How I calculate fat and protein for pancreatic enzyme replacement therapy (PERT) dosing in homecooked meals

As I’ve been re-adding food items to my diet now that I know I have exocrine pancreatic insufficiency (EPI), I’ve been eating a lot of packaged foods with nutrition labels that are quick and easy to read. I’ve done a few meals that are takeout from a restaurant, and certainly the ones from chain restaurants with nutrition labels online are the easiest to enable me to optimally dose my PERT. (But not all restaurants, including my new favorite local taco place, have them and so I also do quite a bit of guesswork and experimenting.)

I’m now at the point where I can eat some onion and garlic and other FODMAPs again (yay!), so a lot of the homecooked meals I used to love to make – especially crockpot meals – are back on my list to try. This week I decided to try taco soup, a longtime favorite that involves cans of black beans, corn, dark red kidney beans, light red kidney beans, cooked ground beef, tomato paste, and ranch and taco seasonings.

One of the reasons I waited to cook large meals until this point in my EPI discovery experience was to save my energy for figuring out the fat and protein per portion size.

I’ve been creating a tab in my PERT enzyme tracking spreadsheet that’s labeled “ingredients”, and I’ve been listing commonly used ingredients (e.g. an egg, 1/4 cup of cheddar cheese, 1/4 cup of parmesan, 1 cup of milk) that I often add to my food and repeatedly need to add to my nutrient totals. I listed out all the ingredients for my taco soup recipe (see above), looked up the fat and protein and logged those, then added them all up for what one giant crockpot full of taco soup would be. That’s 44 grams of fat and 177 grams of protein.

(Side note – I found that Impossible ground beef tastes the same as ground beef and ends up being lower fat and protein. I was going to use it anyway, but that makes it easier to dose PERT by slightly reducing the fat and protein quantities.)

Then, after I cooked it (truly, set it and forget it), I scooped out a cup at a time to estimate the number of cups. For my current crockpot, it was about 12 cups.

So to figure out the taco soup individual serving size, I take 44 and 177 and divide each by 12, so it’s about 4 grams of fat and 15 grams of protein per cup of soup. I usually eat 2 cups at a time, so multiply by two to get the total of what I’m needing to dose PERT for, which is 8 grams of fat and 30 grams of protein. That’s *just* at my 1-PERT limit (at my current dosing)  for protein and well under my 1-PERT limit for fat (also about 30 grams), so I was able to cover 2 cups of soup with 1 PERT pill.

However, were I to add 1/4 cup of cheddar cheese, as I sometimes do, I’d need to add on additional enzymes to cover the protein. (It’s frustrating that I’m this sensitive to protein, enzyme-wise!)

This is also what I’ll do with potato soup (another crockpot favorite) and any other recipes that I make. Like diabetes tasks, I’ve found that splitting up the work whenever possible makes a difference, so I’ll list out the ingredients and look up the data and determine the total recipe counts separately from when I cook it, and from when I measure out how many servings there are and arrive at the final serving math.
An overview of the process of adding up fat and protein for all ingredients in a recipe; cooking and counting out the number of portions, then dividing the fat and protein totals by the number of portions (I use cups) to determine how many grams of each per serving and determine how much PERT to dose.

(PS, if you didn’t see them, I have other posts about EPI at

6 thoughts on “How I calculate fat and protein for pancreatic enzyme replacement therapy (PERT) dosing in homecooked meals

  1. I had been looking for something similar and was wondering if you have any resources you use to determine how much of your enzymes to take per meal? My issue is my Creon had a high dosage for fats, but low doses for carbs and proteins. I need the medicine to eat everything and everything I eat. I feel I often have to take a lot of my enzymes simpy to cover the carbs in things I eat.

    What pointers would you have for someone navigating EPI. I am still looking into how imaging I’d had that shows non-alcoholic fatty replacement of the pancreas keys into things.

    1. If you haven’t stumbled across them yet, I have a couple of other blog posts ( to see the full list) that describes in more detail how I figured out what to take. It involved testing different sized meals – low fat, higher protein; higher fat; lower protein; etc – to see what worked and what my “ceiling” was for the size of PERT I had, then using that to create the ratio to decide what to take in the future. You could do the same thing for carbs as well (although I found I wasn’t sensitive to carbs enough to bother using a ratio for; but I definitely am sensitive to protein!).

      If you find that you’re short on one type of enzyme (eg amylase for carbs), you could also look into some over the counter (OTC) enzyme options and test using that to “top off” your prescription PERT, as a way to more cheaply cover the carbs. But I’d start with testing first and figuring out your ratios for each enzyme and macronutrient; then you can figure out if you could more efficiently use a different dose of prescription PERT and/or if you want to supplement some with OTC.

    2. My mom has exactly the same problem. I realized that in Europe do exist only Creon 10.000 and 25.000* capsules, but they are not really convenient if you want to have a small snack or an egg white for example.

      In USA there are plenty of options (Creon 3.000, 6.000 etc) and they are more focused on protein and carb absorption.

      I would be very interested to know how do you deal with EPI and what pancreatic enzymes you take in every meal. Thank you!

      *Creon 10.000 lipase: 8.000 amylase, 600 protease
      Creon 25.000 lipase: 18.000 amylase, 1.000 protease
      Creon 3.000 lipase (USA): 15.000 amylase, 9.500 protease

      1. Hi Christina – this is where I have experimented with over the counter enzymes. After I estimated my ratios to figure out how much 1000 units of lipase and protease each “covers” for me, I tested different small snacks with the OTC enzymes to see if they work for me. (They do). So for small snacks under 1/2 of a full PERT of my typical dose, I often just do a combination of the lipase-only and the multi-enzyme OTCs. That works for me for snacks and also for when I’m fueling for ultrarunning (otherwise it would be $$$$$$ for every run!). I do also “top up” my PERT at meals, so if one of my standard PERT covers 30g of fat and I am eating 37g of fat, I would take one PERT plus one or two OTC lipase, as that covers the additional 7g of fat. (I often round up one more OTC, because it’s $.34 per OTC and better outcomes to be over on enzymes than under on enzymes!).

        So “what I do for each meal” depends on what I’m eating. It’s like dosing insulin based on carbohydrates, I dose my PERT based on exactly what I’m eating (fat and protein, as I don’t seem to be as sensitive to needing amylase for carbohydrates).

        I have read other people who have different PERT prescriptions, as you indicate, where they have one brand of PERT with two different sizes, and use that to differently dose snacks vs meals, or different sized meals. Either strategy would work, especially if someone has an awareness of what they need for each meal!

  2. My diet includes lots of carbs. Example: a large bowl of fresh fruit. What is a ratio to use for 1 gram of carbohydrates?

    1. You can follow the same process for identifying your ratio for amylase to carbs – find a meal or snack that “works” under your one PERT pill. Take the amount of carbs and divide it by the amount of amylase; that will tell you how many g of carbs to 1000 units of amylase. Then the next time you eat a meal, figure out the carbs and use the ratio to estimate your amylase units. If it’s above one pill size, you may want to round up to two (or one more to whatever number you typically take). You could also consider trying supplementing with OTC versions of pancrelipase and see if that works for you.

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