Consequences of Exocrine Failure

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In this episode of Metabolic Classroom, Ben Bikman takes a detailed look at the pancreas, a small but mighty organ with two major roles—endocrine and exocrine. The endocrine pancreas (just 1–2% of its mass) regulates metabolism by secreting hormones like insulin, glucagon, somatostatin, pancreatic polypeptide, and ghrelin. These hormones work together in a push-pull fashion to control blood sugar, fat storage, appetite, and nutrient use. Importantly, the flow of blood from endocrine tissue directly into the exocrine portion of the pancreas allows these hormones to rapidly influence digestion—a unique design seen in few other organs.

Dr. Bikman explains that the exocrine pancreas (about 98% of the organ) produces powerful digestive juices that include enzymes for breaking down carbohydrates, fats, and proteins. This fluid is rich in bicarbonate to neutralize stomach acid and protect the small intestine. The enzymes are released in inactive forms and activated only in the intestines to avoid damaging the pancreas itself.

The endocrine and exocrine systems are closely linked. For example, insulin not only manages nutrient storage but also supports the function and growth of the exocrine acinar cells. Conditions like pancreatitis and type 2 diabetes often affect both systems due to this interdependence. If one side of the pancreas is disrupted—such as when insulin production is impaired—the exocrine side may also begin to fail, leading to digestion and nutrient absorption problems.

This lecture underscores the critical role the pancreas plays in total metabolic health. From blood sugar control to nutrient absorption, its dual functionality makes it a cornerstone of digestive and hormonal balance. Supporting the pancreas through diet, exercise, and reduced insulin demand is essential for maintaining metabolic health across the board.

Show Notes/References:

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IMPORTANT NOTE: The information presented is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Dr. Bikman is not a clinician—and, he is not your doctor. Always seek the advice of your own qualified health providers with questions you may have regarding medical conditions.

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