Abdominal discomfortThe pancreas has two main functions in the body. The first is digestive (exocrine function): to produce digestive enzymes to break down fat, carbohydrate, and protein; and bicarbonate to neutralize stomach acid once the food moves from the stomach to the duodenum. The second function of the pancreas (endocrine function) is production of insulin and glucagon to regulate blood sugar levels. Insulin tells your body to store glucose as glycogen; glucagon tells your body to raise blood glucose levels, turning glycogen back into glucose.
The main health problems with the pancreas are insufficiency of enzymes, acute or chronic pancreatitis, pancreatic cancer, diabetes, and cystic fibrosis. In type 1 diabetes, the pancreas is no longer able to produce insulin. Many people with type 2 diabetes have insulin resistance, which can overwhelm the pancreas so that it stops producing enough insulin. Some of the medications used in type 2 diabetes can also affect the beta cells so that they stop producing insulin.
If you have pancreatitis, you will have elevated serum lipase and amylase levels. To assess pancreatic insufficiency, stool testing for pancreatic elastase or chymotrypsin is used. You will often see levels of pancreatic elastase that are less than 400 mcg/g, which indicates pancreatic insufficiency. If pancreatic elastase levels are less than 200, pancreatic insufficiency may be a lifelong issue. For chymotrypsin, the lowest normal value is 100 or 72 mcg, depending on the study. Low chymotrypsin levels were found in people with celiac disease, psoriasis, and gastric surgery. Pancreatic elastase is not affected when you take digestive enzymes; chymotrypsin is.
If your pancreas cannot secrete enough enzymes, you have pancreatic insufficiency. While in conventional medical terms pancreatic insufficiency is rare, for those of us working in integrative health we see it all the time. How would you know?
Abdominal discomfort
Bleeding tendency (vitamin K deficiency)
Bloating
Can’t gain weight
Failure to thrive in children
Fatigue for no obvious reason
Food sensitivities
Gas
Hypoglycemia
Malabsorption
Steatorrhea—pale, tan colored stools
Stools that float (fat maldigestion)
Undigested food in your stools
Pancreatic insufficiency is common in people who have celiac disease, psoriasis, cirrhoses, pancreatitis, and cystic fibrosis. Other triggers are parasites, bacterial over-growth, dermatitis herpetiformis, inflammatory bowel disease, Zollinger-Ellison syndrome, and AIDS. Stress (mental and physical), getting older, nutritional deficiencies, poor diet, eating only cooked foods, exposure to radiation or toxins, hereditary weaknesses, drugs, and infections also contribute to pancreatic insufficiency.
Stool pancreatic elastase test
Stool chymotrypsin test
Food allergies—IgE test; food sensitivities—IgG or IgG4 test
Improve your eating habits. Eat in a relaxed manner. Chew your food thoroughly. Limit beverage intake with meals. Drinking liquids at meals dilutes the gastric juices in the stomach and pancreatic juice in the small intestines.
Take pancreatic enzyme supplements. Clinical experience shows that pancreatic enzymes work well as a digestive aid. Glandular-based supplements, like pancreatic enzyme preparations, are directed to specific tissues, helping to initiate repair. Pancreatic enzymes also help restore the balance of GI flora. In studies done on monkeys, it was shown that pancreatic enzymes were able to kill clostridium, bacteroides, pseudomonaceae, enterobacter, E. coli, and klebsiella. Continued use of pancreatic enzymes can help with repair and maintenance of pancreatic tissue.
The United States Pharmacopoeia (USP) regulates the strength of pancreatic enzymes. Take one to two tablets or capsules at the beginning of meals.
Try vegetable enzymes. For people who would rather have a vegetarian alternative to pancreatic enzymes, vegetable enzymes are a suitable option. These enzymes are derived from a fungus called Aspergillus oryzae. Take one to two capsules at the beginning of meals.
Pancreatitis is an inflammation of the pancreas. There are two types of pancreatitis, acute and chronic. Acute pancreatitis is typically caused by gallbladder disease or alcohol abuse. The typical symptoms are abdominal pain, nausea, vomiting, and loss of appetite. Serum amylase and lipase levels are elevated. In acute pancreatitis, it’s important to keep electrolytes in balance. People are hospitalized and given IV solutions or medical foods until the inflammation has calmed down.
