Pancreatic Enzyme Supplements and Nutrition
Information provided and written by Dr. Peter Durie, MD and Lynda Ellis, RN
SDS is not considered a nutritional disorder. While many children are underweight or malnourished at diagnosis, once the pancreatic insufficiency is addressed with pancreatic enzymes, the children usually begin to gain weight, height and gain better health. Therefore, it is not generally recommended that feeding tubes be used. Of course, every situation is different and only you and your doctors can figure this out for your family member. SDS patients are generally shorter than average.
Pancreatic Defect in SDS
The pancreas is an organ located just beyond the stomach. It produces a number of enzymes that are essential to digest or breakdown protein, fat, and carbohydrates. This allows the nutrients and the fat soluble vitamins (A, D,E,K) to be absorbed in the body. In reality, the pancreas has a very large reserve – only 2% of the pancreas is needed for normal digestion to occur. In people with SDS, the cells in the pancreas that make the enzymes are mostly absent – especially in infancy. Fortunately, about 50% of patients with SDS have a small improvement in pancreatic function, usually after age 4 and MAY be able to stop enzyme therapy. Recent research has suggested that when the pancreas improves for fat digestion, there may continue to be a problem with starch (complex carbohydrates) digestion. This may require a low dose of enzyme replacement to prevent symptoms such as bloating or abdominal cramps after a high starch meal.
Pancreatic Function Assessment
Pancreatic supplements should not be started until the pancreas has been assessed properly because some people with SDS do not need to use them. Tests such as the 72-hour fecal fat, serum typsinogen and iso-amylase, serum vitamin levels or stool for elastase are some of the indirect ways of assessing how the pancreas is working.