Why is so little focus given to the pancreas?
An Internet search shows 5,890,000 results for endocrine pancreas while the exocrine pancreas show 1,420,000. A search of PubMed, a database of studies on life sciences and medical topics shows: 44,811 endocrine pancreas; 9447 exocrine pancreas. Quite the difference! So much focus is 1% of the pancreas. Why? It is simple. Where money flows research goes. There is money to be made with the endocrine pancreas. The exocrine pancreas that makes up 99% of the pancreas while 78% of the research is devoted to 1% of the endocrine pancreas.
What is the Pancreas? Normal Pancreas Anatomy & Physiology
It is a “silent,” solid organ positioned behind the stomach in the upper part of the abdomen. The pancreas is composed of 2 types of glands: exocrine (glands that secrete into a duct) and endocrine (glands that secrete into the blood). The exocrine pancreas, which comprises about 99% of the entire organ, produces pancreatic enzymes (amylase, lipase, trypsin, collagenase, elastase, and several others). The enzymes are released into the pancreatic duct, which, together with the common bile duct, opens into the duodenum. Most of the pancreatic enzymes (including trypsin, phospholipase A, and colipase) are produced as inactive precursors (also called proenzymes or zymogens). In other words, they are not activated until they reach the duodenum. For example, trypsin is activated when enterokinase (an intestinal enzyme) hydrolyzes (decomposes by reaction with water) trypsinogen.
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The endocrine pancreas (1% of the organ) is composed of clusters or islands of cells known as the islets of Langerhans (named for 19th-century German pathologist Paul Langerhans). Islets are composed of different types of cells that release pancreatic hormones: pancreatic beta (β) cells (the most abundant) secrete insulin, alpha (α) cells secrete glucagon, delta (δ) cells secrete somatostatin, and PP cells secrete pancreatic polypeptide.
The most important hormone the pancreas produces is insulin, which controls the amount of glucose in our bloodstream. When an insufficient amount of insulin is secreted, the body’s cells are unable to take in glucose, which raises glucose levels in the bloodstream and may ultimately lead to insulin resistance and then diabetes. In addition to insulin, the pancreas makes other hormones, all of which pass into the blood that flows through the organ (not through the ducts used by the enzymes).
What is the difference between exocrine and endocrine glands?
Exocrine gland: secrete hormones and other chemical messengers into ducts (duct glands) that lead directly into the external environment, i.e. stomach, mouth, small intestine, colon. Endocrine Gland: secrete their products, hormones, directly into the blood, i.e. thyroid, adrenals, and pituitary.
Abnormal Pancreas Anatomy & Physiology
Pancreatic secretion, like stomach secretion is regulated by both nervous and hormonal mechanisms. However, in the pancreas, hormonal regulation is by far the more important of the two. The enzymes necessary for digestion are volatile and cannot be stored. Because of this, they must be produced every time you eat. The thought and smell associated with eating stimulates stomach acid and pancreatic enzyme production before the food arrives.
Pancreatic Failure to Release Juices and Enzymes[i]When food mixed with stomach acid enters the intestine, it causes the release and activation of the hormone secretin, which is subsequently absorbed into the blood. This would make the small intestine an endocrine gland. The one constituent that causes the greatest secretin release is hydrochloric acid, though almost any type of food will cause at least some release.
The commonest cause of abnormal digestion is failure of the pancreas to secrete its juice into the small intestine due to a lack of stomach acid. Lack of stomach acid occurs with:
- Sympathetic dominance shuts off digestive organ function. This is a normal process. But constant stress or destruction of the pancreas can keep you locked into this state.
- Acute stress – causes loss of gastrointestinal (GI) immune system and an inability to protect the lining from damage from microbes.
- Chronic stress – causes an inability to repair the damage to the GI lining.
- Bacteria produce endotoxins, which shut off stomach acid production for their survival.
- Endotoxins cause the damage and thinning of the lining.
- Shuts off stomach acid production when the small intestine is distended by food or gas and bloating.
- Closes the Lower Esophageal Sphincter when stomach acid is produced.
Suppressed stomach acid production from stomach-acid-suppressing drugs:
- Prevacid (which is also available as a generic drug, lansoprazole)
Examples of over the counter antacids include:
- Alka-2, Surpass Gum, Titralac, Tums
- Milk of Magnesia
- Alternagel, Amphojel
- Gaviscon, Gelusil, Maalox, Mylanta, Rolaids
Examples of H2 blockers available over the counter include:
- Axid AR
- Pepcid AC
- Tagamet HB
- Zantac 75
Alkalizing diets or water
Put these points listed above together the next time someone says they have acid reflux. It may just be the irritation and pain is caused by something other than stomach acid. While enzymes require an alkaline pH to work, it requires stomach acid to release them from the pancreas. Alkalizing diets or drinking alkaline water neutralize stomach acid preventing the release, entrapping enzymes in the pancreas promoting pancreas destruction.
Too many people in the U.S. may be taking stomach-acid-suppressing drugs such as Nexium and Prevacid, new research suggests. The drugs, known as proton pump inhibitors, help those with serious stomach and digestive problems, but the risks may outweigh the benefits for people with less serious conditions, experts say.
