The Future Pancreatitis Cure: 3D Bioprinting

One of the most problematic aspects of chronic pancreatitis is that the damage is irreversible.  Even worse, it tends to progress, often destroying more of the pancreas until major complications like diabetes set in.  (See the Cleveland Clinic’s description of chronic pancreatitis.)  Add in the fact that there is no cure, and it ends up being quite a dire prognosis.

3D printed initials ewg

Yet some of the most cutting-edge technology today offers promise:  3D printing.  You may have heard of printers developed over the last decade that can print 3D objects from a variety of materials — usually resins or metals.  At first the devices were used for figurines (such as the 3D set of my initials shown to the right), as well as rapid prototypes of fairly simple objects.  This has evolved tremendously over the last several years; not only can 3D printers fabricate very complex parts and products, but huge 3D printers are used to fabricate entire buildings.  At the same time the price of the devices has plummeted, so that entry level versions are affordable for consumers.  (See an article in The Atlantic today predicting massive growth in 3D printing.)

Most exciting for our purposes, 3D printing can now utilize human tissue.  Earlier this year, a San Diego company called Organovo announced that it used 3D printing to create liver tissue that remained stable for several days, performing some essential functions of the organ.  And researchers at the University of Iowa are exploring “bioprinting a glucose-sensitive pancreatic organ that can be grown in a lab and transplanted anywhere inside the body to regulate the glucose level of blood.”  (ThinkProgress, the Five Most Promising Uses of 3D Printing in Medicine)  It seems a relatively short step from there to a treatment that could allow patients regain pancreatic function…or eventually even replace a failed pancreas entirely.

“Bioprinting” an entire viable organ is an incredibly ambitious goal, and despite promising developments there is still much hard work to be done.  (See “Bioprinting Towards Organ Fabrication” for a curent in-depth analysis of the state of the science.)  However, many pancreatitis sufferers don’t need an entire new organ — we need to stop the ongoing destruction and regain some degree of functionality.  Given the lightning speed of progress in bioprinting right now, and the fact that the pancreas can indeed regenerate in certain ways, this is an area that should command our serious attention.

Actually, more than our attention.  The pancreatitis community is diverse, committed and supportive.  (See some examples of patient support groups.)  We have to be — we face a debilitating, painful chronic disease with no reliable cure.  I have to think that if we direct resources at supporting research into this area, help will finally be on the way.

Indian Gooseberry (Emblica) for Pancreatitis?

Indian Gooseberry pancreatitis

Indian Gooseberry (photo courtesy of Wikipedia)

In the ongoing search for an effective therapy for pancreatitis — conventional or alternative — Indian Gooseberry (otherwise known as phyllantus emblica, or emblica officinalis) comes up fairly frequently as a suggested herbal remedy.

The University of Maryland Medical Center is one of the few medical sites that suggests specific non-traditional remedies for pancreatitis.  They recommend “Indian gooseberry (Emblica officinalis) powder, 3 – 6 grams daily in favorite beverage for antioxidant support. Emblica is a traditional Ayurvedic medicinal plant used to treat pancreatic disorders. It is a powerful antioxidant and one of the richest natural sources of vitamin C. Animal studies suggest that this herb can be used to prevent pancreatitis.”  (Source: Pancreatitis — University of Maryland Medical Center.)  Non-scientific sites like the Wellness Times and Mother Earth Living echo this advice.

I was able to find only two relevant studies, both on animals.  One study in India induced acute pancreatitis in rats, and then gave them the herb; control groups received either no treatment or vitamin C (thought to be the key active ingredient in Indian Gooseberry).  The study concluded that “E. officinalis treatment was found to be beneficial for treating acute pancreatitis. Serum levels of lipase and interleukin-10 were significantly lower than in the arginine group. Nucleic acid content, rate of DNA synthesis, pancreatic proteins, and pancreatic amylase content were significantly improved. Histopathological examination showed significantly lower total scores in the Emblica group.”  This was true compared with both the non-treatment group and vitamin C group.  (See the abstract of the study here.)

A much older study (1995), also out of India, tested the herbal remedy with dogs.  It found that “acinar cell damage was less and the total inflammatory score was significantly lower in the E.o. treated group” than the control group, concluding that more research was warranted.  (Abstract here.)

