All You Need to Know About Exocrine Pancreatic Insufficiency

Here at My Pet Nutritionist, we help customers tackle a host of different health conditions and concerns. Some diseases our customers’ dogs come to us with are common, and simple, others are not so common, and more complex. Exocrine Pancreatic Insufficiency is one of the not-so-common examples of health concerns we have helped customers with. While it is rare, and not tested for as standard, we are beginning to see more and more cases of EPI, so this blog post will be a great educational tool for those who want to learn more about EPI, as well as those who’s pet has been diagnosed with it.

What is EPI?

EPI, as its commonly called, is shortened from Exocrine Pancreatic Insufficiency. ‘Exocrine’ is the system to do with the body’s enzymes. The pancreas is an important part of the digestive system, and also an important part of the exocrine and endocrine systems.

The pancreas is an organ, located in the right side of the abdomen, close to your dog’s stomach. There are two parts to the pancreas – the exocrine pancreas and the endocrine pancreas. The endocrine pancreas releases the hormone, Insulin, which controls blood sugar levels. The exocrine pancreas releases enzymes responsible for food digestion, particularly the macronutrient, protein.  
In those suffering with EPI, the pancreas is unable to produce enough of these enzymes, which leads to major malnutrition, unless treated daily.

EPI is an incurable disease, and requires daily management to keep symptoms at bay.

Findings Here

Symptoms of EPI

There are a number of symptoms associated with Exocrine Pancreatic Insufficiency. Many of these symptoms are common symptoms of other health conditions, which makes diagnosis of EPI quite tricky, but the symptoms can be severe, and in some cases life threatening. Here’s some of the main symptoms you could expect from a dog suffering with EPI include:

  • Rapid weight loss
  • Lack of ability to put weight on
  • Insatiable appetite
  • Chronic diarrhoea
  • Mucus in the stool
  • Vomiting
  • Lethargy/fatigue

If your dog has a number of these symptoms, it is extremely important you have your dog assessed by a veterinarian, as EPI dogs can go downhill very quickly.

Findings Here

Diagnosis of EPI

Exocrine Pancreatic Insufficiency is rarely routinely tested for upon first signs of symptoms, and is regularly misdiagnosed. As the disease is quite rare, and little is taught about it in initial veterinary qualifications, dog owners who suspect this disease often have to specifically request for testing for EPI in their initial consultations.

So how is EPI diagnosed?

There are two tests carried out in those with suspected EPI. A fasted blood test, and a faecal test.

Once the sample has been taken, the test used is called a Canine Trypsinogen-like Immunoassay (or cTLI for short!). For this test, pets must be starved for a minimum of 6 hours – this is usually best done overnight. Trypsinogen is a non-activated enzyme; known as a proenzyme. The pancreas of healthy individuals secretes Trypsinogen into the small intestine with other enzymes in the mix, where it converts to Trypsin – the activated form, which is used to digest proteins. It is very much normal for Trypsinogen to be detected in blood tests of healthy animals, because a little Trypsinogen leaks into the blood stream where it is circulated around the body.

How do cTLI results differ for those with EPI? The results from a cTLI of a dog with EPI will show as low to no Trypsinogen when analysed. This is because those suffering with EPI have a reduced functionality of the pancreatic tissues, resulting in less Trypsinogen being secreted into the intestine, and therefore less leaking into the bloodstream, if any.

Findings Here

Another blood test is usually carried out in cases where EPI is suspected, to test for levels of Vitamin B9 (Folate) and Vitamin B12 (Cobalamin). While these vitamins aren’t directly related to the pancreas, they can easily be affected by a poorly functioning pancreas due to the affect EPI has on the microbiome of the gut. Blood serum analysis for Vitamin B12 will be low, as EPI can lead to B12 deficiency, whereas serum analyses for Folate will usually come back in excess. You can read more about high Folate and it’s relationship with low Vitamin B12, and how these are affected by the pancreas in our blog here.

Findings Here

Let’s move onto the faecal testing side of EPI diagnosis. The test carried out is called a Faecal Elastase Test. This test is for another of the pancreatic enzymes used during digestion, called Elastase. As with all enzymes, Elastase performs a specific job – it’s role in digestion is to help break down fats, carbohydrates and proteins, for use by the body for energy, growth, and cell maintenance. Healthy individuals with a well functioning pancreas will have elastase in their stools, however those with EPI will not produce as much elastase due to damaged pancreatic tissues, so elastase would be lacking in faecal samples.

