All You Need to Know about the Pancreas

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The pancreas, in the upper part of the abdomen, behind the stomach, is protected by the ribs to the rear. It isn’t a big organ – it’s around half the size of its owner’s hand – but it is a very important one.

“The most important digestive juices don’t come from the stomach, but from the pancreas. People can live without taking any medicine after having their stomach removed, but once the pancreas is gone, replacement enzymes must be given whenever someone eats anything,” says Dr Paul Ng, a Hong Kong-based specialist in gastroenterology and hepatology.

Ng explains that the pancreas is a factory that produces exocrine secretions, known as pancreatic juices, that are released into the gut.

They are mostly enzymes, and include amylase, which digests starch; protease (which digests protein); lipase (which digests fat); DNase (which breaks down DNA); RNase (which does the same for RNA); gelatinase (which breaks down gelatin); and elastase (which breaks down collagen).

The pancreas also performs an endocrine function, delivering important hormones into the bloodstream, including insulin, which lowers blood glucose, and glucagon, which raises it. Insulin forces excess sugar towards muscles and other cells to avoid the damage a sugar overload can cause. Glucagon, on the other hand, is produced when blood sugar is too low, and prompts the liver to release sugars.

It is a clever mechanism – but how does the pancreas know how much insulin to release at a given time and in what amounts? It has taste buds that are similar to those in the tongue. These taste receptors “taste” how sweet foods are and release the appropriate amount of insulin to support a balanced reaction to the resultant glucose.

The word pancreas comes from the Greek, pankreas; pan meaning “all,” and “kreas”, meat. So, pancreas literally translates as “all meat”, which describes its fleshy, rubbery appearance and may explain why in many parts of the world, people consider the pancreases of various animals as valuable.

The Chinese used ground dried pig pancreas as a medicine to treat diabetes more than 2,000 years ago, Ng says. And some cultures value certain animals’ pancreases, usually that of a calf or lamb, and call this culinary treasure sweetbread.

Early physicians could not explain the function of the pancreas and considered it little more than a shock absorber – on account of its rubbery texture and its location: they believed it was there to protect the stomach from the spine.

In the mid-17th century, German anatomist Johann Georg Wirsung established that the pancreas is connected to the duodenum via a small duct; in 1642 he named this the “duct of Wirsung”. Later it became known as the pancreatic duct.

The function of the pancreas was not established until the very late 19th century and the beginning of the 20th century when some extraordinary advances were being made in the field of chemistry.

It was at this point that scientists came to understand that the juices the pancreas produced aided digestion. They realised this digestive ability was based on “ferments” which they noticed were present in these secretions. Today we know those ferments as enzymes.

Slowly it was understood that these enzymes break down food particles into molecules so that they can be absorbed by the intestines – until 1902, it was believed that the brain did that job.

Only in the last century have we begun to understand the pancreas well – and much of that knowledge is thanks to the work of scientists in the first half of the 20th century.

So which illnesses can affect this clever little organ? Pancreatitis and pancreatic cancer, says Ng, who notes that “both can cause severe pain in the stomach region and sometimes back pain.

“Pancreatitis is a nasty condition – it is triggered by any sort of damage to part of the pancreas, which then leads to a leak of pancreatic juice causing the digestion of one’s own body – because, remember, the pancreas has the wherewithal to digest protein, fat, DNA, RNA, collagen and more.”

A person can survive without a pancreas but only, says Dr Ng, with “pancreatic enzyme replacement and insulin injections” to do the jobs it does naturally.

Sometimes, he says, “after a bad episode of acute pancreatitis, or after very prolonged chronic pancreatitis, the pancreas is ‘eaten away’ by the process and becomes absent functionally”. And sometimes the pancreas must be surgically removed – in the case of cancer, for example.

Pancreatic cancer is among the most common types of cancer in both men and woman. There are more than 380 new cases each year in Hong Kong – and around 53,000 in the United States.

The mortality rate of pancreatic cancer is often high. Symptoms may include central or upper abdominal pain, weight loss, jaundice, steatorrhea (fatty stool) or newly developed diabetes. In most patients, symptoms do not appear until later stages of the disease, when it is often too late to treat or control.

Oddly, patients with rarer forms of pancreatic cancer – which account for about 5 per cent of cases and include neuroendocrine tumours (as opposed to the more common adenocarcinomas) – often have a more favourable outlook.

