The pancreas is a gland within the digestive system that makes two hormones needed to regulate blood sugar. The pancreas also secretes enzymes into the small intestine to help break down proteins, fats, and carbohydrates so they can be digested and absorbed into the blood. The part of the pancreas responsible for producing digestive enzymes is known as the exocrine pancreas, and the production of these enzymes is controlled by the presence of food in the stomach and small intestine. As a meal is eaten and swallowed, the release of pancreatic juices is triggered to help break down nutrients so they can be more easily absorbed.
What is exocrine pancreatic insufficiency (EPI)?
EPI is defined as a partial or complete deficiency of pancreatic digestive enzymes. This condition is caused by inadequate production and release of pancreatic enzymes. Primary EPI occurs when specific cells, called acinar cells, shrink for some unknown reason. This form of EPI is more commonly seen in dogs. Secondary EPI, which is more common in cats, is due to chronic inflammation that occurs in cases of end-stage chronic pancreatitis. To learn more about pancreatitis, check out this previous blog post.
The clinical signs of EPI in dogs and cats include:
- Weight loss with a normal or increased appetite
- Loose stools
- Large volume of feces
- Steatorrhea
- Glistening feces indicate excess fat excretion
- Decreased muscle tone
- Poor hair coat
- Increased flatulence and gut sounds
Risk Factors:
- Genetics: German shepherd dogs and rough collies are at higher risk of developing EPI
- Secondary EPI due to pancreatitis can occur at any age
Nutritional Management
The goal of nutritional management in cases of EPI is to provide enough energy to maintain a stable body weight and appropriate body condition, to avoid nutrient deficiencies (outlined below), and to minimize excretion of fat.
Protein
EPI causes diminished protein digestion and absorption, which can lead to weight and muscle loss. To combat this, a protein source that is easily broken down and absorbed by the body and that contains all essential amino acids should be used. For cats, a moderate to high protein diet with >30% protein on a dry matter basis is recommended. For dogs, a diet containing 15-30% protein on a dry matter basis is recommended. If the animal has lost weight and muscle, then an even higher protein content may be required. A hydrolyzed protein source may be helpful as it provides protein in a predigested form that may be easier for an animal to absorb.
Carbohydrates and Fibre
Carbohydrates with starches have been shown to be readily digested. Good sources include corn, wheat, rice, legumes, potatoes, and sweet potatoes.
Dietary fibres are complex carbohydrates, which can be characterized as soluble or insoluble. Pets with EPI should eat foods that are low in complex carbohydrates. A recommended level is a crude fibre content less than 5% on a dry matter basis.
Fat
Pets with EPI may exhibit a variety of reactions to the amount of fat tolerated in the diet. A trial-and-error process is important in finding a food that fits each individual pet.
Feeding a higher-fat diet has its benefits as fat helps to increase the caloric density of foods. This could help increase the rate of weight gain in pets who have experienced weight loss due to EPI. Fat is also helpful in the absorption of some vitamins, and fat makes food more palatable for pets who may be feeling unwell. Therefore, a moderate fat diet containing 10-15% fat on a dry matter basis for dogs and 15-25% on a dry matter basis for cats is recommended.
Supplementation
When the pancreas does not make enough enzymes, they must be given as a supplement or treatment to help the pet digest food every day. Digestive enzymes can be delivered as pancreatic enzyme powder or as a tablet that gets mixed into the food. Enzyme supplementation will be required for the lifetime of the pet.
EPI inhibits digestion and absorption of fat-soluble vitamins: Vitamins A, D, E, K, as well as the water-soluble vitamin B12. If there are signs of a vitamin deficiency, supplementation through oral preparations or injections is needed.
Feeding Recommendations
f the current diet does not match the recommended nutrient levels, then it is recommended to change to a more appropriate diet. For dogs, this would consist of 15-30% protein, 10-15% fat and less than 5% crude fiber on a dry matter basis. For cats, the ideal diet would contain more than 30% protein, 15-25% fat, and less than 5% crude fiber on a dry matter basis. Often, it may be necessary to change to a veterinary therapeutic diet to fulfill these criteria.
During the initial stages of this disorder, pets are unable to digest nutrients and often require more Calories per day. In cases where pets are underweight, it is important to increase Calories being fed and to monitor weight gain. A safe way to do this is by increasing the number of Calories fed by 10% and to continue increasing caloric intake in 10% increments until the animal’s body weight stabilizes.
Pets with EPI may benefit from having smaller meals, multiple times a day. Once the right dose of pancreatic enzymes has been determined and digestion improves, caloric requirements may decrease.
If you have any questions or concerns about your pet regarding EPI and their diet, please contact your veterinarian before making any changes.
Written by: Alison Ng BScH, OVC Class of 2027
Reviewed by: Sarah K. Abood, DVM, PhD, Associate Professor, Nestlé Purina Professorship in Companion Animal Nutrition; Becky Hunt, RVT, VTS (Nutrition), Hill’s Pet Nutrition Registered Veterinary Technician; Zahra Sadat Rahimi, DVM, PhD, Hill’s Pet Nutrition Intern
References
Karpińska M, Czauderna M. Pancreas—Its Functions, Disorders, and Physiological Impact on the Mammals’ Organism. Front Physiol. 2022 Mar 30;13:807632.
Bhutta ZA, Sadiq K. Protein Digestion and Bioavailability. In: Caballero B, editor. Encyclopedia of Human Nutrition (Third Edition) [Internet]. Waltham: Academic Press; 2013 [cited 2025 Feb 1]. p. 116–22. Available from: https://www.sciencedirect.com/science/article/pii/B9780123750839002403
Kayser E, Finet SE, de Godoy MRC. The role of carbohydrates in canine and feline nutrition. Anim Front Rev Mag Anim Agric. 2024 Jun 20;14(3):28–37.
Mott J, Morrison JA. Blackwell’s Five-Minute Veterinary Consult Clinical Companion. Hoboken: Wiley Blackwell; 2019. (Blackwell’s five-minute veterinary consult series).