Gland: Pancreatic Tail

THE PANCREAS

The pancreas is composed of a head and a tail. The purpose of the pancreatic head is used to secrete pancreatic enzymes. The purpose of the pancreatic tail is to produce insulin. I will first discuss the pancreatic head.

THE PANCREATIC TAIL

The pancreatic tail (islets of Langerhan) produces the following hormones:

1. Insulin-which has a molecular weight of 5,808, is produced by the beta cells and has the following functions:
a. Inhibits liver phosphorylate for prevention of glycogen breakdown
b. Increases activities of enzymes that promote glycogen synthesis
a. Increases the flow of glucose to the liver
b. Increases sugar flow into fat cells, causing the production of glycerol for fat production with fatty acids
c. Increases membrane permeability for glucose, amino acids, potassium, magnesium, and phosphates
f. Increases translation of messenger RNA and the formation of proteins
g. Decreases the rate of gluconeogenesis in the liver
h. Decreases catabolism of proteins

It is interesting to note that gastrin, secretin, cholecystokinin, somatotrophin, cortisol, glucagon, progesterone and estrogen all affect the release of insulin.
It is also interesting that resting muscles use fatty acids for energy and, when working hard, use glucose for energy.

2. Glucagon-which has a molecular weight of 3,485 and is 29 amino acids long, is produced by the alpha cells and has the following functions:
a. Promotes the breakdown of glycogen in the liver (glucogenesis) by the following process. Glycogen is activated by adenyl cylclase, which is found in the hepatic cell membranes. This forms cAMP (adenosine mono-phosphate), which activates the protein kinase. The protein kinase then activates phosphorylate B kinase, which is converted into phosphorylate A kinase, which causes the degradation of glycogen into glucose 1 phosphate, which is then dephosphorylated into glucose and released into the bloodstream.
b. Promotes gluconeogenesis in the liver

3. Somatostatin-which is 14 amino acids long, produced by delta cells and does the following:
a. Decreases insulin and glucagon secretion
b. Decreased motility, secretions of the stomach and the GI tract
It is interesting that somatostatin is the same chemical substance as somatotrophin inhibiting hormone, which is released by the hypothalamus and suppresses the anterior pituitary from releasing growth hormone.

4. Pancreatic polypeptide secreted by the PP cells and has uncertain functions.

The overall purpose of the pancreatic tail is to regulate muscle tone by balancing sugar and water across the muscle cell interface (membrane.) The pancreas via insulin utilizes zinc as a carrier mechanism to create this effect. As you may recall, actin is the active fiber that is burning and myosin, the stable protein block that contracts and is dramatically affected by this process.
If sugar and water are not balanced accurately, then we have a loss or increased amount of insulin penetration into the cell. This will cause the body great difficulty with sugar metabolism. This may lead to a crystalline blockage, especially at the level of the motor end plate, creating neurological problems. The true pancreatic patient does not have stamina and ages quickly. One of the first complaints of a diabetic is that they sweat a lot and have increased urination, which causes the diabetic to drink a lot of water.
The hypoglycemic, on the other hand, has poor circulation and muscle coordination. The tone of the blood vessels is poor and causes the blood vessel walls to prolapse, allowing blood to pool in the central cavity of the body. The hypoglycemic patient breaks out into cold sweats with spastic trembling to get sugar across the muscle wall. Hypoglycemics also hold fluid, as the kidneys go alkaline which prevents urination.
In order for sugar to be handled properly it must go through the following four processes:
Reaction 1-Copper via the parotids must first tag the carbohydrate. The parathyroids, through the process of “phosphorylation,” add phosphorus to the carbohydrate. So, the first thing that takes place with the preparation of sugar is the phosphorus injecting ability of choline and inositol into the sugar, creating the proper acid-alkaline balance within that sugar for further breakdown. Therefore, the first step in preparing the sugar zinc compound (insulin) occurs in the stomach via pepsin. Chlorine is then added to the compound via HCl acid/pepsin release in the stomach, which is controlled by the adrenal medulla. Once the carbohydrate is properly prepared, it now enters the bloodstream and travels to the liver.

