the pancreatic or biliary duct (the tubes that carry pancreatic juice or bile), pancreatic or duodenal tumors, cystic fibrosis or pancreatitis.
Some of the symptoms associated with pancreatic enzyme insufficiency include:
- feelings of indigestion
- cramping after meals
- large amounts of gas
- foul smelling gas or stools
- floating or greasy/fatty stools
- light-colored, yellow or orange stools
- frequent stools
- loose stools
- weight loss
Patients with these symptoms should discuss with their medical team whether taking supplemental pancreatic enzymes may be beneficial for them.
About 25% of patients who have the Whipple procedure will have long-term malabsorption and will need to take supplemental enzymes for life. Other patients may need enzymes for a few months or years after surgery. Patients who have radiation therapy along with the Whipple procedure are much more likely to have long-term malabsorption. Fat absorption usually does not return to normal in these patients even if they are taking enzyme replacement products. In this case, the goal is to eliminate diarrhea, restore adequate nutrition and prevent weight loss.
MCT (Medium Chain Triglyceride) oil may help control weight loss in patients with uncontrolled malabsorption. MCT oil is a calorie-rich type of fat that bypasses usual fat absorption and is rapidly absorbed by the body. It is found naturally in coconut oil, palm kernel oil and butter. MCT oil is added to some medical nutritional supplements and can also be purchased alone as a nutritional supplement. Use of oral nutritional supplements may promote weight gain, help increase strength and physical activity, and improve quality of life.
In patients with unresectable (non-operable) cancer in the head of the pancreas, bile duct and/or pancreatic duct obstructions are common. For these patients, a combination of pancreatic enzyme replacement therapy, nutritional counseling and drainage of the bile duct can prevent weight loss and improve symptoms.
Sources of Supplemental Pancreatic Enzymes
Pancreatic enzyme products are available in both prescription and non-prescription forms. The different brands of pancreatic enzyme products are not identical. All prescription pancreatic enzyme products are regulated by the United States Food and Drug Administration (FDA) to ensure their effectiveness, safety and manufacturing consistency.
Over-the-counter pancreatic enzyme supplements are available without a prescription. Since they are classified as dietary supplements rather than drugs, the FDA does not control their production. While manufacturers of over-the-counter supplements are required to ensure the safety of their products, there are no controls on manufacturing consistency from one batch to the next. Therefore, these products are not recommended for use in patients with pancreatic cancer.
The recommended type and dosage of pancreatic enzymes must be individualized for each person. Most people should start off by taking 10,000 – 20,000 lipase units with snacks and 20,000 – 40,000 lipase units with meals. Patients should not exceed 2,500 lipase units per kilogram of body weight per meal (assuming 4 meals per day). For example, a person that weighs 150 pounds (68kg) could safely take up to 170,000 units of lipase at one meal. Some individuals adapt to different doses of enzymes throughout their care. It is important to discuss with a doctor or dietitian the appropriate type and dose of pancreatic enzymes at regular visits.
Prescription Pancreatic Enzymes
All prescription enzymes come from a porcine (pig) source. If a person has allergies to porcine products, consult a doctor and/or dietitian for alternative options.
Approved by the United States FDA:
Taking Pancreatic Enzymes
Conventional and integrative oncology doctor usually prescribe an acid-reducing medication to help improve the effectiveness of some pancreatic enzyme products. Acid reducing medications include proton pump inhibitors, such as esomeprazole (Nexium®) or omeprazole (Prilosec®), and H2 blockers, such as famotidine (Pepcid®), cimetidine (Tagamet®) and ranitidine (Zantac®).
However, holistic oncology experts usually do not.
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