Silent but Deadly: The Body's Hidden Organ


Sweet Sorrow: The Problematic Pancreas Pancreas

In human adults, the pancreas is a flattened gland, about six to eight inches long. It is buried deep in the abdomen behind the stomach, where it connects the small intestine at the duodenum, just under the stomach. Also called the "hidden organ," the pancreas is not readily accessible and is thus difficult to examine by conventional methods. It is hidden, too, from our understanding, to a large extent.

Symptoms of a pancreatic disorder often mimic other common health problems, including simple indigestion. Little is known about the cause of such disastrous diseases as chronic pancreatitis, with as many as 40% of adult cases labeled "idiopathic," meaning of unknown origin.[sup1,2] Even pancreatic cancer is not well understood; so far, the most consistently reported risk factor for tumor development is cigarette smoking.[sup3] We do know this type of cancer is the fifth leading cause of cancer deaths in the U.S. and around the world. It is nearly always fatal; more than 98% of patients die, and its incidence is on the rise in industrialized nations.

Diabetes is, by far, the most renowned form of pancreatic disease wherein the pancreas either does not produce sufficient insulin, or, as is sometimes the case in adult-onset diabetes, the cells of the body simply do not respond to insulin's message. Other, even more silent and potentially more deadly disorders include ( 1) acute and chronic pancreatitis, each often very painful; ( 2) cystic fibrosis, which affects pancreatic function; and ( 3) organ tumors, either benign or malignant.

Finally, a little-known disease in which the symptoms might sound familiar is pancreatic enzyme insufficiency. This disorder can be mistaken for indigestion, and patients experience few or no symptoms at all while it slowly robs the body of important nutrients. When the disorder is left untreated, severe malnutrition can result.

There are two types of diabetes, type 1 (juvenile onset) and type 2 (adult onset). In type 1 diabetes, the pancreas produces insufficient or no insulin. Patients must have daily insulin injections, and they live on the balance beam between diabetic coma (too much acid in the blood from an inability to use blood sugar) and insulin shock (too much insulin taken to protect against diabetic coma).

Type 2 diabetes can actually occur at any age. The body produces plenty of insulin, but the cells have become resistant to its message. Type 2 diabetic patients are, more often than not, overweight, leading some to postulate that the constant barrage of refined carbohydrates (which release glucose into the bloodstream quickly after ingestion of table sugar or white flour) is at the heart of the disease.

Under normal circumstances, before a meal, we should have about one to two teaspoons of sugar circulating in our bloodstream. After a meal that is rich in refined carbohydrates (which break down quickly into glucose), there is a significant spike.

For example, a person might eat a hamburger with a bun, a small order of "french fries," and even a diet cola for lunch. Because of the way he digests certain foods, his blood sugar (glucose) level spikes quickly; he has just dumped as many as 12 teaspoons of sugar into his system. As a result of that burst of sugar, a healthy pancreas releases a burst of insulin, telling the body to take up the overload.

A healthy liver responds by taking up as much of the overload as it can (about 30 percent for short-term storage). Another 30 percent is used immediately as energy. The rest of it (up to 70 percent, depending on the actual amount taken up by the liver) is stored as fat. You might recognize that feeling of a temporary burst of energy, accompanied by feeling really good, followed by a marked decline and usually a mild case of "the blues."[sup4]

As a result of chemical reactions, including the fact that our brains need blood sugar to function, the body and the brain signal for more food, and we crave, in particular, carbohydrates having a high glycemic index. Our body receives a "signal" to obtain more sugar immediately. About halfway through the afternoon, we might find ourselves picking away at just half that candy bar we saved. A quick sugar spike, an immediate insulin spike, and more frantic messages to take up that sugar.

Just for a moment, imagine a friend or a loved one who constantly barrages you with frantic demands, such as "Quick, do this," or "Hurry up, do that!" Perhaps this will give you an idea of why our bodies begin to turn a deaf ear to the constant insulin scream that we subject ourselves to by eating a diet tilted toward carbohydrates, especially highly refined carbohydrates.

The "good" carbohydrates are low on the glycemic index; they release glucose more slowly, and spikes are avoided. "Bad" carbohydrates are high on the glycemic index and create spikes.

