To complicate matters, EPI is generally caused by another condition. As many as 8 in 10 adults with chronic pancreatitis — which is inflammation of the pancreas — develop EPI, according to the Cleveland Clinic. Other causes can include diabetes, celiac disease, pancreatic cancer, weight-loss surgery, and inflammatory bowel disease. Staying healthy with EPI can be a challenge, but there are many tips and tricks that gastroenterologists recommend because they work so well for their patients. Here are some top strategies that people with EPI have found helpful, according to doctors.

EPI is a lifelong, chronic condition. “There is often no cure for the underlying cause of EPI,” says Aniruddh Setya, MD, a gastroenterologist at Memorial Healthcare System in Hollywood, Florida. “Management is focused on getting your body the nutrients it needs to maintain optimum health.” EPI is usually managed by a three-part system, says Dr. Setya:

A diet that’s as close to normal as possible: Years ago, the recommendation for people with EPI was to eat a low-fat diet. But because fat helps your body absorb nutrients, doctors now advise eating a diet that steers clear of unhealthy fats (such as foods high in saturated fat) but includes healthy fats found in nuts, seeds, and fish. A registered dietician is often essential in helping you navigate EPI.Pancreatic enzyme replacement therapy (PERT): This prescription medication is a substitute for the missing digestive enzymes in your body. You take PERT with meals to help your body break down the proteins, carbohydrates, and fat in food.Vitamins: You may need to take dietary supplements such as vitamins A, B12, D, E and K, as well as calcium and magnesium.

Because EPI is often caused by another condition, it’s also important to address that as well. “You have to tease out which parts of your symptoms are related to EPI, and which parts are not,” says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “For example, if someone has chronic pancreatitis and takes adequate supplementation of enzymes, they may still be in pain due to inflammation of the pancreas, but it won’t be due to EPI anymore.”

Tips to Help You Remember to Take Your Medications

Taking PERT is key to keeping EPI in check. “PERT replaces your body’s missing pancreatic enzymes and has to be taken every time you eat, even with snacks,” says Setya. “This can be challenging when you are out with your friends or at parties.” Your medication will need to become ingrained in your daily habits. “First, you have to associate foods with PERT medication,” says Shiv Desai, MD, a gastroenterologist at Austin Gastroenterology in Texas. “I think a visual aid and a mantra that, ‘If I eat, I must take the medication’ is the best way to remember.” Setya and Desai also recommend the following to help make taking PERT medications easier:

Keep your medications in more than one place. Always have your PERT medications in your bag and a separate set at home, as well as at your place of work.Don’t rely on memory for taking medications. Whatever works for you, find a system to keep track of when to take your dose, whether it’s a pen and paper or an electronic reminder on your phone. Some people also find pill counters helpful.It’s okay to take an extra dose on occasion if you forget. “There is little harm in taking an extra dose if you’re uncertain if you have taken it or not prior to a meal, other than a potential side effect of constipation,” says Dr. Desai. However, it isn’t necessary to double up on PERT doses later on in the day, as this may lead to extra GI symptoms. In rare cases of people with cystic fibrosis, frequently having extra PERT doses can be associated with narrowing of the colon, Desai notes.

Strategies to Manage EPI Symptoms

EPI can cause a host of unpleasant symptoms, including diarrhea, abdominal pain, gas, bloating, cramping, and fatty, oily stools. “With diarrhea, we try to increase the PERT medications to see if that helps,” says Debashish Bose, MD, a surgical oncologist at Mercy Medical Center in Baltimore who frequently works with people who have pancreatic cancer. Other strategies to help with symptoms include:

Stay hydrated, as diarrhea can lead to dehydration.Eat small, frequent meals to help your digestion and lessen symptoms.Manage constipation with over-the-counter medications, like laxatives and stool softeners.Have your PERT medications with you at all times.Keep your underlying disease in control; for example, if you have celiac disease, avoid gluten.Avoid smoking and alcohol, which damage the pancreas.Download a bathroom-finding app such as Flush so you can plan ahead for bathroom access wherever you’re going.

Strategies to Stay Positive With EPI

It can be discouraging when your PERT medications aren’t working as well as they should, or if you feel isolated because you don’t know other people who have EPI. Here are some ways to stay mentally strong, according to experts:

Make physical exercise part of your daily life.Try meditating, either on your own or with an app.Connect to EPI-related organizations like EPIC (Exocrine Pancreatic Insufficiency Coalition).Reach out to others with EPI through recognized online support groups, like the NPF’s Pancreatitis Support Community or the Living With Exocrine Pancreatic Insufficiency (EPI) Support Group on Facebook.Talk to a therapist if your EPI is taking a toll on your mental health. You might specifically look for therapists who work with people who have chronic health conditions.

With the right strategies and support, you can feel your best with EPI.