Features March 2009 Issue

Exocrine Pancreatic Insufficiency in Dogs

Exocrine Pancreatic Insufficiency (EPI) prevents absorption of food.

[Updated December 10, 2018]


1. When you see or hear about an apparently starved (or extremely thin) dog, please let the owner know about EPI. Few people know that it can affect any breed.

2. If your dog's digestion is poor, with frequent diarrhea, consider having him tested for EPI. Visible symptoms of the disease may not appear until 80 to 95 percent of the pancreas has atrophied. Early diagnosis and treatment improve his prospects.

Kanis Fitzhugh, a member of the Almost Home organization, knew she had to rescue Pandy, an extremely thin and seemingly vicious four-year-old Dachshund. Pandy had been relinquished to a shelter in Orange County (California), who turned her over to Southern California Dachshund Rescue. Deemed people- and animal-aggressive, Pandy appeared to have been starved, and weighed just 13 pounds. Fitzhugh thought the dog deserved a break, and brought Pandy home in May 2007.

During the first couple of weeks in her new home, Pandy managed to pull a chicken down from the counter and proceeded to eat the entire bird, including bones, plastic tray, and grocery bag, in less than the 10 minutes that Fitzhugh was out of the room. Pandy was rushed to the vet and emergency surgery was performed, as the bones had ruptured her stomach lining in three places. Luckily, she survived.

Exocrine Pancreatic Insufficiency

Pandy was found in a shelter, aggressive and seemingly starved. A year later, with a new owner, an EPI diagnosis, and treatment, she looks and feels great.

Pandy’s voracious appetite, large voluminous stools, and aggressive disposition were all caused by a medical condition called exocrine pancreatic insufficiency (EPI). With Fitzhugh’s loving care, including enzyme supplements and a change of diet, Pandy stabilized. Within a year, Pandy had transformed into a beautiful, funny, 26-pound Dachshund who gets along great with all the human and animal members in the Fitzhugh household.

What is Exocrine Pancreatic Insufficiency?

Exocrine Pancreatic Insufficiency, or EPI, also referred to as Pancreatic Hypoplasia or Pancreatic Acinar Atrophy (PAA), is a disease of maldigestion and malabsorption, which when left untreated eventually leads to starvation. One of the major difficulties with this disease is in the prompt and accurate diagnosis. Astonishingly, visible symptoms may not appear until 80 to 95 percent of the pancreas has atrophied.

There are two primary functions of the pancreas:

(1) Endocrine cells produce and secrete hormones, insulin, and glucagons.

(2) Exocrine cells produce and secrete digestive enzymes.

EPI is the inability of the pancreas to secrete digestive enzymes: amylase to digest starches, lipases to digest fats, and proteases to digest protein. Without a steady supply of these enzymes to help break down and absorb nutrients, the body starves. When EPI is undiagnosed and left untreated, the entire body is deprived of the nutrients needed for growth, renewal, and maintenance. In time, the body becomes so compromised that the dog either starves to death or dies of inevitable organ failure.

Incomplete digestion causes the continual presence of copious amounts of fermenting food in the small intestine. This can lead to a secondary condition that is common in many EPI dogs, called SIBO (small intestinal bacterial overgrowth). If an EPI dog has a lot of belly grumbling/noises, gas, diarrhea, and sometimes vomiting, she most likely has SIBO.

The condition occurs when the “bad” bacteria that is feeding on the fermenting food overpopulates the tissue lining the small intestine, further impairing the proper absorption of vital nutrients and depleting the body’s store of vitamin B12. Treatment of SIBO includes a course of antibiotics, to eliminate the bad bacteria. Treatment may also include supplemental cobalamin (B12) injections that help reestablish friendly bacteria colonies, which in turn helps inhibit the malabsorption.

Severity of the disease may vary, making it even more difficult to diagnose. EPI can be subclinical (no recognizable symptoms) for many months, sometimes even years, before it worsens and becomes noticeable. The symptoms can be exacerbated by physical or emotional stress, change of food or routine, and/or environmental factors. The most common symptoms include:

- Gradual wasting away despite a voracious appetite.

- Eliminating more frequently with voluminous yellowish or grayish soft “cow patty” stools.

- Coprophagia (dog eats his own stools) and/or pica (dog eats other inappropriate substances).

- Increased rumbling sounds from the abdomen, and passing increased amounts of gas.

- Intermittent watery diarrhea or vomiting.

Due to the lack of absorbed nutrients, the body starves: muscle mass wastes away, and bones may also be affected. An EPI dog’s teeth may be slightly smaller, and older EPI dogs appear to have a higher incidence of hip dysplasia. Every part of the body is at risk, even the nervous system (including the brain), which in turn wreaks havoc with the dog’s temperament. Some EPI dogs exhibit increased anxiety, becoming fearful of other dogs, people, and strange objects.

With hunger as an overwhelming force, many dogs act almost feral. Desperately seeking vital nutrition, many ingest inappropriate items, but nothing gets absorbed. As the disease progresses, the deterioration becomes quite rapid. Some dogs lose interest in any activities, preferring to just lie down or hide somewhere. Many owners of EPI dogs become increasingly frustrated, as they feed more than normal amounts and yet their dogs continue to waste away before their eyes.

Since chronic loose stools are usually the first visible symptom in an EPI dog, most vets will prescribe an antibiotic to destroy what they suspect to be harmful intestinal bacteria. Owners are happy because the problem appears to go away, at least for a while. No one has any reason to investigate further, until the loose stools return or the dog starts losing weight, and then the merry-go-round cycle begins. Vet visits become numerous and costly, and one possible diagnosis after another is suggested. Expenses may include testing (and retesting) for giardia, coccidiosis, and other parasitic diseases; x-rays; ultrasound; MRI; antibiotics; and even surgery.

EPI Testing for Dogs

Until recently, EPI was most prevalent in German Shepherd Dogs. For this reason, a vet may fail to consider EPI as a possible diagnosis in other breeds and not pursue EPI testing: a trypsin-like immunoreactivity (TLI) blood test. TLI measures the dog’s ability to produce digestive enzymes. The test is done following a fast of 12 to 15 hours, and costs about $100.

