What are pancreatic enzymes?

The food that reaches our body is not absorbed as it is. The food we consume is broken down into small units of protein, fat, and carbohydrates to allow for absorption. Pancreatic enzymes (pancreas, pancreas) are proteins secreted naturally by the pancreas. They break down the food consumed and thus help the absorption of fats, proteins, and starches. The deficiency of digestive enzymes will lead to impaired food absorption.
Digestive enzymes are secreted from other places, such as the salivary glands. However, the pancreas is the primary source of enzymes that break down fat. In most patients with cystic fibrosis, the pancreas is damaged and unable to secrete the enzymes needed for digestion. As a result, there is an impairment in the absorption of fats and proteins. The undigested food is excreted from the body without use, while the patient suffers from abdominal pain, bloating, gas, cramps, fatty discharge, and weight loss. Although a decrease in pancreatic activity can be detected at a relatively early stage, most of the signs will appear only after losing about 90 percent of pancreatic activity. In the case of moderate injury, the patient may suffer from only mild symptoms, which are manifested in average, seemingly normal bowel activity.
Impaired pancreatic enzyme secretion may lead to absorption of fat-soluble vitamins (A, D, E, K). This condition may later cause weight gain, delayed growth in children, the formation of bone diseases, impaired night vision, and more.

In what ways can pancreatic enzymes be consumed?

בארץ, משווקים אנזימי הלבלב תחת השם המסחרי קריאון (creon). כרגע משווקים שני מינונים: 10,000 יחידות ו-25,000 יחידות. מינון נוסף, של 4,000 יחידות, אושר בישראל, אך עדיין לא משווק מסיבות שונות. המינון נקבע לפי תכולת הליפאז (האנזים מפרק השומן) בכול קפסולה. אולם, כל קפסולה מכילה גם עמילאז (אנזים המפרק פחמימות) ופרוטאז (אנזים מפרק חלבונים).
האנזימים ארוזים בתוך הכמוסות כגרגירים קטנים המצופים בחומר, המגן עליהם מפני פירוק בסביבה החומצית של הקיבה. חומר זה מתמוסס כאשר הגרגיר נחשף לסביבה הבסיסית של המעי. בצורה זו, יעילותם של האנזימים נשמרת עד להגעה לאתר שבו הם אמורים לפעול, ונמנע גירוי של הקיבה כתוצאה מחשיפה אליהם. 

מהם המינונים בהם יש ליטול אנזימי לבלב?

The dose is individually tailored to each patient, depending on their typical weight, age, symptoms, and diet. In any case, the dietitian should be consulted to determine the appropriate dosage.

However, there are general guidelines for adjusting the dose of crayon. There are three options for dose adjustment in adults and children over four years of age. The amount of the drug is determined according to one of the following parameters: the fat content of the food consumed, the daily amount by body weight, dose per meal according to body weight.

Dose per meal: In most cases, the initial amount for adults and children over four is 500 units per kilogram of body weight per meal. That is, the starting dose in a patient weighing 40 kilograms will be 20,000 units (two capsules at a dose of 10,000 units). When taking a snack, add half the quantity, ie 10,000 units (one pill in the same amount).

This dose can be changed according to the clinical signs (diarrhea, fatty stools, etc.). The changes should be made gradually, once every few days, to allow an assessment of the reaction. The recommended maximum dose is 2,500 units per kilogram of body weight every meal. The same patient who weighs 40 pounds should consume a maximum of 100,000 units per meal (which are four 25,000 Kryon capsules). When taking a snack, add half the dose, ie, 50,000 units (two tablets of the same amount).

According to the patient’s weight, Dosage is up to 10,000 units per kilogram of body weight per day. This dose refers to the consumption of 3 meals a day and 2-3 snacks in between. That is, a patient weighing 40 pounds should receive a maximum of 400,000 units per day (16 Kryon 25,000 capsules). When dividing this amount by the number of meals, four capsules are obtained per meal, plus 1-2 capsules per intermediate serving.

• Fat content per serving – a maximum of 4,000 units per gram of fat from food. Here, no reference is made to the patient’s data. But, of course, the amount of fat in the diet should match the nutritional requirements, and these are dictated by age and weight.

How is the amount calculated for babies?

The initial dose is 1,000 units per kilogram per feeding in formula or breast milk (even if the final amount is unknown, or less than 120 ml). Typically, breastfed infants will receive 2,000-4,000 units per 120 ml bottle (formula or breast milk). To avoid overdose, open the capsule and divide the berries. The maximum dose is 10,000 units per kilogram per day. That is, a baby who weighs 6 pounds should receive up to 60,000 units per day.

Dosage for children aged 1-4 years

In children over one year of age weighing over 8 kilograms, the initial dose is calculated according to 1,000 units per kilogram per meal, i.e., a child weighing 10 kilograms should receive one capsule of 10,000 units. The dose can increase up to 2,500 units per kilogram per meal (i.e., 25,000 units per meal), or 10,000 units per kilogram per day, or 4,000 units per gram of fat in food.

How should pancreatic enzymes be taken?

• It is important to take the preparation with any fatty foods. No need to take enzymes with juices and fruits.
• The preparation should be taken at the beginning of the meal. You can divide the amount of balls between the beginning of the meal, the middle and the end, or take 2/3 of the amount at the beginning of the meal and 1/3 at the end.
Do not crush or chew the capsule.
• Do not leave the capsule in your mouth beyond the time it takes to swallow.
• Be sure to drink plenty of fluids.

And what about those who can not swallow pills?

