The pancreas is a small pear shaped gland which hides behind the stomach, sneakily out of view and reach for physical exams and routine imaging. A fully functional pancreas performs an immense service to the body by aiding digestion and regulating blood glucose levels. These two broad functions have led to two pancreatic 'personalities' ('exocrine pancreas' and the 'endocrine pancreas') based on excretion from the pancreas through a duct (exocrine) or the bloodstream (endocrine). Pancreatic malfunction may be isolated to the exocrine pancreas or endocrine pancreas individually or may manifest as complete pancreatic disease (both endocrine and exocrine insufficiency). Luckily, the exocrine pancreas and endocrine pancreas do not work alone - a variety of other glands and organs participate in your exocrine and endocrine systems. Keeping everything in check can become a challenge when one or the other pancreatic functions is compromised.
The exocrine pancreas works in collaboration with the stomach, small intestine, liver and large intestine (in addition to other organs and processes occuring simultaneously) to break down the fats, carbohydrates, sugars and proteins consumed through food and drink. The role of the pancreas in this process is twofold: to neutralize stomach acid by excreting a basic bicarbonate solution and supply your intestines with digestive enzymes used to break down components of foods. For example, lipase produced by acinar cells in the pancreas acts by cleaving lipid bonds in triglycerides to make fatty acids. Our bodies can more readily absorb these fatty acids and use them in a variety of metabolic pathways, most notably in the regulation of inflammation. The exocrine pancreas also produces and excretes amylases and proteases to break down carbohydrates and proteins, respectively. Quite a heavy burden on one single gland, making its malfunction all the more significant. Exocrine pancreatic insufficiency (EPI) is a digestive condition in which, for a variety of reasons, the pancreas is either not able to produce or not able to excrete the bicarbonate and enzymes required for complete food digestion. EPI is not a disease of its own, but a symptom often recognized too late for preventative treatment. The clinical presentation of EPI (postprandial epigastric pain and steatorrhea) does not develop until over 90% of pancreatic enzyme output is lost. In the meantime, as the acinar cells slowly succumb to damage and cease enzyme production, the remaining organs and glands in the exocrine system make up the deficit (our bodies have incredible reserve capacities!). A few examples: salivary amylase (made in the mouth) begins the is initial breakdown of starches as you chew and gastric lipase (made in the stomach) facilitates lipid hydrolysis. These enzymes differ to those produced by the pancreas and offer only partial resemblance to the role pancreatic enzymes play in digestion. Treatment regimes for EPI include a low fat diet (max. 20g of fat with no supplemental enzymes) or what is known as PERT - Pancreatic Enzyme Replacement Therapy. Future posts will discuss the pros and cons of PERT and what products are on the market for EPI treatment.
The endocrine pancreas is a whole different ballgame, and one which enjoys attention from the media as well as the medical community. The body's relationship with the endocrine pancreas is the key to management of types I and II diabetes (T1D and T2D, respectively). In addition to the production of digestive enzymes (from the exocrine pancreas), the endocrine pancreas is responsible for the production and distribution of insulin. Insulin is a hormone, made by islet cells in the pancreas, which regulates metabolism - specifically regarding blood glucose levels - every second of every minute of every hour of every day. Even when you sleep. Whilst the exocrine pancreas takes a break between meals, the endocrine pancreas works around the clock to keep you feeling at your best. Malfunction of the endocrine pancreas is termed 'diabetes,' of which types I and II are the most common (gestational diabetes describes a third type, which occurs rarely during the later stages of pregnancy). Type I diabetes is an autoimmune disorder in which the islet cells in the pancreas are attacked by the immune system and produce little to no insulin. Those who have T1D are required to constantly monitor their blood glucose levels and dose with synthetic insulin to control hormone balance - every second of every minute of every hour of every day. Even when they sleep. Type II diabetes occurs when the body becomes resistent to insulin, for example, when sugar consumption prompts a constantly high blood glucose level. The endocrine pancreas is not able to supply the correct amount of hormone to bring these levels back down and the misuse of insulin becomes systemic. T2D is more common than T1D, and its occurence is growing at a rapid rate as we tend toward to more heavily processed and sugar filled diet. A variety of management techniques for T2D have been reported, and the condition is reversible, meaning that diet and lifestyle modifications have significant influence on the severity of symptoms - good news!
The pancreas, although hidden deep in the abdominal cavity, has huge influences on our daily lives. Its dual personality dictates what we are able to eat, which can be challenging in a society which is very food-centric. But being food driven is not bad. We find commonality, culture and enjoyment out of food - as we should! Taking care of your pancreas involves knowing your limits, specifically with respect to alcohol and fast foods, and giving your system a break when requested. The next time you enjoy a burger, savor the moment and thank your pancreas for the help!
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