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.

It is best for people living with EPI to carefully select their foods so they eat enough calories and nutrients to prevent deficiencies.

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.

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

The lack of these enzymes causes the body difficulty breaking down food and absorbing nutrients.

Issues with digesting and absorbing food can lead to:

EPI can occur in people living with other health conditions, such as:

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

Fat intake is a very important consideration for people with EPI. These individuals will likely have difficulty absorbing fat and fat-soluble vitamins.

Due to this, a person living with EPI must also ensure they are getting enough fat. However, there is mixed evidence on whether someone with EPI should increase their fat intake beyond the Daily Value (DV) of around 78 grams daily.

The authors of a 2017 review note the existing advice for people with EPI and pancreatitis is 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.

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

Most people with EPI need to eat a varied, balanced diet full of carbohydrates, fats, and protein to maintain well-being. A person can prioritize minimally processed, fresh foods whenever possible.

Lean proteins

Lean proteins, such as chicken, turkey, eggs, lentils, and fish, can provide energy while also being low in trans and saturated fats.

Healthy fats

When choosing foods high in fat, it is best to look for foods high in heart-healthy unsaturated fats. A person can limit or avoid products containing lots of saturated or trans fats.

Foods rich in healthy fats include:

Small meals

It is best for a person with EPI to eat small, frequent meals throughout the day. This aids digestion and allows the intestines to absorb as many nutrients as possible.

Dietary supplements

Dietary supplements may help increase the nutrients a person with EPI can absorb.

Taking supplements for fat-soluble vitamins, such as A, D, E, and K, can be beneficial.

A person with EPI can aim to avoid:

High fiber foods

For most people, adding more fiber to the diet helps digestion and promotes a feeling of fullness. However, people living with EPI may need to limit their fiber intake. Fiber can disrupt the functioning of digestive enzymes.

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

According to some guidelines, people with EPI can avoid very high fiber diets of more than 25 grams of fiber per day.

Heavy meals

Eating larger meals can make it more difficult for the pancreas to secrete enough enzymes to adequately break down food.

People with EPI can avoid eating larger meals. Instead, they can aim to eat smaller meals more frequently throughout the day.


It is best for a person with EPI to avoid alcohol.

Heavy 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, minerals, and calories.

Symptoms of malnutrition may include:

  • weight loss
  • skin rashes
  • mouth sores
  • hair loss
  • behavioral changes, in some cases

A doctor or nutritionist will likely prescribe or recommend a combination of vitamin and mineral supplements as part of a person’s treatment.

In addition to dietary changes and supplements, a person may need to take pancreatic enzyme replacement therapy (PERT) while they eat.

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 it can also avoid smoking. According to a 2017 study, smoking is an independent risk factor for developing EPI.

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

  • finding or creating a support group to help with implementing and adhering to dietary changes
  • getting regular physical activity
  • keeping track of what foods work best to manage symptoms
  • 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 treating and managing EPI. Healthcare professionals also recommend other lifestyle strategies, such as avoiding smoking and drinking alcohol.

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 can work with their doctor, dietitian, or healthcare team to develop a diet and treatment plan to help them get the necessary nutrients and maintain their well-being.