An EPI diet consists of a balanced plate with easily digestible nutrients and limiting processed foods, alcohol, and fiber-rich foods. Supplements can boost absorption and prevent malnutrition.
Exocrine pancreatic insufficiency (EPI) occurs when the pancreas doesn’t make or release enough of the enzymes needed to break down food and absorb nutrients.
We’ll review what to eat and what to limit if you need an EPI diet, as well as some other factors that might help ease your symptoms.
If you have EPI, figuring out what to eat can be tricky. You need to make sure you’re getting enough nutrients and vitamins, but you also need to avoid foods that irritate your digestive tract.
On top of this, some conditions associated with EPI, like cystic fibrosis, Crohn’s disease, celiac disease, and diabetes, have additional special dietary requirements.
An EPI diet prioritizes balanced, nutrient-dense, minimally processed, fresh foods whenever possible.
Why should I keep a balanced diet with EPI?
Because EPI causes your body to lose essential nutrients and lose weight, eating a balanced diet can help ensure you’re consuming enough nutrients and maintaining your weight.
A balanced diet is also beneficial if you have a condition associated with EPI. For instance, people with cystic fibrosis need more calories for energy, and people with Crohn’s or celiac disease need to limit or avoid trigger foods without minimizing their overall nutrient intake.
Additionally, EPI is
A balanced diet combined with enzyme replacement therapy can help ease your symptoms and improve your quality of life and general well-being.
Here are some diet tips and recommendations to keep in mind if you have EPI.
Since your body has difficulty absorbing nutrients, it’s extra important that you choose foods with a balanced mix of:
Proteins
Choose lean proteins, such as:
- chicken
- turkey
- eggs
- tofu
- fish
Carbohydrates
Reach for fruits and vegetables, especially:
- Dark leafy greens: kale, spinach, romaine lettuce
- Red and orange vegetables: bell peppers, tomatoes, beets, carrots, squash
- Fruits: bananas, apples, pears, oranges, melons
Fats
It’s important to consume healthy fats, such as:
- nuts
- seeds
- olive oil
- avocado
EPI and fats
In the past, doctors
Avoiding fat can also make weight loss associated with EPI more severe. Taking enzyme supplements allows most people with EPI to eat a diet with moderate fat levels.
When choosing meals, remember not all fats are created equal. Make sure you’re getting enough essential fats. Avoid ultra-processed foods and those high in trans fat, hydrogenated oils, and saturated fat.
Instead, look for foods that contain:
- monounsaturated fat
- polyunsaturated fat
- omega-3 fatty acids
Some foods or drinks can worsen EPI symptoms and might be worth limiting or avoiding.
Fiber-rich foods
Eating lots of fiber is typically associated with a healthy diet. But if you have EPI, too much fiber
Here are some high fiber foods that you may want to limit:
- brown rice
- barley
- peas
- lentils
Alcohol
Years of alcohol misuse can increase your likelihood of pancreatitis and EPI. Reduce your chances of further damaging your pancreas by limiting your alcohol intake.
The
Try to limit drinking:
- beer
- hard cider and seltzer
- wine and mead
- liquor and spirits
Ultra-processed foods
Processed and deep-fried foods often contain hydrogenated oils that could be hard for you to digest.
Try to limit eating:
- baked goods and ice cream
- chips and packaged snacks
- soft drinks
- breakfast cereals and bars
Your pancreatic juice — which is what helps break down food and absorb nutrients — contains enzymes, electrolytes, and water. People with EPI don’t have enough pancreatic juice, but staying hydrated can help.
Drinking enough water helps your digestive system run smoothly. If you have diarrhea caused by EPI, it’ll also prevent dehydration.
The U.S. National Academies of Sciences, Engineering, and Medicine recommends 11.5 cups (92 oz) per day for women and 15.5 cups (124 oz) per day for men.
Here are some examples of what to drink to help with EPI:
- water or flavored seltzer water
- herbal tea or green tea
- electrolyte drinks
You could also eat foods with high water content, such as peaches, cantaloupe, watermelon, strawberries, cucumbers, zucchini, and celery, or make popsicles using these hydrating ingredients.
