Diabetes Complications

Pancreas: Functions and possible problems

Much like many of the organs in the human body, the pancreas is complex. Various things can go wrong with your pancreas and several diseases that can affect their functions.

In this article, we will explore what the pancreas is, which functions it performs, and how it is linked to key health problems like diabetes.

We will also look at the pancreas function and how you can help the health of your own pancreas (if this is in your control).

There will also be links to further reliable information sources where you can find out more.

What is the pancreas, and what functions does it perform?

The pancreas is located in the abdomen behind your stomach (1,2). It measures around 15cm and is composed of several parts. It plays a key role in turning the food that we eat into energy for our body’s cells.

As an endocrine gland, it functions mostly to regulate blood sugar levels, secreting the hormones insulin, glucagon, somatostatin, and pancreatic polypeptide.

As a part of the digestive system, it functions as an exocrine gland secreting pancreatic juice into the duodenum through the pancreatic duct.

The central pancreatic duct and a smaller accessory pancreatic duct, run through the body of the pancreas, joining with the common bile duct near a small ballooning called the ampulla of Vater.

A healthy pancreas is also essential for the maintenance of optimum blood glucose (sugar) levels (2,3). There are instances where this process can go wrong, although there are also things you can do to prevent or manage them.

We will be covering some of the key complications and management strategies in this article.

The pancreas is made up of three parts (1):

  • a wide end (the head)

  • a thin end (the tail)

  • and the central bit (the body)

It has two main functions:

  • exocrine functions

  • endocrine functions.

Exocrine pancreas functions help with digestion. The endocrine functions, among other jobs, help with regulating blood sugar. Hormones that the endocrine portion of the pancreas secretes include:

  • insulin and the hormone glucagon (key hormones in blood sugar control)

  • somatostatin

  • ghrelin (the hunger hormone),

  • pancreatic polypeptide.

Endocrine cells make up approximately 5% of the pancreas. These endocrine cells are arranged as something called the islets of Langerhans, which are made up of five different types of endocrine cells.

These include alpha cells, and critically, beta cells (1,2). In type 1 diabetes, it is these insulin-producing beta cells that eventually become worn out and stop producing insulin.

Type 1 diabetes is a relatively rare auto-immune condition, meaning that it is characterized by a person’s immune system ‘attacking’ their own body. You can read some more about type 1 diabetes here.

The most significant proportion of the pancreas is made up of exocrine tissues, which, as mentioned, help with digestion. Exocrine pancreatic tissues produce something called pancreatic enzymes (also known as digestive juices).

It is these enzymes that aid the digestive process. A healthy pancreas will produce around 1 liter (2.2 pints) of pancreatic enzymes per day.

They are secreted by the pancreas and flow down a tube (the pancreatic duct) into the duodenum (the part of the small intestine that is joined to the stomach). Here, they continue to aid with the digestion of food that has left the stomach (1,2). The enzymes made by the pancreas include:

  • proteases (such as trypsin and chymotrypsin) – which help to digest proteins.

  • analyze – which helps to digest sugars (carbohydrates).

  • lipase – which helps to digest fat

What health conditions can affect the pancreas?

Similar to other organs, various diseases can affect the pancreas. Health conditions that can affect the pancreas include, but are not limited to:

Acute pancreatitis signs and symptoms include

  • Upper abdominal pain

  • Abdominal pain that radiates to your back

  • Abdominal pain that feels worse after eating

  • Fever

  • Rapid pulse

  • Nausea

  • Vomiting

  • Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

  • Upper abdominal pain

  • Losing weight without trying

  • Oily, smelly stools (steatorrhea)

Hereditary pancreatitis signs and symptoms include:

  • Abdominal pain

  • Nausea

  • Vomiting

If you are experiencing any of the symptoms discussed above, you should tell your doctor. The National Pancreas Foundation, based in the US, has lots of useful information about the different types of pancreatitis.

With repeated bouts of severe acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis.

For those who have chronic pancreatitis, developing diabetes is relatively common. In the UK, the NHS state that around one in three people who have chronic pancreatitis develop diabetes.

