Foods To Avoid When Taking Creon – EPI Diet

Creon is a brand name for pancreatic enzymes. The drug/generic name for Creon is pancrelipase.

Creon is used to treat exocrine pancreatic insufficiency (EPI), a condition when your pancreas doesn’t produce enough digestive enzymes. 

Without enough pancreatic enzymes produced by your pancreas, your body will have difficulty breaking down and absorbing foods to give you the nutrition you need.

There are forms of pancreatic enzymes that you can take to help reduce the unpleasant symptoms of pancreatic insufficiency (not producing enough pancreatic enzymes). 

One of the common brands of prescription pancreatic enzymes is Creon.

You may wonder if you can take Creon with fruit like bananas or apple. Your food and diet choices might affect the efficiency of Creon so please pay attention to what food to avoid when taking Creon.

What is Creon (Pancrelipase)?

Creon is a prescription medication for those needing pancreatic enzyme replacement therapy. Pancreatic enzymes are typically produced by your pancreas and include amylase, lipase, and protease. Amylase breaks down carbohydrates (carbs), lipase breaks down lipids (fats), and protease breaks down proteins. Creon is made from pig (porcine)-derived pancreatic proteases, lipases, and amylases.

Creon comes in delayed-release capsules and can be used in infants up to 12 months of age, children, and adults.

The dosing of Creon is based on the number of lipase units and ranges from 3,000 lipase units to 36,000 lipase units. Creon dosage is based on your body weight, eating patterns, and other factors.

The Food and Drug Administration (FDA) approved Creon in 2009, and it was the first pancreatic enzyme treatment to be approved under new guidelines. The only other pancreatic enzymes the FDA has approved are Zenpep, Pancreaze, Ultresa, Viokace, and Pertzye.

What is Creon used for?

Creon is used to treat exocrine pancreatic insufficiency (EPI), a condition when your pancreas doesn’t produce enough digestive enzymes. 

EPI can result from cystic fibrosis, chronic pancreatitis (inflammation of the pancreas), pancreatic cancer, pancreatectomy (partial or total removal of the pancreas), and other conditions.

A healthy pancreas secretes digestive enzymes into your small intestine during digestion. These enzymes break down food to make them easier to digest and absorb. When your pancreas doesn’t make enough digestive enzymes, you can’t absorb the nutrients because they aren’t broken down into usable forms.

Signs of exocrine pancreatic insufficiency (EPI) include:

• Abdominal pain, gas, and bloating
• Constipation
• Diarrhea
• Fatty stools (pale, oily, foul-smelling poop that floats)
• Unexplained weight loss
• Failure to thrive in infants and children

Foods to avoid when taking Creon

You would like to avoid these foods when you are experiencing pancreatic insufficiency.

Avoid High-fat foods

Fat takes longer to digest than the other main macronutrients (protein and carbohydrates). If you take your pancreatic enzymes and then eat a high-fat meal, the food won’t leave your stomach for a while after you take your enzymes. 

By the time the high-fat food is emptied from your stomach, the enzymes might already have passed through your system and cannot help break down the fats.

Examples of high-fat foods to avoid when taking Creon include:

• Beef (especially non-lean cuts)
• Lamb
• Pork
• Poultry with the skin on
• Lard and cream
• Butter
• Cheese
• Ice cream
• Coconut (including coconut oil)
• Palm oil and palm kernel oil
• Some baked and fried foods

Avoid High-fiber diet

While fiber is usually a beneficial nutrient to include in your diet, it can alter the effectiveness of Creon. According to a study, dietary fiber might decrease the activity of pancreatic enzymes (1).

You should aim to eat enough fiber to prevent constipation, but avoid eating a very high-fiber diet while you’re on pancreatic enzyme replacement therapy.

Examples of high-fiber foods to limit or avoid when taking Creon include:

• Whole grains (anything made with whole wheat flour, brown rice, barley, etc.)
• Fruits & vegetables with skins and seeds
• Wheat bran
• Beans 
• Lentils

EPI Food List – Foods to eat when taking Creon

You can consider incorporate these foods into your EPI diet.

