I am not a doctor and this is not medical advice. This is one patient telling you about a gap I fell into, so you can ask the question I did not know to ask.
Here is the chain nobody explained to me at discharge. A damaged pancreas makes fewer enzymes. Fewer enzymes means you digest fat less well. And four vitamins, A, D, E and K, can only ride into your body on fat. So when fat absorption drops, those four can quietly drop with it, even if you feel like you are eating fine.
They are called the fat-soluble vitamins, and they are the ones most likely to run low in chronic pancreatitis and in exocrine pancreatic insufficiency. Vitamin D is the one most people have heard of, partly because low D is common in everyone, but low A, E and K show up more specifically in pancreatitis patients. Low vitamin D over time also pulls calcium out of the picture, which is why people with long-term pancreatitis are at higher risk of thinning bones.
The frustrating part is that none of this shows on a standard blood panel. Your regular check-up will not flag vitamin A or E unless someone deliberately orders it. The current European guidance on pancreatic insufficiency actually recommends periodic screening for these deficiencies, and yet in real life most of us are never tested.
What I actually did
I asked my gastroenterologist to check my fat-soluble vitamins and my vitamin D specifically, and to think about bone density given how long I had been dealing with this. I did not self-prescribe megadoses off the internet. Fat-soluble vitamins store in the body, so more is not automatically better, and vitamins A and D can actually be harmful in large doses. That is exactly why you want a level checked first, then a plan, rather than guessing.
If you take enzymes, taking them properly also matters here, because better fat digestion means better vitamin absorption. Getting the enzyme timing right is half the battle.
Stepan’s Rule: Ask for the fat-soluble vitamin panel by name: A, D, E and K, plus your vitamin D level. If the answer is “we do not usually check those,” that is the moment to ask why not.
Where this lives in the book
The full picture, which tests to ask for, how enzymes and vitamins connect, and the questions to bring to each appointment, is laid out in the PancreasZen book. It is the guide I wish someone had handed me on the way out of the hospital.