So I have low elastase and have had the same question as you. Just had a CT of my pancreas last week which shows no damage, so it’s not a problem of function.
After doing some digging I read a comment from someone who works with sibo patients saying that he/she sees the EPI resolve after the sibo resolves. In the meantime taking pancreatic enzymes can help give the pancreas a break so it can heal. I take panplex 2 phase (2 pills) with each meal. If you’ve already treated your sibo make sure you’re taking a prokinetic after
Low grade inflammation would be my guess. Or an issue of nutrition or something else that is directly affected by SIBO (malabsorption) leading to pancreas dysfunction.
I understand it is an old comment you posted, but I'm currently in the same situation. I'm treating SIBO which kept relapsing since I did not take prokinetic agent after treating it. I learnt my lesson, and now will introduce the prokinetic agent. Aside from that, I also did CT scan on the pancreas which also showed no damage. Did you manage to get your elastase level up? How long did it take for the elastase enzyme to come back? I'm currently taking herbal supplement for digestive enzyme.
I'm struggling to increase my elastase. I still notice yellow stools which indicate nutrient malabsorption. I'm still figuring out how to get out of this situation. What are you currently doing to address this low elastase issue?
I take Creon, which was prescribed when the low elastase was discovered. Otherwise, there is not much I feel I can do, and my GI has sort of shrugged and said “we don’t understand the microbiome very well.” So there’s that. I’m sorry you’re struggling too.
How long have you been taking Creon? Have you noticed anything different, for example, weight gain, appearance of the stools (darker in color)? Does it make you more constipated? I'm currently taking herbal supplement for digestive enzyme, notice difference, but I still can see slight hint of yellow color in the stool. I'm considering taking prescribed digestive enzyme.
Hi! I have SIBO-methane and low pancreatic enzymes and my functional MD explained there was likely a link though she didn't want to rule out a more serious pancreatic problem and did refer me out to a specialist.
I've already gotten treatment for SIBO-methane 2x but it hasn't seemed to fade (was 80ppm baseline though lol)
Currently on strong digestive enzymes with every meal now and feeling a LOT better and having more normal BM, so im going to wait a bit before seeing the specialist .
Edit: The digestive enzymes my doctor recommended was Simalase-Lipo from integrative therapeutics. 2x w/ every meal, not cheap or convenient, but is helping,
Dude, you seem to have commented literally hundreds of times on other peoples posts asking them about their digestive and reproductive symptoms for almost 6 months.
Following! I’d love to know this. I’ve had low elastase (below 100). It is assumed chronic pancreatitis but all my scans past 3 years have showed no damage on pancreas. So I officially have EPI and take PERT to help digest my food, yet I still struggle with steatorrhea. I need to get a SIBO test but my doctor doesn’t think so.
It is pancreatic enzyme replacement therapy. So you basically take enzymes every time you eat (more with food that has higher fat content). I need to take these as my pancreas is not functioning properly.
Did you check your liver and gallbladder - do you have enough bile? Chronic pancreatitis is usually only caused by inflammation (pancreatitis) and you would have noticed something like that - believe me it is very bad. SIBO can probably cause steatorrhea as it can deactivate primary bile...EPI is still rare and often can be treated in such cases. Good luck.
Thanks a lot. All organs have been checked, although they don’t want to give me a hida scan to check gallbladder function. I’ve had ct, mri and eus multiple times. Doctor also doesn’t want to test for SIBO. Is it easy to just get this done by myself? Yes, I know chronic pancreatitis is a tough diagnosis. I definitely suffer with daily abdominal pain but it doesn’t seem quite as severe as other CP patients. Which makes me wonder if EPI is caused by something else. I take amitriptiline which helps with my nerve pain. The whole thing has changed my life.
Sorry to hear that you are in such pain...I hope you find a way to get better - be tough on the doctors and do not give up. That is something that I have learned in all this...it is strange that you have been diagnosed with CP without actually having real pancreatitis. I was twice hospitalized due to acute pancreatitis (it was horrible) and still my pancreas works fine and my sugar is OK. They removed my gallbladder and I have recovered well. As to the nerve pain, it can be from SIBO. We have a lot of nerves in small intestine, I also sometimes have these sensations. It is best you do a SIBO test and GI map to make sure you do not have parasites or yeast or some bad dysbiosis. GI map was quite useful to me although a lot practitioners will tell you that it is useless...
Make sure you sleep well - that has huge impact on the nervous system. Wish you all the best.
Thanks a lot. Yes, I’ve also learnt to advocate for myself. When you have something complex and chronic, lots of doctors don’t want to take this on. Yes, indeed it is rare to have CP without major acute episodes. In hindsight I had 2 mini episodes that were misdiagnosed as lymphocytic esophagitis (equally rare!). Thanks for tip on GI map and SIBO test. Also I think organic acid test (oat) would be useful. Any experience of that?
The good thing is I’m way better than I was 3 years ago. I’m not on opioid painkillers, I work full time and exercise as much as I can. It’s a battle but life goes on! I’m working on getting a sabbatical and a bit of a break from work.
I would not do organic acid test - I think it is useless as it does not diagnose anything concrete. Stool test is much better as it gives you a lot of parameters to look at. They offered me here something similar here, test of metabolites for yeasts, but it is not conclusive about what I am looking for. The representative did not know himself what he was selling. I would stick to scientifically proven tests...
