The pancreas is an organ essential for digestion and blood sugar regulation. Many diseases are associated with the pancreas, including pancreatitis, type 1 and type 2 diabetes. This article will discuss what the pancreas is, including its role in the body. We’ll then discuss conditions associated with the pancreas, how they're diagnosed, and how functional medicine testing can help to further evaluate them. Complementary and integrative treatment options will also be discussed.
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What is The Pancreas?
The pancreas is an organ located inside the abdomen, behind the stomach. It has an elongated shape with a head and a tail. The head of the pancreas lies near the duodenum (small intestine), with the tail of the pancreas pointing upward near the spleen. The tissue of the pancreas is composed of two types of glands: endocrine and exocrine. The endocrine glands of the pancreas consist of cells called islets of Langerhans, which release hormones. The exocrine glands of the pancreas release digestive enzymes into smaller ducts which connect to the main duct, the pancreatic duct, which will eventually connect to the bile duct and then the small intestine.
What Is the Pancreas' Role in The Body?
The pancreas has two main functions: endocrine and exocrine. The islets of Langerhans are the cells that make up the endocrine glands of the pancreas. These cells produce and release hormones that affect blood sugar (glucose). The two main hormones produced are insulin and glucagon. These two hormones work opposite of each other: insulin lowers blood sugar while glucagon raises it. Blood sugar regulation cannot be understated; having proper blood sugar levels is important for major organs, including the brain, kidneys, and liver. The exocrine functioning of the pancreas includes the production and release of digestive enzymes. There are different enzymes for the different macronutrients. The enzymes trypsin and chymotrypsin break down proteins, amylase breaks down carbohydrates, and lipase aids in fat breakdown. When food enters the stomach, the pancreas begins to produce these enzymes and then sends them through ducts into the small intestine. Bile, produced by the liver and stored in the gallbladder, will also be released into the small intestine and, together with the pancreatic enzymes, will aid in digestion.
What are the Top Medical Conditions Associated with The Pancreas?
The top medical conditions associated with the pancreas include pancreatitis, type 1 diabetes and type 2 diabetes. Let’s discuss each condition:
Pancreatitis
Pancreatitis is inflammation of the pancreas. The inflammation occurs when the digestive enzymes that are produced in the pancreas, rather than flowing into the small intestine, leak into the tissues of the pancreas and cause swelling, irritation, and inflammation. The two most common causes of pancreatitis include excessive alcohol use and gallstones. Additional causes include cystic fibrosis, elevated triglycerides (fats), high calcium levels (hypercalcemia), certain medications, abdominal trauma, surgeries, and certain infections. Pancreatitis can be acute or chronic. Acute pancreatitis symptoms include fever, nausea, vomiting, swollen and tender abdomen, and a decreased appetite and weight loss due to pain. Chronic pancreatitis symptoms include severe abdominal pain radiating to the back, diarrhea with greasy stools, and weight loss.
Type I Diabetes
An autoimmune process attacks the pancreas's insulin-producing cells, resulting in Type I diabetes. This lack of insulin results in elevated blood sugar. While the onset of disease can occur at any age, it commonly begins in childhood and thus is often referred to as “juvenile diabetes.” People with type 1 diabetes may have the following symptoms: increased hunger and thirst, blurry vision, unintentional weight loss, fatigue and weakness, dry skin, increased urination, recurrent infections, numbness and tingling in the hands and feet, and slow wound healing.
Type II Diabetes
Type 2 diabetes is when the body stops responding to insulin, and thus blood sugar is elevated. There are both lifestyle and genetic factors that cause type 2 diabetes. Lifestyle factors include diets high in refined sugar, fats, and processed foods, lack of exercise and obesity, and disruptions in the body’s circadian rhythm or sleep-wake cycle. Genetic and hereditary causes include a family history of type 2 diabetes and certain ethnicities, including Native Americans, Asian Americans, African Americans, Pacific Islanders, and those of Hispanic descent. Symptoms of type 2 diabetes include feels of fatigue, blurred vision, increased hunger and thirst, frequent urination, frequent infections, areas of dark skin, slow wound healing, and tingling and numbness in the hands and feet.
How are Pancreatic Diseases Diagnosed?
Blood tests and imaging studies can be used to diagnose pancreatic diseases.
