EPI * Exocrine Pancreatic Insufficiency

After you discover that your dog has EPI, and the shock wears off…you are told that there are some standard recommendations regarding how to treat an EPI dog:

1.     Give pork-based enzymes with every meal (powdered enzymes work best)

2.     Change the diet to a no-grain diet, low in fiber and fat and incubate for 20 minutes

3.     If the dog has the secondary condition, B12 Deficiency, Treat with B12 injections- - pills don’t work

4.     If the dog has the secondary condition, SIBO, Treat with Tylan or Metronidazole (the preferred antibiotics for SIBO) for 30 days

5.     Keep an EPI log of everything you give your EPI dog, and the reactions

The reality is that this DOES work for many of the dogs, but not all EPI dogs!!

The best recommendation to anyone new to EPI is to:

1. start keeping an EPI Log,  
2. if possible, do try all the standard recommendations first
3. if your dog is not improving, do not be afraid to try things not touted standard protocol, but keep records (the EPI Log) to determine what might work best for your individual dog.
   

Remember, there are no absolutes, no right or wrong, but only what works best for your dog.

I would like to share some of the following exceptions that have worked for “some” EPI dogs.

ENZYMES: Although all documentation recommends pork enzymes, and then further states that powdered enzymes are the best, sometimes powdered is not available in some areas, and other products have been used with great success. CREON, for example is an enteric coated capsule and has worked well, as has other products.

Althoughit is recommended to give 1 level teaspoon of powdered enzymes with each meal… the standard protocol … once the dog is stabilized, this may also be modified depending on the individual dog, to a lesser amount.

Although touted by many to incubate the enzymes, this also is not true with every EPI dog. Some do just as well when the enzymes are not incubated. Others do not. But it does help alleviate the possibility of mouth sores (as does reducing the amount of enzymes given), so we do continue to just recommend incubating to all at the beginning stages of learning to manage EPI.

DIET: There are so many variables to this one, that I will not try to cover all of them, but just a few supposedly hard and fast rules about EPI that also do not hold true with every EPI dog.

Grain-Free food… yes, this does seem to work with “most” EPI dogs (they do seem to have the most difficulty dealing with certain fibers) HOWEVER, there are some EPI dogs that do not show improvement until they are feed a diet with a moderate amount of grain. This is why it is extremely important to keep an EPI Log… so that you can best determine what best suits your individual EPI dog, especially when it comes to diet.

Raw… yes,some folks with EPI dogs have struggled with little success to manage their EPI dog until they switched to raw food…. However, this does not work for all EPI dogs, some cannot handle raw food. Again, if you are still having difficulty managing your EPI dog….do not be afraid to try things “out of the norm” after you have exhausted the standard EPI protocols. No two dogs are exactly alike with this condition.

Low Fat…it used to be highly recommended that EPI dogs be placed on a low fiber, low fat diet. However, once the dog is on replacement enzymes, many dogs CAN and should, if possible, have normal amounts of fat. Actually restricting fat long-term can cause problems all in itself. So, this is another EPI step for “trial and error”.We like to recommend restricting fiber and fat only at the very beginning and then to slowly re-introduce regular amounts of fat% to the dogs diet. Many will do just fine, others won’t. For those dogs that cannot digest normal %’s of fat in their diet, you will need to supplement their fat intake with an alternative

Grinding food...If you are feeding with a hard kibble, one that does not crush easily, it may take more than 20 minutes for incubation.  Also, on these hard kibble, it may need to be ground for some dogs.   Another fact touted taht is not always hold  true for all EPI dogs. Sometimes it helps to do this in the beginning, but not necessary once the dog is stable.

B12 Deficiency: The standard protocol for an EPI dog with B12 Deficiency or low side of normal B12 levels is that the only scientifically proven thing that works is to administer B12 injections.

Again, we have noted (and this has been tested) exceptions.. Many EPI dogs that were having difficulty are finally being stabilized with a combination of the B12 injection and a B12 pill called Metagenics B12/Intrinsi/Folate pills.

• 500 mcg B12
• 800 mcg Folate
• 20 mg Intrinsic Factor 
  

Another exception that we have "observed" is :

Some dogs are finding stabilization with just the Metagenics pill alone. Again, toutedt that it works because it has the Intrinsic Factor in it.  But again, we have observed more exceptions:

We are now beginning to hear of some examples from some of our own EPI FORUM members having positive results from other B12 pills that are working for “some” EPI dogs. 

For example, one pill, the Metagen B12/Folate has a high concentration of B12 coupled with just Folate, and has been used successfully.

• 1000 mcg B12
• 500 mcg Folate 

Another over-the-counter B12 pill that has worked for another member did not have any Folate in it but rather an extremely high concentration of B12.

• 3000 mcg B12  

Antibiotics: The standard EPI recommendation for treating SIBO with antibiotics is 30 days of Tylan. Tylan is preferred over Metronidazole because there have been some (not many) cases where Metronidazole may cause an adverse reaction such as neurological-like symptoms.

But, sometimesTylan doesn’t work, sometimes some dogs have an allergy to Tylan. Sometimes only Metronidazole works, Or doesn’t work. And sometimes neither work and they have to switch to Amoxicillin and/or a combination of two antibiotics, or for those outside the U.S, different brand name products.

Sometimes when using a combination, 14 days or 20 days seem sufficient, sometimes not. And sometimes some of these dogs appear to need to be on antibiotics continuously.

So although we “recommend” a certain antibiotic regimen… sometimes, this needs to or should be modified.

If anyone has any more “exceptions” they would like added to this list, please just post (and I’ll add it to this master FILE).

My goal with this FILE is to let everyone know that although there are “standard” EPI recommendations, that there are exceptions, lots of exceptions… so I would like to share these exceptions too in hopes of helping some others who may be having difficulty of one kind or another stabilizing there EPI dog…  

Olesia,

Great info!!!!!  One thing you may want to include for the newbies:  If you are feeding with a hard kibble, one that does not crush easily, it may take more than 20 minutes for incubation.  Also, on these hard kibble, it may need to be ground.  And if you need to grind your kibble  measure first then grind.  Not doing this will throw off the enzyme to kibble ratio.

Frank

Thanks Frank!  Too often we tell people what "normally" works... but that is not always the entire story......and I just want people to realize that sometimes doing something a little differently is okay too, if it works for your dog!

I will cut and paste your suggestion into the original FILE. Thanks!