Exocrine pancreatic insufficiency (EPI) affects nutrient absorption. People with EPI need to ensure they eat a varied, balanced diet that provides carbohydrates, fats, and protein.

EPI happens when the pancreas does not produce enough exocrine pancreatic enzymes.

The lack of these enzymes causes a person to have difficulty breaking down food and absorbing nutrients. Issues with digesting and absorbing food can lead to weight loss, fatty stools, and malnutrition. They can also decrease a person’s quality of life. Without treatment, malnutrition from EPI can be fatal.

EPI often occurs in people living with other health problems, such as:

  • cystic fibrosis
  • Crohn’s disease
  • diabetes
  • celiac disease
  • chronic pancreatitis

People with these conditions often need to eat a special diet, but EPI may require further dietary changes. Alongside treatment with nutrition supplements and enzyme replacement therapy, dietary changes can help manage EPI.

This article explains how diet affects EPI and its role in managing it. It also provides tips on which foods to eat and avoid with EPI and how to prevent malnutrition.

A person living with EPI needs to select the foods they eat very carefully to ensure they are eating enough calories and getting sufficient nutrients to prevent nutritional deficiencies.

Fat intake is a very important consideration for people with EPI. These individuals are likely to have difficulty absorbing fat and experience deficiencies in fat soluble nutrients. Fat soluble nutrients include vitamins A, D, E, and K.

Due to this, a person living with EPI also needs to make sure that they are getting enough fat. However, there is mixed evidence on whether someone should increase their fat intake beyond the recommended dietary levels to manage EPI.

The authors of a 2017 study note the existing advice for people who have EPI and pancreatitis to refrain from increasing their fat intake to avoid further pain from fatty stools associated with chronic pancreatitis. Conversely, they state that a high fat diet can benefit people with cystic fibrosis and EPI.

However, an older 2013 study recommends that people with EPI eat a moderate amount of fat and undergo enzyme replacement therapy.

A person with EPI should consult a doctor about which dietary approach is right for them. They should aim to choose foods with healthy monounsaturated or polyunsaturated fats and fatty acids instead of foods high in saturated and trans fats.

Most people with EPI should eat a varied, balanced diet full of carbohydrates, fats, and protein. A person should choose unprocessed, fresh foods whenever possible.

When choosing foods high in fat, a person should look for nutritious choices instead of products containing lots of saturated or trans fats. Foods rich in healthy fats include:

  • nuts
  • coconut
  • olive oil
  • avocado
  • seeds
  • fatty fish, such as salmon

A person with EPI should avoid:

  • high fiber foods
  • heavy meals
  • alcohol

High fiber foods

For most people, adding more fiber to the diet aids digestion and promotes satiety. However, people living with EPI need to limit their fiber intake, as fiber can disrupt the digestive enzymes.

A 2019 review of studies found that high fiber foods can increase the amount of fat that a person loses in their stool. This can increase the severity of nutritional deficiencies.

Heavy meals

Eating larger meals can make it more difficult for the pancreas to break down food. People with EPI should avoid eating larger meals and, instead, eat more, smaller meals over the course of the day.


Frequent and prolonged alcohol consumption is the most common cause of chronic pancreatitis, which can lead to EPI. Alcohol also further disrupts the production of pancreatic enzymes, which can worsen EPI symptoms.

People living with EPI have a high risk of developing malnutrition, which involves deficits in vitamins and minerals, as well as calories. The main symptom of malnutrition is weight loss, but a person may also experience behavioral changes over time.

As part of a person’s treatment, a doctor or nutritionist will likely prescribe or recommend taking a combination of vitamin and mineral supplements. High dosages of these nutrients can help prevent malnutrition.

In addition to dietary changes and supplements, the main treatment for EPI is pancreatic enzyme replacement therapy (PERT). PERT works by replacing the defective or insufficient enzymes that the pancreas typically supplies. A person needs to take PERT with each meal to help aid digestion.

People living with EPI and those at increased risk of developing the condition should also avoid smoking. According to a 2017 study, smoking is an independent risk factor for developing EPI.

Some other tips that a person can follow to help manage EPI include:

  • finding or creating a support group to help with implementing and adhering to dietary changes
  • exercising regularly
  • keeping track of what foods work best to manage symptoms
  • drinking minimal amounts of fluid with meals and then hydrating about 20–30 minutes after the meal
  • eating frequent, smaller meals throughout the day
  • making sure to take the correct dosage of medication before each meal

Dietary changes can play a large role in the treatment and management of EPI. Healthcare professionals also recommend other lifestyle changes, such as avoiding smoking and alcohol consumption.

Additionally, treatment with vitamin and mineral supplements and PERT is important to help ensure the proper absorption of nutrients into the body. A person with EPI should work with their doctor, dietitian, or healthcare team to develop a diet and treatment plan that will help them get the nutrients they need.