If you take pancreatic enzymes (PERT) and they do not seem to be working, the problem is usually timing, not dose. Most people are told the number of capsules and almost nothing about how to take them. That gap is where the bloating, the urgency, and the greasy stools come back.
Here is what actually matters day to day. Your dose is between you and your doctor. How you take that dose is something you can get right starting at your next meal.
Take them with the first bites, not before
Enzymes need to mix with food in your stomach and move through with it. Swallowing them ten minutes before you eat means they arrive early and leave early. Take the first capsule as you start eating.
Spread them across a longer meal
A capsule released at the start of a 30-minute meal is mostly spent by the time dessert arrives. For a long or large meal, split the dose: some at the first bites, the rest partway through. This single change fixes more enzyme problems than any dose increase.
Match the dose to the fat, not the clock
Enzymes are for digesting fat. A big plate of plain rice needs far less than a smaller plate with oil, cheese, or meat. Snacks with fat need enzymes too. A black coffee or a piece of fruit usually does not.
Do not crush or chew enteric-coated capsules
The coating protects the enzymes from stomach acid so they release in the small intestine where they work. Crushing or chewing destroys that. Swallow them whole with cool or cold drinks. Heat can damage them, so do not stir them into hot soup or tea.
Store them properly
Keep them at room temperature, out of heat and direct sun. A capsule that has been sitting in a hot car all summer is not the capsule you think it is.
If they still are not working
Timing fixed and still having symptoms? Two common causes are too low a dose for what you are eating, and high stomach acid breaking the coating early (which is why some people are prescribed an acid reducer alongside). Both are conversations to have with your doctor, with specifics: what you ate, how much you took, when, and what happened after.
Related: flare vs attack, how to tell the difference. This post is condensed from the book.
Not medical advice. Enzyme dosing is individual and set by your medical team. This covers timing and handling only, the part you control at the table.