When you have chronic pancreatitis, your pancreas may not effectively produce insulin. This can lead to diabetes and should be something that those with chronic pancreatitis are aware of (3). As with most medical conditions, there is some dietary advice you can also be aware of when you have pancreatitis.

Pancreatic cancer

Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

Cancer of the pancreas is the fourth most common cause of cancer death in males and the fifth most common in females. In the UK, pancreatic cancer is the eleventh most common cancer (2,4).

Another disease that can affect the health of the pancreas is cystic fibrosis (CF).

People who have CF have digestive issues that are linked, in part, to the pancreas. CF can prevent pancreatic enzymes from flowing down the pancreatic duct into the small intestine, as the ducts can become blocked with mucus.

This leads to the pancreas becoming inflamed, and therefore, less effective at producing digestive enzymes. A person with CF whose pancreas is affected in this way has ‘pancreatic insufficiency.’

For those with ‘pancreatic insufficiency’ as a feature of their CF, they have to rely on pancreatic enzyme replacement therapy (PERT), to help them digest and absorb their food (5).

PERT is a type of pancreatic enzyme supplements, which are taken with food. Chronic pancreatitis and pancreatic cancer can also lead to the need to take pancreatic enzymes (4).

What is the relation between the pancreas and diabetes?

As previously mentioned, the pancreas is responsible for the production of insulin. Insulin is one of the main hormones that control blood sugar.

If your pancreas is not effectively producing enough (or in the case of type 1 diabetes mellitus) insulin, your body cannot regulate your blood glucose levels. As a result, insulin cannot help transport glucose to the body’s cells for energy, it continues to build up in the blood (6).

If you are concerned about your blood sugar levels and whether they are normal, seek advice from a diabetes medical professional.

We have briefly covered the link between the pancreas and type 1 diabetes earlier in this article. Yet, to fully understand the connection between the pancreas and diabetes, it is important to know the difference between how problems with the pancreas can lead to the 2 main types of diabetes.

In type 1 diabetes, the way the body attacks the insulin-producing beta cells leads to them no longer producing any more insulin. This is when symptoms of diabetes begin to show, which, in type 1 diabetes, typically happens in childhood.

For those who have type 2 diabetes, the story is quite different. Your pancreas does not produce enough insulin, or the insulin that it does produce does not work effectively. Another way to describe this is that you develop insulin resistance. (7)

Insulin resistance and type 2 diabetes are often, although not always, related to body weight and lifestyle. Other key risk factors for an increased risk of developing type 2 diabetes are as follows:

  • Family history (it is more common if you have a first-degree relative who has diabetes)

  • Ethnicity (type 2 diabetes is more common among those from South Asian backgrounds

  • Age (type 2 diabetes is more common among Caucasians over 40, or those from South Asian backgrounds who are over 25) (7).

There are things that you can do to reduce your risk of developing type 2 diabetes. Eating a healthy diet, being physically active, and maintaining a healthy weight are all things you can do to prevent developing type 2 diabetes.

How can you maintain a healthy pancreas?

As the health of the pancreas plays an essential role in the prevention and management of type 2 diabetes, you are likely to want to know how you can support the health of this vital organ. For some people, this is out of their control, but for others, there are things you can do.

1) Limit alcohol consumption

It is widely agreed that if you drink alcohol, doing so within sensible limits is important for the health of your pancreas. Government recommendations, like these from the UK, can guide you toward what safe alcohol limits it.

If you have a pancreatic disease, always follow the advice of your doctor when it comes to alcohol consumption. Staying well-hydrated is also important for the health of your pancreas.

2) Enjoy a healthy diet

One of the other vital things you can do to help the health of your pancreas is to eat a healthy diet.

But what does that look like, you might be asking? With so many descriptions of what a ‘healthy’ diet is and countless claims from various foods and products that can help you achieve it, it’s no surprise that people are confused!

In the next section of this article, we hope to break in down for you and help increase your confidence when it comes to making nutritious food choices.

It is important to point out that a healthy diet looks different for everyone. For example, some people will benefit from more fiber and fewer fats.

In contrast, some people may need additional fat for increased energy needs, or may naturally eat a higher fat and protein diet if they manage their diabetes with a lower-carb diet.