Other well-documented pancreatic disorders are acute and chronic pancreatitis. Acute pancreatitis occurs when the gland becomes quickly and severely inflamed. The major causes of pancreatitis are[sup5]:

* Heavy alcohol ingestion
* Gallstones or gallbladder disease
* Trauma
* Drugs
* High levels of fats in the blood
* Heredity
* Unknown factors

The main symptoms are severe pain in the upper abdomen, vomiting, fever, and tenderness of the abdominal area. Binge drinking is a common cause of the disease, as are gallstones, particularly when a stone becomes lodged in the main bile duct next to the pancreas. Sometimes, for unknown reasons, pancreatic enzymes break into pancreatic tissue, basically digesting the pancreas and damaging the tissue.

Chronic pancreatitis occurs mainly in alcoholics and binge drinkers. The major symptoms are recurrent, dull or moderate pain, without the severe toxic features of the acute form of the disease. The diagnosis of the acute and chronic forms is made by measuring blood enzymes and by performing abdominal computed tomography, radiography, and ultrasound examinations.

The pain and danger of both diseases are so great that sometimes patients become dependent on, or even addicted to, narcotic pain relief; surgery to remove all or part of the organ is sometimes recommended.
Cystic Fibrosis

Another disease that can affect the pancreas is cystic fibrosis, the number one genetic killer of children in the U.S. The body overproduces thick, sticky, mucus, which blocks the pancreatic ducts and inhibits the flow of pancreatic juice. Food cannot be digested properly without pancreatic juice. Without treatment, patients suffer from malnutrition and constant diarrhea. They have an average life span of 21 years. Replacement of digestive enzymes is the most common therapy.
Pancreatic Cancer

Cancer can arise anywhere in the human body, and pancreatic cancer affects men twice as frequently as women. It is most likely to develop after the age 40 years.[sup1]

Symptoms may include weight loss (in about 75 percent of those affected), abdominal pain, loss of appetite, jaundice (if the bile duct is blocked), itching, nausea, and constipation. Abdominal pain is generally characterized as the gnawing kind that occasionally spreads from the area of the stomach to the back. Weight loss is most often caused by loss of appetite, but it may also result from malabsorption of fats owing to an inadequate supply of pancreatic enzymes for digestion. The risk of this disease increases with chronic pancreatitis, diabetes, smoking, excess alcohol consumption, high-fat diets, and exposure to industrial chemicals such as urea, naphthalene, and benzidine.

There seems to be a genetic link, with the cancer occurring more commonly in blacks than whites. Because its symptoms mimic other everyday health problems, cancer of the pancreas often goes undetected until it is too late to be treated effectively. Approximately 95 percent of malignant tumors begin in the part of the pancreas that normally delivers enzymes needed for digestion into the duodenum. These tumors, known as adenocarcinomas, represent what is known as pancreatic cancer.[sup3]

Complete resection is the only effective treatment; however, because the disease is often diagnosed late, this surgical procedure is possible only in about 15 percent of patients. Even under these conditions, removal of pancreatic cancer is technically difficult. Complications have been associated with operations performed by nonspecialists.

Tumors that have spread to the abdominal cavity, liver, or lungs are seen in about 85 percent of patients with pancreatic cancer. At this stage, symptomatic control remains the primary focus of care. Although the results of radiation therapy and standard chemotherapy in the management of patients with unresectable pancreatic cancer have been disappointing, some patients have benefited from the use of gemcitabine or 5-flourouracil.[sup3]
Hormones and Enzymes: Endocrine and Exocrine Functions

Why are diseases of the pancreas so elusive?

Pancreatic hormones result from endocrine activity, as performed by the islets of Langerhans. From one to two million round islets of cells are scattered throughout the gland. The pancreas produces insulin and two other hormones: ( 1) glucagon, which releases stored glucose when blood sugar levels fall, and ( 2) somatostatin, which appears to act locally as a tissue hormone that inhinits the secretion of both insulin and glucagon.[sup6] It is only because of the prevalence of diabetes, which affects about 13 million Americans alone, that we think of the pancreas mainly and the insulin connection.

Of course, the pancreas is the insulin connection, but only about 2 percent of the organ is involved in hormonal (endocrine) production.[sup1] The other 98 percent produces and secretes pancreatic juice, vital for the proper metabolism of everything we eat. Known as the exocrine function, two major secretions originate in the pancreas:

* A watery liquid, rich in sodium bicarbonate, helps to ensure an alkaline environment in the duodenum for the proper digestion of food.
* A complete set of hydrolytic enzymes is designed for chemical processing and breakdown of most large molecules in the diet.