Chronic pancreatitis is an ongoing inflammation of the pancreas. In 70 percent of people it’s alcohol induced. Seven percent of people with pancreatitis have genetic alterations in either the cystic fibrosis gene (CFTR), the serine protease inhibitor gene (SPINK 1/PSTI), or the cationic trypsinogen gene (PRSSI). If it’s inherited, it often begins in childhood or adolescence with acute pancreatitis, which eventually becomes chronic. Other causes include tropical pancreatitis (due to unknown nutritional issues), hyperparathyroidism with high calcium levels, extremely high levels of triglycerides, and obstruction of the pancreatic duct.
The main symptom of chronic pancreatitis is a dull pain around the stomach with pain that radiates to the middle of your back. The pain is intermittent and gets worse if you eat. People with pancreatitis gradually lose weight. If the pancreas isn’t producing enough lipase, stools will get lighter, float, and have a bad odor. You may need to urinate often and have symptoms of vitamin A, D, E, and K deficiencies. Sometimes people get jaundiced.
It’s important to consider the entire DIGIN model in people who have chronic pancreatitis.
Stop drinking alcohol. Easier said than done, but essential. If necessary, join Alcoholics Anonymous or enter treatment.
Use a restorative healing diet. See Chapter 13 for details.
Use medical foods. In some cases, eating predigested foods can provide calories and needed nutrients.
Take pancreatic enzymes. There are many prescription and over-the-counter pancreas enzymes. According to Maurice E. Shils, et al., in Modern Nutrition in Health and Disease, 10th Edition, from 4,500 to 20,000 USP will be needed with a minimum of 28,000 IU of lipase. Take one tablet with the first bite of your meal and continue sprinkling your tablets throughout the meal.
Take vitamins. You are likely to be deficient in many nutrients, especially vitamin B12 and the fat-soluble vitamins A, D, E, and K. Take an excellent multiple vitamin and have your vitamin and mineral levels assessed.
Increase antioxidants to reduce inflammation. Eat more fruits and vegetables. Make fresh vegetable and green juices. Use wheat grass juice. Use powdered greens or powdered reds, which typically contain dehydrated green vegetables and grasses or red and orange fruits and vegetables, to add antioxidants. Take antioxidant supplements.
Alkalize, alkalize, alkalize. Follow the recommendations in Chapter 17.
Try Chinese medicine and acupuncture. Several studies looked at the combined effect of Chinese herbs with Western treatment for pancreatitis. Patients who received traditional Chinese medicines had better outcomes. Miltiorrhiza, known as red sage, Chinese sage, tan shen, or dan shen, was given to rats and people with pancreatitis with protective effects. There are lots of other studies coming out of China on pancreatitis and herbs. I recommend finding a doctor of oriental medicine to help you with this.
Cystic fibrosis is covered well in Digestive Wellness for Children.
Diabetes is a worldwide epidemic that’s increasing fast. In 1985 30 million people worldwide had diabetes. Today, one billion people have diabetes and a third of the children born each day are expected to have diabetes later in life. In the United States, 23.6 million people, 7.8 percent of the population, have diabetes. Diabetes rates are highest in Native American populations, where the incidence of childhood diabetes can be up to 45 percent in some communities. Overall, the incidence of diabetes in Native American populations is 17 percent. Blacks, Hispanics, and Asians are also more likely to develop diabetes than whites. Most people with diabetes have never been diagnosed. If you’ve never had your blood sugar levels looked at, do so.
You may recall that glucose is the main energy source for most of our cells; when blood glucose levels rise, the pancreas normally secretes the hormone insulin, which acts as a transporter, allowing glucose and amino acids to leave the bloodstream and be taken into the cells for use. This process, however, can go awry. Diabetes occurs when the body:
Doesn’t produce insulin
Or makes insufficient amounts of insulin
Or is resistant to insulin
Diabetes is a common chronic illness that runs in families, so children with parents or grandparents who have diabetes are more likely to develop diabetes than other children are.