When it comes to the main take-home messages, for eating a nutritious pancreatitis diet, it is widely accepted that you should aim to:

  • Eat more fruit and vegetables – aiming for at least 5 portions of a variety of fruit and vegetables per day

  • Eat more fiber-rich foods. You can achieve this by swapping starchy foods like bread, rice, and pasta from white to wholegrain versions, including nutritious beans, lentils, and pulses in your diet, including your intake of fruits and vegetables and snacking on nuts and seeds (ideally unsalted).

  • Having some sources of heart-healthy unsaturated fats, like olive oil, oily fish (mackerel, sardines, fresh tuna, salmon), nuts, and seeds. Remember that high levels of fat in your diet can lead to a surplus of calories being consumed. If you are trying to maintain a healthy weight, a high-fat diet can make this more difficult. You can read some more about the different types of dietary fats, here.

  • Try and avoid eating lots of processed confectionary foods, like sweets, cakes, and biscuits. There is no need to cut these foods out completely, but they are concentrated sources of sugar and can contain harmful trans fats, so they should not make up a large portion of your diet.

  • Cut back on salt. You can do this by adding less when you cook and at the table and choosing fewer processed foods such as sausages, salamis, and bacon; some vegetarian meat alternative products and tinned foods with added salt.

  • Think diversity! By including a wide range of foods in your diet, you are more likely to be getting a good overall balance of nutrients. Diet diversity, particularly of plant-based foods, is also generally great for your gut health.

  • Enjoy your food! Eating a healthy diet is, of course, very important for health. But try not to get too hung up on it as this can cause stress and an unnecessarily high focus on your diet. This can be detrimental to your health as much as, if not more than, having a poor diet.

3) Maintain a healthy body weight

Maintaining a healthy body weight can also help you to maintain a healthy pancreas. If you have excess fat, particularly around your abdomen, it can put pressure on your organs, including your pancreas.

This study reviewed the evidence behind excess abdominal fat and fat within the pancreas itself. It provides evidence that both types of excess fat can lead to the development of type 2 diabetes.

One way of determining if you are of healthy body weight is to know your body mass index (BMI). While BMI can be a useful measure, it does also have limitations such as the fact that it does not consider muscle mass.

Many are critical of the use of BMI for determining various health indices, such as its link with healthy body weight and maintaining good cardiovascular health. The question of whether so much emphasis should be put on BMI has been explored in this high-quality 2016 study.

Despite these differing opinions about what healthy body weight is, there is evidence that losing body weight can reduce your risk of developing type 2 diabetes. Numerous studies indicate that by losing 5% of your body weight when you are obese, you can reduce your risk of developing diabetes by up to 58%.

There is also evidence of people who lose weight achieving remission of their diabetes.

While for some people, they cannot influence the health of their pancreas; for others, there are lifestyle changes they can make to help maintain this organ in good working order. If you are concerned about your link with diseases of the pancreas, do not hesitate to contact your doctor.

Conclusion

The pancreas is a complex organ and is linked to several diseases. It is centrally related to our understanding of diabetes and how we digest our food.

Limiting alcohol, considering how your body weight may be impacting your physical health, and eating a nutritious diet, can all positively impact the health of your pancreas.

There are several places you can gain support and access evidence-based information about the pancreas. As always, consult your doctor if you have any specific medical questions or concerns.

Sources

  1. El Sayed, S, A and Mukherjee, S (2019). Physiology, pancreas. Online. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459261/
  2. Cancer Research UK. Pancreatic Cancer. Online. Available at: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/about
  3. Chronic Pancreatitis. Online. Available at: https://www.nhs.uk/conditions/chronic-pancreatitis/
  4. Pancreatic Cancer UK. Online. Available at: https://www.pancreaticcancer.org.uk/
  5. Cystic Fibrosis Trust. The effect of CF on the pancreas. Online. Available at: https://www.cysticfibrosis.org.uk/what-is-cystic-fibrosis/how-does-cystic-fibrosis-affect-the-body/symptoms-of-cystic-fibrosis/digestive-system
  6. Diabetes UK. Diabetes, the basics. Online. Available at: https://www.diabetes.org.uk/diabetes-the-basics
  7. Diabetes UK. Differences between type 1 and type 2 diabetes. Online. Available at: https://www.diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes

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