How Pancreatic Enzyme Replacement Therapy (PERT) Can Help Your Digestion

Written by Rachel Reiff Ellis
Medically Reviewed by Melinda Ratini, MS, DO on July 01, 2026

Even when you eat enough calories, pancreatic cancer can change your body so that food doesn’t get digested properly. Your doctor may suggest pancreatic enzyme replacement therapy (PERT) to help your body absorb the vitamins and minerals (nutrients) it needs. 

PERT replaces special proteins called digestive enzymes that a damaged pancreas no longer makes or delivers. This treatment can help your food digest better, ease uncomfortable symptoms, prevent weight loss, and improve your overall quality of life during cancer treatment.

PERT is a type of medicine prescribed by your doctor that contains certain digestive enzymes lost with advanced pancreatic cancer. Normally, your pancreas makes:

  • Hormones like insulin, which controls blood sugar
  • Digestive enzymes, which break down fats, proteins, and carbohydrates in your food

These enzymes travel down from your pancreas through the pancreatic duct into your small intestine, where digestion happens. If you have advanced pancreatic cancer, tumors can:

  • Block the pancreatic duct
  • Damage tissue that makes pancreatic enzymes
  • Prevent digestive juices from getting to your intestines

With pancreatic cancer, the tumors can block or limit how many digestive enzymes are made. PERT helps replace the missing enzymes so your body absorbs nutrients again.

Treating exocrine pancreatic insufficiency

If your digestive system doesn’t break down your food properly, it can cause a condition called exocrine pancreatic insufficiency (EPI). Chronic pancreatitis is the most common reason for EPI, but other common causes can include:

  • Digestive problems
  • Pancreatic cancer
  • Surgery on your digestive tract, such as the Whipple procedure

If you don’t treat EPI, it can cause serious problems including:

  • Ongoing diarrhea that’s frothy, pale grey, and extremely foul smelling
  • Greasy or oily poop
  • Rapid weight loss
  • Muscle loss
  • Fatigue
  • Malnutrition
  • Brittle nails, hair loss, and skin problem (symptoms of vitamin deficiency)

Treating your EPI with PERT can help you get the nutrients your body needs, so you may:

  • Improve your quality of life
  • Maintain a healthy immune system
  • Better tolerate your cancer treatments
  • Prevent malnutrition, low bone mass, and vitamin deficiencies (especially fat-soluble vitamins like A, D, E, and K)

“PERT can play a vital role for people with pancreatic cancer who develop EPI, because inadequate enzyme production can lead to gastrointestinal symptoms, weight loss, and reduced quality of life,” says Michele Stack, a registered dietitian at the Froedtert & MCW Clinical Cancer Center at Froedtert Hospital campus in Milwaukee.

Inside each PERT capsule are hundreds of tiny enzyme-containing beads. These beads have a special coating to protect the enzymes from your stomach acid. This allows the enzymes to work in your intestine.

The capsules have three types of enzymes to help you break down different types of food and take in the vitamins and minerals for energy.

Lipase

Lipase is the enzyme that helps break fats into fatty acids and glycerol. These are both forms of energy that your body can use to function. When your digestive system is low on lipase, after eating oily foods, you may notice:

  • Floating poop
  • Weight loss
  • Bloating

You might also develop problems absorbing fat-soluble vitamins such as A, D, E, and K.

Protease

Protease helps break proteins into smaller amino acids that the body can absorb and use. Your body uses proteins to:

  • Maintain muscle mass
  • Repair tissue
  • Help the immune system work

Amylase

Amylase helps break down carbs and starches into simple sugars, which are one of the main energy sources for your body. 

“It is important to replace these when the pancreas is not producing enzymes sufficiently on its own, to support proper digestion, absorption, and nourishment,” says Stack.

How PERT is made

Because the enzymes are very similar to those in humans, most types of PERT are made using enzymes from pork intestines. If eating animal (pork) products is a concern for dietary, cultural, or religious reasons, talk to your doctor or dietitian. 

Different brand names for PERT include:

You and your doctor will talk about the best way to take PERT, and your dose will be specific to you.

