Pancreatic enzymes: a guide to PERT

Pancreatic cancer can leave your body short of the enzymes it needs to digest food. This guide explains how PERT works, how to take it with food, and what to ask if symptoms continue.

NUTRITION & DIGESTION

Pancreatic cancer and pancreatic surgery can affect how your body digests food. If you are not getting enough digestive enzymes, you may lose weight or develop symptoms such as oily stools, diarrhoea, wind, and bloating.

Pancreatic enzyme replacement therapy—usually called PERT—replaces these enzymes. You take it with food to help your body digest and absorb nutrients.

This guide explains what PERT does, how to take it, and what to discuss with your healthcare team if symptoms continue. It is for people with pancreatic cancer in Canada, and for those helping with their care.

This guide is general information, not medical advice. Your prescribed plan and your own care team's advice come first.

Already taking enzymes?
Take them with food, follow your prescribed plan, and ask for a review if you are still having digestive symptoms or losing weight. Do not assume you need to eat less fat or simply put up with the symptoms.

On this page: Why enzymes are needed · Taking PERT · Understanding your dose · Ongoing symptoms · PERT calculator · Questions for your team

Why might I need pancreatic enzymes?

Your pancreas normally makes enzymes that help break down fat, protein, and carbohydrate. Pancreatic cancer can interfere with enzyme production or stop enzymes reaching the bowel. Surgery can also affect how enzymes are produced or how they mix with food.

When there are not enough pancreatic enzymes to digest food properly, this is called pancreatic exocrine insufficiency. You may see it shortened to PEI or EPI.

Food that is not properly digested may not be fully absorbed. This can contribute to weight loss and nutritional problems, even when you are trying to eat enough.

Symptoms worth discussing

Tell your healthcare team if you notice:

Pale, oily, greasy, or unusually unpleasant-smelling stools.
Stools that float or are difficult to flush.
Frequent loose stools or urgency.
Wind, bloating, or discomfort after eating.
Unintentional weight loss or difficulty regaining weight.

These symptoms can have more than one cause. Your team can assess whether enzyme insufficiency, treatment effects, or another problem may be contributing. Do not use stool appearance alone to diagnose yourself or decide your dose.

Questions to ask about digestion

What is PERT?

PERT is a prescription treatment containing digestive enzymes. These include lipase, which helps digest fat, alongside enzymes that help digest protein and carbohydrate.

You take PERT with food so the enzymes can mix with what you eat. It works on that meal or snack; taking capsules earlier in the day does not cover everything you eat afterwards.

PERT is not a treatment for the cancer itself. It treats the digestion problem that pancreatic cancer and pancreatic surgery can cause.

PERT is also different from insulin. Enzymes help with digestion; insulin helps regulate blood glucose. Some people need both types of treatment after pancreatic surgery.

Understanding the label

Enzyme doses are commonly described in units of lipase. The number of capsules alone does not tell you the dose, because capsules can contain different enzyme strengths.

In Canada, pancreatic enzymes are available by prescription, and Creon is a common brand. Check the product name and strength on your own prescription. If the pharmacy supplies a different product or strength, ask the pharmacist to explain exactly how to take it. Do not assume the same number of capsules will give the same dose.

How to take PERT with food

Follow the instructions for your prescribed product and the plan agreed with your doctor or dietitian. These general principles can help you understand that plan.

Situation	General guidance
Starting a meal	Begin taking your prescribed enzymes with the first few mouthfuls.
Eating a longer meal	Spread the prescribed capsules through the meal so enzymes mix with the food.
Having a snack	Snacks often need enzymes too; ask what dose to use.
Having a milky drink or nutrition supplement	These may need enzymes. Include them when discussing your plan.
Having several courses	Ask how to distribute or adjust your prescribed dose for a longer meal.

Taking the capsules

Swallow capsules whole with a cool drink. Do not crush or chew the capsules or the granules inside them.

If swallowing capsules is difficult, speak to your pharmacist. Some products can be opened and their contents taken with a suitable acidic soft food, but the method must follow that product's instructions. Do not improvise or crush the granules.

