How To Manage EPI In Dogs
If your dog seems unusually hungry but is losing weight, he could have a malabsorption problem. Malabsorption means he’s not able to absorb the nutrients from his food. There are several conditions that can cause this, and one common one is EPI … exocrine pancreatic insufficiency. Here’s some background on EPI in dogs, and how to recognize and treat it.
What Is EPI In Dogs?
EPI stands for exocrine pancreatic insufficiency. It’s a serious condition … and if you don’t deal with it, it can eventually lead to starvation. But fortunately, in most cases, it’s not difficult to treat.
As the name suggests, EPI is a disorder of the exocrine function of the pancreas. The pancreas has two functions – endocrine and exocrine. The endocrine pancreas produces key hormones like insulin and glucagon, which control blood sugar levels. But the exocrine pancreas is an important part of your dog’s digestive process.
The exocrine pancreas produces bicarbonate that neutralizes acid gastric juices, and digestive enzymes that help with digestion. These are some of the enzymes that break down the food so your dog can absorb it.
- Protease – digests protein
- Lipase – digests fat
- Amylase – digests starches
So, if the pancreas doesn’t produce these enzymes, your dog’s body can’t obtain nutrients from the food. Over time, if it’s untreated, EPI can cause organ failure and eventually, death.
Keep EPI in mind if your dog has chronic loose stools or diarrhea. Your vet may think of parasites, bacteria or other causes first … so if you suspect EPI, ask your vet to test for it (see Diagnosis of EPI below).
Signs Of EPI
Clinical signs of EPI usually only show up when 90% of exocrine pancreatic function is already lost. Some common symptoms of EPI are:
- Ravenous appetite but losing weight
- Eating poop or trash
- Chronic loose stools or chronic diarrhea
- Flatulence
- Bulky, oily looking stools (steatorrhea)
- Rumbly stomach (borborygmi)
- Vomiting
In advanced cases your dog may become weak and lethargic, and he could lose interest in walks or other activities.
Other Causes Of Malabsorption
EPI isn’t the only reason for malabsorption, so if you see the above symptoms you may need your vet’s help to rule out other possibilities like …
- Inflammatory bowel disease (IBD)
- Leaky gut syndrome
- Antibiotic responsive diarrhea (ARD), also known as secondary small intestinal bacterial overgrowth (SIBO).
Note: SIBO is common as a secondary effect of EPI, because of undigested food in the small intestine. About 80% of dogs with EPI also have SIBO, according to the Merck Veterinary Manual (1).
Causes Of EPI In Dogs
The most common reason for EPI in dogs is pancreatic acinar atrophy. It’s a degenerative autoimmune disease that’s common in German Shepherds, Rough-Coated Collies, Chows, and Cavalier King Charles Spaniels (2), so if you own one of these breeds, be aware of the symptoms so you can identify EPI early. Signs of malabsorption can appear before your dog is 4 years old.
Chronic pancreatitis can also lead to EPI. In a few cases, diabetes may develop before EPI.
Diagnosis Of EPI
To confirm an EPI diagnosis, your vet can do a test called canine serum trypsin-like immunoreactivity (cTLI) (3). This test measures trypsin released by the pancreas into the bloodstream. Low values on this test, meaning under 2.5 µg/L (micrograms per liter), usually confirm an EPI diagnosis (4).
This is a fasting test so your dog shouldn’t eat for 8-12 hours before your vet draws the sample.
Treatment Of EPI In Dogs
This is one situation where conventional treatment is the same as holistic treatment of EPI in dogs. Feeding pancreatic enzymes or raw pancreas is the first step …
Pancreatic Enzyme Supplementation
Giving your dog pancreatic enzymes (or raw pancreas – see below) compensates for your dog’s inability to produce enzymes. A powdered pancreatic enzyme supplement may use porcine enzymes, or, if your dog doesn’t tolerate pork well, look for bovine enzymes. These usually come in a powder to be added to food. Some of the powders also contain lipase, amylase and protease to help digest fats, carbs and proteins. You can use products packaged for people too.
