But EPI can also trigger problems outside the digestive system. That’s because without pancreatic enzyme replacement therapy (PERT) medication, EPI can make it harder to properly digest nutrients, especially fat. Not only is fat an essential part of a healthy diet but it also helps the body absorb certain key vitamins including A, D, E, and K. When you don’t get enough of these vitamins, you can experience symptoms such as vision trouble, bone weakness, fatigue, and more. Here are a few non-GI symptoms of EPI that may occur, plus what you can do to manage them.
Non-Digestive Symptoms of EPI
People with EPI are especially likely to be deficient in vitamins D and A, says Mohamed Othman, MD, chief of gastroenterology at Baylor St. Luke’s Medical Center in Houston. Here are some of the symptoms these deficiencies can cause.
1. Bone weakness and pain
This is the most common — and often the first — sign that you have a vitamin deficiency, says Dr. Othman. Our bodies need vitamin D to absorb calcium. Together, vitamin D and calcium help support bone health and ward off osteoporosis. Without enough D and calcium, our bones can become thin and brittle, causing pain and weakness. “The pain will be like a deep, generalized ache,” says Othman. “People may also experience muscle weakness and become fatigued easily.” You may also have no symptoms of pain at all, which is why it’s important to talk to your doctor about bone density tests.
3. Depression
Vitamin D deficiency has also been linked to depression, says Othman. It’s also true that managing any kind of chronic condition can take a toll on your mental health. According to the National Institute of Mental Health, people living with a chronic medical condition are at a higher risk of depression. Many people have trouble getting enough vitamin D because the chief source of D is sunlight, but people are generally cautioned to protect their skin from the sun. It’s also available in only a few foods, such as fatty fish and fortified milk, which makes people with EPI at even higher risk of deficiency because of their problems with digestion. However, research is mixed as to whether a vitamin D supplement can help treat depression, and you should first discuss the potential benefits for yourself with a doctor, according to an April 2022 review published in the journal Cureus. If you start taking one, be sure to take it at the same time you take your EPI medications. If you suspect you’re experiencing depression, talk to your doctor about whether you should see a therapist or other specialist.
4. Vision problems
If you’re lacking vitamin A, you may experience nighttime blindness. Vitamin A helps with light absorption in the retina and helps keeps the cornea healthy. The most well-known form of the vitamin, beta-carotene, may also help prevent or treat age-related macular degeneration, the leading cause of vision loss in people over 50.
5. Gastroenteritis
Vitamin A plays an important role in boosting the health of the immune system; a severe lack of A can lead to frequent infections such as gastroenteritis, which is commonly known as the stomach flu. You can protect yourself against viruses by washing your hands frequently. If you’re already sick, make sure you stay hydrated.
What to Know About Preventing Symptoms of EPI
The best way to ward off these deficiencies is to treat the cause of your EPI and take PERT. Because EPI occurs when something is wrong with the pancreas, it’s important for people to understand what’s causing the pancreas to malfunction, says Othman, and to treat that root cause. Othman also emphasizes that if your doctor has suggested you take vitamin supplements, always take them at the same time you take your enzymes, because the enzyme replacements help your body absorb these vitamins. It’s a good idea to have your vitamin levels checked regularly (or have vitamin deficiency-related tests done) at your doctor’s recommendation. Try also to eat a diet that’s high in nutrients — one that contains plenty of fruits and vegetables — and limit or avoid alcohol, which some research estimates is involved in nearly half of all cases of EPI. Finally, stop smoking; research suggests that lighting up is a risk factor for developing EPI. Additional reporting by Colleen de Bellefonds.
