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This blog post was originally published in January 2017, it has been updated with new information and republished after my dog was diagnosed with EPI (exocrine pancreatic insufficiency) in December 2019. Please keep in mind that I'm not a veterinarian. If you are looking to treat your dog through diet for EPI or pancreatitis, please work with a pro-raw, holistic veterinarian.
In 2019, my dog was diagnosed with EPI (Exocrine Pancreatic Insufficiency). Shit. Literally.
I learned about EPI several years ago, and as I read more about the condition and experiences shared by pet parents, I began to think that I finally figured out the source of Rodrigo’s digestive issues. I brought this up to the veterinarian and was told that Rodrigo didn’t have EPI. This was based on his normal blood work, not a special test.
Looking back, my vet may have been correct. Most cases of EPI develop before a dog reaches his/her fourth birthday. And 70% of the cases of EPI are seen in German Shepherds, and 20% are seen in Rough-Coated Collies. However, other dogs can develop the condition, and older dogs can develop EPI or pancreatitis.
Exocrine Pancreatic Insufficiency (EPI) in Dogs
If a dog's pancreas cannot produce enough digestive enzymes to break down proteins, fats, and carbohydrates, the dog may develop EPI, which…
- impacts a dog's GI system,
- disrupts the absorption of nutrients,
- may lead to weight loss and chronic diarrhea,
- and will eventually lead to starvation.
Symptoms of EPI in Dogs
- Continued weight loss despite always being hungry
- Pooping more often than the other dogs; poop is larger, yellow or gray in color, and soft
- Dog eats his own poop (coprophagia)
- Increased gas and tummy noises
- Occasional diarrhea and vomiting
- Increased anxiety, fearful behavior
My Dog has Exocrine Pancreatic Insufficiency (EPI)
In November 2019, after a few months of steady weight loss, Rodrigo was examined again. The results of his blood work showed that something was up with his pancreas. It wasn't a clear sign that we were dealing with pancreatitis, but the vet decided to test him for EPI, given the blood work and symptoms (weight loss, constantly hungry, loose stool, and diarrhea)
Accurate Blood Test for EPI
The Trypsin-Like Immunoreactivity is a blood test preferred to fecal tests because the latter has proven to be inaccurate. According to my veterinarian, “a dog or cat with EPI will have almost no serum trypsin-like immunoreactivity in the bloodstream. The patient must be fasted for the test to be accurate, but only a single blood sample is needed to make the diagnosis. The feline version of this test often requires that the sample be sent to a university laboratory and generally a week or so is needed to get results but the canine test can be run in just a few days.”
Did My Dog Have Low-Grade Pancreatitis?
I suspected that Rodrigo had EPI, but he tested negative. What changed?
Our veterinarian explained that the most common cause of digestive enzyme deficiency is pancreatic acinar atrophy (PAA), where the pancreas becomes shriveled and useless (see image above). While we usually see the signs of EPI before a dog reaches four years of age, the onset of EPI can happen if a dog is subjected to chronic pancreatitis that has destroyed over 90% of the functioning acinar glands. This was hinted at in his complete blood panel results; the EPI test confirmed his condition.
Another cause of EPI in dogs is cancer of the pancreas. However, this is rare, and it isn't the case with my dog.
Pancreatitis develops when a dog's pancreas is inflamed and not working correctly. It's seen in overweight dogs, older dogs, and dogs fed a high-fat diet. I only saw a couple of the symptoms listed below in Rodrigo, and I thought it was just his digestive issues acting up. Maybe all this time, he was going through periods of pancreatitis.
Symptoms of pancreatitis, according to PetMD, include:
- Fever
- Vomiting
- Diarrhea
- Loss of appetite (anorexia)
- Weight loss (more common in cats)
- Dehydration
- Fatigue and sluggishness
- Mild to severe abdominal pain (may become more severe after eating)
- Depression
- Increased heart rate
- Difficulty breathing
The only symptoms Rodrigo exhibited were occasional diarrhea and weight loss. The diarrhea was attributed to his digestive issues, which he's had his entire life. And the weight loss can be attributed to a slight decrease in meal size and an increase in exercise.
Best Diet for Dogs with EPI
Of course, I'm biased, so I will say a raw diet is best for dogs with EPI. Once we received this diagnosis, I was relieved that I was already feeding fresh food and wondered how much of my dog's current diet contributed to him going so long without developing full-blown EPI.
I believe that a raw diet is best because it's easier to digest, and the nutrients are readily available for absorption. But raw isn't the cure for EPI. Since my dog's pancreas isn't providing the necessary enzymes, I need to add them to Rodrigo's diet as food (pancreas) or supplements.