Risk factors for pancreatic cancer include age, being male (it has claimed the lives of, among others Luciano Pavarotti, Steve Jobs, and Patrick Swayze), smoking and a history of obesity and diabetes.

The pancreas, warns Ng, “is not a fan of alcohol: sometimes we see patients die from severe acute pancreatitis after bingeing. Toxins such as certain mushrooms and medicine can also trigger pancreatitis.

“Gallstones sometime get stuck near the pancreas causing pancreatitis, too. Uncontrolled diabetes and high triglyceride blood levels (cholesterol) can cause pancreatitis too.”

This clever, compact organ has a key role to play in your health, so remember to take care of it, too.

Source : SCMP

For Inflamed Pancreas, Eating Right Away May Be Best Medicine

Getting hospital patients with mild pancreatitis to start eating sooner may speed their recovery, a new study says.

The finding challenges the long-held belief that these patients should avoid solid food for days.

The University of Michigan researchers analyzed studies that included nearly 1,000 people hospitalized for pancreatitis. This is when the pancreas becomes inflamed, causing pain and swelling in the upper abdomen. Some common causes include gallstones and chronic alcohol use, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Patients with mild pancreatitis who were given food by mouth or by feeding tube within 48 hours of admission had fewer symptoms such as nausea, pain and vomiting.

They also had faster recoveries and spent less time in the hospital, the study authors said.

The risk of hospital readmission, complications or death was no higher than among patients who weren’t given food until several days after being hospitalized.

While the evidence of benefits was weaker in patients with more severe pancreatitis, there was no harm in having them begin eating earlier in their illness either, the researchers said.

The study was published in the Annals of Internal Medicine.

“Food does more than just provide nutrition. It stimulates the gut and protects your body from harmful bacteria that might enter through the bowels,” study author Dr. Valerie Vaughn said in a university news release. She is a clinical lecturer in general medicine at Michigan’s medical school.

“Historically, we’ve been taught that if the pancreas was inflamed, eating would cause it to release more digestive enzymes and may worsen the situation — so whatever you do, don’t feed patients,” Vaughn explained.

“Then, studies in Europe began to suggest that patients did fine if they were fed early, so we started feeding when lab values or symptoms reached a certain point,” she said.

“Now, our thinking has moved all the way toward letting them eat immediately. Our thought process over the years has really changed, and we hope this study will lead to consideration of early feeding for more patients,” Vaughn concluded.

Source: HealthDay

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Researchers Find Magnesium Intake May be Beneficial in Preventing Pancreatic Cancer

Indiana University researchers have found that magnesium intake may be beneficial in preventing pancreatic cancer.

Their study, “Magnesium intake and incidence of pancreatic cancer: The Vitamins and Lifestyle study,” recently appeared in the British Journal of Cancer.

Pancreatic cancer is the fourth leading cause of cancer-related death in both men and women in the United States. The overall occurrence of pancreatic cancer has not significantly changed since 2002, but the mortality rate has increased annually from 2002 to 2011, according to the National Cancer Institute.

“Pancreatic cancer is really unique and different from other cancers,” said study co-author Ka He, chair of the Department of Epidemiology and Biostatistics at the IU School of Public Health-Bloomington. “The five-year survival rate is really low, so that makes prevention and identifying risk factors or predictors associated with pancreatic cancer very important.”

Previous studies have found that magnesium is inversely associated with the risk of diabetes, which is a risk factor of pancreatic cancer. But few studies have explored the direct association of magnesium with pancreatic cancer; of those that did, their findings were inconclusive, said Daniel Dibaba, a Ph.D. student at the School of Public Health-Bloomington, who led the IU study.

Using information from the Vitamins and Lifestyle study, Dibaba and the other co-authors analyzed an enormous trove of data on over 66,000 men and women, ages 50 to 76, looking at the direct association between magnesium and pancreatic cancer and whether age, gender, body mass index, non-steroidal anti-inflammatory drugs use and magnesium supplementation play a role.

Of those followed, 151 participants developed pancreatic cancer. The study found that every 100-milligrams-per-day decrease in magnesium intake was associated with a 24 percent increase in the occurrence of pancreatic cancer. The study also found that the effects of magnesium on pancreatic cancer did not appear to be modified by age, gender, body mass index or non-steroidal anti-inflammatory drug use, but was limited to those taking magnesium supplements either from a multivitamin or individual supplement.

