Diabetes and Pancreatic Insufficiency: An Often Neglected Connection

Monday, April 17, 2017
By: Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

Millions of Americans have diabetes and if you are one of them, you know that your pancreas is stressed. Often the concern is about blood sugar management and preventing long-term damage. There is another condition that affects the pancreas called exocrine pancreatic insufficiency or EPI. Experts believe this is an overlooked concern and is interlinked with diabetes. 

[Jump to: Nutritional Options]

The Pancreas

The pancreas has a dual function in the body as an endocrine and exocrine organ essential for digestion, absorption, and use of nutrients with blood sugar and insulin. Pancreatic endocrine function is related with insulin. Pancreatic exocrine function relates to the production of pancreatic enzymes amylase, protease, and lipase that help with digestion. The pancreas secretes these enzymes through a small duct into the small intestine to digest carbohydrates, proteins, and fats once food has left the stomach.

The body produces large amounts of these enzymes when the pancreas is healthy. When the production of enzymes is lost, it is called exocrine pancreatic insufficiency or EPI. Western medicine has traditionally focused on the separate endocrine and exocrine function. For patients with diabetes, one sees an endocrinologist. For someone with fat malabsorption and digestive symptoms, patients will see a gastroenterologist. However, the link between insufficient pancreatic enzymes and pancreatic blood sugar dysregulation and diabetes has often been overlooked.

Researchers have been exploring the inter-related loss of pancreatic exocrine function and diabetes and have realized that there is much more of an inter-relationship than previously thought. In fact, studies demonstrate that loss of exocrine pancreatic insufficiency affects over 75 percent of type 1 diabetics and nearly 50 percent of type 2 diabetics. Many type 1 and type 2 diabetic patients are simply unaware of this concern. Individuals with EPI are diagnosed instead with irritable bowel syndrome, inflammatory bowel disease, or Crohn’s disease.

This dual relationship with EPI and diabetes cause and effect is recognized in type 3C diabetes which is a lesser known form of diabetes. Type 3C diabetes occurs as a result of pancreatitis, which impairs pancreatic enzyme production first. Inflammation scars the pancreas and damages insulin producing cells.

What is EPI?

Exocrine pancreatic insufficiency or EPI causes trouble with how you digest food. In EPI, the pancreas fails to produce enough enzymes or the duct that the enzymes travel through to the small intestine is blocked. Enzymes produced by the pancreas are amylase, protease, and lipase which break down carbs, proteins, and fats. Pancreatic insufficiency or EPI diagnosis usually occurs when 90 percent of the pancreas is non-functioning. Diagnosis is commonly made with a stool test that measures a specific pancreatic enzyme called fecal elastase-1. Optimal levels of fecal elastase-1 are between 200-500 mcg/g. Mild-moderate EPI levels is 100-200 mcg/g; severe EPI is below 100 mcg/g. 

Symptoms are similar to many other gastrointestinal disorders and include nausea, gas, bloating, and diarrhea, an oily appearance to the stool, anemia, fatigue, and SIBO. As pancreatic reserves are exhausted, concerns with weight loss, malnutrition, bone loss, blood clotting disorders, night blindness, neurological dysfunction, vitamin deficiency, and other signs of malabsorption occur.

Additional Causes of EPI

Acute or chronic pancreatic inflammation leads to pancreatic insufficiency and is considered the most common cause of EPI. Acute pancreatitis is often related to excessive alcohol consumption, high triglycerides, and medications like steroids, antibiotics, and blood pressure meds. Chronic pancreatitis is related to chronic alcohol intake, hereditary, or blocks in the duct where enzymes are released from the pancreas into the small intestine. Smoking, abdominal surgery, cystic fibrosis, gallbladder problems, pancreatic cancer, celiac disease/gluten intolerance, Crohn’s disease, and lupus can lead to pancreatic insufficiency. Research does not say that if EPI always causes diabetes in these other disorders, but one can see multi-directional effects in diabetes and EPI linked with celiac disease, and pancreatic cancer.

The understanding with this pancreatic dual relationship is to not ignore one or the other but rather to take steps to protect the pancreas. A recent review study found that pancreatic insufficiency occurred in 40 percent of individuals newly diagnosed with prediabetes or diabetes after an acute episode of pancreatitis. If you have diabetes and symptoms of gas, bloating, diarrhea, etc, it may be more than a little minor indigestion. It may reflect the need for pancreatic enzyme support. On the other hand, if you have a history of pancreatitis or pancreatic insufficiency, it is important to be evaluated for type 1, 2, or 3C diabetes. Basic lab tests may include pancreatic fecal elastase-1, fasting blood sugar, fasting insulin, and hemoglobin A1C.

EPI Support

In pancreatic insufficiency, the medical treatment is replacement pancreatic enzymes usually from pork. One of the most popular prescriptions drugs for EPI is Creon. Creon contains sodium lauryl sulfate and polyethylene glycol which raises the concern for cancer risks. It is an expensive drug often with other side effects. Keep in mind that treatment for EPI is usually long term or life long. Plant-based enzymes offer natural options without the risk. We use uncut plant based enzymes that survive stomach acid and function in a wide pH range.