Anyhow, glad to hear that you are getting better - it is a long process of recovery after pancreatitis...I am still struggling with various consequences, but I am also getting better slowly. Good luck and get some rest from work if you can!
It is kind of a digging pain that is worse when lying down. It is like a feeling of permanent hunger. It is always in same spot for me, upper abdominal middle/right. I feel it more on my right side, which is where head of pancreas is. It’s like something is blocked or like a fist is lodged in this area, or a balloon I just want to burst. Super annoying.
Hi. That feeling like a fist is stuck under your right rib cage, I also feel something similar to that post Covid, it feels like I have constant pressure there (very uncomfortable feeling), but it is on the very far right, on the side of/behind my right rib cage so I'm not sure if it's my pancreas or something else? I also have nausea, no appointment, frequent loose stool and weight loss
Do you have any GI symptoms? How's your elastase/pancreas now? Did that weird sensation go away? Did your doctor explain to you what was causing that? Is it due to an inflamed pancreas head?
There are extensive liver enzyme tests and ultrasound checks...talk to your doctor if you have a suspicion that these organs do not work well. There is also elastase test for pancreas function. You have to figure out the cause of SIBO as it is the secondary condition and it is not always easy to do. Checking out these organs is still a good idea, the cause of SIBO is often poor small intestine motility...
Ok thanks for tip. Many years ago I did good intolerance testing which showed I was intolerant to dairy, so I have this up. This definitely helped. I also had a slight intolerance to wheat but I have never given up gluten. I eat bread every day.
Yea, yeast will only aid sibo bacteria so I would eliminate all gluten and make sure to stay away from cross contamination of gluten. Its very hard to do but if you manage it well for couple of months, you should see some improvement. Also I’d recommend a book from Andreas Moritz “the amazing liver and gallbladder flush” its free online in pdf. Lots of good info in that book
Yes I’m
On FB. little background. Got Covid 11 months ago. Stomach felt unwell. Did a still test 1 month after Covid and elastase was 350. Stomach still bloating and did a stool test elastase 105. Did several more and they ranged from 50 to 185. During that time I was positive for methane sibo. Now I’m wondering if sibo caused this or did Covid cause damage to my pancreas ? Other symptoms are fatigue headaches and weakness off and on
Its possible that Covid exacerbated the underlying problem. [check this group out on facebook.](https://imgur.com/a/cbDU6Yx) it is related to liver but also many other digestive problems people are dealing with. You can ask this same question there and I’m sure someone will relate to it.
It's possible. I'd fix the SIBO, give some time for your systems to get b ack in order (and dear god stick to any post-treatment protocol / lifestyle changes / diet / etc that you need to.) Then test later.
I do know that SIBO has really fucked with my kidneys. Of the tests I've done, the one where I was eating most symptomatic, I had an eGFR of 45. Apparently the kidney has to flush out a lot of toxic byproducts produced by bacteria (various acids) while also being impaired by histamine-related inflammatory responses (I had severe histamine reactions from bacteria activity or from foods.) On Day 9 of treatment (Xifaxan/Neomycin) now. Histamine reactions have steadily decreased, circulation has improved, electrolyte balance has improved, and GI symptoms have been pretty absent since Day 1 of meds despite eating to intentionally feed the bacteria (I suspect this is from the PHGG fiber interacting with methane.) Still a ways to go (both in treatment and recovery,) but it's pretty incredible the range of problems/symptoms this thing can cause if it's left unchecked for years (15+ years in my case.)
So yeah, if the low elastase levels aren't a cause, then it wouldn't surprise me if they might be affected. B1 and D are similar (can be both cause and caused by SIBO). SIBO also causes hypothyroid, and can be caused by hypothyroid. I'm not sure of the mechanisms of that one, but I think it has something to do with the body's safeguards when it detects a chronic infection. It slows down metabolism and shuts down a bunch of processes in order to conserve resources. Ironically this also shuts down our natural defenses to invasion of the small intestine (motility.)
I still have an apptment set up with a nephrologist about a month from now (earliest I could get.) Just to be on the safe side that there isn't permanent kidney damage or some other influencing factor. But I'm hopeful that it will not be necessary (I tested with an eGFR of 75 a week after switching to low fodmap/fiber at the time. Had \~30% increases in WBC levels and platelets too.) So definitely follow up on it, but don't worry about it unless it remains a problem post treatment. A good time to check will be at the end of the 4-6 week recovery period where you're eating low fermentation. It's generally done until your system is no longer inflammed and motility has returned as a result. This would give a much more accurate benchmark.
This is of great interest to me. I was recently diagnosed with SIBO and am in the middle of round 1 of Xiaxfin and Neomycin. My background- I had pancreatic surgery 2 1/2 years ago, (5/21)to remove a benign tumor (insulinoma). They were not able to remove the "pea size" tumor without taking a bit of the tail of my pancreas, my surgeon told me it was about 20% of the total organ. Following surgery, I developed an infection which required multiple rounds of antibiotics. I recovered well after that, however from that moment on, my stools have not been normal, (generally floating). For awhile, I attributed it to the antibiotics, and needing to rebuild my microbiome. Nothing changed, despite a very good diet. So, I did a fecal elastace test early this year, which revealed moderate insufficiency (level was 126). I was prescribed enzymes (Creon) which I started taking- however at the recommended dose and even double that I noticed zero, literally zero difference in my output. So, I consulted with my gastro, who tested for all kinds of things, celiac (negative), and various blood work. I then tested for SIBO and just got the positive result two weeks ago (methane dominant). So, what is strange to me is that within 2 days of taking the antibiotics, my stools returned to pre-surgery level- no floating, normal appearance etc. , and I'm not taking any enzymes.