Although other laboratories can run the TLI test, most blood samples are analyzed at Texas A&M University. The lab recently revised its reference ranges: values below 2.5 are now considered diagnostic for EPI. Results between 3.5 and 5.7 may reflect subclinical pancreatic disease that may ultimately lead to EPI. When values are between 2.5 and 3.5 µg/L, Texas A&M recommends repeating the TLI test after one month, paying particular attention to the fast before the blood sample is collected.

Even when a dog tests positive for EPI, it is important to retest TLI after the dog stabilizes following treatment. For example, chronic inflammation can put such a strain on the pancreas that the production of digestive enzymes ceases or is greatly reduced. Consequently, when the TLI blood test is analyzed, it accurately depicts lack of enzyme production, even though the dog may not actually have EPI. In this case, it is important for the dog to be treated with pancreatic enzymes until his condition is stable. Enzyme treatment breaks down the food, allowing the stressed albeit non-EPI pancreas to recuperate and, in time, start producing the enzymes needed to digest foods.

Dorsie Kovacs, DVM, of Monson Small Animal Clinic in Monson, Massachusetts, has seen some young dogs with false-positive EPI readings. Even when they display the lighter-colored “cow patty” stools, something other than EPI may be the cause. Sometimes a food allergy or an overabundance of bad bacteria has irritated or inflamed the pancreas, temporarily inhibiting enzyme production. In these situations, says Dr. Kovacs, it’s important to put the dog on a pancreatic enzyme supplement for two months, allowing the stressed pancreas to heal. The dog should then be retested to either confirm or rule out EPI.

In addition, Dr. Kovacs says, “It is also important to introduce good gut flora (bacteria) by adding yogurt, green tripe, or supplements such as Digest-All Plus (a blend of plant enzymes and probiotics). Good gut flora should continue to be maintained with supplements even after the inflamed or irritated pancreas has healed.” Dr. Kovacs has also noticed that some dogs with food allergies (especially dogs who are fed kibble) show rapid improvement when their diets are switched to raw or canned food. Raw meats contain natural enzymes, and fresh vegetables support the growth of good bacteria in the dog’s gut.

Managing a Dog's EPI

Most dogs with EPI can be successfully treated and regulated, although customizing the dog’s diet and supplements may involve much trial and error.

Enzyme supplementation is the first step in managing EPI. The dog will need pancreatic enzymes incubated on every piece of food ingested for the remainder of his or her life. The best results are usually obtained with freeze-dried, powdered porcine enzymes rather than plant enzymes or enzyme pills. Plant enzymes and enzymes in a pill form do work for some, though with enzyme supplements, as with diet, much is dependent on the individual EPI dog. Some of the most widely used prescription enzyme supplements are Viokase, Epizyme, Panakare Plus, Pancrease-V, and Pancrezyme. Bio Case V is a non-prescription generic equivalent.

Exocrine Pancreatic Insufficiency

The author's Spanish Water Dog, Izzy, has the dubious distinction of being the first of her breed to be confirmed with EPI. However, with diligent managment and adjustments to her diet and supplements, she's doing very well.

Enzyme potency is measured in USP units. Prescription enzyme powders range from 56,800 to 71,400 units of lipase; 280,000 to 434,000 units of protease; and 280,000 to 495,000 units of amylase per teaspoon.

Pancreatic enzymes are also available as generic pancreatin. Strengths of 6x10, 8x10, etc., indicate that the dosage is concentrated. Thus, a level teaspoon of pancreatin 6x10 contains 33,600 units of lipase and 420,000 units of protease and amylase, comparable to prescription enzyme products.

Some EPI dogs have allergies and cannot tolerate the ingredients in the most common enzyme supplements. Those owners learn to develop alternative methods such as using plant enzymes, or a different source of pancreatic enzymes such as beef-based (rather than porcine-based). Raw beef, pork, or lamb pancreas can also be used. One to three ounces of raw chopped pancreas can replace one teaspoon of pancreatic extract.

The starting dosage of prescription enzymes is usually one level teaspoon of powdered enzymes per cup of food. As time goes on and a dog stabilizes, many owners find that they can reduce the amount of enzymes administered with each meal, sometimes to just ˝ teaspoon, although some EPI dogs require an increased dosage of enzymes in their senior years.

Enzymes need to be incubated, meaning that you add them to moistened food prior to feeding, letting them sit on the food at room temperature for at least 20 minutes. Some owners find that incubation up to an hour or more works even better. Too often, EPI owners are instructed that enzyme incubation is not necessary; however, some dogs will develop blisters or sores in their mouths from the enzymes when they are not first incubated on the food.

How do you judge what works best for your dog? When dealing with EPI, everything is gauged by the dog’s stool quality. EPI dog owners are always on “poop-patrol.” The goal is to obtain normal looking, chocolate brown, well-formed stools. When your dog produces something other than normal poop, it indicates she is not properly digesting her food. Sometimes longer enzyme incubation helps. Other times using more or less enzymes (since too little or too much enzymes can both cause diarrhea), changing the diet, treating a flare-up of SIBO, or starting a regimen of B12 shots solves the problem. Make only one change at a time. It is advisable to keep a daily journal as it may help you to identify the cause of a flare up or setback.

Prescription enzyme supplements can be very expensive. A $5,000 per year price tag for enzymes is not uncommon for a large dog – but don’t panic! There are several ways to reduce this cost. My 40-pound Spanish Water Dog has the dubious honor of being the first of her breed ever to be positively diagnosed with EPI. When the TLI results came in, I felt like my world came crashing down. Izzy is my once-in-a-lifetime companion, and was very sick. Using information my vet gave me, I estimated that the enzymes she needed were going to cost me $1,200 a year. She was just over a year old at the time, with an expected life span of 13 to 15 years. Eeek!

