Metabolic Syndrome and the Pancreas

Posted on by Jesse Santiano, M.D.

What is the Pancreas? 

The pancreas is a vital organ located behind the stomach. It makes digestive enzymes and the hormones insulin and glucagon. It is connected to the gallbladder system and intestines by small tubes that conduct the bile and digestive enzymes to go to the duodenum to digest fat, carbohydrates, and proteins. Insulin and glucagon are hormones that travel in the bloodstream that regulate blood sugar.

Blausen_0699_PancreasAnatomy2

Pancreatitis

Acute pancreatitis means inflamed pancreas. The most common cause of pancreatitis is a stone coming from the bile duct. Any stone in the bile duct is abnormal, and metabolic syndrome contributes to its formation. This article describes the association between metabolic syndrome and bile duct formation.  Alcohol abuse used to be the most common cause of pancreatitis, but the biliary duct stone from the metabolic syndrome has overtaken it.

Acute pancreatitis is very painful. It is the “Bring me to the hospital!” type of pain. The pain is usually middle just under the ribs and radiates to the back. The pain is magnitudes worse than heartburn and may even mimic a heart attack. Profuse sweating, nausea, and vomiting are present. Diagnosis is confirmed by an elevated serum lipase. Some patients may need a CT scan of the abdomen to define the severity. In rare cases, the severely inflamed pancreas can literally melt (necrotizing pancreatitis) and release all the digestive enzymes that will cause the rest of the abdominal organs to be inflamed and infected. Severe pancreatitis has a high mortality rate. Patients with pancreatitis should be hospitalized for bowel rest, observation, pain control, and continuous intravenous fluids.

Pankreatitis_exsudativ_CT_axial
The massive, blurry grayish thing in the middle is the inflamed pancreas

Obesity and Pancreatitis

Increased fat inside the abdomen (visceral) fat leads to fat deposits in the to other organs and inflammation. When the liver gets filled with glucose, there comes a time when it cannot store glucose anymore, and the excess glucose becomes fat deposits in the liver. A condition called the fatty liver. The same is valid with the pancreas, which is another solid organ. (Unlike the hollow intestines). The pancreas can be infiltrated with fat and be called nonalcoholic fatty pancreas disease (NAFPD). NAFPD may lead to an inflamed pancreas called nonalcoholic steatopancreatitis (NASP). NASP is a chronic inflammation of the pancreas that may not produce a severe pain as acute pancreatitis but causes damage nonetheless.  NAFPD and NASP may (1) promote the development of chronic pancreatitis and pancreatic cancer, (2) exacerbate the severity of acute pancreatitis, and (3) increase the risk of complications of pancreatic surgery. 

Metabolic Syndrome and Pancreatitis (Warning: Technical Language ahead)

The mechanisms that are involved in pancreatitis are the same in endothelial dysfunction. Namely, nuclear-factor kappa βeta (NFκβ) activation, cytokine production, neutrophil, and monocyte activation and recruitment to the pancreas exaggerating the damage to the pancreas. The neutrophils are the source of tissue degrading enzymes, reactive oxygen species, and inflammatory cytokines. Endothelial dysfunction and injury, increased vascular permeability, activation of coagulation, and increased leukocyte rolling, sticking and transmigration to pancreatic tissue, all lead to endothelial damage and pancreatitis. Refer to The Magical Endothelium to know how important it is.

Therefore people with Metabolic syndrome can still develop acute pancreatitis even if they do not drink alcohol.

To Summarize,

  1. Metabolic syndrome is highly associated and contributes to acute and chronic pancreatitis, nonalcoholic fatty pancreas disease (NAFPD), nonalcoholic steatopancreatitis (NASP), and pancreatic cancer.
  2. Inappropriately high and frequent carbohydrate intake leads to metabolic syndrome.
  3.  Low carbohydrate diet, intermittent fasting, and exercise. (HIIT) or resistance training can reverse metabolic syndrome

Related Readings:

  1. How to Do Intermittent Fasting
  2. The Kaizen Way of Fasting
  3. How to be Active from Sedentary
  4. High-intensity interval training (HIIT)
  5. 21 Benefits of High-Intensity Interval Training
  6. The Metabolic Syndrome
  7. Diseases Associated with the Metabolic Syndrome
  8. The Magical Endothelium
  9. How Effective is Quitting Cigarettes?
  10. Hair Loss and Heart Attacks
  11. The Real Effect of Statins on Heart Disease
  12. Erectile Dysfunction is a Sign of Coronary Artery Disease

References:

1.Pitt HA, Hepatopanreaticobiliary fat: The good, the bad, and the ugly. HPB (Oxford). 2007;9(2):92-7. doi: 10.1080/13651820701286177. 

2. Dumnicka et a., The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications              
Int J Mol Sci. 2017 Feb; 18(2): 354.
3. Mikolasevic et al.,  Metabolic syndrome, and acute pancreatitis. D Eur J Intern Med. 2016 Jul;32:79-83. doi: 10.1016/j.ejim.2016.04.004. Epub 2016 May 4.

4.Pérez et al.,  Redox signaling in acute pancreatitis. Redox Biol. 2015 Aug; 5: 1–14. Published online 2015 Jan 27.

Image Credits:

  • BruceBlaus.  Pancreas
  • CT scan of exudative pancreatitis By Hellerhoff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27846842

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