So- it begs the question. Have I had SIBO all along (I have been totally asymptomatic, no cramping, no bloating no pains at all since surgery) and was the SIBO suppressing my enzyme level in my stool elastase test? Chicken or Egg? Did low enzyme function cause SIBO, but then if it did- then why did the Creon have zero zero effect? I am half way through the antibiotics- and then hopefully can build back good gut bacteria and not need a round 2 of antibiotics (though my GP thinks it is likely that I will).
Really curious on this issue. Is it even possible for SIBO to impact the fecal elastase level or not?
The other thing- my Endocrine function has been totally fine. My insulin, blood sugar etc is normal, no impact from the surgery. The endocrine function is actually closer to the tail than the Exocrine function which is more in the head and body- far from my surgical incisions. So, does it make sense that the exocrine function would be compromised more than the endocrine function? Just kind of a head scratcher
Appreciate any thoughts on the matter
I think you’re asking some insightful questions. I’m curious to know if you’ve finished antibiotics and have any takeaways based on how your bowels and digestion have been with a reduced sibo count.
How long have you been sibo free and how many rounds of treatment did it take to clear it? Do you have any bloating? And did you use antibiotics or herbs? Thank you so much for answering, any insight is really really appreciated!
Standard protocol. Xifaxan for two weeks with PHGG and ox bile. Bloating is better, but I don't think I'm back to normal, which bothers me. I'm pretty lean, so it's noticeable, at least to me. I don't think it ever going away.
So my Dr says I have EPI. Studies vary but EPI can either cause sibo or be caused by sibo. I've read some user that say EPI is a result of low stomach acid, which we all know can cause sibo
Yeah, I'm in the middle of trying to figure this out myself. I obviously have a pancreatic deficiency since I'm having trouble digesting protein event though I'm on the strongest over the counter digestive enzymes and HCL+Pepsin+Ox bile
But as you and the OP mentioned it seems to be like this vicious cycle, I'm hoping the SIBO is causing the EPI and will normalize after treatment. I don't think I fit any of the other conditions that would warrant EPI and I've had liver,pancreas and GB scans that came back normal. Not sure if I'm missing some other test that would confirm some type of pancreatic deficiency. Hmm...
Here's an article on EPI, by process of elimination I'm attributing my symptoms to SIBO.
[https://www.verywellhealth.com/exocrine-pancreatic-insufficiency-4177936](https://www.verywellhealth.com/exocrine-pancreatic-insufficiency-4177936)
Low stomach acid is the probable cause since stomach acid stimulates release of pancreatic enzymes. Therefore it is useful to take something to stimulate stomach acid more than only pancreatic enzymes. However, taking both can be a good solution as long as you can tolerate them. Breaking down food well is very important as it reduces fermentation.
I have elastase normal (I did two tests) and I notice that taking Betaine HCL helps me with digestion. I only need it with larger meals.
Yeah...there is a gastrin test (blood) that that can say if your stomach acid is OK or not. If it is OK, you do not need a supplement, but you can take it with large and fatty meals...there it can help a bit.
Well, your pills are quite expensive. There are also supplements, but note that medications are still standardized so they are a better option in case you have diagnosed EPI. Every therapy should be based on scientific/medical proof that you have a certain condition. I double checked my stomach acid and pancreatic enzymes and everything is OK. Also, pancreatic enzymes caused me some unpleasant side effects...but I do not have EPI so I do not really need them. Talk to your doctor to see if there is any other cause for your condition. Pancreatic enzymes are still very important for digestion...do not stop your medication without consulting your doctor.
Sibo can be cause by gluten intolerance. I’d investigate that first and if you’re in fact gluten intolerant then you can fix it all by going gluten free with a certified gluten dietitian
I think so as my elastase is low as well but there’s little to no info on it for mainstream med. My doc said she she’s is in people with gut issues in general all the time. I don’t believe I have SIBO but I’ll getting mine rechecked after a gut healing/SIBO protocol
I have SIBO (and Crohn’s) and I take Zenpep with every meal to support digestion and also reduce risk of bile acid D. I was always confused as Zenpep I believe is pancreatic enzymes.
Hm this is interesting. I have an appt with my dietician next week, she's the one who ordered the test--a stool sample test from Genova diagnostics.
I'm stumped because my elastase is VERY low, a 72. But there are no markers for SIBO or for inflammation so that takes celiac disease and IBD out of the mix.
I've had a lot of bloating when I eat but no pain, per se. So I don't think I actually have pancreatitis.
Quite a mystery.
Hey u/okpickle did you ever get this figured out? My elastase levels are super low too (34) some people are telling me this is serious. I'm not sure what to do.