Blurred vision
Darkened and velvety areas of skin, most typically in the armpits and neck folds
Fatigue
Frequent infections
Frequent urination
Increased appetite
Increased thirst
Irritability (in children mainly)
Skin tags
Slow healing of sores
Weight loss
If you have diabetes, a hemoglobin A1c (HmgA1c; also called glycosylated hemoglobin) test is a simple way to monitor your blood sugar levels. It gives a three-month average of the sugar levels on the outside of red blood cells. Imagine a gum drop. Recall that it has sugar crystals on the outside of it. Imagine that your red blood cells look like gum drops. The more sugar crystals they have on the outside, the more damaging those crystals are inside a person’s blood vessels, heart, eyes, and kidneys and the greater risk of long-term health issues relating to the diabetes. Healthy levels of HmgA1c are less than 7 percent of total hemoglobin. Keeping levels as low as possible helps prevent damage throughout the body.
Uncontrolled diabetes of either type can lead to serious complications later in life. High blood glucose level is the most significant risk factor for developing heart and vascular disease, and diabetes is the leading cause of kidney failure and adult blindness. Careful blood sugar control is essential for preventing these and other complications, including nerve problems and gum disease.
Type 1 diabetes is considered to be an autoimmune disorder. It is typically diagnosed in children and young adults. Five to 10 percent of people with diabetes have type 1 diabetes. Type 1 diabetes, which used to be called juvenile diabetes, is more specifically termed insulin-dependent diabetes mellitus (IDDM). Diagnosed in about 13,000 children in the United States each year, its onset is usually sudden and can occur at any time during childhood. People with type 1 diabetes require injections to replace the insulin that their bodies can no longer make. Children with type 1 diabetes are usually thin, and they may complain of thirst. Type 1 diabetes is often triggered by an infection, typically a virus. The body’s immune system mounts an attack on the infection and also mistakenly attacks and destroys the insulin-secreting beta cells in the pancreas. Allergy to milk has also been implicated as a possible trigger for diabetes.
New Ideas About Underlying Causes of Type 1 Diabetes. Accumulating research findings suggest that the gut immune system plays an important role in type 1 diabetes. Like all autoimmune diseases, there is a growing consensus in research indicating that people with type 1 diabetes have increased intestinal permeability (leaky gut) and dairy allergy, gluten intolerance, or celiac disease. Alessio Fasano, M.D., medical director at the Center for Celiac Research at University of Maryland School of Medicine, and his research group believe that intestinal permeability is a necessary ingredient for the development of autoimmune conditions, along with genetic and environmental factors. Outi Vaarala and her group report that a disordered gut microbiota contributes to the development of type 1 diabetes. High levels of zonulin have been found in people with type 1 diabetes. Zonulin is a protein that contributes to leaky gut by opening up the tight junctions between cells. Zonulin levels can increase on exposure to specific foods and bacteria. Animal study shows that if zonulin is blocked, destruction of the pancreatic beta cells can be prevented.
There is a small but important crossover in people with type 1 diabetes and celiac disease. A study of 141 children with type 1 diabetes, for example, found elevated antigliaden antibodies in more than 8 percent and found celiac disease in almost 3 percent, which is 10 times the average incidence. Pyira Narula reported a 3.3 percent incidence of celiac disease in children with type 1 diabetes. Another study of 331 children with type 1 diabetes from 1987 through 2004 reported 6.6 percent of the children had celiac disease as well (determined by elevated tTg levels and confirmed with biopsy). Interestingly, the incidence of celiac in these children rose from 3.3 percent in 1994 to 10.6 percent in 2004. One has to ask the question, what specifically has changed in this decade? Two things pop into my mind: increased vaccination requirements and the introduction of large amounts of genetically engineered corn, soy, cottonseed, and canola oil to our food supply.
A considerable amount of research has shown a link between infant allergy to cow’s milk and development of type 1 diabetes. In a similar vein, an epidemiological study in 40 countries found that the incidence of type 1 diabetes in children was highest in the countries with the highest consumption of dairy and other animal foods. In children who develop both celiac disease and type 1 diabetes, celiac disease often precedes or develops at the same time as the diabetes. (See sections on autoimmune disease and celiac disease in Chapter 14 for a more complete analysis of the gut-autoimmune connection.)
Children eating a mainly vegetarian diet had a lowered incidence of type 2 diabetes. This needs to be explored more fully to determine what components of a vegetarian diet helped to protect these children. What can be supposed is that vegetarian diets have a higher level of polyphenols and fiber which both have protective properties.
