Hi,
I had experience care for my son w/CF in Spain and in USA.
In Spain docs at Hospital Universitario Infantil Niño Jesus, Madrid, tell us to give the creon 5-10 min before meals, because this way when food reach the intestine, the creon is there ready to work. When we came to the States, 5 years ago, Docs tell us to give the enzymes just at the beginning of the meal. And they make fun of the care in Spain, btw.
I asked recently which is the right dose and what type of foods really need creon, because my son is not gaining weight, and the nutritionist tell me to give the enzymes only for foods that contains fats. She said 1 cap. of creon for every 5 grams of fats (creon 12). If the enzymes are only for fats, I wonder why they contain also protease and amylase (to absorb proteins and carbohydrates?) but nobody truly answer my question. The nutritionist at Nationwide Children's Hospital in Columbus, Ohio, decides the amount of enzymes based in annual blood tests, and the charts of percentile of growth, which are taken every 2 or 3 months. In Spain, beside blood work and track of the weight, we had to make every few months a very nasty test: Van de Kamer. This test consisted in keeping track for 3 days of ALL what my son ate, measuring every ingredient of the meal before cooking, measuring the leftovers, snacks, everything..., and, collecting, starting 1 day after the tracking of the ingested food, all the stools for 3 days. With this test, Docs were able to measure absorption and prescribe the right amount of enzymes. When I asked Docs in Columbus to do the same test, they said to me that this test was not necessary. Well, I am not a doctor, not a scientist....I really do not know what is the right thing to do... I am just a mom dealing for 8 years with CF... I feel I have developed a great intuition to anticipate was going on, before docs decide to take part... Sorry I have no answer for your question, I just shared my experience, just in case it could help you.
