how do I know how many enzymes to take?



I'm not pancreatic sufficient, but I've always followed a very low fat diet and therefore only take 6 zenpep 20s a day.
My BMI is 24 and I've always thrived on this type of diet.

I am starting a new supplement that is best absorbed with 10 grams of fat. How do I know how many enzymes to take? It seems like something I should know, but I honestly have no idea. I never talk to the nutritionist at clinic because there is never a need to and with my current diet if I forget enzymes, it doesn't really bother me.

Any help is appreciated.


New member
You should be dosing by grams of fat within the meal. For me I take one Creon 20 per 5 grams of fat in the meal. Remember the enzymes only work for 30-60mins after consumption. Dosage varies per person so you'll have talk to your nutritionist about how she originally calculated your dose. You then titrate up or down based on symptoms.


just try- I started with one and then up'ed it to 4 per meal


I am curious about this too. My daughter takes three per meal or snack as directed by her nutritionist but this has been the same for years. It was admittedly easier to know when to adjust dosage when she was in diapers and I could just talk to the nutritionist and adjust as needed.



Why don't you call your CF center and ask them?

Over the last 8 years I've been to three different centers. (I only switched because of convenience.) They all were great, and were always willing to answer any questions I had over the phone, by email, or via a text message.


Super Moderator
Good question. A lot of CFers taking enzymes wonder too.

The Creon metric contributed by Calebf assumes no contribution of enzymes by the body or total PI. Even then it is a SWAG because people are just different; What fats are being digested? What other foods are consumed with the fats? And simply how well do you chew your food? Creon is a cocktail of several different enzymes, lipase for example digests lipids or fats and protease breaks down proteins to amino acids, the goal of digestion.

Short of some specific testing that Printer might offer some insight into, doctors mostly rely on how we feel and they monitor markers in blood tests that would show failure to thrive or low vitamin and mineral assays in blood tests. When things really get out of whack, they do fecal studies to determine digestive quality.

Three years ago, I embarked on a scientific study of the CFer’s GI tract, and their issues. I was the test subject and had very good reasons to need scientific answers instead of waving of hands and such. I had just broken a six week log jam, and swore to fix my bowel health. There is a direct correlation between the fecal volume, elasticity and consistency, and the amount of enzymes a person takes.

Too little enzyme produces large volumes of feces, seemingly way too much for the food intake. The elasticity is mostly a quality of water in the fecal material, another problem of CF, however inadequate amounts of enzymes can slow digestion, allowing feces to linger in the bowel. A primary job of the large bowel is reabsorbing most of the water. If food lingers in the bowel, it is dehydrated and literally squeezed into hard stool. This limits the amount of nutrients the probiotic intestinal flora absorbs and it creates other problems like chronic constipation. It could be too little enzyme or too little hydration. Add hydration first, if that doesn’t solve the hard constipation, increasing enzymes until feces become pliant may be the right course, done with your doctor.

The sleeper symptom is fecal consistency, specifically, STICKY POOP. Several months back a contributor described their child’s poop as the consistency of peanut butter. As funny as it is to watch a pet lick peanut butter off the roof of their own mouths, applying that joke to the insides of your intestines and nobody is laughing. Distal Intestinal Obstructive Syndrome, or DIOS, a form of soft stool constipation is exactly this, pliant sticky feces that has adhesive qualities so fine it literally strips the intestines of their epithelia as it passes through and out the body. DIOS is potentially a life threatening condition as a soft blockage, underscoring the adhesive quality of mal-digested food. Many CFers live on the margin of a DIOS crisis and have never been told what to watch for. Enzymes may have a lot to do with DIOS, increasing mine eliminated it like magic.

For my money, most enzyme imbalance manifests as, mal-digested/mal-absorbed foods. Sticky poop means you need more enzymes. This is not a rule for everything but think through digestion. We chew food, mixing in saliva, a cocktail of water and the starch reducing enzyme amylase and it is swallowed by the stomach. Mostly a very strong mix of hydrochloric acid, sodium bicarbonate and some limited enzyme action, food is churned and mashed as the acid reduces the food to a thick, sticky paste we call chyme. Chyme squeezes down from the stomach into the duodenum where it is met by enzymes and bile from the pancreas and liver/gall bladder. The various enzymes have one of two goals, make sugars which are immediately absorbed and reduce the rest to amino acids, period. What isn’t an electrolyte, vitamin or water beyond the amino acids, is waste.

About a year and a half back, I was trying to get my insurance to cover a drug called relistor, a peripheral nerve antagonist that prevents narcotics from binding with nerves outside the brain. I had a condition known as iatrogenic narcotic bowel. My bowels were paralyzed by the powerful pain medications I need to take. My insurance would only cover relistor in a hospice environment, or if I was certified dead in six months, something like that.

I read everything on bowel health over the last sixty years and finally achieved daily pliant bowel movements. As delighted as I was, it was a painful BM, taking way too long to extrude massive amounts of peanut butter like feces. I began to increase my Creon intake and my stools began to lose volume, meaning it was being digested and absorbed by my intestines. Almost as soon as the fecal volume began to drop, the color darkened to a normal brown color instead of the pale paste it had been. With one last bump in my enzyme regiment the feces lost all adhesive quality and now it is almost pleasant compared to an hour on the toilet and two hours in bed afterwards.

Not a single doctor gave me any hint of what enough enzymes is like and how to tell if I had too much or too little despite my constant asking. I don’t quite get it, when I explained my remarkable improvement to my GI doctor he simply nodded and said the super sticky stool was due to mal-digestion of the food! For a moment I wished I had “Alien” enzymes, jeeeze!!! Too much enzyme may not show in your food, though most report diarrhea, it could silently kill your colon in time.

Yes Virginia, it comes down to the poop to get the straight poop.



New member
When your poop is hard and looks like pieces of poop clumped together, or if it becomes so hard and big that you have trouble pushing it out, then you're taking 1 too many. But be careful, too few enzymes can also cause constipation.

You have to go by trial and error according to what you eat.