Benefits of Beef Pancreas for Dogs
As a raw feeder, I prefer to feed my dogs whole foods instead of supplements when I can, so the first thought for me would be to add fresh pancreas to Rodrigo’s diet to supplement what he lost through EPI.
The pancreas is a glandular organ in the digestive system and endocrine system of vertebrates. The pancreas is involved in blood sugar control and metabolism within the body, and also in the secretion of substances which help digestion. The pancreas plays a vital role in the digestive system (which captured my attention). It secretes a fluid that contains enzymes into the duodenum. These enzymes help to break down carbohydrates (usually starch), proteins and lipids (fats).
Source: Wikipedia
In my research on raw feeding, I saw pancreas listed as beneficial to dogs because…
- it's part of a balanced raw food diet (pancreas is offal),
- it can be used medicinally for dogs that have EPI (Exocrine Pancreatic Insufficiency) or pancreatitis,
- it's great for digestion.
Learn 3 Things You Need to Know When Feeding Pancreas
Feeding Pancreas Medicinally to Dogs
Please keep in mind that I'm not a veterinarian. If you are looking to treat your dog through diet for EPI or pancreatitis, please work with a pro-raw, holistic veterinarian.
Serving Amount of Pancreas for Dogs
I reached out to my source of pancreas and was told to feed 2 ounces of raw beef pancreas twice daily for every 20 lbs of body weight. Feeding more than 2 ounces twice daily isn't recommended.
To maximize enzyme efficiency, we're advised to whip the pancreas with a fork or wire whisk to a pudding-like consistency or liquefy in a blender and serve at room temperature. And it's important to remember that pancreas has a shelf life of only three months.
I chose not to feed raw pancreas because I don't have a consistent source, and a supplement is easier to use.
How to Prepare Pancreas for a Dog
Adding pancreas to a dog's raw meal isn't as easy as adding a spoonful (or forkful) of pancreas to the dish, or so I've been told. Someone advised me to use a blender or food processor to puree the pancreas until it's smooth in texture. You can also…
- Add 1.5 ounces of pancreas to a bowl.
- Mix in a small amount of hot water, whipping the two as you would scrambled eggs.
- Mix into the meal.
- Allow to sit for 20 minutes, then feed.
Pancreas Supplements for Dogs
My veterinarian recommended several supplements and approved the two I've tried with Rodrigo. Bio Case Plus is a powder supplement made of porcine pancreas, containing B12 (intrinsic factor to aid absorption) as many dogs diagnosed with EPI are also vitamin B deficient. I later switched to Enzyme Diane's Pancreatin 8x, which contains Protease (protein), Amylase (starch/vegetables), and Lipase (fat).
The Enzyme Diane supplement doesn't contain cellulase, an enzyme our dogs cannot produce. Cellulase helps to break down the cellular wall of vegetables, which makes the nutrients more bioavailable. Although our dogs do produce amylase, it's produced by the pancreas in low amounts. Therefore, I break the cellular wall of vegetables in my meal prep through pureeing, blanching, or freezing.
USING DIGESTIVE ENZYMES: Mix the powder into my dog's food, allow it to germinate for 15-20 minutes (to begin predigesting the food), and then feed my dog. This supplement provides enzymes to help my dog digest food and absorb nutrients.
PREMIXING MEALS WITH ENZYMES: Some supplement brands advise against premixing batches of food with enzymes. With Enzyme Diane, I can premix up to four days of food for my dog.
If your dog has been diagnosed with EPI, send the link to Enzyme Diane's for review. They may recommend a slightly different product than what I give to my dogs. Also, if you have pet insurance, contact them to find out if the supplement will be partially covered.
More Supplements for Dogs with EPI
Other supplements recommended by our veterinarian and by pet parents raising dogs with EPI are:
- LIV- PROPETS.com
- Pancrezyme (available through a veterinarian)
Helpful Resources for Dogs with EPI
The resources that I've found most helpful include:
- Raw Feeding Group: EPI – K9EPIGlobal – this group has a lot of members who are raw feeders.
- Enzyme Diane: This website contains information about EPI for dogs, success stories to give us hope, and a supplement that people rave about.
- EPI4Dogs Foundation: this is another website that has a lot of great information to help us learn about raising dogs with EPI.
My Questions About Feeding Raw to a Dog with EPI
1 – Do I have to use the supplement with every meal? – Yes. Rodrigo won't be able to digest his food without using the supplement. The supplement doesn't last a full day in his system. Instead, it pre-digests his food, allowing him to absorb the nutrients.
