Fasting and Exercise for Fatty Pancreas

This post is a continuation of the previous article, Metabolic Syndrome and the Pancreas.  The recent post described the progression of the pancreatic disease from fat infiltration, nonalcoholic fatty pancreas disease (NAFPD) to nonalcoholic steatopancreatitis (NASP) characterized by chronic inflammation resulting in scarring and even pancreatic cancer in some patients. The pancreas serves a vital function in digestion and maintenance of a reasonable range of blood sugar.

Pancreatic Malfunctions

Fatty deposits in the pancreas can affect the production of pancreatic enzymes responsible for protein, fat, and carbohydrate digestion. The fat infiltrating between the cells of the pancreas interferes with the function. It destroys the acinar cells that produce the lipase, amylase, and proteases that digest fats, carbohydrates, and proteins, respectively. The leptin, which is an adipokine from the excess intraabdominal (visceral) fat, also decreases the production of the digestive enzymes. (1)

Metabolic syndrome leads to Type 2 Diabetes by affecting the insulin-producing capacity of the pancreas thru different mechanisms.

1. Early death (apoptosis) of the cells that produce insulin (Beta cells)
2. Toxicity from the high blood sugar (glucotoxicity)
3. Toxicity from high levels of fatty acids (lipotoxicity)
4. An abundance of substances from the visceral fat that causes inflammation (pro-inflammatory cytokines)
5. Increased leptin
6. Islet cell amyloid.

At the time of diagnosis, the beta cells maybe 50% of functional and as much as 60% at necropsy.

Can Medications Help?

Some medications for type 2 diabetes can help lower the blood sugar and improve beta-cell function but only to a certain extent. TZDs or thiazolidinediones, incretin mimetics, and enhancers.   TZDs lowers the blood sugar by making the fat cells more sensitive to glucose, which causes the glucose goes inside the fat cells. This results in a lowering of the blood sugar. However,  there is a resulting increase in the number and size of the fat cells and water retention leading to edema, weight gain, and heart failure. The very things that you don’t want to happen to anybody diabetic or not. A short period of insulin initially was shown to be effective at increasing the beta-cell function; however, insulin will make you fat and worsen diabetes in the long term. Another problem is that insulin does not address the issue of hyperinsulinemia in Type 2 diabetes.  The blood sugar may be controlled, but diabetic destruction continues. DPP – IVs like Sitagliptin and Vildagliptin have been studied to preserve and increase the beta cells. But since they are relatively new, it means that they are more expensive. (2)

Bariatric Surgery

Stomach (Gastric)  Surgery has been shown to improve the function of the beta cells by decreasing the food intake and consequent decrease in glucotoxicity and lipotoxicity. (3)  A study was done on pigs who underwent bariatric surgery, and it showed an improvement in the beta-cell function and beta-cell mass. (4) In a group of teenagers who were morbidly obese, their diabetes also improved after gastric bypass surgery (5)

Fasting and Exercise Can Bring Back Pancreatic Function

The initial recommendations for a patient with elevated blood sugar are mostly diet and exercise. This study was conducted in mice since it involves removing and studying the pancreas after 6 weeks of intermittent fasting. There was an increase in the pancreatic cell mass, insulin levels from the beta cells, and glucose-stimulated insulin secretion. (6)

In Finland, 28 healthy men and 26 pre-diabetic or Type 2 diabetic patients performed Sprint Interval Training (SIT) consisting of 4 – 6 episodes of all-out cycling effort lasting 30 seconds each separated of 4 minutes of recovery. Another group did Moderate Intensity Continuous Training (MICT). And they cycled for 40-60 minutes at an intensity of 60% of peak overload. The study was done in 2 weeks. After two weeks, the pancreatic fat decreased in both study groups. Pancreatic fat correlated positively with Body Mass Index (BMI), fat percentage, visceral fat, and fasting glucose concentration. Both exercise groups in the SIT and MICT showed a decrease in the fat content, abdominal fat, and glycosylated hemoglobin (HbA1c). A marker of blood sugar control. (7)

Fasting and exercise allow the body to use the normal body processes to heal itself. Both are affordable and available to all.

Related Readings:

1. Metabolic Syndrome and the Pancreas
2. Diseases Associated with the Metabolic Syndrome
3. How Does Exercise Burn Visceral Fat?
4. How to Do Intermittent Fasting
5. How to Perform High-Intensity Interval Training
6. Fatty Liver and Metabolic Syndrome
7. Gallbladder Diseases and Metabolic Syndrome
8. Kidney Stones and Metabolic Syndrome
9. Skin Signs of Secret Sickness
10. Management Principles Applied in Medicine

References:

1. Can pancreatic steatosis affect exocrine functions of the pancreas? Tahtacı M, Algın O, Karakan T, Yürekli ÖT, Alışık M, Köseoğlu H, Metin MR, Bolat AD, Erel Ö, Ersoy O.  Turk J Gastroenterol. 2018 Sep;29(5):588-594. 

2.Beta-cell failure in diabetes and preservation by clinical treatment. Wajchenberg BL., Endocr Rev. 2007 Apr;28(2):187-218. 

3. Insulin resistance and beta-cell function before and after sleeve gastrectomy in obese patients with impaired fasting glucose or type 2 diabetes. Eickhoff H, Guimarães A, Louro TM, Seiça RM, Castro E Sousa F. Surg Endosc. 2015 Feb;29(2):438-43. 

4. Gastric Bypass Improves β-Cell Function and Increases β-Cell Mass in a Porcine Model.  Lindqvist A et al., Diabetes 2014 May; 63(5): 1665-1671.

5. Insulin Sensitivity and β-Cell Function Improve after Gastric Bypass in Severely Obese Adolescents.  Inge et al., J J Pediatr. 2015 Nov; 167(5): 1042–8.e1. 

6. Intermittent fasting preserves beta-cell mass in obesity-induced diabetes via the autophagy-lysosome pathway. Liu H et al., Autophagy. 2017;13(11):1952-1968. 

7. Exercise training decreases pancreatic fat content and improves beta-cell function regardless of baseline glucose tolerance: a randomized controlled trial. Heiskanen MA et al., Diabetologia. 2018 Aug;61(8):1817-1828.

Image Credits:

• Pancreatic cells by Open Stax College from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/
• Gastric Sleeve Surgery photo By Manu5 – http://www.scientificanimations.com/wiki-images/, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=66621203
• Gym photo by Humphrey Muleba on Unsplash