Food Sensitivity and Diabetes. Looking for food sensitivities and allergies may help stabilize the blood sugar levels and reduce the need for medications in people with type 1 diabetes. A recent study done by Russell M. Jaffe, M.D., Ph.D., and colleagues looked at the role of diet and food intolerance in 26 adults with type 1 diabetes. The control group ate their regular diabetic diet and followed their usual lifestyle program. The test group ate a dairy-free diet, removed any additional foods that showed antibody reactions, and were given specific nutritional supplements. After six months, the test group showed significantly greater improvement in blood glucose levels and hemoglobin A1c than the control group. Clinical nutritionist Jayashree Mani reports that by working with an allergen-free and alkalizing diet, she was able to lower blood glucose levels in a type 1 diabetic teenage boy from 350 to 125 mmol/l, while also reducing his insulin needs by more than a third.
Type 2 diabetes, which used to be called adult diabetes, is more specifically termed non-insulin-dependent diabetes mellitus (NIDDM). Type 2 diabetes occurs mainly in adults older than 45 and constitutes 90 to 95 percent of all diabetes cases. Type 2 diabetes was virtually unknown in children 30 years ago, but it is on the rise. In some Native American communities, it occurs in 45 percent of children. In children, it is first diagnosed between the ages of 10 and 19 years, and the hormonal changes around puberty seem to be an important trigger. Between 45 percent and 80 percent of children with type 2 diabetes have a parent with diabetes. Children with type 2 diabetes are commonly overweight but typically have no other symptoms until they are diagnosed.
Type 2 Diabetes Is Largely Preventable. Type 2 diabetes at first appears to be a disorder of overly elevated blood glucose (blood sugar) levels. Yet for most people with type 2 diabetes, disordered glucose levels are just the end of a long road that led to diabetes in the first place. Type 2 diabetes is often the result of lifestyle choices. In other words, we “earn” it. It’s often termed “a feast in the middle of a famine” because your blood has excessive amounts of glucose (the feast) while your cells starve for the sugar they desperately need to produce energy. If left unchecked, high insulin levels affect our kidneys, eyes, and heart and are linked to fatty liver, nerve damage, brain compromise, gastroparesis or dumping syndrome, maldigestion and malabsorption, sexual dysfunction, and problems with the genitourinary system, such as polycystic ovary disease.
Eating a low-nutrient, highly refined diet; eating a diet low in antioxidants and polyphenols and fiber; obesity; lack of exercise; and lack of sleep all help us build to a point where our metabolism begins showing signs of metabolic syndrome: weight gain around the middle (apple shape or beer belly), low serum HDL cholesterol levels with high LDL cholesterol levels, high insulin levels, rising blood pressure, and/or rising triglycerides. In metabolic syndrome, also called Syndrome X, we don’t have the right cellular conditions to properly use glucose. Our pancreas responds by making more insulin to get the glucose into the cells. This is called insulin resistance, which leads to more weight gain and even more insulin resistance in a vicious circle. Eventually we cannot overcome this by just producing more insulin, and our blood sugar levels skyrocket. This condition is diabetes. Often we have decades of warning signs before we are diagnosed with diabetes. We can stop metabolic syndrome by changing our lives, and in most cases we can prevent diabetes.
Eating a low-glycemic diet, getting plenty of exercise, and having the right nutrients can turn type 2 diabetes and metabolic syndrome around.
A third type of diabetes is called gestational diabetes. It occurs only during pregnancy and typically resolves once the baby is born. This affects about 4 percent of all pregnant women. It’s important that these women be closely monitored during pregnancy for the safety of the mom and baby. Babies born of women who developed gestational diabetes are more likely to develop type 2 diabetes later in life.
There are three other types of diabetes that have been more recently codified.
Latent autoimmune diabetes of the adult (LADA) happens in people who are not obese but have antibodies to insulin. They typically have signs of metabolic syndrome, so if monitored they can prevent diabetes decades earlier.
People with type 1.5 diabetes have anti-insulin antibodies and are typically obese and insulin resistant.