Today those enzymes cost me a mere $200 a year. How? I joined an EPI support group and learned what others do to better manage the ongoing care of their EPI dogs. I buy enzymes from an EPI enzyme co-op that purchases enzymes in bulk and passes the savings on to owners who have a veterinarian-confirmed EPI dog. The savings from these bulk purchases can be quite substantial. (For both groups, see “Resources for Products Mentioned in this Article,” page 22.) Today, Izzy is a plump, active, happy dog who gives me more joy than any dog I’ve had in my 55 years. I would have paid whatever it cost to help her, but not everyone has this option.

Another solution that can dramatically save money is to obtain raw beef, pork, or lamb pancreas. Ask your butcher if he can get fresh pancreas, or check with meat inspectors in your state to find out if and where you can obtain fresh pancreas. A letter from your vet explaining why you need fresh pancreas may allow you to purchase it from a slaughterhouse. Fresh beef pancreas can also be ordered from suppliers such as Hare Today and Greentripe.com.

The suggested dosage of raw pancreas is 3 to 4 ounces per 44 pounds of the dog’s weight daily. The pancreas can be blended or finely chopped, then frozen into either cubes in an ice tray or “calculated by the dog’s weight” single meal amounts in Ziploc bags. Raw pancreas can be frozen for several months without losing potency. When ready to use, thaw and serve the raw pancreas with the dog’s food.

A very important factor about enzymes – whether using raw pancreas, powdered pancreatic enzymes, or pills – is that all digestive enzymes work best at body temperature. Cold inhibits the enzymatic action while heat destroys it. Never cook, mix with very hot water, or microwave raw pancreas or supplemental enzymes.

Antibiotics are the next line of defense, in order to combat SIBO (bad bacteria growth that overtakes the growth of good bacteria), the secondary condition that frequently accompanies EPI. Tylosin (Tylan) or metronidazole (Flagyl) are the most commonly prescribed antibiotics, and they are usually given for 30 days. Some dogs have trouble with metronidazole due to possible side effects; in that case, Tylan is given. Be warned: Tylan is bitter-tasting, and many dogs refuse to eat their meals when it’s added. There are tricks to deal with this. Some put the Tylan powder in gelatin capsules; I camouflage it for my dog by inserting the required dose in a small chunk of cream cheese. Not all EPI dogs can tolerate dairy, so the camouflage method should depend on the individual dog’s tolerance.

B12 (cobalamin) injections are needed if the dog has very low serum cobalamin. A blood test is required to determine this, costs about $31, and is best done simultaneously with the TLI test. Many EPI dogs cannot replenish B12 levels on their own, so B12 injections are used. B12-complex formulas are not recommended since they contain much lower concentrations of cobalamin and appear to cause pain at the injection sites. Generic formulations of cobalamin (B12) are acceptable.

The recommended cobalamin dosage is calculated according to the dog’s weight and may be found on Texas A&M University website (see page 22). Your vet can show you how to give your dog subcutaneous (beneath the skin) B12 injections. What seems to work best are weekly injections for the first six weeks, then biweekly (every other week) injections for the next six weeks, and finally monthly B12 injections.

Feeding Dogs with EPI

A common saying among those whose dogs have EPI is, “If you’ve met one EPI dog, then you have met just one EPI dog.” Even with pancreatic enzyme supplements, much of the health and well-being of each EPI dog depends on his diet. Sometimes all that’s needed are supplemental enzymes and the standard recommended dietary modifications: no more that 4 percent fiber and no more than 12 percent fat (on a dry matter basis).

Sometimes it’s much more complicated! Some dogs can tolerate much more fat. My dog, Izzy, for example, does extremely well on grain-free kibble with 22 percent fat content, well above the 12 percent range. Other dogs cannot tolerate even as little as 12 percent fat. The same applies to the fiber content. Some EPI dogs have unrelated food allergies, further limiting their diet.

Many dogs with EPI thrive on raw diets and some owners find that a raw diet is the only one that works for their dogs. Conversely, other EPI dogs cannot tolerate raw diets. Some owners successfully feed grain-free kibble, some make home-cooked meals for their dog, while others feed a combination of commercial and homemade. When adding to or adjusting a diet, feed the dog tiny chunks of raw carrot with the diet. These carrot pieces will present themselves in the stools (for better or worse) of that meal’s elimination. This helps you understand which foods/vitamins, etc., work well together and which don’t.

Recommendations keep evolving and changing with new research, as well as the feedback from networks of owners of EPI dogs. A recent change in feeding recommendations concerns dietary fat. Multiple studies from the past decade indicated that a fat-restricted diet is of no benefit whatsoever to the EPI dog. A 2003 paper by Edward J. Hall, of the University of Bristol in England, states that there is experimental evidence to show that the percentage fat absorption increases with the percentage of fat that is fed. This may explain why some EPI dogs can tolerate higher concentrations of fat. For those dogs who cannot tolerate more than 12 percent fat, this may mean that the fat content needs to be increased very gradually, or perhaps that certain types of fat may be tolerated better than others. Much more research is needed to answer these questions.

Veterinarians usually recommend an initial diet of a prescription or veterinary food, such as Hill’s Prescription Diet w/d, i/d, or z/d Ultra Allergen-Free; Royal Canin’s Veterinary Diet Canine Hypoallergenic Diet or Digestive Low Fat Diet.

Prescription diets that are made with hydrolized ingredients (carbohydrates and proteins that have been chemically broken down into minute particles for better absorption in the small intestine, leading to more complete digestion, better/faster weight gain, and firmer stools) appear to work for many EPI dogs.

However, these diets are usually starch-based (often almost 60 percent carbohydrates on a dry matter basis); the digestive system of a dog is designed more for fats and protein than for starches, which may be why many EPI dog owners achieve better results by reserving prescription diets for short-term use and feeding other diets over the long haul.

The best results for managing EPI requires combining veterinarian advice with the experience of actual EPI dog owners. Too many times, managing EPI can be a real roller coaster ride! For example, initial research studies showed that supplemental enzyme powders needed to incubate on the food. Additional research studies then suggested that food incubation with enzymes was no longer necessary. Consequently, some EPI dogs developed mouth sores, so owners are again being advised to let the enzymes incubate to prevent this side effect. Until the causes and effects of this disease are better understood, it will continue to be managed via trial and error.