Unique PERT dose

Your PERT dose can depend on things such as: 

  • Your body weight
  • How severe your EPI is
  • The size of your meal
  • The protein and fat content of your meal
  • How you respond to the symptoms

Starting dose can vary

Even though there isn’t one standard daily dose of PERT, most people start using: 

  • 50,000 to 75,000 units with meals
  • 25,000 to 50,000 units with snacks or milky drinks

Your doctor will help you adjust your PERT dose based on your symptoms and nutritional needs. “[Work] with your medical team for guidance on the dosage, brand, and how much to take,” says Stack.

Doses can change over time

The number of capsules you take per meal or snack, as well as the dosage, may change over time. That’s because everyone has a different response to the enzyme. An important rule to remember is that the enzymes need to mix with food to work. So always take PERT with food. 

Here are some ways to take these enzymes.

PERT is generally safe, and most people can take it without problems. In fact, if you still have digestive symptoms while taking PERT, it may indicate that you aren’t taking a high enough dose of PERT. As your body adjusts to PERT, you may have a few symptoms such as: 

  • Mild stomach discomfort
  • Nausea
  • Constipation
  • Diarrhea
  • Gas
  • Bloating

These side effects are typically temporary and get better as you adjust to PERT. Call your doctor if your symptoms are severe or last a long time because higher PERT doses can raise your chances of colon, kidney, and gout problems.

One of the clearest signs that PERT is working is your bowel habits going back to normal. “If you’re having normal, formed, brown, sinking bowel movements — instead of tan, floating, odorous bowel movements — and your weight has stabilized, these are good indicators that the PERT is helping,” says Stack.

Other positive signs include:

  • Less bloating
  • Better appetite
  • Boost in energy
  • Improved blood test results

 

 

If you keep having digestive symptoms while taking PERT, your doctor will try several tweaks to help figure out the problem. 

Review how you take PERT

How you take PERT is important. The enzymes need to work well for you to get enough nutrients. Common problems include:

  • Skipping snack doses
  • Taking enzymes after the meal is finished
  • Taking enzymes with hot liquids
  • Forgetting doses when you drink nutritional shakes or take supplements

Change the dose

If you’re still having symptoms after you eat, it may mean you still don’t have enough digestive enzymes. Some people may need a much higher level of enzymes than others. Always talk to your doctor before increasing your PERT dose. 

Treat stomach problems

Sometimes, your stomach can make too much acid, and so the PERT capsule cannot survive long enough to be helpful. If your doctor suspects your stomach is too acidic, they may treat any stomach problems first and suggest:

  • A proton pump inhibitor (PPI)
  • An H2 blocker (histamine-2 antagonist)

Both are pills you take by mouth that stop your stomach from making too much acid.

Check for other health problems

If your doctor adjusts your PERT dose and you still have symptoms, they’ll likely run tests to make sure another medical condition isn’t causing the problem. Some health issues can mimic EPI, including:

Treating these conditions and any vitamin deficiencies may improve your symptoms.

If you have pancreatic cancer, you may develop exocrine pancreatic insufficiency (EPI), which means your pancreas may not make enough digestive enzymes to break down food properly. PERT can replace these missing enzymes to help prevent weight loss, digestive problems, and malnutrition. Your doctor will work with you to prescribe a unique dose just for you. But if you’re still having symptoms such as diarrhea, bloating, or weight loss, you may need to adjust your treatment or look for other causes of digestive issues.

How long does it take for PERT to work?

Pancreatic enzyme replacement therapy (PERT) should ease your digestive symptoms within days after taking it with every meal, but it can take longer for some people. 

How expensive is PERT?

PERT can be costly, especially if you take the most popular brand called Creon. One pill can cost $11 without insurance or under a dollar for other brands. If you’re looking for a cheaper option that’s similar, try Pancreaze and Zenpep — both contain pork enzymes. 

Are PERT and Creon the same?

No, Creon is a brand of PERT, which stands for pancreatic enzyme replacement therapy. PERT is a general category of medicine that replaces your digestive enzymes with enzymes derived from animal pork. Other PERT brands include Zenpep, Viokace, Pertzye, and Pancreaze.

Is Creon hard on your kidneys?

Higher doses of Creon or PERT can affect your kidneys and cause problems, especially if you already have kidney trouble. If you’re taking higher PERT doses, tell your doctor about any bowel changes, kidney problems, or higher uric acid levels because you have a higher risk for:

  • Fibrosing colonopathy
  • Kidney trouble
  • Gout

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