Reaction 2-Once in the liver, the thyroid converts sugar into glycogen by removing nitrogen via iodine. Then glycogen is released by epinephrine and is then activated on by adenyl cylclase that is found in the hepatic cell membranes. This forms cAMP (adenosine mono-phosphate), which activates protein kinase. The protein kinase then activates phosphorylate B kinase, which is converted into phosphorylate A kinase, which causes the degradation of glycogen into glucose 1 phosphate, which is then dephosphorylated into glucose and released into the bloodstream. This only occurs if there are sufficient amounts of zinc and selenium (insulin) outside the liver, which will draw the sugar out of the liver and into the blood.
Zinc is also used to make peptidases for protein digestion and is a component part of LDH via inter-conversion of pyruvic acid into lactic acid. Zinc is also an integral part of carbonic anhydrase, which is found in red blood cells. The purpose of carbonic anhydrase is to adhere to carbon dioxide and water so that it can be expired by the lungs.
Carbonic anhydrase is also found in the gastrointestinal tract and kidneys.
Reaction 3-In order for the insulin/sugar compound to leave the blood and enter the extracellular fluid, glucagon is now necessary for this to occur. When zinc is in higher quantities in the extracellular fluid, in combination with selenium, they draw sugar out of the blood and into the extracellular fluid. The uterus and prostate control selenium. This will be discussed later.

Reaction 4-When the sugar/insulin compound reaches the cell membrane, the selenium draws the sugar into the membrane. At this point, there is a selenium and potassium regulator known as oxytocin, which is released by the posterior pituitary (and closely resembles antidiuretic hormone), which holds the sugar for storage in the cell membrane. This membrane oxytocin is the regulator at every cell membrane for sugar and water entry into the cell to be metabolized. The oxytocin now causes the internal potassium to oxidize the chloride, shifting chloride out of the way, allowing the sugar and water to pass into the cell, which is then combusted to form lactic acid and converted back into lactic acid dehydrogenase in the veins.

The following blood tests determine pancreatic tail function:

1. PHOSPHORUS-indicates the amount of acid balance in the body. It does this via regulating secretions of HCl/pepsin ratios in the stomach. For example, if the food you eat contains large amounts of phosphoric acid, pepsin will be released to neutralize the acid. If the food contains very little phosphoric acid, large amounts of HCl will be released. Phosphoric acid, as explained before, creates the proper balance of choline and inositol into the sugar, affecting sugar metabolism from this point forward. Increases in blood acidity may be due to an increase of zinc and sugar. Alkaline blood is due to a decrease of zinc and sugar. The pancreatic tail regulates this acidity/alkalinity via insulin/glucagon.

2. LACTIC ACID DEHYDROGENASE-is a byproduct of sugar metabolism, as mentioned above. Lactic acid dehydrogenase (LDH) is a glycolytic enzyme that functions as a catalyst in carbohydrate metabolism, which aids the pyruvic and lactic acid interchange. LDH is a byproduct of muscle metabolism. When sugar and water (fatty acid metabolism) are exchanged across a muscle cell interface, a byproduct known as lactic acid is produced. Lactic acid is a byproduct of fatty acid metabolism via the alkalizing and oxidizing effect of the pancreatic head. When lactic acid combines with the venous blood (carbon dioxide), there is a hydrogen displacement. Lactic acid then bonds to a double hydrogen, forming lactic acid dehydrogenase. The organs and glands most responsible for the sugar and water interchange across a muscle cell interface are the pancreas and posterior pituitary (via antidiuretic hormone.)
LDH is chiefly found in the heart, kidneys, liver, skeletal muscle, as well as all tissues. LDH is a normal component of the cerebral spinal fluid.

IGF-1

Somatomedin is a polypeptide (carried by a protein) that is produced by the liver and other tissues. It mediates growth hormone function and utilization (metabolism) of glucose. This test monitors child growth and is used to diagnose acromegaly and hypopituitary conditions. Somatomedins inhibit the release of growth hormones by acting directly on the anterior pituitary and by stimulating the secretion of somatostatin from the hypothalamus.

Somatomedin levels are increased in: 

  1. Acromegaly 
  2. Hypoglycemia 
  3. Hepatoma 
  4. Wilm’s tumor 
  5. Precocious puberty 
  6. Hyperthyroidism 
  7. Hyperhypothalamic conditions 
  8. HyperPituitary conditions 
  9. Elevated 2-3 times during pregnancy 

Somatomedin levels are decreased in: 

  1. Dwarfism 
  2. Hypothalamic conditions 
  3. Hypopituitary conditions 
  4. Hypothyroidism 
  5. Delayed onset of puberty 
  6. Cirrhosis of the liver 
  7. Malnutrition 
  8. Anorexia 
  9. Acute illness 
  10. Aging 
  11. Diabetes mellitus 
  12. Maternal deprivation 

AGE MALE FEMALE ng/ml nmol/L ng/ml nmol/L 

  • YEARS 0-5 0-103 0-13.5 0-112 0-14.7 
  • YEARS 6-8 2-118 0.2-15.4 5-128 0.6-16.8 
  • YEARS 9-10 15-148 2.0-19.4 24-158 3.1-20.7 
  • YEARS 11-13 55-216 7.2-28.3 65-226 8.5-29.6 
  • YEARS 14-15 114-232 14.9-30.4 124-142 16.2-31.7 
  • YEARS 16-17 84-221 11.0-28.9 94-231 12.3-30.3 
  • YEARS 18-19 56-177 7.3-23.2 66-186 8.6-24.4 
  • YEARS 20-24 75-142 9.8-18.6 64-131 8.4-17.2 
  • YEARS 25-50 60-122 7.9-16.0 50-112 6.6-14.7 