Findings Here

Causes of EPI

There are various reasons a dog may have EPI – it can be congenital (present from birth), hereditary (genetically inherited), or acquired (through trauma or disease).

Congenital and hereditary causes are self-explanatory – it’s important to source puppies from health tested breeding pairs, with no history of EPI in their immediate or extended genetic lines. If you are opening up your heart and home to a rescue dog, there is a small chance of congenital or hereditary EPI, as you don’t know the history of the dog’s genetic lineage, however it is a rare disease, so it wouldn’t be on the forefront of our minds when considering a rescue dog. Should you experience the symptoms listed in this blog post, hopefully our guide will help you and your rescue dog should the need arise.

As with many diseases we write about here at My Pet Nutritionist, there are some breeds which are genetically predisposed to EPI, including:

  • West Highland White Terriers
  • German Shepherds
  • Akitas
  • Border Collies
  • Miniature Schnauzers
  • Pembroke Welsh Corgis
  • Cardigan Welsh Corgis
  • Australian Shepherds
  • Shetland Sheepdogs
  • Cairn Terriers
  • French Bulldogs
  • Australian Heelers
  • Rough Collies
  • Cavalier King Charles Spaniels

Findings Here
Findings Here

Moving onto the potential acquired causes of EPI, after trauma or disease.

EPI can be as a result of damage to the pancreas following chronic pancreatitis. The main suspected cause of EPI is progressive loss of pancreatic cells, which happens in individuals with chronic pancreatitis. It can form as an autoimmune response to the chronic inflammation that occurs during a pancreatic flare. You can read more about pancreatic flares in our blog here.

Findings Here

Diabetes Mellitus has been shown in some studies to be a potential pathway to the onset of EPI, as a secondary condition. Studies are quite conclusive in humans, and more studies are required in dogs to ascertain whether it is a definite link, but evidence so far is conducive to EPI being secondary to Diabetes Mellitus in dogs too! Read on to find out the theory behind this link!

At the beginning of this blog, we mentioned that the pancreas has two parts – the endocrine and the exocrine. Diabetes is very much linked with the endocrine part of the pancreas, as the pancreas produces the insulin hormone, which is responsible for transport of glucose into the body’s cells. As food digestion is also linked back to diabetes and the need for glucose etc, diabetes is well known to put strain on the pancreas, which ultimately leads to pancreatic damage, causing EPI through trauma.

Findings Here
Findings Here

Another of the more common causes of EPI as a secondary disease, is pancreatic cancer. You may be able to spot a theme here – all these conditions as potential triggers to EPI, cause damage to pancreatic tissues. Pancreatic damage leaves the body vulnerable to EPI  because it is no longer fit enough to produce the required enzymes, or hormones, which leads to a host of health complications.

Pancreatic tumours can cause chronic pancreatitis, and also block the pancreas’ ability to produce digestive enzymes, leading to malnutrition as a result of EPI.

You can read more about malabsorption and malnutrition here.

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Conventional Treatments for EPI

When your dog has been diagnosed with EPI, it is very important that you work closely with your veterinarian. EPI is not a curable disease, and will require daily enzymes to be given for life. Without the appropriate treatment, your dog’s life may be drastically shortened, as those with undiagnosed and untreated EPI can essentially starve themselves to death, as the body becomes severely undernourished.

The results of the various tests will very much determine which dietary supplements are required, but regardless of results, those diagnosed with EPI require some changes to the main diet. They should be fed easily digestible, low fat diets. Your veterinarian may offer you some ‘prescription food’, however there are other, much healthier options – more on this later!

Your EPI dog will require pancreatic enzymes, which your veterinarian will recommend and prescribe. There are a number of pancreatic enzymes on the market suitable for EPI dogs. These are very important, alongside the aforementioned dietary changes.

If your dog’s blood tests show a Vitamin B12 deficiency, they will most likely require a Vitamin B12 supplement within their daily supplement regime.

If your dog’s folate levels are high, as per the blood test results, they likely have SIBO – Small Intestine Bacterial Overgrowth, for which your veterinarian may prescribe specific antibiotics. There are other gut friendly supporting supplements we can recommend to combat SIBO, which we will discuss in the next section of this blog post.

Findings Here
Findings Here

Supporting the Body Naturally

Finally, we will look at some of the natural things we can do to support those diagnosed with EPI.