The usual dosage is 1 tsp powder per 10 kg body weight with each meal. As your dog’s symptoms improve, you can lower the dose until you reach an effective level. However, keep a close eye on your dog, because different enzyme batches can vary and produce different results.
How To Feed Pancreatic Enzymes
You should “incubate” the powder before feeding. That means you need to add some water and keep it at room temperature for 20 to 60 minutes before feeding. Add it to your dog’s regular meal. If you don’t incubate the powder, the enzymes may cause mouth bleeding or sores. If that happens, reducing the dose usually resolves the problem.
Raw Pancreas
Feeding raw pancreas (usually pork, beef or lamb) can have the same effect as the powdered pancreatic enzymes, so if you can get it, you may want to substitute this food solution. The Merck Veterinary Manual advises that 1 to 3 oz of raw pancreas can replace 1 teaspoon of enzyme powder. You don’t need to incubate raw pancreas – just add it to your dog’s food. It’s important not to cook the pancreas because heat will kill the enzymes.
Probiotics
Probiotics have an important role in managing your dog’s EPI and helping balance his gut bacteria. Feed your dog probiotic-rich foods like fermented veggies … or give high quality probiotic and prebiotic supplements. Prebiotics help feed probiotics and make them more effective.
But if your dog also has SIBO, there’s something important you need to know …
The Right Probiotics For SIBO
If your dog has secondary SIBO (which happens in about 80% of dogs with EPI), it’s essential you give the right kind of probiotics. SIBO is an overgrowth of bacteria into the upper small intestine where it disrupts absorption of nutrients.
Most probiotics will start working in the small intestine, where they’ll feed the small intestinal bacteria … and that makes SIBO worse. The special type of probiotic you need is a soil-based probiotic (SBO). SBOs have a protective layer that helps the probiotics reach the colon, where it needs to do its work helping to balance the good bacteria.
What To Feed A Dog With EPI
Some EPI dogs have food intolerances, so you may need to try different foods. A raw diet is best for most dogs with EPI, because it delivers natural live enzymes. It’s a good idea to feed smaller, more frequent meals as they’re easier on your dog’s digestive system.
Track Nutrient Absorption
Ask your vet to monitor your dog’s nutrient absorption in future. He may need some extra nutrients, because, according to the Merck Veterinary Manual, over 80% of EPI dogs are deficient in cobalamin (vitamin B12) (1). B12 is especially important as it improves treatment results for dogs with EPI. And if B12 is too low, your dog’s EPI treatment may not be successful. Some EPI dogs may also lack nutrients like zinc, or vitamins E or K.
Does EPI Shorten A Dog’s Life?
The good news is that if you identify EPI and treat it, your dog should have a normal lifespan and activity levels. The Merck Veterinary Manual says that even though loss of pancreatic acinar tissue is irreversible, “… with appropriate management and monitoring, these animals usually gain weight quickly, pass normal feces, and can live a normal life for a normal life span.” (1)
So … most dogs with EPI will do very well with these dietary changes, and they’ll even put on weight and have normal poops again!
References
1. Jorg M Steiner DVM DACVIM DECVIM-CA, AGAF. Exocrine pancreatic insufficiency in dogs and cats. Merck Veterinary Manual. October 2020.
2. Batchelor DJ, Noble PJ, Cripps PJ, Taylor RH, McLean L, Leibl MA, German AJ. Breed associations for canine exocrine pancreatic insufficiency. J Vet Intern Med. 2007 Mar-Apr;21(2):207-14.
3. Thomas Spillmann, Dipl Vet Med. Canine Pancreatitis: From Clinical Suspicion to Diagnosis and Treatment. World Small Animal Veterinary Association World Congress Proceedings, 2007.
4. JA Morgan DVM, LE Moore DVM DACVIM. A quick review of canine exocrine pancreatic insufficiency. DVM360, August 31 2009.
