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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 in December 2019.
This week, my dog was diagnosed with EPI (Exocrine Pancreatic Insufficiency). Shit. Literally.
I learned about EPI a couple of 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 we had at the time and was told that Rodrigo didn’t have EPI. This was based on his normal blood work, not a special test. However, I didn’t know any better and I believed my vet.
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 isn't able to 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)
The more I read about EPI, the more convinced I was that this was the explanation for Rodrigo's history of digestive issues. Although the diagnosis sucks, it's nice to have a clear direction to follow.
In November 2019, after a few months of steady weight loss, I took Rodrigo in to make sure nothing serious was going on. The results of his blood work showed that something was up with his panreas. It wasn't a clear sign that we were dealing with pancreatitis, but the results along with what I was witnessing (weight loss, constantly hungry, loose stool and diarrhea) lead to him being tested for EPI.
The Trypsin-Like Immunoreactivity is a blood test, which is preferred to fecal tests because the later have 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.”
A couple of years ago, Rodrigo's veterinarian said that he didn't have EPI; however, today, at nearly 10 years old, he's been diagnosed with EPI. What changed?
Our veterinarian explained that the most common cause of digestive enzyme deficiency in dogs is pancreatic acinar atrophy where the pancreas becomes shriveled and useless (see image above). While we usually see the signs of EPI before a dog reached 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.
Did My Dog Have Low-Grade Pancreatitis?
So, did Rodrigo have pancreatitis all this time? Thank Heavens I didn't start adding satin balls to his diet.
Pancreatitis develops when a dog's pancreas is inflamed and isn't 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:
- Loss of appetite (anorexia)
- Weight loss (more common in cats)
- Fatigue and sluggishness
- Mild to severe abdominal pain (may become more severe after eating)
- 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 contributed to a slight decrease in meal size and an increase in exercise.
So what do I do now?
Best Diet for Dogs with EPI
Of course, I'm biased, so I'm going to say a diet of raw 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 contributing to him going so long without developing full-blown EPI.
The reason I believe that a diet of raw is best is that it's easier to digest and the nutrients are readily available for absorption. But raw isn't the cure to EPI. Since my dog's pancreas isn't providing the necessary enzymes, I need to add them to Rodrigo's diet in the form of 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.
I ordered a few chubs of pancreas a few years ago to give to my dogs – they loved it – and I made one crucial mistake; I didn't look into serving amounts until after they had enjoyed a couple of meals of beef pancreas. I also didn't ask myself if my dogs needed straight pancreas; I was just overjoyed to have found a new offal to feed to my dogs.
I later learned that we have to be careful when feeding pancreas, because feeding too much can lead to issues with the 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
As part of a raw diet, I've been told to go light on the amount of pancreas I add to my dogs' meals. Too much can create problems rather than fix them.
I reached out to my raw food co-op group and was told the following:
Feed 2 ounces of raw beef pancreas for every 20lbs of body weight, two times per day. Feeding more than 2 ounces twice daily isn't recommended.
- Rodrigo weighs 60 pounds; he would get 6 ounces of raw pancreas twice daily.
- Sydney weighs 70 pounds; she would get 7 ounces of raw pancreas twice daily.
- Scout weighs 72 pounds; he would get 7 ounces of raw pancreas twice daily.
- Zoey weighs 60 pounds; she would get 6 ounces of raw pancreas twice daily.
To maximize enzyme efficiency, we're advised to whip 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.
Feeding Pancreas to My Dogs
I no longer feed straight pancreas to my dogs because the work that goes into preparing it is a pain in the butt. I’m feeding five dogs a raw food diet and I’m trying to make it as convenient as possible. But just because I no longer order the chubs of pancreas, doesn’t mean that there is zero fresh pancreas in their diet.
I order an organ blend from GreenTripe.com that contains beef heart, lungs, liver, spleen, and pancreas. As you can see, pancreas is the last ingredient, so there isn’t enough in green tripe to help a dog with EPI. Therefore, I now add supplements to his diet.
Pancreas Supplements for Dogs
When it comes to EPI and other digestive disorders, feeding a raw diet can be tricky for some and a lifesaver for others. I recommend working with a holistic veterinarian who is experienced in raw feeding if your dog has underlying health issues.
My veterinarian recommended several supplements and approves of one that I discovered a couple of years ago. Bio Case Plus* is a powder supplement made of porcine pancreas and it contains B12 (intrinsic factor to aid absorption). Many dogs diagnosed with EPI are also vitamin B deficient.
You mix the powder into your dog's food, allow it to germinate for 15-20 minutes (to begin predigesting the food), and then feed your dog. This supplement provides enzymes to help your dog digest food and absorb nutrients.
But I added this back to Rodrigo’s diet a few months ago. Why didn’t it work?
I was tossing capsules into his dish instead of opening them up and adding the powder and allowing it to sit for 15-20 minutes. Duhhhhh!!! I now get up earlier in the morning to start preparing food for the dogs, which allows time for Rodrigo's supplement to work. A follower recommended preparing his food the evening before to save time on this step.
I'm confident that Bio Case Plus will work, because a couple of years ago when I added the powder to his diet, I saw improvements within three days.
*2020 Update: Thomas Labs increased the price of its supplement. It's now $200/month for Rodrigo, which forced me to look for a quality supplement that I could afford. I didn't have a lot of confidence, but I'm glad that I looked. I was introduced to Enzyme Diane in an EPI support group on Facebook. Enzyme Diane offers recurring shipments, the supplement is less expensive, and less is needed for Rodrigo, so I save money there too.
Shop Enzyme Diane here: https://enzymediane.com/
I order the Pancreatin 6X – 1 Kilo (2.2 pounds) on a recurring order which drops the price from $160 to $158. One package of Enzyme Diane lasts for at least 7 weeks. Bio Case Plus is $175 on Amazon and Chewy.com (price drops to $166 for recurring shipments). Bio Case Plus lasts 4 weeks for Rodrigo. To compare, Enzyme Diane is $23/week and Bio Case Plus is $42/week.
More Supplements for Dogs with EPI
Originally, Bio Case Plus was my chosen supplement for Rodrigo, however, after their price increase during Summer 2020, I switched to Enzyme Diane. Other supplements recommended by our veterinarian and by pet parents raising dogs with EPI are:
- LIV- PROPETS.com
- Pancrezyme (available through a veterinarian)