A nutritionally adequate diet does not, in itself, guarantee that vitamins, proteins, fats, and other nutrients will be effectively utilized by the body. For this to happen, food must first be digested into molecules capable of crossing the intestinal wall. In this process, the pancreas plays a central role.
Besides its well-known role in glucose control through insulin production, the pancreas has an extensive exocrine function. This part of the organ produces digestive enzymes, such as lipase, amylase, and proteases, which are subsequently released into the small intestine. Lipase is mainly involved in the digestion of fats, amylase acts on carbohydrates, and proteases break down proteins.
When the amount of these enzymes becomes insufficient, a condition called exocrine pancreatic insufficiency (EPI) can occur . In this condition, the problem is no longer just what the person ingests. Some of the nutrients present in food may not be properly digested and, consequently, absorbed.
Symptoms may appear to be purely intestinal.
Epilepsy can manifest as abdominal distension, discomfort, diarrhea, oily or greasy stools, unintentional weight loss, nutritional deficiencies, and muscle wasting. Inadequate fat digestion can also impair the absorption of fat-soluble vitamins A, D, E, and K. Alterations in vitamin B12 and other micronutrients may also be present.
This helps explain why certain persistent gastrointestinal symptoms warrant investigation when they appear repeatedly. Bloating, changes in stool, or apparent intolerance to fatty foods have numerous possible causes and do not automatically mean pancreatic disease. However, the exocrine function of the pancreas is part of the differential diagnosis.
Conditions that can cause exocrine pancreatic insufficiency (EPI) include pancreatic diseases, cystic fibrosis, and diabetes. Exocrine pancreatic function can also decline with aging. The analyzed material cites studies with varying results, but points to estimates of EPI in approximately 15% of people over 70 years of age and 30% among those over 80 years of age.
Pancreatitis can also interfere with enzyme production.
Pancreatitis represents another important mechanism. Under certain circumstances, digestive enzymes can be prematurely activated within the pancreas itself, contributing to cell damage and inflammation. Pancreatitis can present acutely or develop a chronic course, and episodes of the disease can temporarily or persistently impair exocrine function.
The consequence is biologically relevant. If digestion remains impaired for long enough, the problem can extend beyond the gastrointestinal system. Chronic malabsorption can contribute to weight loss, micronutrient deficiencies, reduced muscle mass, and compromised bone health.
This does not mean that anyone with gas or loose stools has pancreatic insufficiency. These symptoms also appear in food intolerances, celiac disease, microbiota disorders, inflammatory bowel diseases, functional gastrointestinal disorders, and various other conditions.
Diagnosis should precede supplementation.
When clinical suspicion exists, medical investigation is necessary to determine if there is indeed a deficiency in pancreatic function. One of the tests used is fecal pancreatic elastase , an indirect marker of exocrine pancreatic secretion.
In confirmed cases of EPI (Excessive Pancreatitis), pancreatic enzyme replacement therapy can be used during meals and snacks to improve digestion. Treatment and dosage depend on the clinical situation and should be determined by a qualified professional.
Over-the-counter digestive supplements should not be confused with enzyme therapy prescribed for diagnosed pancreatic insufficiency. Indiscriminate use of them can also mask symptoms that require investigation.
The central issue is simple: it’s not enough to observe what enters the body. It’s necessary to consider what is actually digested and absorbed . When digestive symptoms become persistent, especially when accompanied by weight loss, fatty stools, or nutritional deficiencies, investigating the digestive capacity of the pancreas can reveal an important part of the problem.