Pancreatic enzymes are stimulated by the presence of fat and protein in the duodenum. Initially, most of these enzymes are secreted in their inactive form, as larger pro-enzyme molecules, because pancreatic enzymes are so powerful that they can (and sometimes do) digest the pancreas itself, causing death within days.

The three basic pancreatic enzymes are ( 1) protease, which digests proteins, ( 2) lipases, which digest fat, and ( 3) amylase, which digests starches and carbohydrates.

In a complex and delicate ballet of body chemicals, the pancreas secretes and activates the enzymes that we need to digest and absorb our food. Without these chemicals we would die.

Dr. Edward Howell, considered by many as the father of modern food enzyme research, has written that a deficiency of food enzymes is a significant cause of premature aging and the development of degenerative disease. Cooking food at 118 degrees Fahrenheit or more, for more than one half-hour, kills all of the naturally occurring enzymes for digestion of that food, and many theorize that our American diet is a recipe for indigestion. Dr. Howell, who lived to be nearly 100, warns us that living on cooked food without enzyme supplementation results in enzyme exhaustion, a basis for weak immunity and, ultimately, for disease.

Nobel Prize recipient Jams B. Sumner, in his book The Secret of Life, tells us that people feel old after 40 because they are experiencing reduced enzymes in the body. More than 100 times more enzymes are present in the bloodstream of a newborn human than in that of an older person. Unfortunately, a reduced enzyme count or pancreas insufficiency often masquerades as common indigestion; patients have many complaints, such as bad breath, heartburn, belching, flatulence, abdominal bloat, constipation or diarrhea, skin problems, recurring headaches, muscle wasting, depression, insomnia, antacid dependency, post-meal mental fatigue, diminished concentration, and food allergies.[sup7] (In studies performed as early as the 1930's and 1940's, pancreatic enzyme supplementation was shown to be effective in preventing food allergies.[sup8])

A healthy pancreas produces about 1.5 quarts of pancreatic juice a day. Although starches and fats can be broken down without pancreatic enzymes, pancreatic proteases are crucial for protein digestion. Incomplete digestion of proteins creates a number of problems for the body, including the production of toxic by-products when incompletely digested protein putrefies (is broken down by bacteria) in the system. Proteases also keep the small intestine free from parasites such as protozoa, yeast, and even worms. A lack of proteases or other digestive secretions greatly increases the risk of intestinal infection.

People with pancreatic insufficiency often have pale, foul-smelling, bulky stools that stick to the side of the toilet or are difficult to flush. Patients might also have bone pain, muscle cramps, night blindness, and easy bruising as a result of malabsorption of fat-soluble vitamins.

Medical tests are available to determine your enzyme output, and several supplements can aid digestion.

The pancreas is more than just an insulin factory — it is vital for life. As with any course of action you might consider, if you recognize any of the symptoms in this article, consult a health care professional for your personal profile and the best course of action.




1. Reid, C.D. Probing the pancreas. FDA Consumer, October 1996.

2. Freedman, S. Chronic pancreatitis. The National Pancreas Foundation, 1999-2002.

3. Mayer, R.J. Pancreatic cancer. The National Pancreas Foundation, 1999-2002.

4. King, B.J. Fat Wars: 45 Days to Transform Your Body. Hungry Minds, Inc., 2002.

5. Pancreas disease.

6. Kapit, W., Macey, R.I., Mcisami E. Physiology Coloring Book, HarpeiCollins, 1987.

7. Eating with enzymes. Nutrition News, Vol 2.

8. Murray, M., Pizzorno, J. Encyclopedia of Natural Medicine, revised 2nd ed. Roseville, Calif., Prima Publishing (Crown Publishing/Random House), 1998.


By Gail German

Obese Children and Impaired Glucose Tolerance

Although the epidemic of child obesity has been reported in many medical journals, the link between obese children and impaired glucose tolerance remains less well known.

Researchers in New Haven, Connecticut, studied glucose metabolism in 55 obese children between ages 4 and 10 years and 112 adolescents between ages 11 and 18 years. One quarter of the children in the study and 21 percent of the adolescents were found to have impaired glucose tolerance. Asymptomatic type 2 diabetes was found in 4 percent of the adolescents. A parental history of type 2 diabetes, body mass index, and age had no relation to impaired glucose tolerance.

These results confirm the widely held suspicion that many obese children and adolescents have impaired glucose tolerance.

(Source: New England Journal of Medicine, 346:854; March 14, 2002.)

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