How to use enteric coated capsules (Lypex)

[Kirsten]

Hello to all,

I'm new to this forum, coming from Germany and I'm very thankful for all the information I get here!

I have a female GSD, 2,5 years old, diagnosed with EPI 4 weeks ago. My vet recommended Lypex, which seemed to work fine the first 2 weeks. (She gets dry food, grain free with single protein and moderate fat. Fiber is about 3%.)
Stool elimination became less voluminous with the capsules and less often, the color turned into more "normal" and you could see her gaining weight. After 2 weeks the improvement stagnated. Poops were becoming bigger again. I didn't change food at that time.
I then found a source where I could get raw beef pancreas (frozen). The effect was enourmos. Poop was almost solid and the amount reduced even more. After about 10 days she was suddenly thrown back 4 weeks. Poop became bigger, more often and very soft. I thought that maybe the raw pancreas (which was delivered in 250g packages) does not have the same quality and effectiveness each package. So I switched over to Lypex again (opened the capsule and sprinkled it over), but it didn't change a thing. She now has diarrhea and even vomited her meal, so I guess it is an infection, which probably has nothing to do with her EPI. I didn't change her food in that time.

So my urgent question now is concerning the use of the enzyme capsules (Lypex in my case).
I studied "Managing EPI" on this side and there it says recommendation in using enteric coated capsules is to give the whole capsule with the meal. It further says "Some do open the capsule and sprinkle on top of the food but DO NOT mix these tiny pellets in the food." I can't understand what difference it makes when I mix it IN the food instead of sprinkle it OVER. Can somebody please explain?
And why do humans (the enzymes are the same) take those capsules in WHOLE and recommendation on the Lypex package is to open the capsule and sprinkle it on the food. It says in fat letters: "Do not give the capsule in whole"!
I'm very confused how to use them correctly now.

Thanks for answering!
Kirsten

[Olesia711]

Hi Kirsten and thanks for those questions..... and you are correct... it does sound very confusing.

First... let me address your dog's loose stools....then i'll answer the questions. What you are describing sounds like SID/SIBO/Dysbiosis. ALL dogs with EPI have this... and it almost always repeatedly happens in the same time-frame you are describing. Dog is started on enzymes. everything goes well for a few weeks and then "Oh-NO!" loose stools again. what is happening is that (and this is in no way a technical explanation... but an easy way to explain it).... when a dog has EPI.... all the nutrients that are not being properly digested wreak havoc in the digestive system and accumulates, when enzymes are started . it is kind of like the enzymes are now shaking loose all the bad particles. We don't yet know how to fix SID/SIBO/Dysbiois in an EPI dog........ but our objective is to get it under good control. This is what is recommended:
1. start giving a prebiotic (here in the USA we start with SLippery ELm powder https://epi4dogs.com/slippery-elm/) but there are others that you can talk to your vet about:
2. if the above fails, talk to your vet about starting a pre+probiotic; Some of the recommended ones are: Visbome, Proviable, Vetri-Science Mega Probiotics, Mercola Complete, ..... unfortunately all dog's gut floras are unique, and all probiotics are one-size-fits-all... so you ight have to try a few... if you do not see any results by the end of two weeks... it is not working.
3. at this point, the next recommendation is Tylan (Tylosin Tartrate) antibiotic... or.. since you are in Germany, Oxytet (Oxytetracycline) DO NOT let your vet prescribe Metronidazole. Metro kills all bacteria and EPI dogs not only do not have enough bacteria but they also do not have enough variety. Tylan only prohibits reproduction...so we safely give Tylan for 45 days/twice a day. https://epi4dogs.com/antibiotics/

Now to answer your questions.

Lypex is an excellent enzyme for EPI dogs.... you just have to use more than what is stated on the label ... read the UK guidelines on Lypex located on this page: https://epi4dogs.com/epi-quick-guides-outside-usa/.... it is also possible that you might not have been giving enough Lypex to your pup that prompted the SID to get "out-of-control". Here is an example of using Lypex: 1 capsule.. However.. Some EPI dogs need much more for example “Many EPI dog owners who have used Lypex have found that the directions on the Lypex packaging is not sufficient. Here is one example, “I used 4 Lypex per day. , whether it was two , three or four meals for my dog that weighed 17 kg when at her worst , to her optimum weight of 24 kg”

Regarding the raw pancreas. You are correct in thinking that maybe the pancreas potency varied and this caused an issue. Again.... may not have been enough and this too can trigger SID to become out of control.

Regarding enteric coated pancreatin, CREON, LYPEX, etc- -these capsules are designed to activate in a human's digestive system of 5... whereas a dog's digestive system has a pH of 1. This is why we recommend opening the capsule and sprinkling the enteric coated pellets on top of the food... BUT the food needs to be a little moist so that the pellets have something to stick to . the reason why not to mix the pellets in the food, but rather just sprinkle on top is because when mixed in the moist food... the wetness may dissolve the enteric coating exposing the enzymes. SO the dog will not get the full benefit of the enzymes.

Let me explain. WHen powdered enzymes are given they need approximately 71,400 USP units of Lipase (and a high amount of Amylase and Protease)..... because approximately 70% of these enzymes are destroyed by pH before it gets to be utilized. With CREON or Lypex.... they only use between 10,000 and 30,00 USP units of Lipase, etc.... because these enzymes are enteric coated and therefore approximately 70% is not destroyed before being utilized as needed.... so they use much less. You want to preserve that enteric coating to stay intake so that it is properly utilized. I hope this makes some sense......

Oh and you do NOT want to sprinkle these enetric coated pellets on just dry food... because as the dog eats the food, some of these pellets will then stick in his/her mouth and the moisture there will dissolve the enteric coating.......

[Kirsten]

Hi Olesia,

thank you so much for your detailed explanations. I need to understand everything in detail (sorry I'm scientist...)

I couldn't imagine what happens in my dogs digestive system when giving enzymes. My vet (which does not have much experience with EPI) told me, you just give the capsules and then it works immediately (forever I thought).
I will now increase the amount of enzymes (1,5 capsules Lypex per meal) and see what happens. And I will give probiotics.
The probiotics you named aren't available in Germany, but we have Bactisel, which we have made good experiences with in the past when healing our dogs diarrhea. Can I also use human probiotics?

My further questions:
1. Can/should I give slippery elm all the time, even when her stool is ok?
2. Can I replace Lypex by other capsules from human medicine? We have pancreatin enteric coated capsules for humans which are comparable in their strength with Lypex. And I can get Creon in Germany (capsules), but it also is for humans.

Thank you so much for your support and help! I really appreciate that!

Kirsten

[jilbert57]

Hi Kirsten. Sorry you are having ups and downs.
I would give the SE twice a day. If and when the poop becomes better you can stop it and see if the increase in Lypex helps. That and the added probiotic should help the stool. One thing is if you change more than one thing at a time you don't know which helped or hurt.
Are you supplementing with Oral B12 or B12 shots 1/a week for 6 weeks?
I don't know why you can't use the Pancreatin enteric coated just make sure of the lipase amount in each capsule as per Olesias email.
The goal is to get the poop stable and keep it as such
It is a management of tweaking things in Epi to get it to come together.

Jill