Pancreatic Endocrine Support

Protection of the pancreas from oxidative stress is a primary focus. This is done through diet and nutrients. High dietary intake of fructose puts significant strain on the pancreas as it damages pancreas insulin producing cells and other tissues throughout the body. Besides high fructose corn syrup that should be avoided, other natural forms of fructose may need to be limited. Many of these foods are rich in antioxidants and provide nourishment, but the key is moderation. Fructose rich foods may include fruit and fruit juices, dried fruits, honey, maple syrup and sweet wines and fructan-rich foods like wheat products. To reduce the amount of stress induced by fructose, consume them with meals or reduce intake. The proteins, fats, and fibers and other forms of glucose buffer the stress effect on the pancreas from fructose.

Other pancreatic dietary support includes removing processed foods and other irritants like alcohol and smoking. Replace them with whole foods especially vegetables which are rich in enzymes. Remember to chew your food until it is liquid in your mouth. Lack of adequate chewing requires tremendous output of stomach acid and pancreatic enzymes to make up for the lack of mechanical breakdown of food. Follow the Five Rules of the Leptin Diet to help your body produce and use insulin in a natural ebb and flow circadian rhythm.

There are several nutrients essential to protect the pancreas from oxidative stress and damage. Green tea extract and quercetin have been shown to protect the insulin producing cells of the pancreas. The herbs, bitter melon, gymnema sylvestre and pterocarpus marsupium are highly valued for their protective effects on the pancreas and even regenerative impacts.

Pterostilbene is a powerful antioxidant similar to resveratrol for its superb protection with blood sugar and other metabolic disorders. Pterostilbene has been shown to protect pancreatic beta cells from oxidative stress. New research demonstrated that pterostilbene markedly improved glucose homeostasis, stopped pancreatic beta cell death and improved survival in mice.

Ellagic acid, one of the active compounds found in pomegranate and pomegranate extract has shown great promise in modulating several mechanisms that lead to diabetes and its progression. Research on this compound showed that it helped protect the pancreas, liver, brain, and fat tissue from inflammatory cytokines and cell death. It even helped to prevent diabetes associated complications. Grape seed extract also helps protect the pancreas from oxidative stress and inflammation.

Aging certainly plays a role in the health of the pancreas and the onset of EPI and diabetes. While we can’t turn back the hands of time, research shows us that resveratrol can help protect the pancreas against the oxidative stress effects of age. Animal research published this month demonstrated that resveratrol at a dose of 5 mg per 2.2 pounds per day which equates to about 350 mg/150 pounds per day in humans significantly reduced NF kappaB. Resveratrol modulated several other oxidative, cell damaging effects on the pancreas due to age.

Increased gut permeability or leaky gut syndrome is linked with type 1 diabetes development and type 2 diabetes. Healthy gut flora actually helps reduce oxidative stress on the gut and pancreas.

If you have blood sugar and digestive trouble, your pancreas is in trouble. It is likely that pancreatic enzyme support is needed in addition to healthy blood sugar management. While western medicine likes to compartmentalize functions and organs into nice neat categories, the reality is that the whole pancreas is affected and creates a ripple effect. EPI affects the whole body with the consequences of malabsorption, malnourishment and disrupted gut health. Diabetes affects the whole body too. This dual-purpose organ gets a workout with every bite of food, blood sugar management and the fitness level of digestion. Is your pancreas trying to tell you something?

Nutritional Options

Pomegranate – This natural compound provides a wide array of benefits. It is often used to support heart health, cholesterol, and reduce cancer risk. Because of its strong antioxidant protection throughout the body, research shows pomegranate extract protects the pancreas from significant inflammatory stress. The antioxidants found in pomegranate juice are degraded and lost with the pasteurization process whereas standardized extracts maintain good antioxidant activity.

Quercetin – Quercetin is known for its anti-histamine properties, but it also provides natural anti-inflammatory support. It works well with other antioxidants like grape seed extract, green tea extract, and cinnamon extract to protect and support the pancreas and insulin function.

Green Tea Extract –  Green tea extract has been used for thousands of years to help blood sugar and metabolism. Animal studies show that it protects beta cells or insulin-producing cells in the pancreas. Wellness Resources offers standardized green tea extract with 70% polyphenols, 60% catechins, and 30% EGCG.

Gymnema sylvestre – This Ayurvedic herb has a long-standing history in blood sugar management. It works to manage insulin and stabilize blood sugar. Gymneman helps support pancreatic insulin production. We have used it for several years to help reduce sugar cravings.

Plant based digestive enzymes – Digesting food well is a top priority for all. Eating large meals, processed foods, and rushing through meal time place high energetic demands on the pancreas. Gas, bloating, indigestion, diarrhea, constipation, food intolerances and allergies increase the need for enzymes. Wellness Resources provides enzymes that help digest gluten and dairy and soothing herbs that protect the digestive lining.

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