What are the treatment aims for pancreatic insufficiency?
Promote optimal digestion by supporting breakdown and absorption of nutrients
How do you promote optimal digestion by supporting breakdown and absorption of nutrients
Support production of pancreatic enzymes via nutritional precursors and cofactors
Stimulate release of pancreatic enzymes by activating the vagal nerve and CCK via eating habits and bitters
Create an environment in the SI lumen which facilitates pancreatic enzyme function - pH 5.9. Increase gastric secretions and bicarbonate
Support pancreatic tissue integrity via increasing enzymes for digestion and recycling
Increase repair of pancreatic tissue by reducing damaging factors such as oxidative stress and inflammation
What is another treatment aim for pancreatic deficiency?
Correct side effects of poor enzyme levels - dysbiosis, food allergies, nutritional insufficiencies (especially fat soluble insufficiencies).
What are the holistic considerations for pancreatic insufficiency?
Nervous system activity - manage stress levels
Impact on liver function - decrease nutritional status and increased workload from the GIT
What are pancreatic enzymes?
Pancreatic enzymes are natural chemicals that help break down fats, proteins and carbohydrates. A normally functioning pancreas secretes about 8 cups of fluid, called pancreatic juice, daily into the duodenum, the portion of the small intestine that connects with the stomach. This fluid contains pancreatic enzymes and helps neutralize stomach acid as it enters the small intestine
Lipase: Lipase works with bile from the liver to break down fat molecules so they can be absorbed and used by the body.
A shortage of Lipase may cause; Lack of needed fats and fat-soluble vitamins.
Diarrhea and/or fatty stools.
Proteases: Proteases break down proteins. They help keep the intestine free of parasites such as bacteria, yeast and protozoa
A shortage of protease may cause; Allergies or the formation of toxic substances due to incomplete digestion of proteins.
Increased risk for intestinal infections.
Amylase: Amylase breaks down carbohydrates (starch) into sugars which are more easily absorbed by the body. This enzyme is also found in saliva.
A shortage in Amylase may cause: Diarrhea due to the effects of undigested starch in the colon.
What type of digestive enzyme supplements can we use to treat pancreatic insufficiency?
Vegetable enzymes: These are microbe derived enzymes and contain a mixture of lipase, amylase, protease, and lactase which are used in the breakdown of each macro nutrient
They are effective over a wider pH range
Bromelain: Bromelain is derived from pineapple from the fruit and the stem.
It is a protelytic enzyme which hydrolyzes proteins to oliopeptides and amino acids.
Take with food to aid protein digestion.
It operates in a broad pH range
It is also antioxidant and anti-inflammatory
Papain: Derived from papaya fruit
It is also a proteolytic enzyme
How can Zinc help with pancreatic insufficiency?
Zinc is an anti-oxidant which reduces oxidative stress which contributes to pancreatic damage. Zinc is needed for pancreatic tissue and enzyme production. Deficiency is associated with impaired exocrine function. Pancreatic enzyme insufficiency decreases the absorption of zinc, creating a vicious cycle.
What anti-oxidants can be used to treat pancreatic insufficiency?
Do fat soluble vitamins need to be replenished if there is pancreatic insufficiency?
Yes, they need to be replenished due to malabsorption
Would you treat pancreatic insufficiency with bicarbonate?
yes - if production is decreased and or reduced stimulus for release
Should a person with pancreatic insufficiency avoid high fat fried foods and high fat foods?
Yes- In exocrine pancreatic insufficiency, undigested fat is passed in the stool, causing greasy, foul-smelling, loose stools. A low fat diet can also reduce pain associated with pancreatitis.
How would you advise a patient with pancreatic insufficiency to eat?
Chew food thoroughly in order to stimulate the cephalic phase of digestion (secretion release) and don't over eat.