The human studies that have been done have not been specific to pancreatitis, but seemed to demonstrate positive outcomes in preventing cell death in the liver and reducing oxidative stress and inflammation in diabetes.   If accurate, these at least seem to support the potential benefit for pancreatitis.

As with other promising alternative remedies, it seems clear that rigorous research involving human subjects with pancreatitis would be extremely informative.  In the meantime, it is hard to evaluate whether it would be helpful, and to know what formulations or dosages would be best.  If I am able to turn up any additional results (scientifically or anecdotally), I will report back.

When Obesity and Gallstones Lead To Pancreatitis

We are excited to present a guest post from Dr. Lisa Oldson, a physician at Northwestern Memorial Hospital specializing in Internal Medicine.  She has a blog and a YouTube Channel covering medical issues related to obesity and weight loss that are well worth visiting.    Our thanks!

What does pancreatitis have to do with obesity? Plenty. The link between the two is gallstone disease, the #1 cause of acute pancreatitis. More than 20 million people in the US have gallstones, and one of the biggest risk factors for gallstone disease is obesity. When I was in medical school, the unkind mnemonic of “female, fat and forty” was passed down from the residents to the students as a way to remember those at highest risk for gallstones. I can only hope today’s medical students are more thoughtful!

Biliary Tract

The gallbladder and the bile ducts. Also called biliary system or biliary tree. (Photo credit: Wikipedia)

Let’s start with a quick review of the anatomy and then discuss how it all works. For most of us, the gallbladder isn’t a familiar organ. This oblong pouch sits near the pancreas, just under the liver. The liver and gallbladder are located in the upper abdomen, on the right side, so gallbladder pain can be felt on the right or sometimes toward the middle of the upper abdomen. Exiting the gallbladder is a tube, or duct, that transports a liquid, called bile, into the intestines to help with digestion. Can you live without your gallbladder? Certainly, though a small percentage of people have problems with diarrhea after removal of the gallbladder.

Occasionally bile, which is made in the liver and stored in the gallbladder, clumps together to form hard stones. Some people with gallstones are unaware of these little rocks in their abdomen, but others are acutely aware, particularly when ingestion of fatty foods leads to upper abdominal pain and nausea. We don’t fully understand why gallstones form, but we do know that they occur more often in those who are obese, and we know that women are impacted more often than men.

Now it’s time to meet the pancreas. Again, let’s start with a quick review of the anatomy and how it works. The head of the pancreas begins near the gallbladder on the right side of the abdomen. It stretches across the top of the abdomen, behind the stomach, towards the middle, and ends on the left side. Imagine you laid a banana across the top of the abdomen. That gives you a rough sense of the size and shape of the pancreas.

The pancreas has a tube, or duct, that connects to the tube leaving the gallbladder. This larger tube (formed by the common bile duct from the gallbladder and the pancreatic duct from the pancreas) dumps enzymes into the small intestine. These enzymes aid in digestion. In addition to helping with digestion, the pancreas also makes insulin which helps to regulate sugar (glucose) levels in the body. When insulin isn’t present in large enough amounts or when the body doesn’t respond to insulin appropriately, it leads to diabetes.

What happens when obesity leads to gallstones and then to pancreatitis? Remember, the gallbladder and pancreas each send out a tube toward the intestine, and those tubes merge into one tube. If a gallstone from the gallbladder sneaks into the tube and gets stuck, it can block the enzymes trying to leave the pancreas. These enzymes back up and become toxic, actually trying to digest the pancreas in the way they intended to digest your food. Ouch! If you’ve had pancreatitis, I don’t have to tell you that this condition can be incredibly painful. Occasionally, recurrent bouts of acute pancreatitis can lead to debilitating chronic (long term) pancreatitis.

With gallstones (and alcohol) causing the majority of pancreatitis, and obesity contributing to gallstone disease, I would be remiss if I didn’t offer a few recommendations on how to address obesity. Ironically, an extremely low calorie diet can precipitate gallstones, so if you’re embarking on a weight reduction program, please consult your health care provider for personal guidance to avoid complications that can occur from rapid weight loss.

When it comes to obesity, many people aren’t sure where to begin to take back control of their health. Research shows that tracking your food intake and activity can be highly motivational. Consider an online tracking device (many are free) that will educate you about the calories, fat, fiber, sugar and other details of your food consumption.