PSA TOTAL

A "PSA total" in a male refers to the level of prostate-specific antigen (PSA) measured in a blood test, which is a protein produced by the prostate gland; generally, a normal PSA level for most men is considered to be below 4.0 ng/mL, though this can vary depending on age and individual factors, with higher levels potentially indicating the need for further investigation regarding prostate health. 

Key points about PSA total:
  • Interpretation depends on age:

    As men age, their PSA levels naturally tend to increase, so a "normal" range may be higher for older men compared to younger men. 

  • Factors affecting PSA levels:

    Besides cancer, other conditions like prostatitis (prostate inflammation), recent prostate biopsy, or vigorous exercise can also elevate PSA levels. 

  • High PSA and further testing:
    If a man has a significantly elevated PSA level, further testing like a prostate biopsy may be recommended by a doctor to determine the cause.

PSA FREE

"PSA free" in a male refers to the portion of the prostate-specific antigen (PSA) protein in the blood that is not attached to other proteins, meaning it circulates freely in the bloodstream; a higher percentage of "free PSA" compared to total PSA is typically associated with benign prostate conditions, while a lower percentage might indicate a higher risk of prostate cancer. 

Key points about "free PSA":
  • What it means:

    When a PSA test is done, the result includes both the total PSA level and the "free PSA" level, which is calculated as a percentage of the total PSA. 

  • Interpretation:

    A higher percentage of free PSA compared to total PSA is generally considered a good sign, as it suggests a lower likelihood of prostate cancer. 

  • Clinical use:

    Doctors may use the "free PSA to total PSA ratio" to help interpret PSA results, especially when the total PSA level is borderline. 

     

ESTRADIOL (E2) (Male)

ESTROGENS

Estradiol (E2) is the most active estrogen and is used to evaluate menstrual and fertility conditions. In males, it is used to evaluate estrogen producing tumors. Estriol (E3) is the chief urine-monitoring hormone in pregnancy. 

BLOOD TOTAL ESTROGEN pg/ml ng/L

MEN 20-80 20-80

ESTRADIOL URINE LEVELS ARE INCREASED IN: 

  1. Estrogen producing tumors 

  2. Hepatic cirrhosis 

  3. Hyperthyroidism 

  4. Precocious puberty 

  5. Feminization in children 

  6. During menstruation, before ovulation and between the 23rd to the 41st week of 
gestation 


 

ESTRADIOL URINE LEVELS ARE DECREASED IN: 

  1. Hypogonadism 

  2. Hypofunctioning hypothalamus 

  3. Hypofunctioning pituitary 

  4. Hypofunctioning adrenals 

  5. Menopause 


ESTRIOL URINE LEVELS ARE INCREASED IN: 

  1. Pregnancy


ESTRIOL URINE LEVELS ARE DECREASED IN: 

  1. Placental insufficiency 

  2. Congenital heart disease 

  3. Down’s syndrome 


BLOOD AND URINE TOTAL ESTROGENS LEVELS ARE ELEVATED IN: 

  1. Malignant neoplasms of the adrenals 

  2. Malignant neoplasms of the ovaries 

  3. Benign neoplasms of the ovaries 

  4. Lutein cell tumor of the ovaries 

  5. Theca cell tumor of the ovaries 

  6. Testicular tumors 


BLOOD AND URINE TOTAL ESTROGENS ARE DECREASED IN: 

  1. Hypopituitism 

  2. Hypofunctioning hypothalamus 

  3. Hypofunctioning ovaries 

  4. Intrauterine death 

  5. Menopause 

  6. Anorexia nervosa 

  7. Preeclampsia 


 

Glucose

GLUCOSE

Glucose is an important fuel for the body, which affects all tissues, organs, and systems.
Glucose also affects the acid/alkaline balance in the body.
Breakdown of glucose or starch starts in the mouth via ptyalin, then in the stomach via HCL, and then by pancreatic amylase, lactase and other enzymes.
Glucose is then absorbed in the small intestines and is then stored as glycogen in the liver.
The liver is the primary site of glucose production.
The liver converts lactic acid to glycogen and back to glucose via epinephrine.
The liver converts fats and proteins via gluconeogenesis into glucose or glycogen.
The head of the pancreas controls chromium, which controls insulin levels and assists in the enzyme action of fats via bile salts. The tail of the pancreas controls zinc, which maintains and sustains levels of insulin.
Blood sugar depends on:
1. The liver which stores and releases glycogen
2. The pancreas, which produces insulin that transfers sugar from the blood to the extracellular fluid
3. The adrenal glands, which produced glucocorticoids that, cause the liver to release glycogen into the blood as glucose
4. The sex organs, which deliver the extracellular glucose to the cell
5. The thyroid, which affects the storage of glycogen in the liver
6. The thymus and spleen, which affect the levels of iron and copper in the liver which, determine the liver's ability to handle glucose
As you can see there are many organs, or combinations of these organs and glands, which affect glucose levels in the body. Therefore, glucose in itself cannot specifically determine where the problem may lie. Other indicators are necessary to pinpoint the problem.