“For those at a higher risk of pancreatic cancer, adding a magnesium supplement to their diet may prove beneficial in preventing this disease,” Dibaba said. “While more study is needed, the general population should strive to get the daily recommendations of magnesium through diet, such as dark, leafy greens or nuts, to prevent any risk of pancreatic cancer.”

Source: Indiana University

Type 2 Diabetes Reversed by Losing Fat from Pancreas

Type 2 diabetes is caused by fat accumulating in the pancreas – and that losing less than one gram of fat through weight loss reverses the diabetes, researchers have shown.

Affecting two and a half million people in the UK – and on the increase – Type 2 diabetes is a long-term condition caused by too much glucose, a type of sugar, in the blood.

The research led by Professor Roy Taylor is being published online today in Diabetes Care and simultaneously he is presenting the findings at the World Diabetes Congress in Vancouver.

Bariatric surgery

In a trial, 18 people with Type 2 diabetes and 9 people who did not have diabetes were measured for weight, fat levels in the pancreas and insulin response before and after bariatric surgery. The patients with Type 2 diabetes had been diagnosed for an average of 6.9 years, and all for less than 15 years.

The people with Type 2 diabetes were found to have increased levels of fat in the pancreas.

The participants in the study had all been selected to have gastric bypass surgery for obesity and were measured before the operation then again eight weeks later. After the operation, those with Type 2 diabetes were immediately taken off their medication.

Both groups lost the same amount of weight, around 13% of their initial body weight. Critically, the pool of fat in the pancreas did not change in the non-diabetics but decreased to a normal level in those with Type 2 diabetes.

This shows that the excess fat in the diabetic pancreas is specific to Type 2 diabetes and important in preventing insulin being made as normal. When that excess fat is removed, insulin secretion increases to normal levels. In other words, they were diabetes free.

Drain excess fat out of the pancreas

Professor Taylor of Newcastle University who also works within the Newcastle Hospitals as part of the Newcastle Academic Health Partners said: “For people with Type 2 diabetes, losing weight allows them to drain excess fat out of the pancreas and allows function to return to normal.

“So if you ask how much weight you need to lose to make your diabetes go away, the answer is one gram! But that gram needs to be fat from the pancreas. At present the only way we have to achieve this is by calorie restriction by any means – whether by diet or an operation.”

In patients who had started with Type 2 diabetes, fat levels in the pancreas (pancreatic triglyceride) decreased by 1.2% over the 8 weeks. Very exact methods were needed to be able to measure this and a new method using a special MRI scan was developed. With an average pancreas for a person with Type 2 diabetes having a volume of 50 ml, this is the equivalent of around 0.6 grams of fat.

However, the patients who had never had diabetes saw no change in the level of fat in their pancreas demonstrating that the increase in fat in the pancreas is specific to people who develop Type 2 diabetes. Importantly, individuals vary in how much fat they can tolerate in the pancreas before Type 2 diabetes occurs.

Transforming the thinking on Type 2 diabetes

Traditionally, Type 2 diabetes has been thought of as a progressive condition, controlled by diet initially then tablets, but which may eventually require insulin injections.

It affects 9% of the global population and was once known as adult-onset diabetes but is now found in young adults and children. It causes too much glucose in the blood due to the pancreas not producing enough insulin – a hormone which breaks down glucose into energy in the cells – together with insulin resistance, a condition in which the body responds poorly to insulin.

Previous work by Professor Taylor and his team highlighted the importance of weight loss through diet in reversing Type 2 Diabetes. This work in 2011 transformed the thinking in diabetes as it was the first time that it had been demonstrated that diet could remove fat clogging up the pancreas allowing normal insulin secretion to be restored.

Professor Taylor adds: “This new research demonstrates that the change in level of fat in the pancreas is related to the presence of Type 2 diabetes in a patient. The decrease in pancreas fat is not simply related to the weight loss itself. It is not something that might happen to anyone whether or not they had diabetes. It is specific to Type 2 diabetes.

“What is interesting is that regardless of your present body weight and how you lose weight, the critical factor in reversing your Type 2 diabetes is losing that 1 gram of fat from the pancreas.”

Newcastle Academic Health Partners is a collaboration involving Newcastle University, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Northumberland, Tyne and Wear NHS Foundation Trust. This partnership harnesses world-class expertise to ensure patients benefit sooner from new treatments, diagnostics and prevention strategies.

Source: Newcastle University

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