Proton pump inhibitors can have rare but serious side effects, including an increased risk of bacterial infection and bone fracture, according to several new studies in the Archives of Internal Medicine.
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Proton pump inhibitors are among the most commonly prescribed drugs in the U.S. Nexium and Prevacid (which is also available as a generic drug, lansoprazole) are the two most popular proton pump inhibitors, according to the most recent government data. Other drugs in the class include Prilosec, Zegerid, Protonix, and Aciphex.
Two of the new studies found that proton pump inhibitors are associated with an increased risk of infection from bacteria.Lack of pancreatic secretion frequently occurs with:
▪ With gastric atrophy or achlorhydria
▪ In pancreatitis, which is discussed below
▪ When a pancreas stones block the pancreatic duct or gallstone at the papilla of Vater
▪ After the head of the pancreas has been removed because of malignancy.
Steve Jobs condition likely occurred in that order. Loss of pancreatic juice means loss of trypsin, chymotrypsin, carboxy-polypeptidase, pancreatic amylase, pancreatic lipase, and still a few other digestive enzymes. Without these enzymes, as much as ¾ of the fat entering the small intestine may go undigested and as much as a third to one half of the protein and starches. As a result, large portions of the ingested food are not utilized for nutrition: and copious, fatty feces are excreted evidenced in the Absorption section of the 2100 GIE.
Pancreatic Antimicrobial Defense
The pancreas defends itself from microbes by secreting protein threads, which microbes stick to preventing them from entering the pancreas. Chronic inflammation and presence of microbes in the upper GI tract results in continuous secretion of these threads resulting in intraductal plug formations blocking the pancreas ducts preventing the release of pancreatic juices and enzymes.
Pancreatitis means inflammation of the pancreas, and this can occur either in the form of acute pancreatitis or chronic pancreatitis. The commonest cause of pancreatitis is blockage of the ducts by stone formation. The stones block the main secretory ducts of the pancreas. The pancreatic enzymes are then dammed up in the ducts and acini of the pancreas. Eventually, so much trypsinogen accumulates that it overcomes the trypsin inhibitor in the secretions, and a small quantity of trypsinogen becomes activated to form trypsin. Free trypsin can activate not only trypsinogen but also three other digestive zymogens: chymotrypsinogen, procarboxypeptidase, and proelastase within the pancreas.[ii]
Once this happens the trypsin activates still greater quantities of trypsinogen as well as cymotrypsinogen and carboxypolypeptidase, resulting in a vicious cycle until all the proteolytic enzymes in the pancreatic ducts and acini become activated.[iii],[iv],[v]
Rapidly these digest portions of the pancreas itself, sometimes completely and permanently destroying the ability of the pancreas to secrete digestive enzymes. As large portions of the pancreas have been destroyed, leaving the person with diminished or sometimes totally absent pancreatic secretions into the gut. In addition to the pancreatic enzymes entering into the blood stream. [vi],[vii]
Pancreatic enzymes from the exocrine section will have access to the endocrine section where they enters the blood stream causing aneurism and varicose veins. From there the enzymes enters the lungs causing asthma, emphysema and Leaky Lung. The enzymes have access to the intestinal blood supply causing keritinization of lining – Diverticulosis, and digestion of tight junction proteins – impaired intestinal lining AKA Leaky Gut.
I have focused my studies on the exocrine pancreas. When a patient comes to me I put together custom made treatment protocols to support healthy pancreas function. If you have questions, call my office today.
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[i] Guyton AC, Textbook of Medical Physiology, 1971:778, 1991:738
[ii] Niederau C, Lüthen R. Current aspects in the pathogenesis of acute pancreatitis Praxis (Bern 1994). 1997 Mar 4;86(10):385-91.
[iii] McClave SA, Snider H, Owens N, Sexton LK. Clinical nutrition in pancreatitis. Dig Dis Sci 1997; 42:2035-44. [PMID 9365132]
[iv] Zhao G, Wang CY, Wang F, Xiong JX. Clinical study on nutrition support in patients with severe acute pancreatitis. World J Gastroenterol 2003; 9:2105-8. [PMID 12970916]
[v] Ioannidis O, Lavrentieva A, Botsios D, Nutrition Support in Acute Pancreatitis JOP. J Pancreas (Online) 2008; 9(4):375-390. JOP. Journal of the Pancreas – Vol. 9, No. 4 – July 2008. [ISSN 1590-8577] 375
[vi] Kaplan, P., Kuhn, C., and Pierce, J.: The Induction of Emphysema with Elastase. I. The Evolution of the Lesion and the Influence of Serum , J. Lab. Clin. Med. 82, 349, 1973
[vii] Talamo, R., Levison, H., Lynch, M., Hercz, A., Hyslop, N., and Bain, H.: Symptomatic Pulmonary Emphysema in Childhood Associated with Heredity alpha-1-Antitrypsin and Elastase Inhibitor Deficiency , J. Pediatr. 79, 20, 1971