Pancreatic Imaging
Pancreatitis diagnosis will often include an ultrasound or computed tomography (CT) of the pancreas to assess for inflammation and structural abnormalities. The ultrasound will also evaluate the bile duct and gallbladder since they are connected and often involved in pancreatitis. An internal ultrasound, called an endoscopic ultrasound or endosonography, involves the insertion of a thin tube with a tiny ultrasound attachment into the stomach and small intestine that will give a clearer picture of the pancreas and ducts. Lastly, an endoscopic retrograde cholangiopancreatography involves inserting dye into the pancreatic or bile duct and evaluating the movement of the dye with a tiny camera that is inserted into the stomach.
Pancreatic Enzymes
Two pancreatic digestive enzymes, amylase and lipase can be measured in the blood, such as the Amylase, Lipase test by Access Med Labs. In acute pancreatitis, the levels of both enzymes will be elevated.
Advanced Blood Sugar Panel
Markers related to blood sugar, including glucose, insulin, and HbA1c, can be used in the diagnosis of all three discussed pancreatic conditions as the pancreas is responsible for blood sugar regulation. HbA1c is a measurement of the body’s average glucose level over the prior three month period and is used in the diagnosis of prediabetes and diabetes.
Functional Medicine Labs That Can Help Individualize Treatment for Patients with Pancreas Disease
There are many functional medicine labs that can be used to individualize treatment plans for pancreatic conditions. Two of the most commonly used are:
Micronutrient Panel
Reduced amounts of micronutrients, including vitamins A, C, E, and selenium, are associated with an increased risk of developing pancreatitis. Additionally, due to the effect on digestion, chronic pancreatitis can lead to malabsorption of nutrients. Due to this, deficiencies of fat-soluble vitamins A, D, E, and K, and also vitamins B1, B12, folate, magnesium, and calcium, have been found in chronic pancreatitis. Additionally, vitamin D deficiencies have been associated with both type 1 and type 2 diabetes. For type 2 diabetes, a lack of chromium, inositol, and magnesium has also been associated with disease development. Micronutrient tests will assess all of these micronutrients on one convenient test and thus can help to distinguish if micronutrients are playing a role in the pancreatic conditions, pancreatitis, and/or type 1 and type 2 diabetes.
Comprehensive Gut Testing
A comprehensive gut test, such as the GI Effects-3 Day test offered by Genova Diagnostics, can assess markers associated with pancreatic diseases. For type 1 and type 2 diabetes, looking at the microbiome on these tests is important. The microbiome is a collective group of organisms that inhabit the large intestine. These microbiomes aid in a number of functions in the body, including digestion, absorption, immune and inflammation modulation, hormone metabolism, and more. A dysbiosis occurs when these microbiomes are imbalanced, meaning there may be more “bad” microbes than “good.” Research has shown that dysbiosis can increase the risk and enhance the progression of type 1 diabetes and is also associated with type 2 diabetes. This stool test also evaluates elastase, a digestive enzyme released by the pancreas that is associated with chronic pancreatitis. Lastly, a marker for leaky gut is also shown. Leaky gut occurs when there is increased permeability in the small intestine which allows for particles not yet ready for absorption to enter the bloodstream. Leaky gut is associated with many autoimmune conditions; type 1 diabetes is one of them.
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Conventional Treatment for Pancreatic Diseases
Acute pancreatitis can often resolve with lifestyle and dietary changes such as removing alcohol. However, in certain cases, immediate medical attention may be needed. In some cases, surgeries are warranted.
Type 1 diabetes is treated with supplemental insulin. Type 2 diabetes can be treated by a variety of blood sugar-regulating medications, but insulin may also be needed.
Complementary and Integrative Medicine Treatment for Pancreatic Diseases
Complementary and integrative medicine treatments for pancreatic disease can include nutrition, supplements and herbs, and acupuncture.
Nutrition for Patients With Pancreatic Disease
The Mediterranean diet has been recommended for pancreatitis, type 1 and type 2 diabetes. The Mediterranean diet is an anti-inflammatory way of eating, consisting of beans, legumes, minimally processed whole grains, fatty fish, olive oil, nuts and seeds, fresh fruits, vegetables, herbs, and spices. This diet has been shown for helping with blood sugar regulation, which is why it is deemed appropriate for the three pancreatic conditions being discussed. Consuming a wide variety of nutrient-dense foods, like with the Mediterranean diet, can help ensure all micronutrient levels are maintained.