2 – Should I use the supplement when feeding raw meaty bones? – Yes. I was advised to mix up a small amount of ground raw with the supplement and feed it to Rodrigo 30 minutes before giving the dogs their bones. If I'm feeding recreational bones or chews to my dogs to clean their teeth and satisfy their chew drive, then the supplement isn't necessary.
3 – Can I premake meals with the supplement, saving time at mealtime? – It depends on the supplement. Some supplement brands advise against premaking meals with enzymes as their supplement doesn't work well under these conditions as it continues to break down the food, even if stored in the fridge. With Enzyme Diane supplements, I can mix up to four days of food, making it easier for others to feed my dogs.
It’s been several years, and I’ve figured out what works best for Rodrigo. I don’t bother with the digestive enzymes when I give him small treats. But if I plan to give him raw meaty bones, then I feed him 1/4 cup of a raw blend and add 1/2 his digestive enzyme dosage to the blend. Then wait about 20 minutes before feeding him raw meaty bones. I do the same with bone broth and kefir (or raw goat’s milk) – 1/2 his dosage and let sit for 15 minutes, then feed.
It took some getting used to, but now I’m used to it. Hope that helps.
Hoping you will get this! we have a mini Aussie with EPI she is stable (but OMG food aggressive still behaves around food like a starving dog suddenly fed) – I wanted to try giving her a “treat” halfway through the day to bridge the gap between breakfast and dinner (she is on darwins raw) – I have freeze dried duck necks (the cats will enjoy them too if i cannot give to the dog) – I saw in your story that you give a “small amount of supplement” in ground meat – can you elaborate on portions? I’m guessing this is a “try it and see” experiment to see if she reacts well and cross your fingers she does kind of thing? I had others comment on an EPI board that someone tried with her dog and it took 3 weeks to get her poo back under control 🙁 … I’m not sure how to find information on how best to prepare her gut before giving her the treat (or if i shouldn’t even try) – any advice is appreciated 🙂
This question is better posed to a veterinarian. Rodrigo hasn’t had this issue.
I also read about SIBO which is common as a secondary effect of EPI, because of undigested food in the small intestine. About 80% of dogs with EPI also have SIBO. How harmonious is this with EPI? What is the probability of getting SIBO with EPI?
Hi Cheryl…
Here is a blog post I wrote about transitioning to raw dog food: https://keepthetailwagging.com/easiest-way-to-transition-a-dog-to-a-raw-diet/
Yes, you can add the enzymes he needs to the food. Rodrigo gets supplements from Nzymes today and he’s doing great on this program; you can check out the supplements I add to his diet here: https://www.keepthetailwagging.com/supplements
Hi my name is Cheryl we have a 3 year old German Shepard that was just diagnose with EPI I want to switch him to raw Where should I start? Can I put the enzymes he needs on raw food?
Hi Magda…I suggest that you contact the company to learn more about their supplement and then talk it over with your vet. That’s what I did to learn about Bio Case V; I no longer use it because my dogs’ health has greatly improved and he no longer needs it. I hope you have the same success.
Hello, I have a min pin on a raw diet and I suspect he has pancreatitis, he’s almost 11 and is skinny despite eating more than his daily share, gets severe abdominal pain after heavy proteins like lamb and duck, and has always had issues around loose stool. I’m in Canada so the Bio Case Pro V product is extremely expensive to get as i can’t find a local source. I found these products locally though which seems to be just powdered pancreas tissue
https://www.nutricology.com/index.php?p=catalog&mode=search&search_in=all&search_str=pancreas&x=0&y=0
Does anyone have any insight on whether this might be better to try than plant based pancreatic enzymes?
Hi Karen,
I just read your post. Just inquiring on your progress with EPI and a raw diet. I have a German Shepherd that has had EPI for about 3 years and now want to switch her to a raw diet. Hope all is well.
Thanks for the comment. Unfortunately, I’m unable to answer your questions because they should be directed to a holistic veterinarian given your dog’s health condition. Anything I share may make the situation worse, not better, since I have no experience with pancreatitis and the other health conditions you mentioned. I wish you the best.
