Pancreatitis: Symptoms, Causes and Natural Support Strategies
Pancreatitis can be a debilitating condition that results in overwhelming pain and malnutrition. Chronic pancreatitis in the United States results in more than 122,000 outpatient visits and more than 56,000 hospitalizations per year. Painful flare ups bring these patients in for help. The most common causes of pancreatitis and additional flare ups include alcoholism and obstructive gallstones in the liver that block the pancreatic duct.
As a healthcare provider, I feel compelled to help these patients deal with their pain naturally and relieve the causes as best as possible. Many of these patients experience their lives being changed forever due to an inflamed pancreas and they go to the medical doctor to receive pain medication and told to consume a low fat and low salt diet. This leaves the patient severely malnourished. They may be pain free, but the effects of opioids, NSAIDs, and malnutrition make the body function decline drastically.
Unfortunately, there is currently little research done on natural ways to overcome pancreatitis. However, this article will dive into the few natural support strategies that that can improve the health of the pancreas. It is important to note that the strategies I discuss are not currently FDA approved to prevent, mitigate, treat or cure pancreatitis and should not be confused as such.
Anatomy and Physiology
The pancreas is located in the upper abdomen close to the liver and rests just behind the stomach. It has a connecting entrance into the duodenum of the small intestine. The pancreas is known for having exocrine and endocrine functions, meaning that it secretes hormones externally and internally respectively.
The pancreas has a pancreatic duct, which runs along the middle of the pancreas and joins the common bile duct and enters the duodenum at the ampulla of Vater. This opening is surrounded by the sphincter of Oddi, which helps to control the rate at which the pancreas and gall bladder elicit secretions into the duodenum (1).
There are three main enzymes, which hare high in protein content and an electrolyte-rich fluid, secreted by the pancreas in order to digest food particles. The secretion itself is alkaline because of the high concentration of sodium bicarbonate present in the fluid.
The alkaline secretion enables the enzymes to neutralize the highly acidic gastric juice before it enters into the intestines. If the pancreas is not secreting enzymes correctly, the acidic gastric contents can go directly into the duodenum and become excruciatingly painful.
The main enzymes are:
- Amylase: Aids in carbohydrate digestion
- Trypsin: Aids in digestion of proteins
- Lipase: Aids in the digestion of fats
- Nucleases: Aids in the breakdown of Nucleic acids
Other enzymes are secreted to breakdown more complex foods, but these four are the main ones to be focused on. The secretion of these enzymes is stimulated by hormones produced in the gastrointestinal tract. Secretin is the major hormone that stimulates increased sodium bicarbonate secretion from the pancreas and the hormone released by the small intestine called CCK is the major stimulus for secretin.
Both of these are located in the cells of the duodenum. As soon as gastric juices enter into the duodenum, the pH and contents stimulate the release of these hormones that cause the pancreas and gallbladder to respond with bile and enzyme release. The vagus nerve also plays a role in exocrine pancreatic secretion (1).
The endocrine portion of the pancreas houses cells known as the islets of Langerhans. These are composed of alpha, beta, and delta cells. Insulin is produced by the beta cells, glucagon by the alpha cells, and somatostatin by the delta cells. These are the three hormones secreted internally by the pancreas that will be focused on here.
- Insulin’s function is to lower blood glucose by stimulating the uptake of glucose into the cells. Once it is pushed into the cells, it is either used for energy or stored as glycogen for later use. Insulin also promotes the storage of fat and protein synthesis. The level of insulin secreted by the pancreas is controlled by the amount of glucose in the blood.
- Glucagon has the opposite function of insulin. It is used to raise blood glucose by converting stored glycogen into glucose in the liver. Glucagon is secreted by the pancreas when blood glucose levels decrease.
- Somatostatin interferes with the release of growth hormone from the pituitary gland and glucagon from the pancreas. Both of these factors act to raise blood glucose levels while somatostatin acts to bring it down.
