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protein breakdown

Question
Hello,
My 17-month-old daughter has CF. She is fine. No airway problems and she grows well. She has a weight above average (11 kg). She eats well. 4 times a day she gets 4 spoons of pancreatic enzymes (20 000 units each time). Sometimes I smell a rotting odor in her regurgitations. I did understand its a result of a bad protein breakdown. Should I rise the dose (she grows well) or could it be the result of not giving creon with certain snacks. E.g. sometimes I give her chips without giving her creon.
Answer
Dear questioner,

Thank you for your interesting question. However, we can only answer this question in general terms. If you want specific advice for your daughter, please contact a CF doctor.
There can be several causes for a bad smell of regurgitations. These causes can be related to various gastrointestinal problems, that are common in patients with CF. Severe constipation can cause for example a septic tank smell. Also bacterial overgrowth can cause the bad smell. Bacterial overgrowth can be the result of frequent antibiotic treatments but causes mostly increased flatulence. Also reflux and/or a slow gastric emptying can give the breath a bad odor.
In CF it is important that digestion is as normal as possible. This can be done by taking the right dose of pancreatic enzymes. Pancreatic enzymes break down the nutrients in the intestine, so that these smaller particles can pass across the intestine to the blood. They are used as energy or as building blocks. Those enzymes are amylase (carbohydrate digestion), lipase (fat digestion), and protease (protein digestion). The pancreatic enzymes should be taken with each meal or snack. If not, some of the nutrients will be lost in the stool. The dose depends on the type of food and the size of the meal. The fatter the meal, (e.g. chips, crisps, chocolate), the higher the need for pancreatic enzymes. With chips you definitely need to take pancreatic enzymes. Only with food that contains purely refined sugars (e.g. candy, fruit, soft drinks ,...) and with water, enzymes should not be taken.
If the pancreatic enzymes are not taken properly, the digestion and absorption of the nutrients won’t be optimally. That will result in undigested food residues in the faeces. Undigested proteins give mostly a typical rotting smell to the faeces.
Yours sincerely,
Claes Ine
26.09.2013