The capsules can be opened. The contents can be swallowed as is, in a spoon, or mixed with a soft and acidic food (like apple sauce) or an acidic drink (orange juice, for example). Make sure the heat of the food or drink is at room temperature at most. The drug should be swallowed immediately after mixing. Immediately afterwards drink water or juice, to make sure that all the preparation is swallowed.
When giving cream to babies, do not mix the substance with breast milk or formula. Open the capsule and mix the contents with a little soft, lukewarm and acidic food (apple or pear puree). The baby should then be given breast milk or formula.

Pancreatic enzymes and the use of gastrostomy

When an entree is fed a medical food with a fatty component, pancreatic enzymes should also be taken. A dietitian should be consulted in order to adjust the dosage individually.

What side effects should be expected during use?

Overall, the use of the preparation is well tolerated. Among the common side effects, abdominal pain, nausea, constipation, diarrhea and abdominal discomfort appeared. A number of rare but important side effects should be considered:
Fibrosing colonopathy – thickening of the intestinal wall and decreased motility, causing abdominal pain, vomiting, discomfort and constipation. This is a rare phenomenon, usually occurring in children who have consumed high doses for a long time (over 6,000 units per kilogram per meal). For this reason, do not exceed the recommended dose without proper medical supervision.
• Stimulation of the mucous membranes: Crushing and chewing the contents of the capsule, or mixing the contents with unsuitable food, may result in premature activation of the enzymes. As a result, mucosal irritation and decreased enzyme efficiency may be induced.

Additional guidelines

• The product is good to use for up to three months from the moment of opening or until the expiration date (whichever is earlier).
The pills should be stored in a cool, dry place (not in the bathroom or car).
• Kryon should also be taken during fasting, in order to prevent intestinal obstruction. Dosage: One capsule, every 3-4 hours.

Food Additives

Food supplements are high-calorie beverages that are suitable for both drinking and gastrostomy delivery.
Some are broken down into the most basic components of the nutrients so that they are not needed for digestion, then there is no need to provide pancreatic enzymes along with them (elemental formulas).
Some are not broken down but simply contain a high concentration of small-volume calories, with which pancreatic enzymes (polymeric formulas) must be taken.

Nutritional supplements used in the country

Ensure: 250 ml cans with liquid in different flavors (vanilla, strawberry, chocolate, coffee), each 100 ml has 106 kcal, 3.72 grams of protein, 3.72 grams of fat, and 14.5 grams of carbohydrates.
Ensure plus: 250 ml cans with liquid in different flavors (vanilla, strawberry, chocolate, coffee), each 100 ml has 150 kcal, 5.49 grams of protein, 5.33 grams of fat, and 20 grams Carbohydrates.
Pulmocare: 250 ml cans, each 100 ml has 150 kcal, 6.26 grams of protein, 9.21 grams of fat (MCT 20%), 10.57 grams of carbohydrates. Vanilla flavor.
L-Emental: Comes in powder form to be mixed with water. Each 100 ml contains 100 kcal, 3.8 grams of protein, 0.28 grams of fat, and 20.5 grams of carbohydrates. This is a broken down formula, no pancreatic enzymes are needed.
Nutren Junior

A full and balanced drinking can for children aged 1-10
Enriched with MCT oil (21%)
Contains: 250 kg, 7.5 g protein, 12.4 g fat
Vanilla flavored

Nutren 1: Full and balanced drink can, enriched with MCT oil (25%)
Contains: 250 kg, 10 g protein, 9.5 g fat. Vanilla flavored

Nutren 1.5: A complete and balanced drink can, enriched with MCT oil (50%) contains: 375 kg, 15 g protein, 16.9 g fat. Vanilla flavored.
Nutrine 2: Full and balanced drink can, enriched with MCT oil (75%)
Contains: 500 kg 20 g protein, 26 g fat. Vanilla flavored.

Semi-elemental drinking can for malabsorption states
Enriched with MCT oil (70%)
Contains: 250 kg, 10 g protein, 9.8 g fat
Vanilla flavored

Skandishake: a powder that is mixed with water or milk and contains after preparation with milk – in every 100 ml 200 kcal, 11 grams of protein, 30 grams of fat, and 69 grams of carbohydrates. Found in flavors, vanilla, chocolate and strawberry. Requires enzymes.
Skandishake – adds a delicious weight to life.
Skandishake: The ideal solution for underweight situations.
Skandishake: A powder for making a delicious, high-calorie smoothie.
Skandishake: Almost double the caloric density of any other product. Each serving has 600 calories.
Skandishake: Prepare by adding the contents of the bag to 240 ml of milk or water.
Skandishake: Plain chocolate-vanilla-strawberry-flavored.
Lactose-free chocolate-vanilla flavored.
Sucrose-free, sweetened with aspartame, chocolate-vanilla flavor.

Scandinavian Shake Mix:
Water or milk calorie enriched powder. Each bag contains 85 grams: about 440 kg, 4 grams of protein, 21 grams of fat. Vanilla, strawberry, chocolate and tasteless flavors

Scandinavian Shake Mix:
Scandinavian Shake Mix: Adds a delicious weight to life
Scandinavian Shake Mix: The ideal solution for underweight situations
Scandinavian Shake Mix: A powder for making a delicious, high-calorie smoothie
Scandinavian Shake Mix: Double caloric density of any other product: 600 kg based on milk
Skandishake Mix: Vanilla, strawberry and tasteless flavors

Magafram, PO Box: 519 Hod Hasharon, 45105
Tel: 09-7604596

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