Epi supplement: 9 Supplements You May Need If You Have EPI
9 Supplements You May Need If You Have EPI
EPI can lead to a deficiency in certain key nutrients. Here are some vitamins and minerals you may need to take to stay healthy.
By Quinn PhillipsMedically Reviewed by Ira Daniel Breite, MD
Reviewed:
Medically Reviewed
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If you have exocrine pancreatic insufficiency (EPI) — a condition in which your pancreas doesn’t produce enough digestive enzymes — then you’re probably used to taking pancreatic enzyme replacement therapy (PERT) and eating a healthy diet.
But sometimes, you may want (or need) to take other dietary supplements, either to ease symptoms of EPI or to ward off nutrient deficiencies that may develop because of the condition, says Julie Stefanski, RDN, CDCES, a national spokesperson for the Academy of Nutrition and Dietetics.
“EPI is a condition that impacts digestion and absorption, and sometimes supplemental nutrients are needed just so that the body absorbs enough [nutrients],” Stefanski says.
But if you’re considering taking any supplements, it’s important to get the green light from your doctor first. If you are cleared to take them, you may also want to schedule follow-up tests to make sure you aren’t getting too many vitamins and minerals — something that can also lead to health problems, Stefanski says.
Here are nine supplements to ask your doctor about.
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Pancreatic Enzyme Replacement Therapy
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PERT is the most important supplement for people with EPI, because it directly treats the condition. It’s important to take your enzymes with every meal, as well as spread your dose out as much as possible during the meal, according to Joshua S. Forman, MD, a gastroenterologist at the University of Maryland St. Joseph Medical Center in Towson.
“Most people with EPI are currently treated with a prescription pancreatic enzyme replacement rather than over-the-counter enzymes,” says Dr. Forman. In rare cases, with patients who can’t afford prescription enzymes, he’s worked to develop a regimen of over-the-counter options, but they can be less reliable.
If you still experience unpleasant symptoms despite taking enzymes diligently, you may need to ask your doctor about increasing your dose, Forman says. “Many people with EPI tend to be underdosed.”
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Vitamin A
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Forman says that because people with EPI have trouble digesting fat, they’re especially at risk for deficiencies in fat-soluble vitamins — including vitamin A — if the condition isn’t adequately treated. According to an article published in the journal Pancreas, as many as 35 percent of people with both chronic pancreatitis and EPI are deficient in vitamin A.
Vitamin A is important for eye health, helps your body maintain healthy teeth and bones, and helps keep your immune system strong. It can be found in beef, liver, fish, eggs, fortified dairy products, carrots, squash, mangoes, and dark green leafy vegetables.
If your doctor recommends vitamin A, stick to the suggested dosage. Too much vitamin A can be harmful to your health; the daily intake for an adult should not exceed 3,000 micrograms, according to the Office of Dietary Supplements (ODS).
The good news? “[Fat-soluble] vitamins are also stored in our fatty tissues in the body, so it takes much longer for the stores to be used up,” Stefanski says.
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Vitamin D
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Because vitamin D is another fat-soluble vitamin, people with EPI are more likely to be lacking in it than in other nutrients. The same study in Pancreas found that 63 percent of people with both chronic pancreatitis and EPI were deficient in vitamin D.
Vitamin D is vital for bone health, because it helps your body absorb and maintain levels of calcium. Vitamin D also helps your body use vitamin K, ensures healthy blood levels of phosphorus, and, as an antioxidant, helps ward off tissue damage throughout the body.
The best way to get vitamin D is through direct skin exposure to sunlight for about 15 minutes three times a week, according to the National Library of Medicine. Most food sources don’t naturally contain much vitamin D, but you can find some in fatty fish, fortified cereals, and dairy products.
Supplements, if recommended by your doctor, can also help you get adequate amounts.
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Vitamin E
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Vitamin E is another fat-soluble vitamin likely to be lacking in people with EPI. It helps strengthen the immune system so that it can fight off bacteria and viruses and helps blood vessels stay wide and reduce the risk of blood clots from forming.
If you’re taking vitamin E supplements, be sure not to take more than 1,000 milligrams/day since high doses can put you at risk for bleeding and other dangerous health issues, according to ODS.
Good food sources of vitamin E include avocados, nuts, seeds, plant oils, and dark green vegetables. If test results show you have a vitamin E deficiency, your doctor will likely tell you to take a supplement.
