The Pancreas: Don’t Mess With It?

In medical school I learned the first rule of surgery: “Eat when you can, sleep when you can, and don’t mess with the pancreas.”

It may seem funny that the pancreas, of all organs, is held in such high regard by surgeons. What would make it as notable to them as eating and sleeping? As it turns out, 95% of the cells in the pancreas manufacture enzymes that help to break down food (protein, fat, and carbohydrates), and these enzymes are so powerful that if they are released into the abdominal cavity, they can create massive damage to our own tissues. So a healthy respect for the pancreas is certainly in order, especially if you have a scalpel in your hand.

The pancreas is about 4 inches long and is located just behind the stomach. It contains a collecting system for enzymes that empty into the small intestine (along with bile from the gallbladder) when the presence of food is detected. This is how we turn tough food like steak into absorbable protein. The intestines have special protective coatings, including a mucous barrier, that prevent the pancreatic enzymes from harming them.

Most people associate the pancreas with insulin, its number one hormone product. Insulin is produced by the other 5% of cells inside the organ. Insulin triggers the body to remove sugar from the blood and use or store it for energy. Without insulin, sugar (contained in the carbohydrate-rich food we eat) remains in the blood, causing it to be sticky and thick. High levels of blood sugar (over time) can cause damage to small blood vessels that supply our eyes, toes, kidneys, and nerves. This is why people with diabetes (who either have too little insulin, or make no insulin) can develop eye damage, foot ulcers, nerve pain, and kidney failure over time. Of note, the pancreas also makes the hormonal antidote to insulin, called glucagon, which triggers the body to release sugar into the bloodstream when levels are low.

What can go wrong with the pancreas?

1. Pancreatitis – inflammation of the pancreas occurs when its digestive enzymes build up to high levels and begin to irritate its own tissue. Pancreatitis can be very painful, and is diagnosed with lab tests that check for high levels of pancreatic enzymes in the blood stream.
2. Pancreatic cysts – because the pancreas is very glandular and is constantly producing enzymes and hormones, it can develop fluid filled sacs, or cysts, that can cause structural problems.
3. Pancreatic Cancer – though rare, cancer of the pancreas is very dangerous. There are several sub-types of cancer, depending on which cells are affected. More information about pancreatic cancer is available here: http://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/home/ovc-20268502
4. Insulin Insufficiency – some people do not produce enough insulin to meet their body’s needs. Being overweight or obese can cause resistance to insulin and a higher insulin requirement. If the pancreas doesn’t keep up with the needs, “Type 2” diabetes develops.
5. Autoimmune destruction of insulin-producing cells – in some cases, our body’s immune system mistakes insulin cells for foreign invaders and attacks them. When these cells are destroyed, the body produces no more insulin, and “Type 1” diabetes results. People with type 1 diabetes cannot survive without insulin injections to replace their lost insulin production.

How to keep your pancreas healthy:

1. Avoid excessive use of alcohol – chronic alcohol consumption is the number one cause of pancreatitis.
2. Maintain a healthy weight – gallstones can hurt the pancreas by plugging up the common passageway that they, along with pancreatic enzymes, flow through to get to the intestine. Gallstones are more likely to form in people who are overweight or obese, or eat high fat diets.
3. Don’t smoke – cigarette smoking increases the risk of pancreatitis and pancreatic cancer.
4. Limit your consumption of sugary food and drinks and high fat and processed foods. They can increase the fat content of your blood, which can lead to pancreatitis.

The bottom line for pancreas health: eat healthfully (such as the Mediterranean diet), maintain a healthy weight, exercise regularly, and avoid drinking and smoking. I suppose you could say that “clean living” is the best way to avoid “messing with the pancreas.”

References
http://columbiasurgery.org/pancreas
http://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/home/ovc-20268502

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