Significant dysfunction of the pancreas must occur before enzyme secretion is impaired and inhibits proper digestion of fats and proteins. Normal pancreatic enzyme secretion is between 1,500-3,000 mL/day (1).
As the body ages, or metabolic dysfunction ensues, there is an increase in the amount of fibrous material and fatty deposition in the pancreas. The rate of pancreatic secretion is decreased, which means decreased amylase, trypsin, lipase, sodium bicarbonate and other enzymes. This could be due to delayed gastric emptying and pancreatic insufficiency.
These malfunctions can cause decreased absorption of nutrients and result in many deficiencies. Promoting dietary choices and supplements that help maintain a healthy pancreas is crucial for nutrient absorption and overall health (1).
Pancreatitis is inflammation of the pancreas caused by the release of pancreatic enzymes into pancreatic tissue, which causes hemorrhage and necrosis. Hemorrhage means that there is excessive bleeding caused by tissue damage. Necrosis is premature cell death due to injury, disease, or lack of blood supply.
Typically, enzymes are not activated until they reach the inside of the intestines where the environment is able to handle activated enzymes. Therefore, when these enzymes get congested and release into the pancreatic tissue, the enzymes begin to digest the pancreas and this is extremely painful.
Most people are aging very poorly due to a number of lifestyle factors including poor dietary habits, exposure to environmental pollutants, medication usage, insufficient sleep, economic pressure and emotional stressors. These all impact the ability of the pancreas to function normally.
There are approximately 5,000 new cases of acute pancreatitis in the United States every year. This can be a deadly attack; studies show that the mortality rate associated with acute attacks alone is 10 percent.
The etiology is not completely clear but alcoholism and gallstones are the primary risk factors for acute pancreatitis, but there are still 20 percent of cases where the cause is unclear. Gallstones can obstruct the pancreatic duct or cause bile reflux, which can activate enzymes in the pancreatic duct system and cause auto digestion, inflammation, swelling, and pain in the pancreas.
Alcohol causes the duodenum of the small intestines to become edematous, or retain water. This causes an increase in pressure and spasm of the sphincter of Oddi and this can obstruct pancreatic enzyme flow. In addition, alcohol actually stimulates the production of more pancreatic enzymes so this just adds more pressure and swelling to the connection point of the pancreas and duodenum
Other causes include tissue ischemia related to trauma or surgery, pancreatic tumors, third-trimester of pregnancy, infections, elevated calcium levels, and hyperlipidemia. Medications that have associated with the disorder include thiazide diuretics, estrogen, steroids, salicylates, and NSAIDs (2).
Symptoms of Acute Pancreatitis
- Epigastric pain radiating to the back (often induced by a fatty meal or excessive alcohol intake)
- Nausea and vomiting
- Abdominal distention and rigidity
- Elevated heart rate
- Elevated temperature
Acute pancreatitis is a medical emergency and help should be sought immediately. The damage done by digestive enzymes on the pancreas can quickly escalate into bleeding internally, dying tissue, edema, pressure in the abdominal cavity, congestion and failure of other organs and lactic acidosis.
Treatment for acute pancreatitis is typically eliminating the cause, hydration and reintroducing food once the inflammation has gone away (2).
Causes of chronic pancreatitis are less clear because they typically do not have classic manifestations of the disease. However, these patients do suffer from long-term effects such as hormone imbalances, enzyme deficiency, chronic pain, and nutritional imbalances. Common characteristics of chronic pancreatitis include chronic inflammation, fibrosis and dysfunction of pancreatic tissue.
Currently, it is deemed by the medical field as irreversible and will eventually lead to pancreatic insufficiency. Alcoholism and malnutrition are the most common risk factors. Approximately 10-20 percent of cases have no identified cause. A genetic link has been made to a specific gene mutation associated with cystic fibrosis in these cases. Cystic fibrosis patients are likely to develop chronic pancreatitis as well.
When chronic pancreatitis is related to alcoholism, the concentration of insoluble proteins increases in the pancreatic secretions. This results in the calcification of the proteins and plug formation that blocks the pancreatic ducts and the flow of juices (2).
