New Potential Treatment for Pancreatitis

This week a study was published by scientists at Cardiff University in the UK entitled “Calcium release-activated calcium channel blockade as a potential tool in anti-pancreatitis therapy.”  As reported by the university, researchers used a calcium-blocking compound to reduce the calcium flowing into isolated pancreatic cells. This calcium is apparently the major cause of cell destruction during attacks of acute pancreatitis.

The principal author was quoted as saying:

“Our research shows that the calcium channel inhibiting compound offers unique and effective protection against inappropriate activation inside the cells of digestive enzymes, which would cannibalise the pancreas and the surrounding tissue.

“This breakthrough shows huge potential to radically change and improve the outcome for patients suffering from severe pancreatitis. The publication of these findings will open the way for further research involving animals and humans – and, if successful, we shall for the first time be able to treat this often fatal disease.”

The sponsors of the study cautioned that considerable work lay ahead in translating this research into a treatment (including replication in animal and then human trials), but that it  showed promise.

The study is to be published in the Proceedings of the National Academy of Sciences, though it has not yet shown up on their web site.  This exciting development certainly warrants closing monitoring.

Cannabis Sativa Flowers

Medical Marijuana for Pancreatitis

Update September 2015

While there is still a troubling lack of scientific studies on the effectiveness of medical marijuana for CP, anecdotal feedback among the pancreatitis patient community suggests that some people have found it helpful in coping with pain, nauseau, or sleep problems, as well as lessening the stress and anxiety associated with chronic pain.  Others do not find such relief or simply do not like the psychotropic effects of marijuana.  Also anecdotally, pancreatitis specialists seem more open to patients experimenting with marijuana, likely figuring that the risks are much less than prescription opiates.

The National Cancer Institute recently issued a report on cannabis and cannabinoids meant for health professionals.  (Cannabinoids are the active ingredients in marijuana, which can be isolated and administered in pill, liquid or other forms.)  The ultimate conclusion was that “At present, there is insufficient evidence to recommend inhaling Cannabis as a treatment for cancer-related symptoms or cancer treatment–related side effects.”  However, the report did include some points relevant to our inquiry (largely from animal or small-scale human studies):

  • Cannabinoids may protect against certain tumors:  “Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death.”
  • A mouse study suggested that cannabinoids may protect against inflammation in the colon.
  • Smoking marijuana may help with pain:  “Two randomized controlled trials of inhaled Cannabis in patients with peripheral neuropathy or neuropathic pain of various [causes] found that pain was reduced in patients who received inhaled Cannabis, compared with those who received placebo.”
  • There is conflicting evidence about whether marijuana helps with nausea and vomiting — one study showed no effect and the other helped 25% of patients.
  •  In very small studies (one had five people), “patients administered THC had improved mood, improved sense of well-being, and less anxiety,” as well as improved sleep.
  • Marijuana won’t kill you.  In sharp contrast to opiates often prescribed for pain, “lethal overdoses from Cannabis and cannabinoids do not occur.”
  • Some consider marijuana addictive, but “their addictive potential is considerably lower than that of other prescribed agents or substances of abuse.”

These findings certainly suggest that the medical profession should give marijuana very serious consideration for treating pancreatitis — especially since there is virtually no risk of overdose and a relatively low risk of addiction…much less than pain medications of choice like oxycodone.

With more states legalizing marijuana for medical or recreational use, and with bipartisan bills pending in Congress to decriminalize marijuana on the federal level, hopefully scientific studies are on the way.  Certainly CP patients living in medical marijuana states might want to address the issue with their doctor.  (You can find a table of state medical marijuana laws here.)

Below is the original article from 2013:

One of the biggest challenges with pancreatitis is pain management.  Those who suffer from chronic pancreatitis are often prescribed strong pain medications such as hydrocodone and oxycodone.  Prescription painkillers are highly addictive and are responsible for over 15,000 deaths a year, amounting to a “public health epidemic” according to the Centers for Disease Control.  Concerns about overuse of painkillers are mounting, and the FDA and states are considering restrictions on their availability.   (CNN:  FDA Advisory Panel Votes to Tighten Restrictions on Hydrocodone)

Cannabis Sativa Flowers

Cannabis Sativa Flowers (source: Wikipedia)

Medical marijuana is obviously gaining in acceptability and availability around the U.S. While some disagree over the long-term health effects, by any measure marijuana is much less dangerous than prescription painkillers.  Recently, there have also been reports that cannabinoids (the principal active ingredients in marijuana) can not only help with pain management, but may be able to help with other symptoms (such as spasticity with multiple sclerosis) or even have the potential to stop tumor progression in certain cancers. (See an article by Dr. Sanjay Gupta supporting use of medical marijuana — “Why I Changed My Mind on Weed.”)