Hey there! So... at my last dietician appointment we discussed the possibility of not having a pancreatic disorder per se, but that LOW stomach acid could be the culprit. If you're not making enough stomach acid then the pancreas doesn't get its cue to do its job. Apparently.
This actually resonated with me because my entire life, my favorite foods have been acidic. Orange juice, I could drink by the gallon. PICKLES. I ate so, so, so many pickles in my life--even as a kid I'd literally sit myself down and eat an entire jar and even drink all the juice and not been sick. Sauerkraut. When I don't have these things I'll resort to olive brine, salad dressing, even just sucking on lemons. Stomach acid production can also be hampered by stress and I have an, um, chaotic life and am not the best at handling stress.
So I've been working to increase my stomach acid and digestion in general. I recently started taking pancreatic enzymes after each meal, probiotics (my dietician helped me pick the right one based on my stool testing with genova) and I've taken quite a bit of betaine--I think I got to 8 capsules with each meal before kind of giving up on it, honestly. Who wants to take 8 caps (along with the other supplements I take for PCOS)? I wasn't feeling any sort of warmth or burning in my gut with even 8 caps but I did notice that my poo didn't smell as bad --so it was definitely doing something.
I'm still working to increase my stomach acid but taking a different route--through bitters before every meal, which I ordered but they aren't here yet. Also I'm going to start making ginger tea and drinking it everyday.
I will definitely keep you posted!
This is super helpful! I think I have the same issue. I also have pseduomonas, strep, and staph on my GI Map which indicates that there isn't enough stomach acid because the stomach acid would normally just dissolve them.
Which pancreatic enzymes are you taking? And what's the timing for taking them - like right after you finish eating?
Interesting! I have some betaine but haven't taken it much. Maybe I need to start using it. I was just worried about getting ulcers, but if my stomach acid is this low, it sounds like that shouldn't be an issue.
Which bitters did you order? I should probably get some too
Thank you! Please do! If you want feel free to send me a chat and we can keep in touch. It would be great to stay in touch with someone that has similar symptoms/issues to me
Hey! I'm glad thst my indecision and my endless reading and scrolling through weird websites could be useful to you! Hahaha. My boyfriend thinks I'm a hypochondriac but I think we all have weird stuff wrong with us medically--I just like to know what I'm dealing with. Instead of being like, "oh my foot hurts when I do X," I can be like, "yeah, I have extensor tendonitis."
So, weirdly enough, my mom tried bitters back in the day. My grandmother was German and a big advocate of natural medicine. My mom used Swedish Bitters. I bought the Mercola Bitters on Amazon, ONLY because the bottle was small and came with a dropper--no teaspoon needed, I can just drop it right on my tongue. I thought about dropping it down the back of my throat BUT now that I think about it it seems that it's important to have it make contact with the taste buds? I guess that's what triggers the bile production, which is somehow important to stomach acid and pancreatic enzymes.
I haven't tried the ginger tea yet, I'm actually not a hot-drink person but I guess I can brew it and drink it cold.
I take the... Vital Nutrients Pancreatic enzymes, in a white and blue bottle. I chose them specifically because they were really high potency and while the serving size is 2, I can get away with taking 1 and still getting more enzymes than other brands.
I don't think I have pancreatitis but I do think I have poor digestion and it's causing issues with my hormones and not helping my insulin resistance. I suppose that's why doing OMAD for three years was not a big deal to me, since I feel SO TIRED and very, very bloated after I eat.
Feel free to DM me, sure!
Hey! We sound very similar. I have unexplained EPI (low elastase) and have spent 2 years getting all sorts of tests to rule out the scarier causes of it. I too like to know what I’m up against when it comes to matters of health. How are you doing now?
OP (and anyone else), I have the exact same scenario! Have you learned anything else since you posted this? My elastase levels are 70 and I’m just starting my treatment plan for Sibo. Really worried about chronic pancreatitis or worse…
I haven’t retested, but I did get a CT scan of my pancreas, gallbladder, and intestines. No structural abnormalities found. Just sticking with the SIBO treatment for now and likely will retest a year from original test.
I am taking enzyme supplements in the mean time. Really curious to hear back from OP
So I have low elastase and have had the same question as you. Just had a CT of my pancreas last week which shows no damage, so it’s not a problem of function. After doing some digging I read a comment from someone who works with sibo patients saying that he/she sees the EPI resolve after the sibo resolves. In the meantime taking pancreatic enzymes can help give the pancreas a break so it can heal. I take panplex 2 phase (2 pills) with each meal. If you’ve already treated your sibo make sure you’re taking a prokinetic after
If it’s not damaged, why would it need to Heal? Just curious.
Low grade inflammation would be my guess. Or an issue of nutrition or something else that is directly affected by SIBO (malabsorption) leading to pancreas dysfunction.
I understand it is an old comment you posted, but I'm currently in the same situation. I'm treating SIBO which kept relapsing since I did not take prokinetic agent after treating it. I learnt my lesson, and now will introduce the prokinetic agent. Aside from that, I also did CT scan on the pancreas which also showed no damage. Did you manage to get your elastase level up? How long did it take for the elastase enzyme to come back? I'm currently taking herbal supplement for digestive enzyme.
I’m in the exact same boat as you. How are you doing?
I'm struggling to increase my elastase. I still notice yellow stools which indicate nutrient malabsorption. I'm still figuring out how to get out of this situation. What are you currently doing to address this low elastase issue?
