Danger of High Dosages
The recommended dose (Editor's Note: predates publication cited above) for digestive enzymes is 1500 to 3000 Units of lipase per kilogram of body weight per meal. Doses above 6000 Units of lipase per kilogram meal, (or 4.5 MT-24 capsules per meal) have been associated with colonic stricture: the ascending colon becomes blocked, sometimes requiring a surgical solution. This has occurred predominantly in young males during the warmest summer months, and may be associated with dehydration. A rule of thumb is one MT-24 for each 18 grams, or 162 calories, of fat. For some people with excessive stomach acid, antacid may insure the enteric coated microtablets reach the digestive tract where the enzymes do their stuff.
Brand names: Pancrease; Cotazym
A First-Person Account
As I'm sure you've heard repeatedly, the symptoms and meds needed will vary considerably between PWCF. For the longest time, (my wife) and I were very concerned over what we felt was the excessively large enzyme doses prescribed for each meal. (My child) (PWCF) was taking three to four times the enzyme doses listed in the enzyme instructions as "typical". We were afraid his digestive system was getting worse and worse.
It took us about a year to come to understand that what works for others (especially the mystical "average" PWCF) isn't necessarily the best for (my child). Right now (my child), who is three years old, takes three Pancrease MT-20 _and_ one Creon-10 before each meal. He also takes Zantac twice daily to reduce stomach acidity, so the coating on the enzymes breaks down properly to release the enzymes. Before starting the Zantac we were using as many as five Pancrease MT-20 and one-to-two Creon-10 with each meal.
(My child)'s diet is consistently a little higher in fat and protein than I would normally plan for myself. We use ADEKs, vitamin-C, and Omega Oil as dietary supplements, and (my child) (surprisingly) loves raw carrots, celery and fresh vegetable juices (so much that we give him extra as rewards instead of sweets). Sometimes, *when* you give the enzymes makes a difference. Because (my child)'s often a picky eater at lunch, we usually give him one Creon-10 and one Pancrease MT-20 in yogurt just before he starts eating, and then give him the additional one or two Pancrease MT-20 during or after his meal (in the same yogurt), depending on how much he ate. Otherwise we give him the whole dose in applesauce a few minutes before he starts eating. For between-meal snacks we usually give one Creon-10 for cookies or a candy bar or a piece of cake. However, we really try to avoid giving him any sweets between meals, because he doesn't eat well following that. Instead, we give him a very small amount of pretzel, carrot, or celery sticks, or maybe a couple slices of fruit.
According to our CF doc, we need to give (my child) enough enzymes to break down most of the fat he eats, so that his stools are well-formed and not excessively foul-smelling or light-colored. At least once a year we collect samples of (my child)'s stool for several days, and the CF doc does a fat-content analysis to make sure he's really getting enough enzymes.
Having said all that, there are children with CF close to (my child)'s age that go to the same center and take wildly different enzyme doses. A good friend of ours also has a three year-old with CF who regularly takes five Pancrease MT-20 and one Creon-10. Some others do well on only two Ultrease (these didn't work well for (my child)). Your doctor should be the best source of advice for your child's treatment. He/she is (or should be) educated and experienced dealing with a wide variety of CF patients. It also doesn't hurt to seek the advice of a second doctor if you have doubts about your regular doctor. We did this once, and it help us better understand the dynamics of treatment.
<a target=_blank class=ftalternatingbarlinklarge href="http://cystic-l.org/handbook/html/digestive_enzyme_supplements.htm">Source of Information: Cystic-L.org Handbook </a>