Healthy fats

You should be careful to avoid eating a high-fat diet while on a pancreatic enzyme replacement therapy like Creon. When you do eat fat, try to choose healthy unsaturated fats which contain beneficial nutrients like anti-inflammatory omega-3 fatty acids.

Some sources of healthy fats include:

• Fatty fish (salmon, mackerel, sardines, etc.)
• Nuts
• Seeds
• Avocados
• Vegetable oils (olive oil, avocado oil, canola oil, etc.)

Nutrient-dense fruits & vegetables

As mentioned earlier, you might want to avoid going overboard with your intake of fiber foods while taking Creon. While they do contain fiber, fruits and vegetables are a great source of vitamins, nutrients, and antioxidants that are important for your overall health.

Opt for nutrient-dense fruits and vegetables in a variety of colors to maximize your antioxidant intake. 

Here are some great choices:

• Berries (raspberries, blueberries, strawberries, etc.)
• Dark leafy greens like spinach, kale, arugula, etc.
• Orange vegetables like pumpkin, sweet potatoes & carrots

Vitamin D-rich foods

A deficiency in vitamin D is common among patients with pancreatic insufficiency (2). Vitamin D is essential for bone health, and deficiency can cause symptoms like muscle pain, weakness, and fatigue.

Vitamin D isn’t found naturally in many foods, so your healthcare provider might recommend a vitamin D supplement. 

If you do want to get vitamin D from your diet, here are the best sources:

• Cod liver oil
• Salmon
• Swordfish
• Tuna fish
• Orange juice fortified with vitamin D
• Dairy and plant milk fortified with vitamin D (almond milk, soy milk, etc.)
• Sardines
• Beef liver
• Egg yolks
• Fortified cereals

Lower-fiber foods

Your healthcare provider might advise you to lower your fiber intake while taking Creon. Not everyone with pancreatic insufficiency will need to limit fiber as it varies among individuals.

If you do need to cut down on your fiber intake in order to boost Creon’s effectiveness, you can choose from lower-fiber foods like:

• Grains made with enriched flours instead of whole wheat flour
• White rice
• Well-cooked vegetables
• Canned or frozen fruit without skin or seeds; fresh fruit without skin or seeds
• Meat (red meat, white meat, fish)
• Eggs
• Low-fat dairy products as tolerated, such as Greek yogurt

Lean protein

Instead of high-fat meat, you can lower your fat intake while still getting plenty of protein by including lean proteins such as:

• Lean beef
• Skinless poultry
• Lean cuts of pork like tenderloin
• Eggs
• White meat fish like tuna, tilapia, and cod
• Beans and lentils
• Low-fat dairy
• Higher-protein grains/seeds like quinoa

Who can take Creon?

Creon can be used in infants up to 12 months of age, children, and adults with pancreatic insufficiency. 

Creon is a category C drug concerning pregnancy. This means the risk to the unborn baby can’t be ruled out if a pregnant woman takes Creon during her pregnancy.

It’s unknown if Creon passes through breastmilk, so there are no official recommendations when it comes to taking Creon while breastfeeding.

How do I take pancreatic enzyme replacement therapy?

Pancreatic enzyme replacement therapy involves taking pancreatic enzymes with all of your meals and snacks. By providing the enzymes your pancreas normally produces but isn’t able to, you might have fewer side effects and be better able to absorb the nutrients from your food.

You should take your pancreatic enzymes as prescribed by your healthcare provider. If you’re just starting out with pancreatic enzyme replacement therapy, it can be helpful to keep a food & symptom journal to track the effectiveness of your current dose. 

It’s not uncommon to need to increase your dose of pancreatic enzymes, which might happen more than once as you figure out what works best for you.

Other things to avoid while taking Creon

Smoking

The tobacco in cigarettes is associated with pancreatic insufficiency, even in people without a history of pancreatic problems. 

According to a study, tobacco exposure might be more detrimental to pancreatic health than alcohol.

Fiber supplements

As we covered earlier, very high-fiber intakes might alter the effectiveness of pancreatic enzyme replacement therapy. Avoid fiber supplements unless your healthcare provider recommends them.

Should Creon be taken with food?

Pancreatic enzymes are meant to be taken with food. Taking Creon outside of meals would defeat the purpose of pancreatic enzyme replacement therapy.