Dear Kimberly, gosh thank you for your hard work with your blog. I am a total virgin to a Raw Diet. I don’t know where to turn at this point and so I am starting here. Our 4 pound dog got pancreatitis about 18 months ago and has not been fully well since. She was very sick for about a month and would not eat, She was finally placed on a diet called Ricks Dog Deli which is not raw but was a specialty diet made for her with no commercial anything and only USDA meats. She finally accepted that food and began to get well. She had mostly long periods of wellness but would have 2-3 days of illness with anorexia and diarrhea for the next year. Each event of illness brought more vets tring to help us. (It’s so frustrating to be the one figuring out what is happening to your dog.) I am a physician and won’t give up reading and came across the right research article that described EPI. I insisted on testing ands she is positive. The vet prescribed Pancrease (Rx form of enzymes) at a high dose and e-gad… was prescribed a horrendous dose. Fortunately I didn’t trust the dose and continued investigating and gave far less divided in meals and allowed it to sit for the 15-20 minutes before feeding – none of that explained to me – if you heard what I was told to do, you’d Croke. Anyway, it burned her throat and she started having reflux with 1/8th the dose of recommendation. I reduced the amounts further and did discuss it with the vet – who agreed on the plan. Inka then seemed to do better in terms of throat irritation but her stools were not improving with yellow/grey color, some mucus and undigested food, but I continued faithfully.. Suddenly after 2 weeks use, she had anorexia and bloody stools. (She had never had blood in her stools before – I had never seen her stools look so horrible.). I stopped the Pancrease enzymes completely and got Mercola’s enzymes and had Ricks dog Deli remove grains from her food. Again it is not raw. It has meat and vegetables and some bone shell. We continued to use a small amount of Mercola’s enzymes and immediately with this change her poops improved. No undigested food particles at all.
NOW fast forward 2 months. Her hair is falling out and with extensive reading, she appears to have developed a seborrhea condition I highly suspect is caused by nutrient deficiency.
I have been afraid of raw diets since I am a stupid conventionally trained physician and my son is actually a stupid conventionally trained TUFT’S vet School veterinarian. (You don’t even want to know how angry I am at myself.)
Anyway… I must go Raw. And I must get nutrients in my poor baby. My question is… if ANYONE out there knows… I know I need to do the following:
1. get a holistic vet
2. read your guides – this I can do immediately
3. get assistance in converting to raw
4. find out if I need to add additional raw pancreas to an already raw diet
5. I need a multi-vitamin mineral and fatty acid. (I have Dr. Mercola’s Krill Oil for dogs and have been afraid to use it due to the severe pancreatitis she had)
6. find out if the fatty acids will be problematic for a dog who had a severe pancreatitis – which was probably the cause of the EPI and could this cause another pancreatic attack by supplementing with additional oils?
7. is there any such thing as IV or IM nutrients? She is currently on B12 injections due to B12 being so low it was unmeasurable when the EPI was positive. If she’s B12 deficient – what about all the other vitamins?! The vet didn’t even test her Folic Acid! (Do note that in a 4 pound dog you can only test a few things at a time because of the amount of blood required for each test!)
If you or anyone can give even one single piece of advice, I would so appreciate it. I appreciate you offering your raw diet recommendations too. We have a raw food manufacturer right here in Sarasota FL, http://marlinsrawsuperfood.com – but can I trust them? How do I know?
Thank you so very much in advance.
I wouldn’t feed them in the same meal. I do plan to place an order for pancreas when it’s available again and I’ll be alternating it with my dog based on how often I can place an order. It only has a 3-month shelf life and I would only be feeding it to one dog so it’s something I still have to figure out (storage, serving, etc.).
Do you feed raw pancreas and give the pancreas enzyme together, or only do one or the other?
Hi Carol, I have noticed bone shards in my dogs’ poop too which is why I won’t feed them certain bones. For example, I buy duck wings and will grind the drumette piece, but I’m okay with the dogs eating the rest. My dogs haven’t been injured by the bone (the drumette) but I’d rather be safe than sorry. They have, however, done great on duck necks and duck frames. They also get recreational bones that they do well on too.
When I add eggshells to my dogs’ diet (because I don’t have bone), I grind them up into a powder in a NutriBullet. A coffee grinder will work as well.
When it comes to digestive supplements, sometimes it takes time to find the right one for your dog. Stumbling across EPI introduced me to Bio Case Pro V which is perfect for Rodrigo. Fermented vegetable work for him as well. Another great supplement is FullBucket: https://www.keepthetailwagging.com/fullbucket
Thank you for your informative article, Kimberly! I’ve been looking into trying raw pancreas to help my poodle and it has been very helpful. I was wondering if I could ask you a few questions, though? Or maybe ask if you know any groups/websites that may help?
At the moment, I don’t think Nancy has EPI (at least not a severe case), but my vet does think she has some defect in her pancreas, which affects her digestion. She eats raw as well (w/ green tripe and digestive enzymes) and has been doing very well on it for the past year (smaller stools, better health/energy) with one exception.