Whether medical marijuana can help people with pancreatitis is therefore of serious interest.  Unfortunately, few studies have been done and it is difficult to find a strong (informed) opinion either for or against.

There are, however, some studies that bear on the subject.  First, it seems that excessive marijuana use can cause acute pancreatitis.  Reports are rare but doctors seem confident in the cause.  

Second, there are some studies (mostly with mice) suggesting that certain cannabinoids can reduce inflammation in the pancreas:

Perhaps most relevant to those of us with chronic pancreatitis, a 2008 German study of isolated cells of patients with chronic pancreatitis found that introduction of cannabinoids can reduce inflammation and prevent fibrosis, or scarring According to the authors, the results suggested that “(re-)activation of the (endo-) cannabinoid system in chronic pancreatitis may be beneficial for suppressing disease progress” (parentheses are theirs).    Find it here:  Cannabinoids reduce markers of inflammation and fibrosis in pancreatic stellate cells

And just to confuse matters, one study found that cannabinoids make acute pancreatitis worse in the early stage and can help at later stages:  Dual, time-dependent deleterious and protective effect of anandamide on the course of cerulein-induced acute pancreatitis.

Clearly more research is needed.  If there is a better route than reliance on addictive, potentially deadly prescription painkillers, pancreatitis patients need to know it.

At least one politician endorses medical marijuana for pancreatitis…as an alibi:  Former House Minority Leader says marijuana is recognized as a treatment for his pancreas pain.

Update August 2013:

A report by the Controlled Substances and Tobacco Directorate at Health Canada found that studies on cannabinoids’ effect on pancreatitis were conflicting:

There are only a handful of reports on the effects of cannabinoids in experimental animal models of acute or chronic pancreatitis, and the findings from these reports are conflicting. Thus, the use of cannabinoids in the treatment of acute or chronic pancreatitis remains unclear.

The report concluded that “These contradictory findings may be due to differences in experimental methods, differences in timing of drug administration, differences in the types of agonists and antagonists that were used, differences in the route of administration, and differences in animal species.”

Time for a rigorous, controlled human study in a state where medical marijuana is legal (California?).

 

Is a Clear Liquid Diet the Best Course for Pancreatitis?

Clear liquidsPart of the gospel for treating acute pancreatitis is to stop feeding orally for some period (usually in the hospital, with nutrition provided intravenously), followed by a clear liquid diet.  Those suffering from chronic pancreatitis may also have been directed to follow a clear liquid diet during a flare-up to allow the pancreas to rest.

If you’ve ever been on a clear liquid diet for more than a day or so — and I have, a good dozen times when dealing with flare-ups — you know that they can be very disruptive to your life.  It is nearly impossible to get the protein and other nutrients you need.  After three days, I end up weak, irritable, and with aches and pains.  Being productive, much less happy, is tough.

Apparently recent research casts doubt on the advisability of the clear liquid diet.  One study compared a clear liquid diet to a soft diet for patients recovering from mild acute pancreatitis.  The conclusion was that “in patients with mild acute pancreatitis, a soft diet as the initial meal is well tolerated and leads to a shorter total length of hospitalization” than a clear liquid diet.  (Read the PubMed Abstract)  Another study concluded that a full solid diet “is safe and result[s] in a shorter length of hospitalization” than clear liquids or a soft diet as the initial meal for patients recovering from mild acute pancreatitis (PubMed Abstract).  Both studies utilized randomized trials and were published in medical journals.

If you are directed to go on a clear liquid diet, it may be worthwhile to call this research to your doctor’s attention.  I did, and was advised to try a soft diet instead.  A soft diet can sustain you and give you the nutrients your body needs, so it can make a meaningful difference.