Here’s an idea to get you started on what to eat with EPI:
| Meal | Example menu |
|---|---|
| Breakfast | Omelet with spinach, bell peppers, and tomatoes. Sip on green tea. |
| Snack | Apple slices with nut butter to dip. |
| Lunch | Greek salad with romaine lettuce, olives, feta cheese, and olive oil (option to add shredded chicken). |
| Snack | Roasted chickpeas sprinkled with cinnamon and paprika. |
| Dinner | Broiled salmon with a side of slaw made of shredded carrots, cabbage, and beets mixed in nonfat plain Greek yogurt and lemon juice. |
Try to eat a small meal or snack every few hours and stay hydrated throughout the day.
Try some of these tips to help stick to your dietary plan.
Eat consistent meals
Eating large meals makes your digestive system work overtime. You’re less likely to have uncomfortable symptoms of EPI if you eat smaller portions three to five times per day, as opposed to having three large meals.
Likewise, it’s best not to skip meals. Skipping meals could prevent your body from getting enough nutrients.
Make a food log
Logging your food can help you find foods that trigger EPI symptoms, such as diarrhea. Then, you can limit or eliminate those foods from your eating plan.
You can use pen and paper or an app to log your food. Here’s an example food log:
| Food or beverage | Include meals, snacks, coffee, tea, water, or other fluids. |
|---|---|
| Meal time | When did you eat or drink? |
| Portion size | How much did you eat or drink? |
| Calories | What were the total calories of each food or beverage based on the portion size? |
| Nutrients | If you’re lacking specific nutrients, log how much you’re consuming. |
| Notes | Did you experience any EPI symptoms after consuming a food or beverage? |
If you’re logging by hand, you can look at the food’s nutrition label to find its calories and nutrients.
Share your log with your healthcare professional to provide them with insight into potential dietary adjustments.
Make sure that you are getting enough nutrients each day
EPI can lead to nutritional deficiencies in some vitamins and minerals.
Try to add sources high in these micronutrients to your daily lifestyle, including:
- liver
- fatty fish like salmon
- nuts and seeds
- leafy greens like parsley, kale, and spinach
- citrus fruits like oranges
- eggs
- dairy products
- sunlight
- supplements
Malabsorption and nutritional deficiencies happen in people with EPI because their bodies lack the pancreatic enzymes needed to properly digest and absorb food into their digestive tract.
Nutritional deficiencies in EPI
- Fat-soluble vitamins: A, D, E, and K
- Other vitamins: B12 (cobalamin), B9 (folic acid), B1 (thiamine), and C
- Minerals: calcium, magnesium, and zinc
You might have a deficiency if you experience:
- weight loss
- skin rashes
- mouth sores
- hair loss
It’s important to get your nutrient levels checked regularly. If you’re deficient in any nutrients, work with your healthcare professional or dietitian on a treatment plan, which might include eating a more varied diet or taking supplements.
After checking your nutrient levels to find what nutrients are more difficult for your body to absorb, it’s important to talk with your healthcare professional about which supplements are right for you.
Your healthcare professional may prescribe vitamin D, A, E, and K supplements to prevent malnutrition. These should be taken with meals in order for them to be absorbed properly.
If you’re taking enzyme replacements for your EPI, they should also be taken during every meal to avoid malnutrition and other symptoms. Talk with your healthcare professional if enzyme replacement therapy isn’t working.
While these tips serve as a starting point, it’s important to work with your healthcare professional or dietitian to create a plan tailored to your specific needs and conditions.
A dietitian can teach you how to cook healthy, affordable meals that work for your dietary needs.
If you have conditions related to EPI, such as diabetes, cystic fibrosis, or inflammatory bowel disease, working with a dietitian can help you find a meal plan that fits all of your health needs.
Everyone has different food tolerances. If your diet isn’t working for you, talk with your healthcare professional or dietitian about other options.