Canine Pancreatic Insufficiency Feeding Guidelines

Enzymes should be mixed with about one to two ounces of room-temperature water per teaspoon of enzymes, then added to the food and allowed to incubate for 20 minutes or more. A couple of tablespoons of room temperature kefir or yogurt (or some other “sauce”) may be used instead of water to mix the enzymes. Once an EPI dog is stable, some owners find that they can “cheat” and give their dog a smidgeon of a treat without any enzymes on it. Others find the least little crumb ingested without enzymes will cause a flare-up.

If possible, feed two to four meals a day, taking into consideration whether the dog’s condition has stabilized and whether the family’s schedule can accommodate multiple feedings. Feeding smaller, more frequent meals puts less stress on the EPI dog’s digestive system.

At first calculation, many owners of EPI dogs wonder if they can sustain the added expense of all these “special foods” in addition to the enzymes. It may take many attempts to find just the right diet for a dog with EPI that is also affordable by the owner, but it can be done. Following are some suggestions and techniques that EPI dog owners have successfully used.

Kibble or canned: Many EPI owners who feed commercial kibble or canned dog food have found more success when feeding a grain-free product. Much depends on the individual dog.

When feeding kibble, many owners let the food and enzymes incubate until the food has an oatmeal-like consistency. Some even grind the kibble to allow for more surface contact with the enzymes. Some also add a teaspoon of pumpkin or sweet potato, which may help firm stools and reduce coprophagia; plus, both ingredients are packed with vitamins C and D. Sweet potato is also an excellent source of vitamin B6.

Combination kibble and homemade: Many owners feed a combination of commercial food and raw or home-cooked. EPI owners generally mix foods at a ratio of 20 to 80 percent. As always with an EPI dog, enzyme supplements should be mixed in with the wet portion of the food at room temperature and allowed to incubate. Depending on each individual dog’s tolerance, any variety of meats and fish may be used. Sources of proteins can include beef, chicken, turkey, pork, venison, rabbit, lamb, canned or cooked salmon, and jack mackerel, as well as eggs, yogurt, and cottage cheese. Organ meats, such as liver, kidney, and heart should also be included in the diet. Green tripe is another good option. Variety is key! Again, incubate the food with the enzymes and feed two to four times daily, depending on your individual dog’s needs and your own schedule.

Raw and home-cooked: Over the past few years, many owners have been able to stabilize their EPI dogs by feeding a raw diet. Raw food has the innate advantage of maintaining natural food enzyme activity that aids digestion. Many vets disapprove of feeding a raw food diet, especially to compromised dogs (possibly exposing them to further complications), while other vets suggest that raw is best for an EPI dog. There have been many anecdotal cases of dramatic improvement when the owners feed their EPI dog a raw diet, especially when all else fails.

Most EPI dogs cannot handle the 20 to 25 percent raw bone content in the diet that is commonly fed to normal dogs. With EPI dogs, it’s smart to start with only 10 to 12 percent of bone. Some dogs still have difficulty digesting this amount of the bone and the ratio will need to be reduced even further, to 3 to 5 percent bone. Note we are talking about the amount of actual bone, not the amount of raw meaty bones, which are usually at least half meat.

Vegetables may be a large or small portion of the diet, or not included at all, depending on the individual dog’s tolerance. If included, they should always be mashed. Organ meats are usually recommended at 10 to 15 percent of the EPI diet, but again, not all dogs can tolerate this.

Supplements for an EPI Diet

Whether you feed dry, canned, home-cooked, raw, or any combination, there are many other ingredients that may be added to provide additional benefits for EPI dogs.

Most EPI dog owners add coconut oil and/or wild salmon oil to their dogs’ diet. Many EPI dogs cannot digest other fats and develop dry, itchy skin or dry, brittle coats. Coconut oil contains medium-chain triglycerides (MCTs). Most vegetable oils have longer chain triglycerides, called LCTs. MCTs are utilized faster and burned more quickly for energy, raising the body’s metabolism, while LCTs are utilized more slowly. Also, coconut oil is one of the richest sources of lauric acid. Its benefits have recently been touted to aid in destroying various bacteria and viruses such as listeria, giardia, herpes simplex virus-1, and maybe even yeast infections such as candida.

Wild Alaskan salmon oil is an excellent source of omega-3 fatty acids, which help reduce inflammation.

Probiotics are another important addition to the EPI diet, especially since most EPI dogs are or have been treated with antibiotics because of SIBO. Antibiotics wipe out not only bad bacteria, but also good bacteria. Probiotics help maintain good gut flora. One popular brand of probiotics that has been successfully used by EPI owners is Primal Defense, but there are many quality probiotics available.

Zinc deficiency is another consideration with EPI dogs. It is difficult to accurately measure zinc absorption. Human EPI patients often develop a zinc deficiency, and though no studies have confirmed this to be true of dogs with EPI, many vets suggest a zinc supplement for EPI dogs.

Vitamin E (tocopherol) levels may also be low in an EPI dog due to malabsorption. Vitamin E is a fat-soluble vitamin that is an antioxidant and helps in the formation of cell membranes, cell respiration, and with the metabolism of fats. Vitamin E deficiency may cause cell damage in the skeletal muscle, heart, testes, liver, and nerves; supplementation with vitamin E can help prevent these problems.

Other natural nutrient sources that are often included in an EPI diet are kelp, green tripe, slippery elm, and alfalfa.

Controlling EPI

Texas A&M and Clemson University are currently embarking on Phase II of an EPI research project to try to identify the genetic markers for the disease. “This disease is characterized by a complex pattern of inheritance,” says Dr. Keith E. Murphy, Professor and Chair of Genetics and Biochemistry at Clemson University in South Carolina. “Thus, we have been limited in how we can attack this in order to identify the gene or genes, that contribute to this horrible disease. However, we are encouraged by the success that we and others have had using SNP technology [unique DNA tests] to identify genetic markers associated with various traits and we will be employing this approach to EPI.”

