Pancreas enzymes

Question

Do you only need to take enzymes with fatty foods or also when you eat protein. Should you increase your enzymes when your stools smell really bad?

Answer

Dear questioner,
The enzymes taken by mouth contain lipases (for the digestion of fat), proteases (for the digestion of proteins) and amylases (for the digestion of starch). It is advised to take enzymes with nearly every type of food. Indeed most food contains a combination of protein, fat and carbohydrates. The higher the fat content of the food, the higher the dose of enzymes should be. Only when you eat refined sugars (sweet fruits, certain candy, sweet drinks,…) you do not need to take enzymes. These sugars do not need pancreatic enzymes to be absorbed. But if you eat cookies or chocolate, it is obvious that they are sweet but they also contain starch and fat and you thus need to take enzymes.
Digestion of fat, carbohydrates and proteins in the food is done by enzymes released by the pancreas. These enzymes will make sure that fats, carbohydrates and proteins are broken down to small substances that can pass through the intestinal wall and reach the blood. In patients with CF, the ducts in the pancreas are obstructed by tenacious secretions. Therefore, the enzymes will not be released to the intestine. It thus follows that fat and proteins will not be (fully) digested. When undigested proteins reach the large gut, they are being digested by bacteria. The brake down products of proteins contain nitrogen and this gives a typical odor of rotten eggs to the stool. Foul smelling stool can thus be a sign of poor protein digestion and is a reason to increase the enzymes. Also copious fatty stools are a reason to increase the dose of enzymes.

Kind regards,
Dr. Mieke Boon

30.06.2011