Quick answer: Pancreatic insufficiency means the pancreas doesn’t release enough digestive enzymes (amylase, lipase and protease) to fully break down food. Poorly digested food can feed unwanted bacteria and add to gut inflammation. Gut hormones such as CCK and secretin coordinate enzyme and bile release. Greasy stools, weight loss and bloating after meals warrant a medical evaluation.
Key takeaways
Pancreatic insufficiency means the pancreas cannot make or release enough digestive enzymes, so undigested food can disturb the gut.
Amylase, lipase and protease break down carbohydrates, fats and proteins, and the hormones CCK and secretin signal the pancreas and gallbladder.
Greasy, pale or floating stools, unexplained weight loss or discomfort after meals are worth getting checked.
What is pancreatic insufficiency?
Chronic inflammation and other conditions can impair the pancreas’s ability to make and release digestive enzymes. Undigested food can then disturb the microbiome and gut lining. See causes of leaky gut.
Digestive enzymes
Amylase breaks down carbohydrates, lipase breaks down fats, and protease breaks down proteins.
Cholecystokinin (CCK)
CCK is made in the duodenum (first part of the small intestine). It signals the gallbladder to release bile and signals the pancreas to release enzymes, and it slows stomach emptying and helps you feel full.
Secretin
Secretin is made in the duodenum in response to stomach acid. It signals the pancreas to release bicarbonate to neutralize acid, increases bile production, and reduces stomach acid release.
Signs to get checked
Get checked if you notice greasy, pale or floating stools, unexplained weight loss, or bloating and discomfort after meals, or if you have a history of pancreatitis, cystic fibrosis or diabetes.
Digestion and healthy aging
Enzyme output can decline with age, which affects nutrient absorption. Good digestion supports protein and nutrient status. See Phase 2: Digestive Revival.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if you have ongoing bloating, gas, diarrhea or constipation, or food reactions that seem to be multiplying. The same is true if you have fatigue, skin flares or joint aches alongside gut symptoms, or if you want a personalized gut plan instead of guessing.
See a medical provider promptly for severe upper abdominal pain spreading to the back, fever, yellowing skin or eyes, or persistent vomiting.
What the research shows
Prescription pancreatic enzymes have been tested in randomized trials. A 2021 pooled analysis by Barkin and Barkin combined two double-blind trials in adults with chronic pancreatitis and moderate to severe pancreatic insufficiency, 59 on pancrelipase and 57 on placebo for one week. Fat absorption improved by 24.7 percentage points with the enzymes compared with 6.4 points on placebo, and 72% of the enzyme group reported fewer bowel movements compared with 38% on placebo. Changes in abdominal pain and gas were not different between groups. These trials involved people with confirmed pancreatic disease, so they do not tell us whether over-the-counter enzymes help people with ordinary indigestion.
Pancreatic insufficiency may be more common than people expect in some groups. In a 2003 multicenter study by Hardt and colleagues, researchers measured fecal elastase, a stool marker of pancreatic output, in 1,021 adults with type 1 or type 2 diabetes who had no history of alcohol misuse or pancreatic surgery. Elastase was normal in 59.3% of participants and severely low in 22.9%, with higher rates in people with type 1 diabetes and those using insulin. Low stool elastase does not always cause symptoms, and the test can be affected by watery stools, so results need to be read in context.
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Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Do my digestive symptoms suggest we should check my pancreatic enzyme function?
Could my digestive symptoms be related to low pancreatic enzyme output?
Could digestive enzymes interact with any of my medications?
Which tests would help us check my pancreatic function?
Frequently asked questions
What are signs of pancreatic insufficiency?
Greasy stools, weight loss, bloating and nutrient deficiencies.
Should I take digestive enzymes?
Discuss with your provider. Prescription enzymes are used for diagnosed insufficiency.
What does CCK do?
It triggers bile and enzyme release and helps you feel full.
How is pancreatic insufficiency diagnosed?
Often with a stool elastase test and medical evaluation.
Sources
- Barkin JA, Barkin JS. Effect of Pancrelipase Therapy on Exocrine Pancreatic Insufficiency Symptoms and Coefficient of Fat Absorption Associated With Chronic Pancreatitis. Pancreas 2021. PMID: 33560089. https://pubmed.ncbi.nlm.nih.gov/33560089/
- Hardt PD, Hauenschild A, Nalop J, et al. High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatology 2003. PMID: 14526149. https://pubmed.ncbi.nlm.nih.gov/14526149/
- Capurso G, et al. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol 2019. PMID: 30962702. https://pmc.ncbi.nlm.nih.gov/articles/PMC6432881/
- Rehfeld JF. Cholecystokinin-From Local Gut Hormone to Ubiquitous Messenger. Front Endocrinol (Lausanne) 2017. PMID: 28450850. https://pmc.ncbi.nlm.nih.gov/articles/PMC5389988/
- Chey WY, Chang TM. Secretin: historical perspective and current status. Pancreas 2014. PMID: 24518494. https://pubmed.ncbi.nlm.nih.gov/24518494/
- Herzig KH, et al. Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus. BMC Geriatr 2011. PMID: 21266058. https://pmc.ncbi.nlm.nih.gov/articles/PMC3039595/
- MedlinePlus: Pancreatitis
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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