Type 3 diabetes occurs when people have insulin resistance in the brain. Insulin is probably the most inflammatory molecule in our bodies. When insulin levels increase in the brain, we have accelerated oxidative stress, nerve damage, cell damage, and early death. This can cause memory loss as well. There is a growing body of research that calls Alzheimer’s disease “insulin resistance in the brain.”
Certainly do all of the regular medical testing for diabetes, including fasting glucose and hemoglobin A1c levels.
Blood sugar levels: Buy a glucose monitor and monitor your blood sugars daily or more often.
One- and two-hour postprandial insulin testing: This is done one or two hours after a high-carbohydrate meal or with a glucose drink.
Anti-insulin antibodies test.
Salivary cortisol: Cortisol levels are often high in diabetes.
Vitamin and mineral assessments, especially B-complex vitamins, RBC zinc, magnesium, and antioxidant status.
First morning urine pH testing.
Food sensitivity testing.
Celiac testing.
If you are taking medication for your diabetes, it is critical to use it consistently and exactly as prescribed. If you need an insulin pump, you’ll need specific instructions on its use from your physician or diabetes educator.
Historically, people worldwide have used various natural remedies to control blood sugar levels: glucomannan fiber, young barley shoots, prickly pear cactus juice, fenugreek—the list is long. As we integrate this sort of information, many more options may become available. You can find many of the herbs and nutrients in the following list in products that combine them to help with glucose regulation.
Buy a glucose monitor. Monitoring your glucose levels is essential. Keeping your glucose levels normalized and having a hemoglobin A1c level below 7 will help to prevent much of the damage caused by high insulin levels.
If you are overweight, normalize your weight. Obesity puts an enormous burden on the body. Losing weight can go a long way toward normalizing insulin and glucose levels.
Exercise regularly. Regular exercise helps to lower blood glucose levels, reduce medication needs, and balance mood and behavior. It is essential that you find some type of exercise you enjoy and can do nearly daily. In type 2, exercise can often make oral medications unneeded.
Get psychological support. Seek support to help manage the times when you just can’t cope. Managing a chronic disease can be difficult. Having a sick family member puts a strain on everyone in the family; you all may need individual and/or family counseling from time to time.
Decrease inflammation. Eat a diet rich in fruits, vegetables, legumes, nuts, and seeds. These contain anti-inflammatory antioxidants and polyphenols. Monitor first morning pH to ensure that you are getting as much as your body needs. You cannot put out a forest fire with a bucket.
Find the diet that works best for you. Most people with diabetes will find that a low-glycemic diet works best. Vegetarian diets, which are richer in fiber, antioxidants, and minerals than meat-based diets are, can help reduce the incidence of type 2 in children and adults. Yet Loren Cordain, Ph.D., professor at Colorado State University and researcher and author on Paleolithic diets, and James Anderson, M.D., from the University of Kentucky, have both demonstrated extraordinary benefits from diets that are high in fiber, high in legumes, and rich in complex carbohydrates. If you monitor your glucose levels carefully, you will discover the best type of diet for you.
Implement a high-fiber diet. Use fiber to regulate blood glucose levels. Research shows that eating a high-fiber diet slows the release of glucose into the bloodstream over time. Peas and beans, fruits, vegetables, and whole grains, and especially high-fiber cereals containing 9 or more grams of fiber per serving, can be extremely useful.
Add insulin- and glucose-modulating foods to your diet. Cinnamon, oat bran, fibers, ginger, rosemary, green tea, cranberries, blueberries, lemon balm, fenugreek, holy basil, and bitter melon are all beneficial. So add some cinnamon to that oat bran!
Discover your food sensitivities. Figure out if you have celiac disease, gluten intolerance, or other food sensitivities. I have seen people whose glucose levels spiked with a single bite of carrot or papaya. Monitoring your glucose levels carefully can help you figure this out. Arthur F. Coca also developed the pulse test. Often your resting pulse will rise more than 16 beats per minute 30 minutes after a meal in response to a food that bothers you.
Take a multivitamin and mineral supplement. Take these supplements to counteract inadequacies in basic nutrients.
Take an antioxidant supplement. Use antioxidants to reduce inflammation and help prevent damage throughout the body. An antioxidant supplement will most probably contain carotenoids, vitamin E, selenium, and glutathione or n-acetyl cysteine, and may also contain lipoic acid and additional nutrients. Find a good antioxidant supplement and use as directed. In addition, take lipoic acid, 100 to 600 mg daily.
