Pancreatic exocrine function

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The pancreas is a large gland which lies behind the stomach and upper gut. It has two major functions of clinical importance - firstly it acts as an endocrine organ to produce insulin and other hormones essential for the control of blood sugar. Secondly it has an exocrine function to produce enzymes essential for the digestion of food. These enzymes include those to digest proteins, fats and starches and to work best they need an alkali environment. This alkali environment is provided by the liver, which produces bile containing bile salts and bicarbonate. When food is present in the duodenum and jejunum, the gall bladder contracts sending a bolus of bile salts and bicarbonate which meet up downstream with pancreatic enzymes to allow digestion to take place in the duodenum and jejunum.

SYMPTOMS OF POOR PANCREATIC EXOCRINE FUNCTION

If the pancreas does not produce digestive enzymes then foods will not be digested. This can lead to problems downstream. Firstly, foods may be fermented instead of being digested and this can produce the symptom of bloating due to wind, together with metabolites such as various alcohols, hydrogen sulphide and other toxic compounds. Secondly, foods are not fully broken down so that they cannot be absorbed and this can result in malabsorption. Where there is severe pancreatic dysfunction it is obvious because the stools themselves become greasy and fatty, foul smelling, bulky and difficult to flush away. Where there is malabsorption of fat, there will be malabsorption of essential fatty acids such as the Omega 3 and 6 and there will be malabsorption of fat soluble vitamins such as vitamins A, D, E and K.

If foods are poorly digested, this results in large antigenically interesting molecules appearing downstream, which alerts the immune system and could switch on allergies, i.e. poor digestion of food is a risk factor for allergy.

DIAGNOSIS OF POOR PANCREATIC FUNCTION

A Comprehensive Digestive Stool Analysis looks at the different fats appearing in the stool and if these are raised, this points to poor pancreatic function. A faecal elastase is also a useful test.

TESTS OF DAMAGE TO THE PANCREAS

If there is acute inflammation in the pancreas, amylase levels may be raised. In acute pancreatitis there is severe dull central abdominal pain, which typically is relieved when the sufferer leans forward - that is because the weight of the stomach is pulled off the pancreas. Conventional medicine tells us a third of pancreatitis cases are due to gallstones, a third due to alcohol consumption and a third unknown. Actually this unknown category is almost certainly due to poor antioxidant status, particularly low levels of glutathione peroxidase (link to the ANTIOXIDANTS page below). This problem probably co-exists in all cases of pancreatitis and indeed is likely to be the mechanism by whihc alcoholism causes pancreatitis!

TREATMENT

Correction of the above factors, in particular poor antioxidant status.

Pancreatic enzymes - these are available on NHS prescription. Creon 10,000 contians phthalates and methacrylate see - [1] and whilst in theory it should be perfect, these toxins make it unsafe to use long term. One can buy pancreatic enzymes on the open market such as Polyzyme Forte, Spectrazyme, Digestaid and so on. I would recommend 1 to 3with meals, depending on the size of the meal.

I would also add in bile salts to emulsify fats (say 333mgs to 1,000mgs) and magnesium carbonate to provide an alkaline environment (500mgs to 2 grams depending on meal size), to be taken 60-90 mins after eating.

A study done on patients with food allergy showed that the majority of them either had hypochlorhydria, or poor pancreatic function, or both. What is interesting is that through correcting the hypochlorhydria with betaine hydrochloride and the poor pancreatic function with pancreatic enzymes, many symptoms due to food allergy were resolved. Supplementation is usually not for life - once the above factors are corrected the pancreas can recover and normal function is restored.

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