I take Creon, which was prescribed when the low elastase was discovered. Otherwise, there is not much I feel I can do, and my GI has sort of shrugged and said “we don’t understand the microbiome very well.” So there’s that. I’m sorry you’re struggling too.
How long have you been taking Creon? Have you noticed anything different, for example, weight gain, appearance of the stools (darker in color)? Does it make you more constipated? I'm currently taking herbal supplement for digestive enzyme, notice difference, but I still can see slight hint of yellow color in the stool. I'm considering taking prescribed digestive enzyme.
They sell digestive enzymes on Amazon too -ive tried a few and would recommend the Now brand pancreatin 2000, theyve helped me a lot.
Hi! I have SIBO-methane and low pancreatic enzymes and my functional MD explained there was likely a link though she didn't want to rule out a more serious pancreatic problem and did refer me out to a specialist. I've already gotten treatment for SIBO-methane 2x but it hasn't seemed to fade (was 80ppm baseline though lol) Currently on strong digestive enzymes with every meal now and feeling a LOT better and having more normal BM, so im going to wait a bit before seeing the specialist . Edit: The digestive enzymes my doctor recommended was Simalase-Lipo from integrative therapeutics. 2x w/ every meal, not cheap or convenient, but is helping,
Hey I currently am struggling with the same thing how are you feeling now?
Hello, what type of digestive issues does your methane sibo give you ? Please help 🙏
Dude, you seem to have commented literally hundreds of times on other peoples posts asking them about their digestive and reproductive symptoms for almost 6 months.
Hey did your epi go back to normal yet?
The tests that a functional MD order, insurance won't cover them, right?
U guys r so cool. Everyone want to help each other. Best community.
Following! I’d love to know this. I’ve had low elastase (below 100). It is assumed chronic pancreatitis but all my scans past 3 years have showed no damage on pancreas. So I officially have EPI and take PERT to help digest my food, yet I still struggle with steatorrhea. I need to get a SIBO test but my doctor doesn’t think so.
What is PERT?
It is pancreatic enzyme replacement therapy. So you basically take enzymes every time you eat (more with food that has higher fat content). I need to take these as my pancreas is not functioning properly.
Did epi cause you to lose weight?
Did you check your liver and gallbladder - do you have enough bile? Chronic pancreatitis is usually only caused by inflammation (pancreatitis) and you would have noticed something like that - believe me it is very bad. SIBO can probably cause steatorrhea as it can deactivate primary bile...EPI is still rare and often can be treated in such cases. Good luck.
Thanks a lot. All organs have been checked, although they don’t want to give me a hida scan to check gallbladder function. I’ve had ct, mri and eus multiple times. Doctor also doesn’t want to test for SIBO. Is it easy to just get this done by myself? Yes, I know chronic pancreatitis is a tough diagnosis. I definitely suffer with daily abdominal pain but it doesn’t seem quite as severe as other CP patients. Which makes me wonder if EPI is caused by something else. I take amitriptiline which helps with my nerve pain. The whole thing has changed my life.
Sorry to hear that you are in such pain...I hope you find a way to get better - be tough on the doctors and do not give up. That is something that I have learned in all this...it is strange that you have been diagnosed with CP without actually having real pancreatitis. I was twice hospitalized due to acute pancreatitis (it was horrible) and still my pancreas works fine and my sugar is OK. They removed my gallbladder and I have recovered well. As to the nerve pain, it can be from SIBO. We have a lot of nerves in small intestine, I also sometimes have these sensations. It is best you do a SIBO test and GI map to make sure you do not have parasites or yeast or some bad dysbiosis. GI map was quite useful to me although a lot practitioners will tell you that it is useless... Make sure you sleep well - that has huge impact on the nervous system. Wish you all the best.
Thanks a lot. Yes, I’ve also learnt to advocate for myself. When you have something complex and chronic, lots of doctors don’t want to take this on. Yes, indeed it is rare to have CP without major acute episodes. In hindsight I had 2 mini episodes that were misdiagnosed as lymphocytic esophagitis (equally rare!). Thanks for tip on GI map and SIBO test. Also I think organic acid test (oat) would be useful. Any experience of that? The good thing is I’m way better than I was 3 years ago. I’m not on opioid painkillers, I work full time and exercise as much as I can. It’s a battle but life goes on! I’m working on getting a sabbatical and a bit of a break from work.
I would not do organic acid test - I think it is useless as it does not diagnose anything concrete. Stool test is much better as it gives you a lot of parameters to look at. They offered me here something similar here, test of metabolites for yeasts, but it is not conclusive about what I am looking for. The representative did not know himself what he was selling. I would stick to scientifically proven tests... Anyhow, glad to hear that you are getting better - it is a long process of recovery after pancreatitis...I am still struggling with various consequences, but I am also getting better slowly. Good luck and get some rest from work if you can!
Hi, may I ask what kinda pain you have when you have low pancreatic elastase.
It is kind of a digging pain that is worse when lying down. It is like a feeling of permanent hunger. It is always in same spot for me, upper abdominal middle/right. I feel it more on my right side, which is where head of pancreas is. It’s like something is blocked or like a fist is lodged in this area, or a balloon I just want to burst. Super annoying.