After you start food tracking, you should challenge yourself to move more. Ideally, that means at least 20 – 30 minutes of brisk walking daily. For those who aren’t exercising at all, even 5 minutes of walking counts as moving more! A pedometer can be a fantastic motivator as you work toward a goal of walking 10,000 steps daily.

If you’re at risk for gallstones or pancreatitis, please consult with your primary care provider to get some guidance on how you can reduce your risk.

Thanks for listening and I wish you the best of health!

Dr. Lisa Oldson

Please follow me on Twitter: @LisaOldson

Please check out my YouTube channel: http://www.youtube.com/user/DrLisaVideo

Lisa Oldson, M.D. is on staff at Northwestern Memorial Hospital in Chicago and is on the faculty at the Feinberg School of Medicine at Northwestern. She specializes in Internal Medicine and has an interest in obesity and weight management.

Can Fruit Cause Pancreatitis? Lessons from Ashton Kutcher and Steve Jobs

fruitMost medical sites put fruit on the recommended list if you suffer from pancreatitis.  (See, for example, my favorite nutrition guide, from Stanford Hospital).  That made a recent news story rather surprising:  Actor Ashton Kutcher was hospitalized with what he described as “pancreas problems” after following a fruit-only diet, which he was following to prepare (via emulation) to play Steve Jobs in the new movie Jobs.  He claimed his pancreas levels were “completely out of whack,” and that he was doubled over with pain.  Sound familiar?

In the wake of the story, some nutritionists opined that the fructose, or simply the carbs, in fruit overworked his pancreas.  For example, a nutritionist on Psychology Today’s web site reiterated her belief that Jobs’ diet contributed to his death from pancreatic cancer.  An article on U.S. News & World Report’s site called “Ashton Kutcher’s Fruitarian Diet — What Went Wrong” cited several experts on the dangers of such a diet, and included a dietitian’s advice that we  stick to two pieces of fruit a day.  Others argued that Kutcher must have had it wrong, that “despite Kutcher’s experiences, there is no evidence that a fruit-only diet leads to pancreatic problems and it is certainly not a risk factor for pancreatic cancer” (from a Huffington Post piece).

Given the pancreas’s role in secreting insulin to control glucose levels, it seems plausible that too much fruit could tax the pancreas.  There is also a study on the effect of eating fruits and vegetables on the incidence of acute pancreatitis that found that fruit consumption correlated slightly with increased risk.   Anecdotally, I found that I began to crave fruit (and sugar more generally) as my chronic pancreatitis worsened…whatever that means.

Some guidance on how much and what kind of fruit to eat would be extremely helpful.  If you know of any, or have experience with one extreme or another, please chime in.

 

A Great TED Talk on How to Game Yourself Back to Health

In this TED talk, Jane McGonical tells how creating a simple game helped her cope with traumatic brain injury, and how you can use the science underlying such benefits to extend your life (or at least your life expectancy).  Well worth 20 minutes.

She also developed a web site called SuperBetter (and an accompanying iPhone app) that teaches people the “gamification” process she used to cope with her own condition.  She claims this will “increase your personal resilience.”  Listen to her talk and you’ll be inclined to believe her.

Now the chronic pancreatitis community needs to come up with our own game — use your superpowers to vanquish flare-ups forever.

Caffeine with Pancreatitis — Acceptable or Horrible?

coffeePeople with pancreatitis are told to give up quite a few of the major guilty pleasures:  Drinking, smoking, steak, pizza, french fries, ice cream, and essentially any other food or drink that isn’t low fat and ridiculously healthy.  (You can find a collection of advice on nutrition here.)  With all those temptations to fend off, most of us would prefer to keep our coffee (or in my case, iced tea) ritual/addiction intact…unless there is a clear reason to give it up.

Some very reputable sources put caffeine on the restricted list.  According to a fact sheet put out by the Pancreas Foundation on Hydration and Pancreatitis, Caffeine and alcohol should be limited, as they are diuretics and promote fluid loss and can also stimulate the pancreas.”  The National Digestive Diseases Information Clearinghouse (part of the Department of Health & Human Services) counsels that “drinking plenty of fluids and limiting caffeinated beverages is also important.”  (Similar advice is on the New York Times health website.)

On the other hand, the Nutritional Guidelines for Chronic Pancreatitis put out by Stanford (the most comprehensive set of recommendations on diet I’ve seen) put coffee and tea in the “recommended” column.  And while caffeine is known to be a diuretic (meaning that it depletes the body of fluids), studies have found that the diuretic effect lessens significantly for regular coffee or tea drinkers.  (See a New York Times web article on whether caffeine causes dehydration and a Mayo Clinic posting on the same subject.)