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Vitamin K
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Vitamin K, also a fat-soluble vitamin, helps heal wounds by triggering blood clotting and is often lacking in people with EPI. A study published in September 2019 in the journal Nutrition in Clinical Practice found that up to 63 percent of people with chronic pancreatitis and EPI had a vitamin K deficiency and needed to take a supplement.
Food sources of vitamin K include dark green and leafy vegetables — kale, spinach, collard greens, Brussels sprouts, broccoli, asparagus, cabbage — as well as cauliflower, beef, liver, fish, and eggs.
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Vitamin B12
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Vitamin B12 is sometimes lacking in people with EPI as well. If that’s the case for you, your doctor may prescribe a vitamin B12 supplement.
The vitamin plays an important role in your metabolism, as do other B vitamins. It helps red blood cells form and keeps your nervous system running effectively. You can find it in red meat, poultry, shellfish, eggs, dairy products, and fortified foods such as cereal and soy milk.
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Zinc
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According to StatPearls, the trace mineral zinc is second only to iron in its concentration in the body. If you have a disease such as EPI, though, you may have a zinc deficiency. Although a study published in the Journal of Gastroenterology and Hepatology Research found that people with EPI may be at high risk for zinc deficiency, the researchers stopped short of recommending routine supplementation with zinc for everyone.
Zinc plays a role in the growth of cells, the healing of wounds, and the breakdown of carbohydrates in your diet. Good food sources include red meat, dark poultry meat, nuts, whole grains, and legumes, such as beans and peas.
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Calcium
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Calcium helps strengthen your bones and teeth. But because it’s regulated by vitamin D — a fat-soluble vitamin — people with EPI can have trouble absorbing it. This lack of both calcium and vitamin D means that people with EPI can be at high risk of decreased bone mineral density, which could develop into osteoporosis or osteopenia, according to a study published in November 2019 in F1000 Research.
Calcium is often lacking in people’s diets. Food sources include leafy green vegetables, salmon and other fatty fish, and dairy products. Calcium supplements can help bridge the gap between how much your body needs and how much it’s able to absorb through diet.
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Probiotics
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Probiotics fall into the category of “shouldn’t hurt, may help,” Forman says.
These supplements contain “good” bacteria intended to promote digestive health and support your immune system.
People can respond differently to probiotics, so it’s important to make sure you’re taking a type and dose that’s right for you. As with other supplements, be sure to talk with your doctor before taking any probiotics.
And don’t assume all probiotics are the same — many strains may be beneficial, but the effectiveness can vary based on the health condition they’re being used for, according to a study published in Frontiers in Medicine. Since very little is known about probiotics and how they impact gastrointestinal disorders such as EPI, don’t just switch from one staring to another without discussing it with your doctor first.
If you’ve recently been on antibiotics, you may especially want to take a probiotic. Probiotics may help replenish the beneficial bacteria in your digestive tract that were killed off along with the harmful, infection-causing bacteria.
Additional reporting by Elizabeth Yun.
Getting the Right Vitamins for EPI
EPI typically leads to a shortage of vitamins A, D, E, and K in the body. Find out how to get the essential nutrients you need.
By Vanessa CaceresMedically Reviewed by Niya Jones, MD, MPH
Reviewed:
Medically Reviewed
Exocrine pancreatic insufficiency (EPI) is a rare health condition in which the pancreas doesn’t function normally, failing to produce the enzymes needed for proper digestion. A common consequence of EPI is that your body may not get enough essential nutrients, such as certain key vitamins. Vitamin supplements may be needed to make up for the shortage. Although the exact vitamin deficiencies can vary from person to person, the fat-soluble vitamins — vitamins A, D, E, and K — are typically the ones that are affected.
“Ninety-five percent of people with EPI need extra supplementation for vitamins A, D, E, and K, because their levels are low,” says Kristi King, RD, MPH, of Baylor College of Medicine and Texas Children’s Hospital in Houston and a spokesperson for the Academy of Nutrition and Dietetics.
Why are these vitamins affected? Absorbing fat-soluble nutrients versus water-soluble nutrients, like vitamins B and C, is a more complex process for the intestines. The process is particularly difficult if you have EPI, explains gastroenterologist Joel B. Mason, MD, of The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University in Boston.
Vitamin Supplements and EPI: How Much to Take
Work with your doctor to determine just how much of each vitamin supplement you should take. “If you have EPI, you need to have a doctor who’s aware of the types of vitamin deficiencies that can arise with EPI so that he or she can monitor you,” Dr. Mason advises. Those deficiencies might change as EPI progresses, he adds.