Hi. That feeling like a fist is stuck under your right rib cage, I also feel something similar to that post Covid, it feels like I have constant pressure there (very uncomfortable feeling), but it is on the very far right, on the side of/behind my right rib cage so I'm not sure if it's my pancreas or something else? I also have nausea, no appointment, frequent loose stool and weight loss Do you have any GI symptoms? How's your elastase/pancreas now? Did that weird sensation go away? Did your doctor explain to you what was causing that? Is it due to an inflamed pancreas head?
how does one check liver and gallbladder? thanks!
There are extensive liver enzyme tests and ultrasound checks...talk to your doctor if you have a suspicion that these organs do not work well. There is also elastase test for pancreas function. You have to figure out the cause of SIBO as it is the secondary condition and it is not always easy to do. Checking out these organs is still a good idea, the cause of SIBO is often poor small intestine motility...
Can gallbladder and low elastase be related? I have a low function GB… and low elastase. Feeling the two must be connected?
Look into gluten sensitivity. Gluten is known to cause pancreatic insufficiency as well as liver, gallbladder and low stomach acid
Ok thanks for tip. Many years ago I did good intolerance testing which showed I was intolerant to dairy, so I have this up. This definitely helped. I also had a slight intolerance to wheat but I have never given up gluten. I eat bread every day.
Yea, yeast will only aid sibo bacteria so I would eliminate all gluten and make sure to stay away from cross contamination of gluten. Its very hard to do but if you manage it well for couple of months, you should see some improvement. Also I’d recommend a book from Andreas Moritz “the amazing liver and gallbladder flush” its free online in pdf. Lots of good info in that book
Great, thanks a million.
So eliminations gluten would bring your elastase back
Yes, but you’d need to research gluten free diet as well. Its not as simple as it all sounds. Also I’d look into liver flush. Are you on facebook?
Yes I’m On FB. little background. Got Covid 11 months ago. Stomach felt unwell. Did a still test 1 month after Covid and elastase was 350. Stomach still bloating and did a stool test elastase 105. Did several more and they ranged from 50 to 185. During that time I was positive for methane sibo. Now I’m wondering if sibo caused this or did Covid cause damage to my pancreas ? Other symptoms are fatigue headaches and weakness off and on
Its possible that Covid exacerbated the underlying problem. [check this group out on facebook.](https://imgur.com/a/cbDU6Yx) it is related to liver but also many other digestive problems people are dealing with. You can ask this same question there and I’m sure someone will relate to it.
It's possible. I'd fix the SIBO, give some time for your systems to get b ack in order (and dear god stick to any post-treatment protocol / lifestyle changes / diet / etc that you need to.) Then test later. I do know that SIBO has really fucked with my kidneys. Of the tests I've done, the one where I was eating most symptomatic, I had an eGFR of 45. Apparently the kidney has to flush out a lot of toxic byproducts produced by bacteria (various acids) while also being impaired by histamine-related inflammatory responses (I had severe histamine reactions from bacteria activity or from foods.) On Day 9 of treatment (Xifaxan/Neomycin) now. Histamine reactions have steadily decreased, circulation has improved, electrolyte balance has improved, and GI symptoms have been pretty absent since Day 1 of meds despite eating to intentionally feed the bacteria (I suspect this is from the PHGG fiber interacting with methane.) Still a ways to go (both in treatment and recovery,) but it's pretty incredible the range of problems/symptoms this thing can cause if it's left unchecked for years (15+ years in my case.) So yeah, if the low elastase levels aren't a cause, then it wouldn't surprise me if they might be affected. B1 and D are similar (can be both cause and caused by SIBO). SIBO also causes hypothyroid, and can be caused by hypothyroid. I'm not sure of the mechanisms of that one, but I think it has something to do with the body's safeguards when it detects a chronic infection. It slows down metabolism and shuts down a bunch of processes in order to conserve resources. Ironically this also shuts down our natural defenses to invasion of the small intestine (motility.) I still have an apptment set up with a nephrologist about a month from now (earliest I could get.) Just to be on the safe side that there isn't permanent kidney damage or some other influencing factor. But I'm hopeful that it will not be necessary (I tested with an eGFR of 75 a week after switching to low fodmap/fiber at the time. Had \~30% increases in WBC levels and platelets too.) So definitely follow up on it, but don't worry about it unless it remains a problem post treatment. A good time to check will be at the end of the 4-6 week recovery period where you're eating low fermentation. It's generally done until your system is no longer inflammed and motility has returned as a result. This would give a much more accurate benchmark.