There has been some research on the subject, and it may be good news for coffee drinkers.  A study done by Kaiser Permanente back in 2004 looked at how smoking and coffee affect the risk of pancreatitis.  Smoking definitely increases the risk of getting pancreatitis — no surprise given the unanimity of opinions on the matter.  But coffee was found actually to decrease the risk of getting pancreatitis very slightly.  (See an abstract of the study here.)  Another journal article stated that the abnormal chemical signals that can trigger pancreatitis (and that are increased by alcohol and biliary disease like gallstones) can actually be inhibited by caffeine (abstract here).

These studies don’t seem to discuss whether people already suffering from chronic pancreatitis will do better or worse with caffeine.  Given these findings, though, and the doubt cast on whether caffeine really dehydrates, there certainly doesn’t seem to be a strong argument for giving it up entirely.  If you’ve heard differently, or had direct experiences, please comment.

February 2014 addendum:

I did some personal experimentation, and found that drinking caffeine does seem to bring on pain within about an hour.  I have therefore cut out caffeine entirely — painful for me but not as painful as pancreatitis.  This is anecdotal, and how you react to various stimuli when you have chronic pancreatitis seems to be quite personal…but I’d suggest that sufferers do some experiments themselves.

 

Turmeric (Curcumin) for Pancreatitis?

There is not a lot of credible information about vitamins or supplements that might help pancreatitis.  Nonetheless, given the lack of an effective treatment for most of us, the search continues for remedies that can make a difference…hopefully without harmful side effects or risks.

curcumin

One natural remedy mentioned often is turmeric — a spice with the main active ingredient of curcumin.  Turmeric is in the ginger family and is primarily produced (and used) in India and Pakistan.  It is used often in ayurvedic medicine, a holistic practice in India that emphasizes plant-based treatments (using spices we know well, like cinnamon).   Dr. Andrew Weil recommends turmeric for pancreatitis — though only in passing, along with ginger and traditional Chinese medicine.  Turmeric also shows up on patient discussion boards, at times from people who say their doctors have recommended it.

Research in PubMed, a repository of medical journals hosted by NIH (and my resource of choice) suggests that turmeric (a) can have anti–inflammatory effects for some conditions and (b) is generally harmless in reasonable doses.  (See abstracts of Curcumin in Inflammatory Diseases, published in Biofactors, and Therapeutic Roles of Curcumin, from MD Anderson Cancer Center.)

Interestingly for pancreatitis sufferers, studies on mice and rats seem to suggest that the spice can prevent or reverse acute pancreatitis, at least in rodents.  One study from Shandong University in China (see Preventive Action of Curcumin in Experimental Acute Pancreatitis in Mouse [sic]) concluded that “curcumin significantly decreased the pancreas injury and reversed the elevation of [relevant enzymes] in mice with acute pancreatitis.”  Another study out of Korea (much of the herb-related research seems to emanate from Asia and India) concluded that curcuma longa “plays a protective role in the development of [acute pancreatitis] and pancreatitis-associated lung injury,” again in mice.

The only human study I was able to find, out of India, examined markers of oxidative stress and pain levels when patients were given curcumin.  They concluded that the markers showed improvement but pain did not decrease.  (See the abstract.)

If curcumin is indeed harmless (refresher:  I am not a doctor, I am not giving medical advice, and I have no idea whether it is harmless or not), then these studies certainly warrant additional exploration into whether turmeric can help with pancreatitis.  In the meantime, I would be very interested to hear if others have had turmeric or curcumin suggested or prescribed, and what the results were.

Radiation Therapy for Chronic Pancreatitis

I recently read about a study conducted in Barcelona, Spain where a single dose of radiotherapy (i.e. radiation) was used to treat chronic pancreatitis with recurrent flare-ups or “unrelenting pain.”  The study was small – only 15 patients — but 12 of them had no further pain or flare-ups.  One other required an additional dose but then also fared well for 50 months.  Two people were not helped by the treatment.

The conclusion was that radiation could be used to delay surgery or as a substitute for it for severe CP.  A summary of the study, which was published in the American Journal of Gastroenterology, can be found here.  It certainly sounds like a promising avenue; I haven’t heard whether it has been used with success clinically.