Other cases may be related to a stricture or stone that is blocking pancreatic outflow, which is known as obstructive pancreatitis. Recurrent episodes of inflammation will eventually lead to fibrotic changes to the tissues and loss of exocrine function, which leads to malabsorption and pancreatic insufficiency. When endocrine function is disrupted, diabetes may ensue.
Treatment for chronic pancreatitis typically evolves around pain management and aiding nutrition absorption. Surgery is also an option.
Patients are typically given opioids to control pain, which can worsen constipation. Non-steroidal anti-inflammatory medications (NSAIDs) are very common to give for inflammation. Most people believe NSAIDs are harmless. However, studies show that they damage the stomach lining, which leads to reduced protein absorption and a much greater increase for food allergens and stomach ulcers.
Pancreatic enzyme supplements are usually given to help with absorption. H2- blockers and proton pump inhibitors are typically given to neutralize or decrease gastric secretions, which further worsens the ability for the body to digest and absorb nutrients. This also slows gastric motility and can worsen constipation. This also puts the patient at risk for developing infections due to the sterilizing effects of stomach acid (2).
Low stomach acid levels are associated with increased risk of developing small intestinal bacterial overgrowth (SIBO), Candida overgrowth, B12, iron and zinc deficiencies. In addition, many individuals with low stomach acid develop protein malabsorption and leaky gut syndrome.
Endoplasmic Reticulum Involvement
There is little research to support the pathogenesis of pancreatitis but a new study has revealed that endoplasmic reticulum stress and calcium signaling could play a big role in this chronic disease. This finding has suggested the need for more research in this area (2). The endoplasmic reticulum is important organelle in human cells that plays a major role in producing, processing, and transporting proteins and lipids.
It produces transmembrane proteins and lipids for its membrane and other cell components such as lysosomes, secretory vesicles, the Golgi apparatus, and the cell membrane. Without this functioning properly, proteins and lipids cannot be transported and processed properly in order to form different structures that are needed. Damage to the endoplasmic reticulum has been found as contributing factor in many chronic diseases and is now recognized as a contributing factor to chronic pancreatitis.
Acute pancreatitis is caused by toxins that induce acinar cell calcium overload, zymogen activation, cytokine release and cell death, yet is without specific drug therapy. Mitochondrial dysfunction has been implicated but the mechanism not established.
Anti-Inflammatory Nutrition Plan
Eating a low salt and low fat vegetarian diet has been shown to decrease painful attacks (3). However, this does not provide the beneficial nutrients of fats and proteins and would leave the patient malnourished. Fats are a vital part of our diets for blood sugar stabilization, decreased disease, hormone production, cell production and protection, decreased inflammation, and overall function. A diet without quality fats is detrimental to our health.
In addition, consuming anti-oxidant rich vegetables from the cruciferous family including broccoli, kale, collards, cabbage, cauliflower and watercress is very beneficial for pancreas function. I also recommend using broccoli and kale sprouts, which provide easily absorbable nutrients needed to support the pancreas.
Using granny smith apples, lemons, limes and berries which are all loaded with anti-oxidants and tissue regenerative nutrients is highly recommended. Look to use as much anti-inflammatory herbs such as turmeric, ginger, cilantro, milk thistle, cinnamon, dandelion, parsley and cardamom whenever possible.
Use MCT Oils
One study was conducted to review the effects of a formula consisting of medium chain triglyceride (MCT) oil and hydrolyzed peptides on the pain associated with post meal pain for patients with chronic pancreatitis. The conclusion was that this formula minimally increased plasma CCK levels, which means that there was minimal stimulation of the pancreas. This proved effective for reducing the amount of pain these patients feel after a meal.
MCT’s are fatty acids present naturally in coconut and palm oils. They are great for stabilizing blood sugar and increasing ketone production. Ketosis is a state where the body is fat adapted and promotes decreased inflammation, steady blood sugar levels, weight loss, and optimal functioning.