It is important that this research continues. EPI is rapidly spreading across all breeds. It is no longer just a GSD disease, or a working dog disease. Dogs of all breeds, including crossbreeds, are being diagnosed with EPI. It is happening in family lines too often to be coincidence without a genetic component. Yet, not every family member or generation in affected lines has EPI. For now, until we can actually test for the genetic markers, the best possible control is to remove positively confirmed EPI dogs from breeding programs. Once genetic markers are identified in GSDs, the markers in other breeds will be more easily detected.

Although there are many success stories, there are also heart-wrenching tales of dogs who cannot thrive, families who cannot afford the treatment, and throughout it all, the painful suffering the dog endures unless successfully treated. EPI can no longer be a “hush-hush” disease. My hope is that this article will make a difference by helping raise awareness of EPI to the level of other major canine diseases.

Many EPI Dogs Flourish

Kara surfaced as a stray in a shelter and was subsequently turned over to the Long Island Shetland Sheepdog Rescue group. When they received her, they did not expect her to survive the night, she was so sick and emaciated. They guessed that she was probably one to two years old, but she weighed barely seven pounds - half her ideal weight.

Kara was lucky; she was diagnosed promptly with EPI. While in foster care for four months, Audrey Blake met Kara twice during training classes and the frail little dog with the outgoing personality captured her heart. Although she understood that Kara would need pancreatic enzymes for every meal and a special diet, Blake took Kara home. Today, Kara is known as “U-CD Twenty Four Karat Gold, UD, TDI, CGC (Kara), Rescue Sheltie,” and happily resides with Blake on Long Island, New York.

Sadly, Some Dogs Perish

At five years old, Wayde was taken in by German Shepherd Rescue of New England. Wayde was found to have EPI, an all-too-common problem with GSDs. He also had the secondary bacterial infection, SIBO. Even with enzymes added to his diet, Wayde continued to drop weight until he was only 54 pounds and seemed sad and listless all the time.

Wayde was in the kennel for many months. Finally, a couple who was familiar with EPI, Pamela and Peter Burghardt from Wilmot, New Hampshire, decided to foster Wayde. In their home, his whole demeanor changed; he became happy and gained more than
two pounds the first week. Wayde soon settled in with his foster family and became a sweet “Velcro” dog. He became best friends with his foster sister, another white GSD.

Sadly, Wayde was diagnosed with cancer a few weeks after going into foster care and passed away four months later. Despite the cancer, he had gained 14 pounds and was active and happy to the end.

Olesia Kennedy, a retired research analyst, and previously involved in Canine Search & Rescue, currently devotes her skills and time to EPI research. She resides with her husband and three Spanish Water Dogs in Georgetown, Indiana.

Comments (34)

After several weeks of trial and error Callie's stool was back to normal and has been ever since being diagnosed in August 2018. However she has NOT gained any weight so I am concerned whether she is getting enough food. She was almost 24 lbs when this started and was 19.5 at diagnosis and still is 19.5. She is a Basenji and this is in her weight range but on the low end. I am also wondering whether she can take Cosequin D or regular digestive enzymes. (probiotics) she was on that before all this started and vet said to stop it all. Now she has arthritis at age 11 and having some spine issues so would love to get her back on cosequin. Would love to hear from any of you and how you handled these issues. KL

Posted by: brkls2 | March 5, 2019 2:10 PM    Report this comment

I have a 2 year old pom with low levels of amylase. She doesnt have classic signs of EPI she did exhibit the agressive behavior and verocious apetitie. I have her on a metabolic food she needed to lose weight Im thinking I need to add some enzymes to her food as well as a probiotic. Anyone have an issue like this?

Posted by: pomcrzymimi | February 8, 2019 6:09 PM    Report this comment

My dog is a 13 year old Cocker Spaniel with several managed health issues and she has been on Pancrezyme for a few months, fed with a homemade diet of chicken, brown rice, broccoli, corn oil, and vitamin supplements. As a few others have commented on here, she smells horrible. The vet said it is likely from the Pancrezyme. I bathe and groom her and literally the next day she smells like dirty socks, or rotten parmesan cheese as my mom refers to it. Any advice on how to remedy this? Its so bad! :(

Posted by: Alisha G | January 30, 2019 2:35 PM    Report this comment

my dog boney was diagnosed with EPI about less than a year ago, since then it was a roller coaster and i've learned a lot by reading this article, is there a forum of EPI dogs, when we can share and consult?
whatsapp group or anything... would love to

Posted by: amirnew | January 7, 2019 5:21 AM    Report this comment

Hi there. I came across this article while researching EPI. I am almost positive my little girl has it. We're taking her to the vet tomorrow morning for TLI/Folate and a B12 test that I cant remember the name of. Anyway, I read in your article that there are support groups to help with the costs of EPI but I couldnt find the section mentioned in the article. Can I get a link? I understand we first need proof from a vet to join but I just want to get the ball rolling asap so we can get our girl the meds she needs. The vet said shes a poster girl for EPI; weight probably doesnt mean much without other dimensions but we got her almost 3 weeks ago. Her ribs were showing when we got her and she has since dropped in weight from 54 pounds to 49.5

Posted by: NicIsAwesome | December 28, 2018 11:31 AM    Report this comment

My G S was just diagnosed. Today we started pancreplus, and I'm at once hopeful and terrified.

Posted by: Susan guffin | October 16, 2018 3:29 PM    Report this comment

My 10 year old Basenji was just diagnosed with EPI about 3 weeks ago. I have started her on Viokase (3/4 tsp. on food twice a day) I feed her Fromms Gold chicken (it is low fat at 15%) I am grinding up the kibble and mixing the enzymes in 2 oz warm water to mix with the food) usually add a bit more water as it is pretty thick. She was not nuts about the food so I have been scrambling an egg and putting half the egg in AM ;and the other half in PM so she eats it. Is giving her an egg okay or wondering what other option I might try? I allow the food to stand for 15 to 20 min before giving to her. She was doing fine and stool was formed and looking normal until this past Friday when she again had yellow mushy stool. MY vet does not seem to be very informed on EPI treatment and just told me to give her a little more enzymes. I did do that and by Sunday her stool was again looking more normal. Today, tuesday it was okay early and then later in the day was more yellow again and softer. Your article also mentioned digestive enzymes. Is that something in addition to the enzymes for EPI? I only give her an occasional Charlie Bear treat which is VERY low fat so can't imagine that is bothering her. this is all very new and frustrating. In the past she got bits of hot dog and cheese, cottage cheese or yogurt which is now a big NO NO. any help would be great. thanks

Posted by: brkls2 | September 4, 2018 5:47 PM    Report this comment

I just joined this forum, and my 9 year old GSD is going to the vet Monday as I suspect EPI in her. I adopted her from a shelter at 2 years of age, and she has always had GI issues and food allergies. Her coat has always been rough, dry and brittle with a lot of shedding. Whenever she would get diarrhea, I could stabilize her with plain rice boiled ground turkey and some pumpkin. But now I cannot, thus I suspect EPI. Her stools fluctuate from watery to some semi-formed, but the yellow color is there.

