Download A guide to eating and pancreatic enzyme supplements

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Website: www.creoninfo.co.uk
With thanks to the Dietitians working in Community Health Oxfordshire
who have compiled this information
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Author: UGI CNS V1&2
Macmillan Dietitians V3
Issue date: July 2010
Reviewed: July 2012
Next Review date: July 2014
Leaflet code: CISS - 65
Version: 3
A guide to eating and
pancreatic enzyme
supplements
Information for Patients
This booklet is for people who need to
take Creon
Issued by:
Date:
Why are pancreatic enzyme supplements needed?
• Rich puddings eg cheesecakes, ice-cream
The pancreas produces enzymes which help to breakdown
(digest) food. You may not produce enough of your own
pancreatic enzymes if you have had part or all of your pancreas
removed or if you have inflammation of your pancreas (chronic or
acute pancreatitis).
• Pudding with cream
Surgery to your stomach or oesophagus can also affect the
release of pancreatic enzymes, necessitating pancreatic enzymes
supplements.
If your pancreas does not produce or release enough enzymes,
digestion of the major food components; fat, protein and
carbohydrate will be reduced. This in turn, may influence weight
loss and nutritional problems due to poor absorption of fat, protein,
carbohydrate, vitamins and minerals.
Symptoms of pancreatic enzyme insufficiency may include:
• Dressings/sauces eg mayonnaise, cheese sauce
NB You do not need to follow a low-fat diet whilst taking
pancreatic enzyme supplements (Creon™).
If you are taking other medications to control stomach acid eg
lansaprazole, omeprazole etc, it is important to take as
prescribed to ensure the Creon™ is effective.
If you have any queries or concerns on how to take Creon,
please discuss this with your Doctor, Dietitian or Upper GI
Nurse.
Doctor:
•
abdominal bloating and/or pain
•
excessive wind (flatus)
•
diarrhoea
Dietitian:
•
pale and offensive smelling stools
Tel No:
•
floating stools (difficult to flush away)
What are pancreatic enzyme supplements?
Pancreatic enzyme supplements should be taken with all meals
and some fluids to help break down nutrients. They are usually in
a capsule form however granules are also available. The
capsules will vary in size, depending upon the dosage.
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Tel No:
Upper GI Nurse:
Tel No:
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Do I need to take Creon™ with all foods?
Some foods will not require Creon™ because they are low in fat
and protein. These include:
• Fruit or vegetables (fresh, tinned, frozen or dried) with no
added butter, oil or dressing except olives or avocado
Types of pancreatic enzyme supplements
Several different brands of pancreatic enzyme supplements
are available. This leaflet refers to the use of Creon™ and the
dosage of Creon™ available.
• Low fat puddings eg sorbet, jelly, meringues (no cream)
You may however be prescribed an alternative pancreatic
enzyme such as Nutrizym 10™ or Pancrex ™. Please speak
with your Dietitian for dosage advice if you have not been
prescribed Creon™.
• Preserves, eg jam /marmalades
How should I take Creon™?
• Sweets, eg boiled or mints
The Creon™ enzymes work by digesting food as it passes
through the gut; therefore the Creon™ must be taken at the
same time as eating a meal or snack.
• Fruit drinks eg squash, juice, fruit smoothie (without yoghurt
or milk)
• Fizzy drinks
• Tea and coffee with a little milk and sugar
• Consommé, Bovril
High fat foods that may require extra Creon™ include:
• Fried foods
• Fatty / processed meats eg sausages, salami
• Takeaways
• Swallow the capsule as you start eating your meal or snack.
• If more than one capsule is required, take one at the
beginning of a meal and one in the middle, or between
courses if more than 30 minute meal.
• If you have problems swallowing a capsule, open it and mix
the contents with soft food or liquid and swallow
immediately.
• Avoid mixing the granules or taking the capsules with very
hot food or drink (eg tea or coffee). This may destroy the
enzyme.
• Drink plenty of liquid each day (8-10 cups).
• If you forget to take your Creon™, wait until your next meal
and take as usual.
• Pastry dishes
• Cakes, biscuits, sweet pastries and chocolate products
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• Do not take Creon™ without food. It will not have a
beneficial effect.
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How much Creon™ do I need to take?
Starting dose:
There are three sizes of Creon, these are:
Breakfast:
Bowl of cereal with
milk and 1 slice of
toast and
butter/margarine
Creon 25,000 x 2
Snack
meal:
Sandwich or light meal
eg egg on toast
Creon 25,000 x 2
Main Meal:
Meat/fish/poultry with
vegetables and
potatoes or pasta/rice
Creon 25,000 x 2
Snacks:
Eg Crisps, biscuits,
cake
Creon 25,000 x 1 or
Creon 10,000 x 1-2
Nourishing
Drinks:
Milk, milkshakes or
supplement drinks
such as Ensure Plus,
Fresubin, Resource,
Fortisip
Creon 25,000 x 1-2
Dessert:
Fruit pie, custard,
cheesecake
Creon 25,000 x 1
• Creon 10,000
• Creon 25,000
• Creon 40,000
Creon 10,000 contains the smallest amount of enzyme and
Creon 40,000 contains the most.
The amount of Creon™ required will vary greatly according to
the size and content of the meal or snack and the reason for
needing the enzyme.
It may take some time to work out how much Creon™ you
need to take. Keeping a food diary to record your food intake,
your symptoms and the Creon™ dose can be very helpful in
working out if more Creon™ is required.
Please refer to the symptoms of not having enough pancreatic
enzymes above. You may have only one symptom or several.
Meal plan example
This is an example of a meal plan and how you should start taking
your Creon™. You will need to adjust the amount of Creon™
according to what and how much you are eating and depending
upon your bowel symptoms.
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Remember, if you are taking more than one Creon™ capsule,
it will work better if it is split throughout the meal.
There is no maximum dose of Creon™. If your symptoms
persist it is likely that you need to increase the dose. If
increasing the dose does not help, speak with your Dietitian
for further advice.
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