Do you have clients who are eating a great diet, but their lab tests come back showing low levels of iron, B12, zinc, and other nutrients?
The problem may not be in what they are eating but what they are absorbing–and a key component of nutrient absorption is pancreatic enzymes.
Studies have found that approximately 5-6% of patients diagnosed with diarrhea-predominant Irritable Bowel Syndrome (IBS-D) actually have undiagnosed exocrine pancreatic insufficiency (EPI).1 Along with poor nutrient levels, it’s helpful to check for pancreatic insufficiency with clients who have digestive symptoms.
In this article, we will focus on the causes of low pancreatic elastase, how to test for it, and what can be done to improve levels naturally.
Table of Contents
First, let's examine some of the common symptoms of low pancreatic enzymes.
Sometimes, clients need to know “why” they are doing tests. And if they have many of these symptoms, it is easier to convince them that testing is necessary.
The most common symptoms of low pancreatic enzymes, or pancreatic insufficiency, often relate to poor digestion and nutrient absorption.
Here are the key signs that may prompt someone to get tested:
When pancreatic enzymes are insufficient, food isn’t fully digested, leading to fermentation in the gut.2 This results in bloating, gas, and discomfort after meals.
Without enough enzymes to break down fats, carbohydrates, and proteins, undigested food passes quickly through the intestines, leading to diarrhea or loose stools. Fat malabsorption can also cause stools to float, appear greasy, or have an oily residue.3
Poor digestion due to low enzyme levels can cause cramping or discomfort, particularly after eating a large meal or foods high in fat.4
When nutrients aren’t absorbed properly, individuals may experience fatigue or weakness, even with adequate calorie intake.5
People with low pancreatic enzymes often lose weight unintentionally, as they’re not absorbing enough calories or nutrients from food.6
A hallmark of low pancreatic enzyme levels, steatorrhea is characterized by pale, bulky, foul-smelling stools that may appear greasy or oily. This occurs because undigested fats are excreted rather than absorbed.
Over time, low enzyme levels can lead to deficiencies in fat-soluble vitamins (A, D, E, K) and other essential nutrients like vitamin B12, iron, and zinc.7 Symptoms can include anemia, easy bruising, bone pain, and vision problems.
Without adequate enzymes, food sits in the stomach longer, leading to feelings of fullness, nausea, and indigestion, especially after meals.
Of course, these symptoms can be caused by many things, which is why testing with the Gut Zoomer is beneficial–it helps identify other possible causes for these symptoms.
When a stool test reveals low pancreatic elastase, the immediate response might be to recommend digestive enzymes to support nutrient absorption and relieve digestive symptoms.
While this might be a good first step, we also need to understand the cause of enzyme deficiency to help increase the natural production of enzymes and reduce reliance on supplements.
One of the most common causes of low pancreatic enzymes is chronic pancreatitis,8 which can be assessed using blood tests for markers like lipase and amylase, along with imaging studies to assess pancreatic health.
However, other potential causes can be assessed with Vibrant Wellness tests such as the Gut Zoomer, Wheat Zoomer, and the Urinary Hormones panel. For example:
Let’s explore some of the key factors these tests can help identify:
Gut inflammation, often related to gut dysbiosis or conditions like irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO), can interfere with pancreatic enzyme production. Chronic gut inflammation can disrupt how the pancreas works, reducing enzyme production.9
The Gut Zoomer tests for a wide range of inflammatory markers and dysbiotic bacteria and is the perfect test to start with.
Diets high in processed foods and sugars or low in nutrient density strain the digestive system and can lead to enzyme depletion. Over time, such diets contribute to inflammation, which may impact pancreatic function indirectly.
If a reaction to wheat is detected, the first step is to eliminate it from the diet and then assess both the client's response to a gluten-free diet and how they respond to a wheat challenge in the future.
Additionally, the presence of leaky gut can help explain systemic symptoms and indicate that a gut healing protocol should be included in the treatment plan.
Low stomach acid (hypochlorhydria) is a common issue, especially in people using acid-suppressing medications or with H. pylori infection. Stomach acid stimulates the release of cholecystokinin (CCK), a hormone that triggers the pancreas to secrete digestive enzymes into the small intestine and the gallbladder to release bile.10
The Gut Zoomer assesses for H. pylori infection, along with levels of fat present in the stool.
Stress activates the fight-or-flight response (sympathetic nervous system), which prioritizes energy for immediate survival needs. This redirection of resources reduces blood flow to the digestive system, including the pancreas, and lowers digestive secretions.11
Oftentimes, clients don’t realize how stressed they actually are. The Vibrant Wellness Urinary Hormones test can measure cortisol levels so they can see how stressed they are–and feel inspired to take action.