Is there any way around the TLI test, as that test alone is $260 here, plus I'm sure they will want to do a full blood panel. Then there is the B12 test, etc. I'm low income and not sure I can afford all this, sadly. Is that the normal cost for that test? Could the vet diagnose this with just the $50 pancreatic function test instead of the full TLI test? Thanks for any information.

Posted by: rcjo | August 11, 2018 10:46 AM    Report this comment

Natural Balance ..venison & sweet potatoes helped fix diarrhea for my cocker spaniel in one day..it aids digestion only has 10% fat..they also have small 2.75oz broth food that has low 2út my dog loves them and seems to be helping him stabilize..
I also use the LICKS digestive enzymes because they are easy to do..
All of this I found at petsmart hope it helps!

Posted by: Mj7 | August 6, 2018 11:32 AM    Report this comment

My GSD just turned1 year in March 2018. April is when đź’© hit the fan. We were in the middle of a food change and for almost a month it was diarrhea. My vet suggested feasting for EPI and was put on Viokase to help aid digestion. It made the liquid stools into a medium tooth paste like stool. Still wasn’t “normal”. Tried a similar prescription from my dr to help with costs. That wasn’t working. On “pancreas support” and “digestive enhancer” from nature’s farmacy.com and those helped more then the vets but still haven’t gained weight. He is on fit and trim from orejen kibble. Tried to do half cooked people food and kibble but he would flare up and have diarrhea, two steps back again. Vet suggested animal pancreas but his poops went back to more soft. He is now a full liquid diarrhea. I am at a loss. Can someone suggest anything I might be missing? Food good for sensitive belly and help him gain weight without diarrhea?

Posted by: smooers | July 12, 2018 10:59 PM    Report this comment

My beagle mix was diagnosed with EPI about 7 years ago. He is 9. He has been on pancreatic powder the whole time and has put on significant weight. But he now acts very aggressive at feeding time and sometimes will not eat. Any suggestions?

Posted by: Arron | April 1, 2018 5:47 AM    Report this comment

This is such a helpful resource! Our dog was diagnosed with EPI in August 2017. Two quick questions:

1. What quantity of coconut oil do you recommend adding to dog’s food. She is so itchy and I really hope the coconut oil will give some relief! She eats grain free kibble mixed with grain free wet food and a prescribed medication.

2. The article mentioned a support group for EPI dog owners. I’m really interested in joining. Anyone know how to access?

Thank you for any help! —Ann

Posted by: AnnG in KY | December 31, 2017 12:34 PM    Report this comment

Our 9 year old shepherd poodle mix was diagnosed with EPI at about a year old. We struggled with low grain low fat food mixes with enzymes but found a winner with Biocase V enzyme powder found on Amazon and Wellness grain free kibble (dark brown bag, green lettering), Wellness grain free cans of lamb, chicken or turkey (tan labels), and Nature's Recipe grain-free wet dog food in cans (which are getting harder to find). We supplement with Nutri-Vet Multi-Vite chewable vitamins. At 50-60 lbs. we feed her a 1/2 cup of kibble and one of the cans for each meal, mixed with a total of 1 1/2 tsp of the Biocase. We've had to tinker with the mix over the years but this has kept her going and her weight on.

Posted by: ChuckK | November 4, 2017 8:16 PM    Report this comment

I have been trying to stabilize my Italian Greyhound for almost 6 months.. (she is an IMHA survivor) She is the VERY PICKIEST of eaters and I throw away lots of food with enzymes in it. I have taken to force feeding her with a large feeding syringe to get her to eat food with enzymes, and then giving her supplemental things like lean cooked steak. I was putting the enzymes in gel caps and she seemed to be a bit better with that, but the Vet nixed that method. She continues to lose weight.. getting down to around 11 pounds.. down from about 16. I am getting to the panic stage. She has been tested, (and tested, and tested) and gets insulin, B12 and enzymes. I can add probiotics, but I feel at a loss, and as if I am not doing something right... She is my heart dog.. and hungry ALL the time.. and dying before my eyes, despite my best efforts....

Posted by: Lorelei | June 21, 2017 12:46 PM    Report this comment

Has anyone with a dog with EPI noticed an odor from their dog. My dog, a 10 year old Yorkshire Terrier has been diagnosed recently. We have tried two types of meds and both make him smell. I don't know if it is his breath or it's being emitted from his body. It is a parmesan cheesy, stinky feet type of smell. Its getting into my furniture and on blankets and pillows. What can I do?

Posted by: katbrody | March 27, 2017 10:41 AM    Report this comment

My German Shepherd bitch developed Pancreatic insufficiency after have a large litter. This was before pancreatic enzymes were available.
She lived to a good age by being fed a totally fat free diet. That and regular cooked bone. A spongy bone -- it helped to slow her digestion down so that her food remained in her digestive tract long enough to be properly digested and absorbed.
I believe, from things I've read, that the problem was a gross Vitamin B deficiency caused by trying to feed all those pups. All my dogs now get regular Brewers Yeast supplement, increased for the bitches when they are nursing a litter. I've also kept my dogs on a low far diet and still use the same vitamin/mineral supplement that I used for Topsy.