You should take Creon with your meals and snacks. Creon capsules should be swallowed whole and shouldn’t be chewed. 

If you have difficulty swallowing Creon in pill form, the manufacturer says you can remove the powder from the capsule and put it in a small amount of room-temperature acidic food like applesauce.

What is the best time to take Creon?

You should take Creon with every meal and snack that you eat. If you miss a dose of Creon, you shouldn’t take another dose in between meals or increase your next dose to make up for it.

Potential Creon Side Effects 

You might experience side effects while taking Creon, such as:

• Nausea
• Vomiting
• Diarrhea
• Changes in blood sugar levels (hyperglycemia [high blood sugar] or hypoglycemia [low blood sugar])
• Greasy stools
• Gas
• Bloating
• Constipation
• Stomach pain or upset
• Rectal irritation
• Headache
• Dizziness
• Cough
• Weight loss

Some of these symptoms are consistent with symptoms of pancreatic insufficiency. If you have worsening pancreatic insufficiency symptoms while taking Creon, you should consult with your healthcare provider. You might need to increase your dose until you find the right amount for you.

In rare cases, Creon may increase your risk of a rare bowel disorder called fibrosing colonopathy. Be sure to tell your healthcare provider if you have a history of intestinal blockage, scarring, or thickening of your bowel wall (fibrosing colonopathy).

Unusual and severe Creon side effects

Notify your healthcare provider right away if you have unusual or severe:

• Stomach (abdominal) pain
• Bloating
• Trouble passing stool
• Nausea
• Vomiting
• Diarrhea
• Painful, swollen joints (gout)
• Allergic reactions (trouble with breathing, skin rashes, swollen lips)

How to reduce the side effects of Creon

You can reduce the severity of Creon’s side effects by taking it as prescribed by your healthcare provider. 

Eating a diet for pancreatic insufficiency can also help minimize symptoms. If you eat a somewhat consistent diet in terms of food volume, fat content, etc., you’ll be more likely to find an effective dose of Creon. 

Alternatives to Creon (natural and pharmaceutical)

Below we discuss some alternatives to Creon.

Pharmaceutical alternatives

There are only five other FDA-approved pancreatic enzyme therapy medications: Zenpep, Pancreaze, Ultresa, Viokace, and Pertzye.

Your healthcare provider might recommend one of the above drugs if you aren’t achieving treatment goals on Creon, or if your medical insurance doesn’t cover Creon.

Natural alternatives

There are several digestive aid supplements you can buy over-the-counter. Some common ingredients for these natural options include enzymes that digest protein, carbs, and fats, probiotics, and fiber-digesting enzymes.

You might benefit from an OTC digestive supplement if you don’t have severe pancreatic issues, such as with cystic fibrosis or a pancreatectomy. 

Your healthcare provider can tell you if you’re a candidate for more natural options or if you would benefit from prescription digestive enzymes.

How do you help the pancreas produce enzymes naturally?

If you’re taking Creon, it’s likely for a medical condition that causes pancreatic insufficiency. Cystic fibrosis, chronic pancreatitis, and pancreatic cancer are all instances when your pancreas might not make enough enzymes on its own.

While you can’t necessarily restore a damaged pancreas’ ability to make pancreatic enzymes, you can do your part to maximize the efficiency of the enzymes your body can still make.

• Drink plenty of fluids. Staying hydrated can help support a healthy digestive system and reduce stress on your body from dehydration.
• Eat smaller meals. Eating large meals can overwhelm your digestive system. Your body might not be able to make enough enzymes to help digest a large meal, so try to eat smaller meals and snacks throughout the day. 
• Avoid drinking alcohol. Alcohol can worsen pancreatitis and lead to further damage to your pancreas. The more your pancreas is damaged from chronic pancreatitis, the fewer enzymes it will be able to produce.

Conclusion

A diet for pancreatic insufficiency while taking Creon should consist of lean proteins, nutrient-rich fruits and vegetables, and lower-fiber foods when necessary. Vitamin D is an important nutrient to include with pancreatic insufficiency as well.

Avoid alcohol, smoking, and eating very fatty foods while taking Creon. You might also need to avoid a very high-fiber diet since fiber can potentially decrease the effectiveness of digestive enzyme replacement therapy.

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