What is Pancreatic Enzyme Replacement Therapy?

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Video Compliments of The National Pancreas Foundation

What is Pancreatic Enzyme Replacement Therapy (PERT)

Written By Tony Subia
April 9, 2022

The term “Pancreatic Enzyme Replacement Therapy” is essentially using prescription capsules of medicinal digestive enzymes to replace the digestive enzymes that the pancreas would naturally produce.

In a normal functioning pancreas, the “exocrine function” portion of the pancreas produces natural digestive enzymes that flow into the small intestine to digest fats, proteins, and carbohydrates in the food we eat. When the pancreas is unable to produce natural digestive enzymes or releases insufficient quantities, the body would need prescription medications that act as a substitute for naturally produced enzymes by the pancreas.

Otherwise, without enough natural digestive enzymes, the foods we eat would never become fully digested into nutrients the body’s cells need to provide energy. Generally the lack of, or reduced naturally produced enzyme production by the pancreas will result in “malabsorption”.

Therefore, “pancreatic enzyme replacement therapy“,  also known as PERT is the use of prescription medications that contain medicinal replacement enzymes which replace what the pancreas is not producing or is not releasing in sufficient quantity needed for complete food digestion. Complete digestion is essential to create nutritients needed to provide the body’s need for energy. Medicinal replacement digestive enzymes contain “proteases” to digest protein, “amylases” to digest carbohydreates and “lipases’ to digest fat.

Proper Dosing of Enzyme Replacement Therapy

There are several options of medicinal enzyme replacement of which “CREON”is the most prescribed. Your doctor will prescribe what he or she initially recommends as a beginning treatment. Pancreatic enzyme replacement therapy dosing may be adjusted thereafter to  levels required by the patient. Replacement enzyme dosing is personalized to the needs of the patient.

Seek The Help of A Registered Dietician Nutritionist To Help Create Diets Low in Fats With foods that provide strong nutrients.

The number of digestive units within a capsule as well as the number of enzyme capsules taken with full meals and snacks is determined by the needs of each individual patient. Instead of three large meals daily, patients are generally encouraged to have six smaller meals each day. For a meal, most doctors initially recommend taking a replacement capsule(s) immediately after your very first bite pf food and a second capsule(s) with the last bite of each meal. This is because it can take 15-20 minutes for the replacement enzymes to flow from the stomach to the small intestine where digestion takes place.

Since dosing is personalized per patient, 2 or 3 capsules of 25,000 units with each standard meal may initially be recommended. 1-2 capsules may be recommended with snacks and very small meals. Depending upon those initial results, your doctor may suggest increasing or lowering the number of capsules and reducing or increasing the number of units per capsule. Consult with your health medical team and A Registered Dietician Nutritionist to test patient dosages until the ideal dose is reached.

Keep This in Mind: A normal functioning pancreas will release about 700,000 Lipase units during a standard meal. If you think you may need more or less number of units per capsule, consult with your doctor and your
nutritionist. Capsules comprised of a higher or lower number of active units will determine the number of capsules taken per meal or snack.

Even though your doctor or dietician should always discuss and recommend what unit strength of dosage and how many capsules are taken and how often…….the patient will be the best judge of what dosages and number of capsules are best for the symptoms. However, the doctor must always know the dosage and capsule quantity because there are risks for over dosing.

Be Observant of Any Side Effects

The most common side effect will likely be constipation, diarrhea , nausea, and abdominal discomfort and pain. Let your doctor know of any severe diarrhea. Sometime switching brands may help. Keep your doctor aware of any experienced side effects.

Although there are alternative digestive enzyme treatments, the most often prescribed replacement therapy is CREON. Visit the CREON Website for more information.


Pancreatic enzyme replacement capsules are made from purified pig pancreas glands. And there is currently no other alternative to using pig pancreas glands. If you have a religious objection to ingestion of pork, it is possible there is special dispensation to allow pork ingestion granted by religious organizations since they are medical needs.

Reference Sources:

Exocrine Pancreatic Insufficiency
Medical News Today

National Library of Medicine

This article about pancreatic enzyme replacement therapy is provided as educational information and is not intended to replace professional medical advice. Always consult with your medical provider with any suspected medical problem or general health advice.

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