Chronic or heavy alcohol use is another leading cause of low pancreatic enzymes, as it directly damages pancreatic tissue. While chronic pancreatitis from long-term alcohol use is a clear cause, even moderate but consistent alcohol intake can have a cumulative effect on enzyme production, especially if other triggers like smoking, obesity, and poor diet are present.12
Gallbladder dysfunction or bile acid abnormalities can indirectly reduce pancreatic enzyme output because bile release helps trigger pancreatic enzyme production.13 Bile acid levels can be measured with the Gut Zoomer test.
Sjögren's syndrome can cause inflammation in the pancreas, leading to low pancreatic elastase levels. Other autoimmune conditions like systemic lupus erythematosus (SLE) and Type 1 diabetes can also potentially affect the pancreas.14
The Vibrant Wellness Autoimmune Zoomer is a new test option that tests for 63 different autoimmune conditions and is a great screening tool for identifying autoimmune conditions.
How To Treat Low Pancreatic Elastase Levels
While supplementing digestive enzymes that contain lipase, amylase, and protease can help provide symptomatic relief by improving digestion and absorption, we also need to treat the underlying cause.
If H.pylori is a contributing factor, I always prioritize treating it first. Once that is managed, the next step is to focus on assessing stress levels, evidence of SIBO, and investigating other potential triggers for low digestive enzyme levels.
Typically, with this systematic approach to patient assessment, you can identify the underlying cause and help restore pancreatic function.
This is more difficult in older clients, and they may require long-term enzyme supplementation. As people age, there is a decline in pancreatic function which is difficult to reverse. Additionally, many older adults who take medications like proton pump inhibitors (PPIs) long-term have other health conditions like diabetes that can affect pancreatic function.
One of the most unusual cases I've encountered was a pancreatic elastase level in the 60s—extremely low—triggered by a box jellyfish sting to the abdomen. The box jellyfish, one of the world's most venomous creatures, can cause severe organ damage and be potentially fatal.
Following the jellyfish sting, the patient developed severe IBS and tested positive for SIBO. They tried various treatments without symptom improvement.
We performed a stool test and identified low pancreatic elastase levels, and we were able to improve their symptoms with supplementation. Over 18 months, their elastase levels improved significantly, with their most recent Gut Zoomer test showing pancreatic elastase levels of 197. This score is still not optimal, but the continued improvement is encouraging.
Top Diet and Lifestyle Strategies to Improve Pancreatic Elastase
Every case is different, which is why starting with a thorough case history is essential. However, while a case history can provide valuable context, it won’t confirm whether low pancreatic enzymes or hidden gut infections are contributing to symptoms. That’s why I always recommend a data-driven approach to treatment plans.
Many people with digestive issues turn to digestive enzymes, hoping for relief. However, testing often reveals that their pancreatic function is perfectly normal, meaning they’ve been taking supplements unnecessarily. This underscores the value of testing—not only to pinpoint what’s really happening in the body but also to avoid unnecessary treatments and costs. (Note: Digestive enzymes won’t interfere with test results).
If you have a client with digestive problems and can only run one test, the Gut Zoomer is an excellent starting point. It provides a wealth of information about gut health and can highlight factors that may be contributing to their symptoms. If your client’s budget allows, additional tests—such as the Wheat Zoomer, Autoimmune Zoomer, or Urinary Hormones Panel—can provide a more comprehensive view of their overall health, helping you refine and personalize their treatment plan.
By relying on strategic testing, you can move beyond guesswork and offer your clients a more effective path to improved digestive health.
Michael Smith, N.D., is a naturopath specializing in functional medicine with over 20 years of experience. He works with clients worldwide through video and phone consultations, offering personalized health solutions. Michael combines advanced testing, nutritional and herbal medicine, and lifestyle strategies to address the root causes of health issues, helping clients achieve lasting results.
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Regulatory Statement:
The information presented in case studies have been de-identified in accordance with the HIPAA Privacy protection.
The general wellness test intended uses relate to sustaining or offering general improvement to functions associated with a general state of health while making reference to diseases or conditions. This test has been laboratory developed and its performance characteristics determined by Vibrant America LLC and Vibrant Genomics, a CLIA-certified and CAP-accredited laboratory performing the test. The lab tests referenced have not been cleared or approved by the U.S. Food and Drug Administration (FDA). Although FDA does not currently clear or approve laboratory-developed tests in the U.S., certification of the laboratory is required under CLIA to ensure the quality and validity of the test.