Additionally, diabetic patients may want to try the Diabetic Plate Method as recommended by the American Diabetic Association. This method recommends organizing a food plate by macronutrients. They recommend, half of the plate be filled with vegetables such as broccoli, kale, and cauliflower. One-quarter should be filled with lean proteins, including chicken, lean beef, eggs, shellfish, and turkey. Carbohydrates should fill the last quarter of the plate, including starchy carbohydrates such as potatoes, squash, and green peas; whole grains, including brown rice, oats, pastas, and popcorn; fruit and dried fruits; and dairy products, including yogurts and milks.
For pancreatitis, avoiding large meals and focusing on small meals throughout the day can help.
Top Supplements and Herbs That Help With Pancreatic Diseases
There are many supplements that integrative practitioners use to help heal the pancreas. The top pancreatic supplements and herbs include:
Berberine for Type 2 Diabetes
Berberine is a plant extract with many physiological actions, including anti-inflammatory actions. Berberine may be helpful for those with type 2 diabetes. In a meta-analysis of 38 studies including over 4,000 participants with either type 2 diabetes or prediabetes, berberine was shown to reduce blood sugar, cholesterol, and inflammatory markers when given alone or in combination with the diabetic drug Metformin.
Omega 3 Fatty Acids for Pancreatitis and Type 2 Diabetes
Omega 3 fatty acids are fats required by our bodies to make cell membranes and modulate clotting, inflammation, and blood vessel constriction and dilation. For acute pancreatitis, one to two tablespoons of fish oil reduced inflammation, mortality, and infection risk, as well as reduced the hospital stay length in one study.
A study on type 2 diabetes with dyslipidemia (high cholesterol levels, including high triglycerides or fats) demonstrated that supplementation with omega-3 fatty acids in conjunction with the diabetic medication metformin significantly reduces triglyceride levels.
Dose: Acute Pancreatitis: 1-2 tablespoons of fish oil
Dose: Type 2 Diabetes with dyslipidemia: 2 grams per day
Vitamin D for Type 1 and Type 2 Diabetes
Vitamin D is a fat-soluble vitamin primarily made from UV sun rays. Multiple studies have shown a link between vitamin D deficiencies and the development of type 1 diabetes. There is a 29% risk reduction in developing type 1 diabetes with vitamin D supplementation early in life. Vitamin D was also shown to modulate immune factors in those with type 1 diabetes.
In type 2 diabetes, vitamin D has been shown to improve glucose and insulin levels while lowering inflammation and cholesterol.
Dose: Type 1 diabetes: 2,000-4,000 IU/day or 70 IU/kg of body weight with insulin therapy
Duration:Type 1 diabetes: 3-18 months
Dose: Type 2 diabetes: 500-4,000IU/day
Duration: Type 2 diabetes: Minimum 3 months
Curcumin for Diabetes
Curcumin is an active component in the Indian spice turmeric. Multiple studies on type 2 diabetes have shown curcumins' ability to lower blood sugar levels, including lowering Hba1C, cholesterol, and markers of inflammation. Additionally, curcumin has been shown to reduce hunger-related hormones in diabetics as well.
Dose: 80- 2,000 mg/day
Duration: 4-12 weeks
*Dose and duration will depend on the type of curcumin administered and if taken with or without other diabetic medication.
Acupuncture for Pancreatic Conditions
Acupuncture is a traditional Chinese Medicine modality and has been used for thousands of years. The goal is to move the body's energy force, known as qi (pronounced CHEE) with the insertion of tiny needles into the skin.
Acupuncture for Acute Pancreatitis
A meta-analysis of 19 studies and over 1,500 people showed that acupuncture in combination with conventional therapy had significantly improved outcomes in patients with acute pancreatitis, including reducing abdominal pain and swelling. Because of its favorable results, more studies are recommended.
Acupuncture for Type 2 Diabetes
Acupuncture may be effective for type 2 diabetes. In type 2 diabetic patients, acupuncture can improve blood glucose and Hba1c levels.
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Summary
The pancreas is an essential organ for life. Disruptions in the functioning of the pancreas can affect digestion, absorption, and blood sugar regulation. Many of the body's systems are affected by these processes, and thus the function of the pancreas can affect the entire body. Functional medicine testing can help to further evaluate conditions of the pancreas, including pancreatitis, type 1 and type 2 diabetes. And complementary and integrative treatments can be excellent options for treatment due to their efficacy, as shown in various studies.
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