MCT oil is effective in reducing inflammation, improving metabolism, and enhancing cognitive function. They are easily digested and do not rely on bile to be excreted from the liver, making them great for people with mal-digestion and absorption issues (4, 5).
Steps to Alleviate Acute Pancreatitis
If you are dealing with acute pancreatitis, then it is important to do a liquid fast with diluted bone broth, green juices, herbal teas and anti-oxidant extracts. It is important to go at least 3 days without any solid foods and absolutely no high sugar, protein or fatty foods. Solid foods put more stress on the pancreas and other digestive organs and will aggravate the symptoms.
Some great herbs for improving pancreatic function include milk thistle, holy basil, ginger, dandelion and turmeric. These herbs can be juiced, found in many organic herbal teas and also in supplements. Drinking water with lemon, lime or apple cider vinegar and various herbal teas is strongly recommended to soothe the pancreatic duct.
I also have my clients juice lemon or lime, ginger, dandelion, cucumber, celery and kale and make nutrient dense green juices. These help to naturally soothe the pancreatic duct and allow for optimal secretion of pancreatic enzymes. I have my patients rest as much as possible, stay hydrated with the recommendations above and use coffee enemas to help move out toxins and relax the pancreas and gallbladder.
Hydrolyzed peptides are easily digestible because they are broken down proteins. Hydrolyzed means to be broken down by water. Collagen is the most abundant protein present in the body and provides the building blocks for connective tissue, the musculoskeletal system, skin, hair, bones, and joints.
Vital proteins has produced a high quality collagen peptide that I recommend to my pancreatitis patients. Their sources are from pasture raised bovine hides to ensure a high quality product.
Adding MCT oil and hydrolyzed peptides to a low salt and low fat diet may be the best way to get fat and protein introduced to these patients when they are struggling with pain (6).
The diet should be advanced as tolerated to include more protein and fats to ensure adequate nutrition. Diluted bone broth protein and low doses of coconut oil mixed in with tolerable foods may be good beginning places for advancing the diet.
Supplements For Nutritional Benefit
Supplementation is extremely important for people struggling with chronic pancreatitis. None of the supplements I discuss here are currently FDA approved to prevent, mitigate, treat or cure pancreatitis and should not be confused as such.
A good systemic enzyme supplement should be used to help replace the lost enzymes due to pancreatic insufficiency (7). Systemic enzymes promote healthy neurological aging, healthy thyroid function, a healthy respiratory tract, central nervous system health and cardiovascular health.
In addition, they can be beneficial for breast health, skin health, coronary circulation health, prostate and sexual function health, reproductive function health, urinary tract and kidney health, knee and hip health, joint health, anti-inflammatory health, and recovery from exercise.
Systemic enzymes are best used away from meals to get into the circulation and break down inflammatory proteins. This can be extremely helpful to support a healthy inflammatory process and improve the bodies natural healing response.
Systemic and Digestive Enzymes
The systemic enzyme we use is called Proteo Enzymes and it can help with the pain, decreased absorption, and utilization of the nutrients that are absorbed. While it is not FDA approved at this time to prevent, mitigate, treat or cure pancreatitis, it can be very helpful. It should always be taken away from meals to ensure it dosn’t act as a digestive enzyme and instead has the whole body anti-inflammatory support we are looking for.
Meanwhile, when you are having food, it is is extremely beneficial to take a specific digestive enzyme to help metabolize the food for absorption. This is absolutely VITAL for individuals with pancreatic insufficiency. This enzyme is geared specifically towards the absorption of carbohydrates, proteins, and fatty acids. These enzymes are also designed to survive the variety of pH levels throughout the gastrointestinal tract.
Pancreatitis Pain Control
Controlling pain naturally and optimizing nutritional absorption are the most important interventions for pancreatic patients. If optimal nutrition absorption can occur without overstimulation of the pancreas in chronic pancreatic patients, this is the best method for controlling pain and increasing nutritional absorption. Unfortunately, these patients may still suffer from nutritional deficiencies but these methods will help the patient get to their optimal potential for their situation.
