What is Pancreatin?
Pancreatin is an enzyme released by the pancreas that aids in the digestion of fats, carbohydrates, and proteins. It is a blend of various digestive enzymes, namely amylase, lipase, and protease.
What is the Pancreatin enzyme used for?
Since pancreas plays a vital role in the digestion of nutrients, pancreatin may be taken to accelerate digestion. In addition, pancreatin can help with several conditions where the pancreas does not function adequately to produce the required digestive enzymes. Some of these conditions include cystic fibrosis, pancreatitis (or inflammation of the pancreas), and surgical removal of the pancreas (called pancreatectomy). Other conditions known to benefit from pancreatin are celiac disease, autoimmune disorders, cancer, and food allergies.
How does Pancreatin work?
Pancreatin is four times more effective due to the presence of three digestive enzymes. The amylase in pancreatin breaks down carbs, lipase splits fats, and protease catalyzes proteins. Pancreatin breaks down the nutrients at the same time that the ingested food leaves the stomach.
Why is it necessary to substitute Pancreatin?
When pancreatin is not replaced in mandatory conditions or conditions associated with pancreatic enzyme deficiencies, it can result in food not being digested or absorbed adequately. This food primarily comprises of fatty foods and fat-soluble vitamins (i.e. vitamins A, D, E, and K). Inadequate absorption of dietary fats, also known as malabsorption of fats, depletes the body of nutrients and leads to bloating, abdominal discomfort, steatorrhea (passage of pale, bulky, oily, and foul-smelling stool that is difficult to flush away), and weight loss.
Moreover, the presence of undigested food in the intestines adversely alters the production of gastrointestinal hormones like cholecystokinin (or CCK). This, in turn, speeds up the emptying of food from the stomach, causing diarrhea and abdominal cramps. 
Data demonstrates that pancreatin is effective at reducing steatorrhea, fat malabsorption, and abdominal discomfort.  Enzyme replacement therapy ensures adequate delivery of pancreatin to the intestine at the same time that food reaches there and thereby optimizes nutrient digestion and absorption.
Undigested proteins that enter the bloodstream can be a source of food sensitivities and allergies. Owing to its protein-digesting properties, pancreatin can prevent the hard-to-digest protein particles from getting into your system, and thereby keeps food allergies at bay. 
Is Pancreatin Enzyme Replacement Therapy safe?
Pancreatic enzymes are considered to be safe with few side effects. The newer enteric-coated pancreatic enzyme formulations are more effective; however, very rarely they may be associated with scarring and shortening of the colon – a condition referred to as fibrosing colonopathy. This is particularly true in individuals with cystic fibrosis who are treated with high-dose pancreatic enzyme replacement therapy. 
A pancreatin enzyme formulation manufactured by Microbiome Plus is four times more potent than the individual pancreatic digestive enzymes.
Most formulations are included in pregnancy class C category, and their safety and use in humans are not evaluated. Whether pancreatic enzymes are passed in breast milk is yet to be determined. 
How is Pancreatin taken?
The enzyme is preferably taken with meals. The goal is to ensure adequate delivery of pancreatin at the right time (i.e. when the stomach empties the food contents) and at the right location (i.e. the small intestine. 
- Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clinical and Experimental Gastroenterology. 2011;4:55-73. doi:10.2147/CEG.S17634.
- Untersmayr E, Jensen-Jarolim E. The role of protein digestibility and antacids on food allergy outcomes. The Journal of allergy and clinical immunology. 2008;121(6):1301-1310. doi:10.1016/j.jaci.2008.04.025.
- Bansi DS, Price A, Russell C, et al. Fibrosing colonopathy in an adult owing to over use of pancreatic enzyme supplements. Gut. 2000;46:283-285.
- Trang T, Chan J, Graham DY. Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21st century. World Journal of Gastroenterology : WJG. 2014;20(33):11467-11485. doi:10.3748/wjg.v20.i33.11467.