To help determine the vitamin supplements you need, your doctor or dietitian will determine your levels of vitamins like A, D, E, and K during an initial visit, King says. “If a baseline check is really low, vitamin supplementation should be started and your levels rechecked in a month.
Based on that, it will likely be determined how often your vitamin levels should be checked from there,” she explains. Having your vitamin levels checked every two to three months is common.
The exact dosage of each vitamin will also be individualized, based on your age and how deficient you are, King says. Dosages of three to five times the normal recommended daily allowances aren’t uncommon, and could even be higher. “In severe cases, a supplement dosage of 5 to 10 times the daily value may be needed to get a vitamin level up to normal,” she adds. Once you’re responding well to supplementation, you may be able to take a lower maintenance dose.
Vitamin D supplementation appears to be particularly important for people with EPI, according to a study published in the medical journal Anticancer Research. Researchers found that people with EPI, along with other people with pancreatic diseases including cancer, often have varying levels of vitamin D deficiency and that individualized dosages of oral vitamin D supplements helped to correct the problem.
Some people needed 20 times more vitamin D than others to get to normal levels.
Maximizing Vitamin Supplements
The vitamin supplements that a person with EPI uses might be a formulation prescribed by his or her doctor or something bought over the counter, King says. “If you need additional vitamin D, you can get a prescription, but some people find that buying an over-the-counter formulation works just as well.” However, make sure it’s vitamin D3, which is better absorbed by the body, she adds.
Generally speaking, you’ll take your vitamin supplements with your meals, King says. This is also when you’ll take your pancreatic enzyme replacements, prescribed to help your body properly absorb the nutrients in your food.
It’s crucial that you follow your doctor’s guidelines regarding supplementation, Mason says. “If your doctor determines that you need a certain vitamin on a regular basis, it should be part of your daily routine to take it.”
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Epi Jay, Pediatric Neurology and Epileptology Clinic Network
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EpiJay adult clinic is within walking distance from Akademicheskaya metro station.
The main direction of the clinic’s work is the treatment of epilepsy and neurological diseases in adults and children.
Specialists working in the clinic have experience in various leading public and private medical institutions in St. Petersburg, are highly qualified, among them are candidates of medical sciences and doctors of the highest qualification category.
The EpiJay adult clinic is equipped with the latest EEG equipment, which allows you to conduct examinations with high accuracy. The clinic has a ward for multi-day pre-surgical Video EEG monitoring for both children and adults.
Examinations and consultations can be obtained within the walls of the clinic, as well as calling a specialist at home.
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Took 15 minutes early, was very kind and responsive) took anamnesis, examined, carefully studied everything on MRI.
Reassured me that it’s not as scary as it seems :))
I prescribed a treatment that already on the third day began to work, the pain finally bothers me less, I hope it will soon pass completely.
Thank you very much Alexandra Vladimirovna!!
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Marvel’s Spider-man (2018) – DLC analysis — DTF 9 games0001
In addition to my previous article, I decided to disassemble the DLC that Insomniac released for the game “Marvel’s Spider-man”.
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Additions will be considered in chronological order. Accordingly, let’s start with the episode “Robbery”. Enjoy reading!
Table of contents:
- Episode “Robbery”
- Episode “Gang Wars”
- Episode “Silver Beam”
- Total
Episode “Robbery”
Plot
After the disappearance of Wilson Fisk, gangs in New York are waging a war for power. Parker learns that a painting was stolen from the leader of one of the mafia, and now it is in the museum, but another gang wants to get it. Spider-Man arrives at the crime scene and deals with gangsters and finds his ex, a black cat, who breaks the canvas and takes out a flash drive from it. Peter wants to catch the thief and find out why she needs a flash drive, but after finding Felicia and hearing some information from her, he cannot refuse to help his old friend.
The setting is, well…normal. There is nothing more to say about her. And, by and large, it is needed only in order to move history from its place.
What’s new?
In this addition, the developers have implemented a little new. Before launching the game, I thought the guys at Insomniac would diversify Parker’s arsenal with new gadgets. But they only managed to add two new types of activities, a new type of opponents, a reskin of bandits (now they are members of the mafia, not street punks, don’t mix it up!), And also three new costumes. More about everything:
Enemies
The new enemy is a typical fat man from the main game, but with a machine gun. He has increased resistance to Spider-Man’s blows, and now it takes more effort to wrap the web around him. By the way, during the passage of all the add-ons, it was this type of enemy that heated up my butt. The rest of the opponents remained unchanged.