Try magnesium. Take this to counteract probable deficiency and insulin resistance. Along with supplements, eat magnesium-rich foods such as green leafy vegetables (like kale, broccoli, spinach, chard, and collards) and whole grains. Magnesium glycinate, malate, succinate, orotate, ascorbate, and fumarate are best absorbed. Start with 100 mg daily; increase the dose by 100 to 200 mg until you get diarrhea, and then reduce it 100 to 200 mg until your bowels are normal. Note: If the necessary magnesium dosage is higher than 1,000 mg daily, 1 or 2 teaspoons of choline citrate daily can help with absorption and allow the dosage to be reduced.
Try chromium. This nutrient will help reduce insulin resistance, improve blood sugar regulation, decrease visceral fat, and increase lean body mass. Take 800 to 1,000 mcg daily whether from nutritional yeast or a chromium supplement. Note: Increase dosage slowly, especially if you are taking medication or insulin, because blood sugar levels can drop suddenly.
Take vanadium. Vanadium helps to move glucose into cells without raising insulin levels. Vanadium ascorbate, citrate, fumarate, malate, glutarate, and succinate are much better utilized than vanadyl sulfate. Take 250 mcg daily.
Take gymnema sylvestre. Try this to improve your body’s ability to use insulin effectively and stimulate insulin production. In type 1 diabetics it lowered insulin needs and hemoglobin A1c levels. Take 400 to 800 mg daily in divided doses. Look for a product that has been standardized to 25 percent gymnemic acids.
Take carnitine. Low blood levels of carnitine, a nutrient needed for burning fat and proper functioning of heart muscle, have been found in children and teens with type 1 diabetes. Take 500 to 3,000 mg daily. Dosage can also be determined through testing.
The treatment goal for children with type 1 diabetes is to minimize the amount of insulin needed and prevent long-term complications by prolonging pancreatic islet beta cell functioning for as long as possible, maintaining good glucose control, and maximizing helpful lifestyle changes. It is unlikely that you will need to use every suggested healing option.
Consider autoimmunity. Autoimmune antibodies against the thyroid, parietal cells, adrenal glands, and endomysium have been found in adults with type 1. People with one autoimmune disease are more likely than other people to develop another. Checking for autoantibodies could prevent damage to other organs and glands. If they are high, you’ll know to be more aggressive about allergy reduction in your environment and foods.
Take digestive enzymes. Research shows that people with type 1 diabetes often lack pancreatic enzymes. Use of digestive enzymes can enhance digestive function. Take one to two capsules with each meal or snack. Dose depends on the type of enzyme product and the size of the meal.
Use nicotinamide. Nicotinamide has been shown to reduce progression of the disease in newly diagnosed children. It can put some children into remission, improve glucose control, and help preserve some of the beta cell function. Children should take 25 mg per kg body weight daily (1 kg = 2.2 pounds).
Take folic acid. Folic acid can protect against vascular damage. Take 800 mcg daily.
Take thiamine. Thiamine can reduce numbness and tingling, protect beta cells, and help normalize megoblastic anemia. The dosage varies; typically it is between 50 and 200 mg daily.
The treatment goal in type 2 diabetes is to maximize lifestyle changes and minimize medication use.
Use a glucose-control supplement. These supplements help regulate blood glucose levels with a combination of vitamins, minerals, and herbs. These products commonly contain B-complex vitamins, chromium, vanadium, bitter melon, and gymnema; they may also contain biotin, vitamins E and C, magnesium, CoQ10, lipoic acid, and/or carnitine. Ask at your local health-food store for recommendations. Use as recommended on the bottle.
Try holy basil. Holy basil is used to help regulate blood glucose levels. When I lived in Hawaii, my diabetic clients swore that eating three leaves of holy basil daily helped normalize their blood glucose without medication. Hairy basil seed has been used for the same purpose. Nontoxic and tasty—you can even make pesto out of it.
Eat bitter melon. Bitter melon is a food that helps regulate blood glucose levels. This is a common food in the Philippines. It’s pretty bitter and is an acquired taste. It can also be used as a tea, 1 to 2 cups daily. If you purchase this in a supplement, use as directed.