If you miss a dose

Check your medicine leaflet or ask your pharmacist what to do. Do not double a later dose to make up for missed enzymes. Enzymes need to be taken with food; a dose taken well after eating may not work as intended.

How much should I take?

There is no single capsule count that is right for everyone. Your prescribed dose depends on the product strength, what you eat, your symptoms, and how well you are absorbing nutrients.

Larger meals or meals containing more fat may need more enzymes. Your team may give you a starting dose and a plan for adjusting it.

Ask for that plan in writing. It should explain your meal and snack doses, when you may adjust them, and when to contact the team rather than keep increasing the dose yourself.

Your personal treatment plan

You can fill this in with your team and keep it with your prescription:

My prescribed product: ______________________
Lipase units per capsule: ______________________
My usual meal dose: ______________________
My usual snack dose: ______________________
My instructions for larger meals or supplements: ______________________
My agreed adjustment plan: ______________________
Who to contact for review: ______________________

Do I need to avoid fat?

Do not cut out fat simply because stools are oily or because you are taking enzymes. Oily stools can mean that fat is not being digested properly—not that you have eaten “too much” fat.

Restricting fat can make it harder to get enough energy and may worsen weight loss. Ask your dietitian how to balance your food intake and enzyme treatment. Follow individualized advice if you have another condition that affects what you should eat.

For meal ideas, appetite, and weight support, see our guide to nutrition and digestion with pancreatic cancer.

What if symptoms are not improving?

If symptoms continue, or you are still losing weight, ask for a review. It does not mean you have failed to take care of yourself.

Your team may review:

The exact product and capsule strength.
When you take the capsules.
Whether the dose covers meals, snacks, milky drinks, and supplements.
Whether the dose is sufficient for what you eat.
Whether another digestive problem needs investigation.

What to bring to the appointment

A brief record can help:

What and when you ate or drank.
The product, strength, and number of capsules taken.
When you took them.
Digestive symptoms and changes in stools.
Weight changes, if you are monitoring weight with your team.

The aim is to give your team useful information—not to make eating feel like a test, and not something you need to track forever.

Do not assume every new or worsening symptom needs more enzymes. Follow your care team's urgent-contact instructions for severe or concerning symptoms.

PERT calculator

The PERT calculator is an online tool to help estimate your PERT dosage.

Use this tool only within the enzyme plan agreed with your healthcare team. Check your product name and capsule strength before entering information. If the result differs from your prescription, ask your pharmacist or prescriber before changing how you take it. A calculator is not a substitute for a prescription or a review of ongoing symptoms.

Open the PERT calculator

Questions to ask your healthcare team

Could enzyme insufficiency be contributing to my symptoms or weight loss?
What product and strength am I taking?
What should I take with meals, snacks, and nutrition supplements?
How should I spread my capsules through a meal?
Do I have an agreed plan for adjusting the dose?
What should I do if symptoms continue?
What should I do if swallowing capsules is difficult?
Who should I contact if the pharmacy cannot supply my usual prescription?
Can I see a dietitian with experience in pancreatic cancer?
When should we review whether treatment is working?

Related resources

This guide provides general information about pancreatic enzyme replacement therapy (PERT) for people with pancreatic cancer in Canada. It is not medical advice, and it does not replace your prescription or the advice of your own healthcare team. Enzyme products differ between countries; Canadian product information and your product's patient leaflet are the instructions that apply to your prescription. The Heather Cutler Foundation does not prescribe medication or adjust doses.

Sources consulted for this guide: Canadian Cancer Society — Supportive care for pancreatic cancer; Health Canada — Drug Product Database: Creon Minimicrospheres product information; Pancreatic Cancer UK — Pancreatic enzyme replacement therapy (PERT) for pancreatic cancer and How do I take pancreatic enzyme replacement therapy? (UK patient-education background; Canadian product instructions govern medication use).

Written by Christopher Cutler, The Heather Cutler Foundation. Last updated October 27, 2026. Spotted an error? Report it here. Our editorial standards explain how pages are sourced and reviewed.