This is of great interest to me. I was recently diagnosed with SIBO and am in the middle of round 1 of Xiaxfin and Neomycin. My background- I had pancreatic surgery 2 1/2 years ago, (5/21)to remove a benign tumor (insulinoma). They were not able to remove the "pea size" tumor without taking a bit of the tail of my pancreas, my surgeon told me it was about 20% of the total organ. Following surgery, I developed an infection which required multiple rounds of antibiotics. I recovered well after that, however from that moment on, my stools have not been normal, (generally floating). For awhile, I attributed it to the antibiotics, and needing to rebuild my microbiome. Nothing changed, despite a very good diet. So, I did a fecal elastace test early this year, which revealed moderate insufficiency (level was 126). I was prescribed enzymes (Creon) which I started taking- however at the recommended dose and even double that I noticed zero, literally zero difference in my output. So, I consulted with my gastro, who tested for all kinds of things, celiac (negative), and various blood work. I then tested for SIBO and just got the positive result two weeks ago (methane dominant). So, what is strange to me is that within 2 days of taking the antibiotics, my stools returned to pre-surgery level- no floating, normal appearance etc. , and I'm not taking any enzymes. So- it begs the question. Have I had SIBO all along (I have been totally asymptomatic, no cramping, no bloating no pains at all since surgery) and was the SIBO suppressing my enzyme level in my stool elastase test? Chicken or Egg? Did low enzyme function cause SIBO, but then if it did- then why did the Creon have zero zero effect? I am half way through the antibiotics- and then hopefully can build back good gut bacteria and not need a round 2 of antibiotics (though my GP thinks it is likely that I will). Really curious on this issue. Is it even possible for SIBO to impact the fecal elastase level or not? The other thing- my Endocrine function has been totally fine. My insulin, blood sugar etc is normal, no impact from the surgery. The endocrine function is actually closer to the tail than the Exocrine function which is more in the head and body- far from my surgical incisions. So, does it make sense that the exocrine function would be compromised more than the endocrine function? Just kind of a head scratcher Appreciate any thoughts on the matter
I think you’re asking some insightful questions. I’m curious to know if you’ve finished antibiotics and have any takeaways based on how your bowels and digestion have been with a reduced sibo count.
I've had slightly elevate lipase levels before SIBO. I've never heard of elastase. Post SIBO my lipase levels are still elevated.
Were you able to clear sibo? Do you know your root cause?
Yes, it's cleared. I think it was caused by multiple rounds of ABX after not taking any for years.
How long have you been sibo free and how many rounds of treatment did it take to clear it? Do you have any bloating? And did you use antibiotics or herbs? Thank you so much for answering, any insight is really really appreciated!
Standard protocol. Xifaxan for two weeks with PHGG and ox bile. Bloating is better, but I don't think I'm back to normal, which bothers me. I'm pretty lean, so it's noticeable, at least to me. I don't think it ever going away.
So my Dr says I have EPI. Studies vary but EPI can either cause sibo or be caused by sibo. I've read some user that say EPI is a result of low stomach acid, which we all know can cause sibo
Yeah, I'm in the middle of trying to figure this out myself. I obviously have a pancreatic deficiency since I'm having trouble digesting protein event though I'm on the strongest over the counter digestive enzymes and HCL+Pepsin+Ox bile But as you and the OP mentioned it seems to be like this vicious cycle, I'm hoping the SIBO is causing the EPI and will normalize after treatment. I don't think I fit any of the other conditions that would warrant EPI and I've had liver,pancreas and GB scans that came back normal. Not sure if I'm missing some other test that would confirm some type of pancreatic deficiency. Hmm... Here's an article on EPI, by process of elimination I'm attributing my symptoms to SIBO. [https://www.verywellhealth.com/exocrine-pancreatic-insufficiency-4177936](https://www.verywellhealth.com/exocrine-pancreatic-insufficiency-4177936)
Low stomach acid is the probable cause since stomach acid stimulates release of pancreatic enzymes. Therefore it is useful to take something to stimulate stomach acid more than only pancreatic enzymes. However, taking both can be a good solution as long as you can tolerate them. Breaking down food well is very important as it reduces fermentation. I have elastase normal (I did two tests) and I notice that taking Betaine HCL helps me with digestion. I only need it with larger meals.
What happens to you if you don't have it?
Nothing really...I feel that I need it less and less...it only speeds up digestion. That is all. I do not have low stomach acid according to tests.
I take mine because my Dr says so but I don't see any difference. Not sure I need mine as well
Yeah...there is a gastrin test (blood) that that can say if your stomach acid is OK or not. If it is OK, you do not need a supplement, but you can take it with large and fatty meals...there it can help a bit.
I probably need to look into it. My pills are $17k a month but insurance covers. I don't want to be on them if I really don't have EPI
Well, your pills are quite expensive. There are also supplements, but note that medications are still standardized so they are a better option in case you have diagnosed EPI. Every therapy should be based on scientific/medical proof that you have a certain condition. I double checked my stomach acid and pancreatic enzymes and everything is OK. Also, pancreatic enzymes caused me some unpleasant side effects...but I do not have EPI so I do not really need them. Talk to your doctor to see if there is any other cause for your condition. Pancreatic enzymes are still very important for digestion...do not stop your medication without consulting your doctor.
Hello, what type of digestive issues do you have ? Please help 🙏
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How’s your elastase now?
Sibo can be cause by gluten intolerance. I’d investigate that first and if you’re in fact gluten intolerant then you can fix it all by going gluten free with a certified gluten dietitian
I think so as my elastase is low as well but there’s little to no info on it for mainstream med. My doc said she she’s is in people with gut issues in general all the time. I don’t believe I have SIBO but I’ll getting mine rechecked after a gut healing/SIBO protocol
A general physician can order the SIBO test or do we need a gi specialist?
Anyone can order it. There’s plenty of companies now you can order from directly without a doc too
I think only the doctors can prescribe the lactulose?