Say hello to my little friend
Trials of the weirdo
Do you remember a very charismatic blogger who leads marginal streams for prisoners? Well, remember not the mad girl from the sideline? So: Insomniac decided that they did not fully reveal this brilliant personality and gave her an arc that lasts all three additions.
Conceptually, these are the same tasks of the Taskmaster, aka the Brigadier, from the main game, only with the addition of new mechanics: if you knock out the enemy in the focus of the camera or fly beautifully between the fences and take a good shot, then you get more points. There are only three tests: in the first you need to knock out all the opponents and score a large number of points, in the second you need to defeat the opponents using two types of gadgets at once, in the third you need to disable the EMP. The first two tasks are interesting to complete, and the last one is rather boring and dreary. The tests themselves are not bad, probably even good, but thanks to the negative charisma of the weirdo, the desire to complete these missions evaporates.
Painting Search
Looking for stolen paintings for a police officer, they tell you an interesting fact about the person who stole the painting. It was about the same in the main game, only there you were looking for backpacks with items, after which Peter talked about the events that happened to him before the start of the story.
A pleasant activity that you perform with the desire to find out the denouement of the story with the thief.
Grandfather talks about the picture thief
Suits
Scarlet Spider, Flexibility, British Spider
Insomniac Added three new costumes for Spider-Man. The Scarlet Spider suit came in the most for me, of all the ones presented, in my opinion, it has normal lenses, the rest of them look ridiculous. “Scarlet Spider” is given for completing all activities by 100%, “Flexibility” appears in your collection after completing the first task, and “British Spider” can be obtained after completing the last mission of the DLC “Robbery”
Episode “Gang Wars”
Cool
Plot
The sledgehammer was locked up in an old Harlem hospital. The NYPD decides to arrest the scoundrel, but the operation does not go according to plan, and Yuuri Watanabe, along with his subordinates, is captured by the Maggia (mafia).
Only Yuuri manages to get out alive, and she, disappointed in Spider-Man, who could not save her comrades from death, decides to take revenge on Kuvalda at all costs, and Parker throughout the supplement tries to dissuade her from this stupid undertaking.
I would like to note a more severe tone of the story, in comparison with the previous addition: it’s raining all the time outside, Yuri goes crazy and the cruelty of a sledgehammer is well shown, which, for the sake of intimidation, is ready to kill a policeman without a twinge of conscience.
There are no difficult situations, situation:
What’s new?
Insomniac has added some new stuff again: upgraded enemies with a shield, granted Sable weapons to members of the Maggia, added sledgehammer points, made a boss fight, and gave Weirdo Challenges a second season.
Enemies
The developers have updated the enemies with a shield: added jetpacks and made the shields energy.
Now this type of criminals has become a more serious threat than the previous one. Now all attempts by the player to snatch the shield from the gangster’s hands end in failure. Shield Bearers can also jetpack up to Spider-Man, leaving behind a streak of electricity that deals massive damage to Peter, but they don’t have the ability to fully levitate in the sky like the Sable operatives.
Also one of the differences of this add-on from the past is the battle with the boss (sledgehammer). It is better executed than many fights from the main game. There, you could defeat the main enemy using only dodge, and the window between the attacks of the villain was very large, even on a high difficulty level. Here, the developers reduced the time between attacks of the boss and diversified his moveset, which makes him feel more difficult than his predecessors.
Once upon a time
Sledgehammer points
Insomniac has added a new type of activity: sledgehammer points, which are very similar to Demon warehouses in gameplay, but due to the updated types of opponents, they are much more difficult and interesting to pass than the caches of Mister Negative’s minions.
You’ll have to sweat.
One of the bases
Second season of testing weirdos
Added stealth missions… Oh my god, I would give anything to leave the tedious trials in which you need to disable EMP generators, but Insomniac gave us stealth missions (also for a while ). At the highest level of difficulty, they just drove me crazy. The worst moments in the main story were connected precisely with the secret passage, apparently, so the developers decided to give them a second chance. Happened? No. They remained the same boring, causing only a desire to sleep. The rest of the challenges are good, as they are based on one of the best mechanics of the game – combat. There are no changes to these quests.