As we mentioned in the last section, a low fat, easily digestible diet is required. In clinical terms we are generally looking at a diet that ranges from 10-15% dry matter fat. You do not need to use a ‘prescription diet’ from a tin or bag! In fact, these formulas do not contain anything needing a prescription – but it’s worthwhile looking at the fat content of a homemade recipe or commercial dog food.

Dry food is not easy to digest due to the high content of carbohydrates and grains, with it being ultra processed and generally extruded, it may be harder to digest. High carbohydrate diets put stress on the pancreas, so in our professional opinion from a nutrition perspective, a fresh cooked, low fat diet would be much more beneficial for your dog with EPI.

When cooking for your dog, it is important to follow a recipe balanced to FEDIAF, so it meets, if not exceeds, minimum nutritional guidelines for the target species; dogs in this case. We have three fantastic, easy to cook, low fat cooked food recipes, balanced and complete to FEDIAF guidelines! Click each flavour below to purchase it from our shop. You only need to purchase each recipe you choose once, and you can use it as many times as you may need! The EPI-friendly recipes are:

Low Fat VenisonLow Fat KangarooLow Fat Horse

If your dog suffers with sensitivities to the above proteins, you may wish to book a Personalise Consultation, through which you will receive a balanced, low fat recipe tailored to your dog.

Vitamin B12 Rich Foods

You will have read in this blog post, that many EPI dogs are deficient in Vitamin B12 (Cobalamin), and it is one of the test results expected as part of your EPI diagnosis. Your vet will be able to recommend some Vitamin B12 supplements, such as the very popular Cobalaplex supplement from Protexin.

You may also wish to introduce some fresh foods high in B12 into your dog’s diet. Some examples of B12 rich foods include:

  • Chicken breast (very low in fat)
  • Turkey breast (very low in fat)
  • Prawns (very low in fat – feed cooked)
  • Eggs (also a great anti-inflammatory omega source)
  • Liver and kidney (though try not to add too much if you are using one of our fresh cooked recipes)
  • Sardiens (also a great anti-inflammatory omega source)
  • Trout (low in fat and saturated fat)

You can read more about Vitamin B12 and why it is important in our blog here.
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Gut Support

When it comes to almost any health condition, good gut health is of utmost importance. In the case of EPI, as it massively impacts the digestive system, gut health is very important, and with the added risk of SIBO, it’s even more important to keep on top of.

There are some supplements we can use to help keep the gut in tip top condition, alongside a high moisture fresh diet, which is step one in the path to good gut health.

  • Mucilage herbs: these are herbs with therapeutic uses for gut healing. They include slippery elm, marshmallow root, and deglycyrrhizinated liquorice.
  • Probiotics: these should be used alongside mucilage herbs to help the gut flourish. The microbiome is a delicate balance of good and bad microorganisms, so adding good bacteria helps to fight the bad bacteria that causes SIBO. We tend to recommend soil based probiotics (SBO) as they’re very clean, and are best to target SIBO because they do not colonize the small intestine. Two strains of traditional probiotics, Lactobacillus and Bifidobacterium can contribute to SIBO because they feed the bacteria already growing in the small intestine, causing the overgrowth.

Our all-in-one supplement, Gut Guardian, may just be the missing piece when it comes to your dog’s gut health. It’s a high quality mixture of all three of the aforementioned mucilage herbs, soil based probiotics, and the added calming benefits of chamomile, although this is not directly related to pancreatic function. What makes Gut Guardian particularly useful in those with EPI, is that it contains Vitamin B12 (Cobalamin), which as discussed, can be a deficiency in many with Exocrine Pancreatic Insufficiency.

Pancreatic Enzymes

Pancreatic enzymes will most likely be prescribed by your veterinarian. It is of utmost importance to give these daily, for life, to help your dog properly digest food and utilise the nutrition provided in the food.

We really hope this blog post has made a complex, tricky situation a little less hazy for those with dogs struggling with similar symptoms, and for those who have recently had a diagnosis of Endocrine Pancreatic Insufficiency in their dogs. You may even benefit from taking a copy of this blog post with your to your initial veterinary consultation to help your vet look into EPI as a possible cause of your dog’s symptoms.

If you feel you would benefit from 1 to 1, tailored nutrition and lifestyle advice following a diagnosis of EPI, our Personalise package would be ideal for you! Head over to our website to view available appointments.

Team  MPN x

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