Exocrine pancreatic insufficiency (EPI) is a rare health condition in which the pancreas doesn’t function normally, failing to produce the enzymes needed for proper digestion. A common consequence of EPI is that your body may not get enough essential nutrients, such as certain key vitamins. Vitamin supplements may be needed to make up for the shortage. Although the exact vitamin deficiencies can vary from person to person, the fat-soluble vitamins — vitamins A, D, E, and K — are typically the ones that are affected.
“Ninety-five percent of people with EPI need extra supplementation for vitamins A, D, E, and K, because their levels are low,” says Kristi King, RD, MPH, of Baylor College of Medicine and Texas Children’s Hospital in Houston and a spokesperson for the Academy of Nutrition and Dietetics.
Why are these vitamins affected? Absorbing fat-soluble nutrients versus water-soluble nutrients, like vitamins B and C, is a more complex process for the intestines. The process is particularly difficult if you have EPI, explains gastroenterologist Joel B. Mason, MD, of The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University in Boston.
Vitamin Supplements and EPI: How Much to Take
Work with your doctor to determine just how much of each vitamin supplement you should take. “If you have EPI, you need to have a doctor who’s aware of the types of vitamin deficiencies that can arise with EPI so that he or she can monitor you,” Dr. Mason advises. Those deficiencies might change as EPI progresses, he adds.
To help determine the vitamin supplements you need, your doctor or dietitian will determine your levels of vitamins like A, D, E, and K during an initial visit, King says. “If a baseline check is really low, vitamin supplementation should be started and your levels rechecked in a month. Based on that, it will likely be determined how often your vitamin levels should be checked from there,” she explains. Having your vitamin levels checked every two to three months is common.
The exact dosage of each vitamin will also be individualized, based on your age and how deficient you are, King says. Dosages of three to five times the normal recommended daily allowances aren’t uncommon, and could even be higher. “In severe cases, a supplement dosage of 5 to 10 times the daily value may be needed to get a vitamin level up to normal,” she adds. Once you’re responding well to supplementation, you may be able to take a lower maintenance dose.
Vitamin D supplementation appears to be particularly important for people with EPI, according to a study published in the medical journal Anticancer Research. Researchers found that people with EPI, along with other people with pancreatic diseases including cancer, often have varying levels of vitamin D deficiency and that individualized dosages of oral vitamin D supplements helped to correct the problem. Some people needed 20 times more vitamin D than others to get to normal levels.
Maximizing Vitamin Supplements
The vitamin supplements that a person with EPI uses might be a formulation prescribed by his or her doctor or something bought over the counter, King says. “If you need additional vitamin D, you can get a prescription, but some people find that buying an over-the-counter formulation works just as well.” However, make sure it’s vitamin D3, which is better absorbed by the body, she adds.
Generally speaking, you’ll take your vitamin supplements with your meals, King says. This is also when you’ll take your pancreatic enzyme replacements, prescribed to help your body properly absorb the nutrients in your food.
It’s crucial that you follow your doctor’s guidelines regarding supplementation, Mason says. “If your doctor determines that you need a certain vitamin on a regular basis, it should be part of your daily routine to take it.”