Stealth test
Suits
Spider Armor MK 1, Spider Clan, Iron Spider Armor
Three costumes were added again in this episode. Of all the three skins, I like the last one the most, because “Spider Armor MK 1” looks kind of weird and awkward, and “Spider Clan” can only be used for fun, since for obvious reasons it is written out of the game world.
“Iron Spider Armor” can be tried on only after completing the story campaign of the episode, “Spider Clan” is given to you after the expansion is completed, but “Spider Armor MK1” can be obtained immediately after completing the first task.
Episode “Silver Beam”
high five
Plot
Maggia Gangsters begin stealing Sable vehicles on a larger scale. Now they have set their sights on the Olympus project. This alignment does not please Silver Sable and she returns to New York in order to deal with the Sledgehammer gang. But there is one problem: despite the common goal, Spider-Man and Sable are on hostile terms.
And I didn’t understand this move by the writers. As far as I remember, at the end of the main campaign plot, Silver Sable and Parker were on friendly terms, even helping him, but here she went crazy, runs into poor, diligent Peter and prescribes a couple of accurate hooks. Why such drastic changes?
What’s new?
Opponents got Sable’s mercenary abuse, a gangster with a jetpack appeared, but unlike his brother with a shield, he can easily fly in the sky, updated the sledgehammer bases and added three suits again.
You probably now thought: “Where is Chudila with her unique tasks?”. Here … The final season of her show has arrived.
Enemies
As I said, the bandits now have sable equipment and become stronger. Much more interesting is the new type of enemy. He will have the ability to fully fly and attack with a superhero landing that can easily be overlooked in the heat of battle.
I would like to note that compared to previous additions, the enemies in this episode are several times more difficult. If in the DLS robbery the opponents act as punching bags, then here the punching bag is you, this is especially felt when passing the bases of the sledgehammer, where sometimes I had to rush around the entire location so as not to grab a couple of good and savory caps.
Also in this Episode, the number of boss battles has been increased, now there are already two of them: with a sable and a sledgehammer. First, about the first fight:
I don’t even know how Insomniac managed to make such a boring and at the same time difficult boss battle.
And the fight is difficult not because the sable has some kind of big moveset, but because it does not allow you to carry out your counterattack normally: after the fourth blow, it throws you into a deflection. And also none of the gadgets that are in Parker’s arsenal work on her. And you just get tired of waiting and dodging, waiting again and dodging again, in order to make your move in this dishonest game.
Fight with a sledgehammer. Spoiled. The sledgehammer turned into some kind of parody of RoboCop, sitting on steroids. Because of which you don’t feel the impact and think that you are fighting not with a person, but with a talking toaster on legs. Yes, okay with him, if he had a normal supply of various types of attacks, but no. Almost the entire fight, he is covered with an energy field, and in order to inflict a couple of blows on him, you throw bombs at him, while dealing with a crowd of minions along the way. All. Interesting? No.
The third season of weirdos
The Gadgets and Combat challenges also remained unchanged, while the Stealth challenge was removed and replaced with Bomb.
Well, thank God, no one will grieve for sure. The essence of the bomb test is that you need to fly to the place where the explosive is located, the charge can also be in trucks, throw a pack into the sky and wrap it in a web: the less damage, the more points.
Bomb Challenge
Olympus caches
These are reinforced warehouses of Kuvalda. Enemies have become much more agile and stronger. On these bases, all new opponents have appeared, which spoil the passage quite robustly. I have nothing more to say about Kuvalda’s warehouses.
Fragments of audio recordings
You collect audio recordings recorded from a psychologist’s appointment, which add up to a full-fledged story, the ending of which intrigues you.
Suits
Into the Universes, Cyber Spiderman, Aaron Aikman’s Armor
Also added three new costumes. I didn’t like any of them, but obviously someone will come in.
Into the Spider-Verse is unlocked by completing the expansion, Cyber Spider-Man is unlocked after completing the episode’s storyline, and Aaron Aikman’s Armor is added to your collection after the first mission.
Total
Liked:
- New types of opponents.
- First fight with a sledgehammer.
- The plot, if we consider each addition as part of a full-fledged work.
- New characters, in particular the Black Cat.
- A couple of new suits.
What I didn’t like:
- Activities that are a copy of tasks from the main game and are only needed to stretch the gameplay.
- First addition.
- Boss fights from the Silver Ray.
DLC can only be tried if you like the game. In other cases, I would not recommend spending money.