Posted by: Jenny H | March 26, 2017 5:58 PM    Report this comment

Praying you have found help for your toy poodle since June :( A dog that size is around 1/4 tsp of traditional enzymes. My dog was 9.5 lbs and dose was 1/4 tsp on every bowl of food.
My rat terrier was wasting away as well, initially misdiagnosed as well, then after $1,500 we got it right. Was prescribed Panakare and gained 1.5 lbs in 10 days but still looked "off". Then her face swelled up, they blamed her teeth being infected. Wrong again! Next day she was hives and welts head to toe. She is allergic to the Panakare that is saving her ( it is porcine- or pork pancreas based). Having a tough time finding beef or lamb specifically for dogs and the plant based is not working for her. Just ordered beef and lamb pancreas enzyme caps for humans out of desperation.

Posted by: tootsiedadoots | February 14, 2017 6:04 PM    Report this comment

Oh my gosh...I have been dealing with this for almost three years!!! Alone!! After being diagnosed with tape worms. My 6 lb toy poodle began losing weight. I caught it quickly took her to vet and wormed with droncit. When she kept losing weight the vet came to my house on newmerous occasion and contimed to worm her and giving her massive amounts of antibiotics. Injected and orally. Then I get a knock at my door from an agent with the Dept of Agricultural!!! This Vet....had no license! Yes he had been a vet for 30 yrs...but had lost his license.. He had killed and maimed a few pets... He got 30 days!!! I have spent thousands on this dog.. And never once was I told about EPI...they gave more antibiotics vet food etc. But she is so thin she looks like a cruelty case. I'm on Social Security and 65... Money is tite and I need help. It seems in this article its all bigger dogs. She only weighs 5 lbs and should weigh at least 8. Food goes in and out she's is just bones. If you can help me figure out the dose I would appreciate it. She also has pica..Kleenex, anybodys food cat and its a constant battle...cause she's starving. Totally against the steroids...I have 7 small dogs ages 16 to her and her sister who are three. All are very healthy. And all related none of the others have ever shown this. Help!!

Posted by: jroth | June 10, 2016 3:45 PM    Report this comment

Adding to my earlier reply to Jilly D - I should have mentioned that the Millies Tracker is made by MILLIES WOLFHEART and is completely grain free and low I fat.
Excellent for EPI dogs.
Judith T

Posted by: Judith T | May 28, 2016 12:06 PM    Report this comment

So sorry to hear the problems Jilly D is having with her GSD. Sorry I am replying so late. Ask the vet for LYPEX (enzyme needed for treating EPI). Buy ROYAL CANIN GASTRO LOW FAT tined food and mix the Lypex in it. Then add MILLIES TRACKER dry kibble. I promise this will get your poor doggie back to health and weight. It has been a life saver for mine.

Posted by: Judith T | May 28, 2016 12:01 PM    Report this comment

My Cardigan Welsh Corgi, Teddy has EPI. we are about 2 weeks into treatment. I am so glad that a friend of mine found this article. It has been such a help. We will begin checking into all these products and places for enzymes that will be affordable for the long term. Thanks. Cat

Posted by: Cathie Dawson | March 12, 2016 4:09 PM    Report this comment

I rescued my GSD 4 years ago from RSPCA. He had been returned to them from 2 previous owners because of his lack of obedience and poor house training. He was 2 years. The center had witnessed what appeared to be ecoli and had him treated for this before I brought him home. The first thing I noticed about him was he was very nervous and cautious of everything. He was also quite thin. For the first three years he flourished, gaining weight, enjoying his walks and toys. He became a member of the family pack. He is also a very clever dog. Back in October 2014 he started with soft and runny stools. I did the 24 hour fast with just water, but it did no good. I took him to the vet who did poo tests with clear results for all known diseases. After months of antibiotics I changed vets. My new vet diagnosed him with EPI. and SIBO. Since then he has had multiple diet changes all with enzymes, Probiotics, antibiotics, steroids all of which he still has daily. Nothing is working and he is now 19 kilo from his original 42 kilo. I am at my wits end and I love him so much and I fear I will lose him. Please if anyone can help me please let me know.

Posted by: JillyD | September 26, 2015 8:07 PM    Report this comment

JillMathias, keep your house up, my gsd was diagnosed about 6 years ago, it took some time for the enzymes to much in but once they did she gradually gained weight. She was down to 55 lbs and it's now holding steady at 66-67 which is good for her size & age. I know how hard it is is the beginning but it will get better..:)

Posted by: michelem | April 24, 2015 11:21 PM    Report this comment

To JB I get my enzyme supplement from
Www.enzymediane.com. it is a good size bag for $70. It whim last my girl about 3-4 months. Which is much better than the 65 I was paying every month. Shipping is fast. How this helps.:) I also feed my girl science diet, large breed. & can get a 38lb bag they Amazon for $30-38. She does well on this for & my vet agrees..

Posted by: michelem | April 24, 2015 11:17 PM    Report this comment

We are into week two of treatment( enzymes and B12 shots) for our Bernese Mountain Dog, Tobias. What an awful disease, I just HATE it! So far no change, in fact his diarrhea seems worse and more often, like water. He smells so bad poor baby. We are currently mixing his enzymes with the wet food from Earthborn Holistic and giving him the same brand dry kibble after he devours his wet food. Should we not be giving the dry kibble at all until he stabilizes? One carton of wet food 3 times a day just doesn't seem like enough food for a dog his size??

Posted by: JillMathias | April 24, 2015 11:20 AM    Report this comment

Our GS was diagnosed 8 years ago and we were feeding her Pedigree with Viokase which I order online at a good discount (Revival Animal Health) and we mix it with a digestive aid. She was doing fine until recently when we switched food to grain-free and low fat; she has lost quite a bit of weight but still has a ton of energy for a 9 year old dog. Her stools are solid and normal color (finally) but huge and multiple per day! I don't understand and am frustrated that I can't get weight on her. She loves raw vegetables and gets them often. I am going to try some of the diet tips I've read above to see if she can get some weight back as well as trying to find a vet who has experience in EPI dogs.