Using an anti-inflammatory protocol that decreases sugar, grains, processed foods, trans fats, and chemical exposure, can help promote a decrease in systemic inflammation and help with pancreatitis pain flare ups. (8)
Each pancreatic patient and their pain should be handled according the individual’s needs. Most likely, no two pain control regimens are going to be the same or tolerated the same by different individuals.
A review of studies came to a conclusion that antioxidant micronutrient therapy that supplied methyl and thiol proved effective for aiding in pain control for many patients. Many patients with chronic pancreatitis are deficient in antioxidants, which are vital for reducing free radicals and reducing inflammation. Using the herbs and foods listed in this article will provide the key methyl and thiol groups needed to support pancreatic health over time.
Natural Support Strategies For Pancreatic Health
Here are the best action steps to support your pancreatic health. It is important to remember that these strategies are not FDA approved to prevent, mitigate, treat or cure pancreatitis and should not be confused as such. You should always consult with your physician before stopping or changing medications or taking on new health strategies.
Additionally, you should be working with a functional health practitioner to help guide you through these strategies. This is not an exhaustive list and there are other natural therapeutic strategies that I and functional health practitioners will utilize to help individuals with pancreatitis.
1. Anti-inflammatory Diet and Lifestyle: Follow an Anti-Inflammatory nutrition plan here and consider the auto-immune diet diet, both of which you can find here These nutrition plans eliminate sugar and processed foods and use an elimination diet that restricts the foods allowed and slowly reintroduces to see what is flaring up the symptoms.
2. Refraining from NSAID and Opioid Usage: Using medications to control pain may provide some relief but they only cause more long-term problems for the pancreas. If you are in extreme pain, you may need the NSAIDs or opioides but you will want to get off of them as soon as possible and begin following the strategies in this article to support your body naturally.
3. Support Mitochondrial function: We discussed the role of the endoplasmic reticulum and the mitochondria in the development of pancreatitis. This article goes into detail on advanced strategies to improve mitochondrial function. In addition, there are specific supplements I use to support the mitochondria such as Brain Supercharge here
4. Control Pain Naturally: Use a liquid diet and a wide variety of anti-inflammatory foods and herbs such as turmeric, ginger, dandelion, lemon/lime, cilantro, kale, parsley, diluted chicken broth and others. Systemic enzyme supplements can also be very helpful to reduce pain.
5. Reduce Stress: Mental and emotional stressors dramatically effect digestive juice production, resulting in less stomach acid, bile and pancreatic enzyme production. Stress also creates an environment for gall stone formation and pancreatic inflammation. Take 5 minutes and focus on doing deep breathing at least 2-3 times daily. In addition, use a gratitude journal to focus on what is going right (as opposed to what you are frustrated about) and walk outside in nature daily to reduce stress levels.
6. Pancreatic Enzyme Supplements: Using systemic enzymes between meals or during a liquid fast will help to reduce pain and overall bodily inflammation. This is a great strategy to support overall pancreatic health. In addition, when solid food is introduced, be sure to use digestive enzymes such as Super Dzyme just before meals. Also doing things like chewing on ginger root and using a tbsp of apple cider vinegar in 4 oz of water about 15 minutes before the meal will help with enzyme production (9, 10).
7. Antioxidant Support: Using a wide variety of anti-oxidants can be very helpful for pancreatic health. You will get these from the foods and herbs I have listed for you to consume and also I recommend taking in extra vitamin C with bioflavonoids. I recommend using Super C, which has a 1:1 ratio of vitamin C and bioflavonoids which will reduce inflammation and tissue damage to the pancreas.
Remember, this product is not FDA approved to prevent, mitigate, treat or cure pancreatitis but it can be very helpful. To support acute pancreatitis, I recommend 2 caps – 6 times daily, while with chronic pancreatitis it is best to do 2 caps – 3 times daily.