I’m not sure if this is something I haven’t noticed before – it might have been happening all along – but this past month I’ve found fragments of undigested bone in her stool. (I feed her chicken feet/wings/quarters, to approx. 10% bone) My other dog is on raw and he does not have this problem (so I’m guessing it’s not normal?). Her stool itself is otherwise normal, but there have consistently been fragments (like, many inch to two inch fragments). I’m wondering if you have had any experience with this before?
I didn’t want anything to cut her intestine so I stopped feeding her bone, and instead just crushed eggshells into her food, at my raw-feeding friend’s recommendation. But when I looked at her stool the day after I found she didn’t digest the crushed eggshell, either (though it wasn’t ground, just broken into pieces, which I’m not sure has anything to do with it). Do you think this means the digestive enzymes she’s taking are not sufficient (would raw pancreas be better)?
Or is bone something in your experience that dogs with pancreatic issues just can’t handle? (It seems she digests everything else fine otherwise (small, dark stool, etc). Just those bone fragments.)
I’m sorry for all the questions. I’m just a bit worried because my vet is already leery of raw, and it took long enough to convince him that the diet is really working for Nancy. I don’t want him to backslide on this magical realization that dogs are carnivores and won’t choke to death/otherwise die by eating bone.
Thank you so much,
– Carol
While Rodrigo has many of the symptoms of EPI, he wasn’t as serious as many of the stories I’ve read since I learned about EPI which is why I haven’t had him tested.
He’s doing fantastic on Bio Case Pro V – he gets 3 pills twice a day added to his raw meals. The difference is amazing. Going over his history with his vet, he has been diagnosed with a bad gut due to repeated dosages of antibiotics to treat allergies when he was younger. The vet he had didn’t understand the correlation between diet, gut health, and the immune system so he treated all of Rodrigo’s issues with prescription medication that destroyed the lining of his gut and this is why he can’t produce enough digestive enzymes.
I’m so thankful that I came across EPI in the first place because although I don’t think that is what he has, the information I read lead me to a solution that works.
Thanks for your input and resources. I hope it helps others.
Kimberly, I have a dog with a confirmed EPI diagnosis (10 years ago). Sydney is not a GSD and it took a long time to figure out what was wrong with her. If Rodrigo truly has EPI all of his food will need to be treated with replacement enzymes. The reason the Mercola ones didn’t work as well is because those are supplemental enzymes and not strong enough for a dog with EPI. Texas A&M is the best place to have the testing for EPI done. You will need the cTLI, B12 or cobalamin and folate tested.
There’s a good website for EPI info. It’s http://WWW.EPI4DOGS.COM I also get generic enzymes for Syd at 1/3 the price of the rx enzymes like the BioCaseV, ViokaseV, etc. I get them through http://WWW.ENZYMEDIANE.COM
I was just trying to remember when we first “met”…it’s been so long, I can’t remember. Our lives certainly run parallel…lol
I’m also quite positive we were sisters in another life. 😉
We’ll have to continue sharing notes on this. I’ve stepped up the green tripe in Rodrigo’s diet and ordered a supplement for him that will help with the pancreas and we’ll see if that makes a difference. How in the WORLD did we find each other? We were probably sisters in another life.
I was convinced Major had EPI before I switched him to raw…his symptoms were spot on with what you described. I had him tested, but he doesn’t have it.
1) Continued weight loss despite always being hungry…
Even after switching to raw, Major counter surfs and acts as tho’ he can’t get enough to eat. Today, he’s fed 8oz more than the other dogs just to keep weight on.
2) Pooping more often than the other dogs; poop is larger, yellow or gray in color, and soft…
Raw food took care of the yellow & gray poop, but Major’s “normal” poop looks puffy (think a regular Cheeto) where the other dogs’ poop is solid (think crunchy Cheeto)
3) Dog eats his own poop (coprophagia)…
Major still tries to eat the poop of the other dogs in the house, but never his own
4) Increased gas and tummy noises…
Major still has inflamed, swirling intestines 24/7 and has extremely loud stomach noises (borborygm)
5) Occasional diarrhea and vomiting…
Raw stopped the daily pouts of diarrhea, but every other week or so Major will have an icky pooh. He never vomits
6) Increased anxiety, fearful behavior…
Major has always been an anxious dog, no doubt about it.
Switching to a raw diet was certainly the best thing for Major…but his EPI-ish symptoms continue.
Pancreas has recently become a part of Major’s diet, we’ll see if that changes any of his continued issues.
Very interesting and informative blog, thank you for sharing the blog, well done.