Posted by: gail a | September 9, 2014 4:30 PM    Report this comment

To JB: I have a now 11 year old German Shepherd who was diagnosed with EPI before he was 1 year old, so we have been dealing with this for over 10 years and have lots of experience. I'm assuming you are getting Viokase from your vet. There are generics available that are much cheaper. I use PancrePlus and get it from "petrx2go.com". You will need a prescription from your vet to send them before they will ship to you. We used the powder for many years, until I discovered that I could buy a bottle of 500 pills and grind a few up into a powder for each meal. You will need to experiment with how many pills will equal the amount of powder you're giving. A 500 count bottle of PancrePlus with shipping is about $75...much cheaper than Viokase from the vet.

As far as food, we were using Hills Prescription Diet I/D for years and it just got too expensive, so I looked for alternatives. I found that you just have to use trial and error to find something on the market that will work. You'll want to watch the protein source, usually a sensitive stomach food works best. We tried several foods, and finally we found of all things Purina One True Instinct turkey & venison actually worked for him. Purina One is not the highest quality of food, but his stools are actually better than with the dry I/D food. We still use the canned I/D to mix his PancrePlus up in, but our expense has dropped drastically. It took many years for that to happen, and alot of money. Hope this helps you out so you are not out what we have been.

Posted by: Fineas | August 13, 2014 10:12 AM    Report this comment

Our 3 year old cavalier King Charles was just diagnosed with EPI today. He went from 8.5 pounds a month ago to 7.4 pounds. Poor little guy is so hungry. But we are limited in what we can give him as he has early second stage kidney disease as well. Waiting for vet to get the enzymes and antibiotics. If anyone has any insight into helping me help him gain weight I would appreciate it. We live in ontario Canada and he is our daughters little guy and she will be devastated if something happens to him. Thanks v

Posted by: haskmorr | July 3, 2014 10:19 PM    Report this comment

We have a 2 year old GS that was diagnosed with EPI in October when she was about 18 months old. Our vet had not seen a case, so I pretty much told him what it was from my research. After thorough blood tests he concurred it was EPI. She has 2, sometimes 3 meals of Hills ID with 1 teaspoon of pancreatic enzyme powder. She has gained all her weight back, stools are normal, however she is now vomiting almost nightly, and grumbling of her tummy. I wonder if it's SIBO, or is this a common trait for EPI dogs?B Also, our vet charges us $90 for a 30 pound bag of ID food, and her powder is $195 and lasts about 1 1/2 months! Expensive!! any suggestions to cut down on cost?

Posted by: JB | June 14, 2014 3:11 PM    Report this comment

I am waiting for my GSD bloodwork to come back but the vet seems pretty sure we have our answer. My baby is 1 year old and weighs only 44 pounds. She was recently spayed and the trauma of that surgery may have kick started her underlying condition. I have always had stool issues with her as a puppy and just figured her system was "fussy". In the past month she has dropped 8 pounds and I have become a worried wreck. I had already changed her diet to a NO GRAIN formula in hopes of some resolution but nothing helped. Hopefully in a few days we will finally be on a path of health for my girl.

Posted by: Norita | June 3, 2014 6:03 PM    Report this comment

My Precious Lady Jewel was first diagnois with diabetes. I kept bringing her back to the vet telling them something still wrong. They finally found that she also has epi. She is on the pancreatic powder plus 1 tsp twice a day with her meals. I had her starting to gain weight. Originally she was 18 lbs shes a king charles cavailier. She lost weight when first diagnois with diabetes at 9lbs. The vet said put her on the science diet w/d then i/d when the epi was found. She lost even more weight to 8.9 lbs. I took her off the sci diet i/d. I had her gaining weight on wellness core grain free. I also added boiled/cooked chicken breast to help her gain weight. She hasn't really gained anything so I changed her diet. I recently read that show dogs are put on a diet to gain weight with satin balls consisting of raw ground chuck with oatmeal,total cereal,wheat germ,egg,molasses,omgega 3. I give her 3/4 of her cord dog food with the patty of satin ball mixture. It'll be a week this fri. She has already started to gain weight of almost a pound. Ive been searching everywhere for a good diet for her to gain back her weight. She has a heart murmer too because of all this. Im afraid of losing my beautiful girl. She has such a loving soul. She melts my heart and yet it breaks to see her so thin and boney. Its so hard to find the right diet for her. Please help. Thxs

Posted by: burnsmish | March 13, 2014 11:54 PM    Report this comment

My registered GSD was diagnosed with Pacreatic insufficiency 4 yrs ago at age 1.It took me a lot of trial and error to get her food desirable enough to eat.She eats canine en dog prescription dog food.I mix 1 cup with 1/2 boiled shredded chicken breast and 1/4 c warm water.Mix with 1 tsp Pancrevid powder enzyme and cover 20 min.She gets one feeding am one pm.I give her a small carrot stick as a treat 1 or 2 times a day.Also a couple prescription dog treats per day.Nothing else.I have kept this going 4 yrs now.She runs 1 mile a day 5 days a week.She went from wasting away to 87 lbs of muscle and energy within a few month of diagnosis.Just saying if you have a dog with pancreatic insufficiency don't give up.Try little changes to get the right taste for your dog.Instead of dog chews and biscuits I have found giving her large marrow filled beef bones cooked with a little skin left on outside provide hours of chewing and taste entertainment for her and clean her teeth and gums.She may eventually chisel off a tiny sliver of bone but doesn't bother her.When the bone starts getting too jagged on the edges I just buy her a new one.So sad they don't make a nice big chewable digestible long lasting dog treat for epi dogs.This is next best thing.I just hope and pray she maintains her good health and lives a long life.Glad to be able to interact with this site!

Posted by: Unknown | April 8, 2013 2:06 PM    Report this comment

There are no links, references, or contact info here, which the article says there are. Please help!

Posted by: osos julie | December 25, 2012 10:29 PM    Report this comment

Our EPI dog is fed the same raw diet as the other dogs, plus a fraction of a teaspoon of enzymes. It seems the raw would be easier to digest, but that is just a semi educated guess. For whatever reason, the dog has no digestion problem. He gained 20 pounds in a couple months.

Posted by: Erich R | July 2, 2012 3:12 PM    Report this comment

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