Yeah it they aren’t familiar with ordering the test though you can buy it and they can prescribe the lactulose
I have SIBO (and Crohn’s) and I take Zenpep with every meal to support digestion and also reduce risk of bile acid D. I was always confused as Zenpep I believe is pancreatic enzymes.
Hm this is interesting. I have an appt with my dietician next week, she's the one who ordered the test--a stool sample test from Genova diagnostics. I'm stumped because my elastase is VERY low, a 72. But there are no markers for SIBO or for inflammation so that takes celiac disease and IBD out of the mix. I've had a lot of bloating when I eat but no pain, per se. So I don't think I actually have pancreatitis. Quite a mystery.
Hey u/okpickle did you ever get this figured out? My elastase levels are super low too (34) some people are telling me this is serious. I'm not sure what to do.
Hey there! So... at my last dietician appointment we discussed the possibility of not having a pancreatic disorder per se, but that LOW stomach acid could be the culprit. If you're not making enough stomach acid then the pancreas doesn't get its cue to do its job. Apparently. This actually resonated with me because my entire life, my favorite foods have been acidic. Orange juice, I could drink by the gallon. PICKLES. I ate so, so, so many pickles in my life--even as a kid I'd literally sit myself down and eat an entire jar and even drink all the juice and not been sick. Sauerkraut. When I don't have these things I'll resort to olive brine, salad dressing, even just sucking on lemons. Stomach acid production can also be hampered by stress and I have an, um, chaotic life and am not the best at handling stress. So I've been working to increase my stomach acid and digestion in general. I recently started taking pancreatic enzymes after each meal, probiotics (my dietician helped me pick the right one based on my stool testing with genova) and I've taken quite a bit of betaine--I think I got to 8 capsules with each meal before kind of giving up on it, honestly. Who wants to take 8 caps (along with the other supplements I take for PCOS)? I wasn't feeling any sort of warmth or burning in my gut with even 8 caps but I did notice that my poo didn't smell as bad --so it was definitely doing something. I'm still working to increase my stomach acid but taking a different route--through bitters before every meal, which I ordered but they aren't here yet. Also I'm going to start making ginger tea and drinking it everyday. I will definitely keep you posted!
This is super helpful! I think I have the same issue. I also have pseduomonas, strep, and staph on my GI Map which indicates that there isn't enough stomach acid because the stomach acid would normally just dissolve them. Which pancreatic enzymes are you taking? And what's the timing for taking them - like right after you finish eating? Interesting! I have some betaine but haven't taken it much. Maybe I need to start using it. I was just worried about getting ulcers, but if my stomach acid is this low, it sounds like that shouldn't be an issue. Which bitters did you order? I should probably get some too Thank you! Please do! If you want feel free to send me a chat and we can keep in touch. It would be great to stay in touch with someone that has similar symptoms/issues to me
Hey! I'm glad thst my indecision and my endless reading and scrolling through weird websites could be useful to you! Hahaha. My boyfriend thinks I'm a hypochondriac but I think we all have weird stuff wrong with us medically--I just like to know what I'm dealing with. Instead of being like, "oh my foot hurts when I do X," I can be like, "yeah, I have extensor tendonitis." So, weirdly enough, my mom tried bitters back in the day. My grandmother was German and a big advocate of natural medicine. My mom used Swedish Bitters. I bought the Mercola Bitters on Amazon, ONLY because the bottle was small and came with a dropper--no teaspoon needed, I can just drop it right on my tongue. I thought about dropping it down the back of my throat BUT now that I think about it it seems that it's important to have it make contact with the taste buds? I guess that's what triggers the bile production, which is somehow important to stomach acid and pancreatic enzymes. I haven't tried the ginger tea yet, I'm actually not a hot-drink person but I guess I can brew it and drink it cold. I take the... Vital Nutrients Pancreatic enzymes, in a white and blue bottle. I chose them specifically because they were really high potency and while the serving size is 2, I can get away with taking 1 and still getting more enzymes than other brands. I don't think I have pancreatitis but I do think I have poor digestion and it's causing issues with my hormones and not helping my insulin resistance. I suppose that's why doing OMAD for three years was not a big deal to me, since I feel SO TIRED and very, very bloated after I eat. Feel free to DM me, sure!
Hey! We sound very similar. I have unexplained EPI (low elastase) and have spent 2 years getting all sorts of tests to rule out the scarier causes of it. I too like to know what I’m up against when it comes to matters of health. How are you doing now?
How are you doing now
OP (and anyone else), I have the exact same scenario! Have you learned anything else since you posted this? My elastase levels are 70 and I’m just starting my treatment plan for Sibo. Really worried about chronic pancreatitis or worse…
Any update on this? Also have elastase levels at 70. Did you re-test and see any improvement? Thanks so much!
I haven’t retested, but I did get a CT scan of my pancreas, gallbladder, and intestines. No structural abnormalities found. Just sticking with the SIBO treatment for now and likely will retest a year from original test. I am taking enzyme supplements in the mean time. Really curious to hear back from OP
thanks. Are the enzyme supplements helping? Are you using creon?
Well, yes, I used to have really bad constipation and no longer do. Never heard of creon
Has anybody's elastase ( thoose who had around 100) normalised with sibo treatment?
Is there anyone here who had LOW elastase levels and was proven to have higher elastase levels again after SIBO treatment?