Balancing diet and enzymes in cystic fibrosis

For kids with cystic fibrosis (CF), taking pancreatic enzymes with meals and snacks helps the digestion and absorption of the nutrients in food. This is important for numerous reasons. It helps fight infections, keeps lungs as healthy as possible, and provides essential nutrition needed for growth and remaining active. 

The enzymes are small coated beads that come in capsules. Enzymes should be taken with food. Stomach juices break down the capsules releasing the enzymes in the small intestine. Kids with CF need help digesting and absorbing nutrients from food.  

Enzyme capsules should be taken at the beginning of each meal and snack.  For younger children and infants who cannot swallow the capsules, the beads in each capsule can be opened and mixed with a small amount of soft acidic food like applesauce. 

How much enzyme is needed? 

When enzymes are started, your doctor or dietitian will estimate the amount needed using your child's weight and usual diet as a guide. The amounts are in terms of the amount of lipase in the capsule. Lipase digests the fat in food. It's usually about 500 to 750 international units (IU) of lipase per pound of body weight. So a 10 pound baby may get 5000 IU of lipase with each bottle. A 40 pound child might start on 20,000 to 30,000 IU with each meal with about half that amount for a snack. 

A supplemental drink or a particularly fatty meal needs even more enzymes. Usually 2,000 IU of lipase for every gram of fat in the supplement or the recipe.

Monitoring the Balance

 Stool tests and your child's weight gain will indicate whether the amount of enzymes needs to be adjusted. If your child isn't gaining well or the bowel movements seem to be greasy or loose, the amount of enzyme may need to be increased. If your child is constipated, the enzyme may need to be reduced at mealtime, snacks or both.