Phosphorus

PHOSPHORUS
85% of the total phosphorus exists as phosphates or esters in the body and is found chiefly in the skeleton and is combined with calcium. 14% of the phosphorus is found in intracellular tissues and 1 % is found in the extracellular fluid. Therefore phosphorus levels are a poor indicator of levels of phosphates in the body.

Phosphorus runs inversely to calcium levels in the body at a calcium to phosphorus ratio of 10 to 4. Therefore, calcium can be a great indicator for phosphorus as well.
As calcium levels increase in the serum, phosphorus levels decrease, and when calcium levels decrease phosphorus levels increase. In fact, causes of high calcium also cause low phosphorus. The controlling factor of phosphorus is parathormone (PTH), which is also the calcium-controlling factor. Phosphorus helps calcium through the cell membrane by increasing the permeability of the cell membrane via oxygen displacement.

1. Phosphorus is responsible for growth and development by way of:
✓ bonding
✓ polymer function
✓ hydration
✓ chemical transport, and
✓ buffering

2. Phosphorus is also responsible for bone formation

3. Phosphorus and metabolism of glucose
Phosphorus is also required for the metabolism of glucose via phosphorylation. Phosphorylation is when a phosphate radical promoted by glucokinase in the liver, or hexokinase in other cells captures the glucose and once inside the cells keeps it there. The exception to this occurs in the liver, the kidneys, and the intestinal epithelial cells.
Ingestion of carbohydrates causes phosphorus to enter RBC’s with glucose causing a reduction of serum phosphorus levels and lipids.
Phosphorus also works in the stomach to stabilize sugars and activate starches by the twofold process of phosphorylation.
Phosphorylation and its counterpart, dephosphorylation, turn many protein enzymes on and off, thereby altering their function and activity.
By altering pepsin/HCL levels phosphorus can:

a. Stabilize simple sugars-simple sugars are easily oxidized (combusted) before they reach the liver, resulting in low sugar levels. Pepsin stabilizes these simple sugars, so they can be transferred to the liver for storage.

b. Activation of starches- HCl is necessary to breakdown oily carbohydrates (grains), which are difficult to oxidize (combust). Thus making them readily available for oxidation.

The above two mechanisms establish an HCl-pepsin balance in the stomach for proper pH digestion.
The presence of both HCl and pepsin in the stomach are critical for preparing carbohydrates, as well as proteins for further digestion in the small intestines.

4. The regulation and maintenance of the acid-base balance in the body by maintaining glandular acidity.

5. The storage and transfer of energy from one part of the body to the other.

6. Used in the Production of phospholipids (90 % produced by the liver): lecithin, A cephalin, and sphingomyelin
Phospholipids are necessary for:
Proper brain function (sphingomyelins)
Phospholipids are a major constituent of lipoproteins which can affect function, formation and transport of these lipoproteins causing serious cholesterol abnormalities
Production of cell membranes
Thromboplastin production produced from A cephalin

7. Intracellular phosphorus is used for:
Energy transport formation of ATP from ADP and creatine phosphate via oxidative phosphorylation.
Major constituent of plasma membranes (phospholipids)
Major constituent of DNA and RNA (nucleic acids)
Calcium transport and osmotic fluid pressure
General nutritional considerations when phosphorus is high:

1. Patient should increase water intake
2. Reduce fat intake
3. Reduce Vitamin D intake if overdosing
4. An isotonic saline solution (sea salt) will decrease phosphorus levels
5. Also, decrease phosphorus in the diet and add calcium carbonate to your diet

General considerations when phosphorous is low:

1. Vitamin D deficiency
2. Calcium deficiency
3. Magnesium deficiency
4. Patient needs a high protein diet

LDH

LACTIC ACID DEHYDROGENASE

Lactic acid dehydrogenase is found chiefly in the heart, skeletal muscles, kidneys, and liver, as well as all cells.
In pathological states, elevated levels indicate damage to the above areas and is used to determine myocardial and pulmonary infarction.

In physiological states, LDH catalyzes the conversion of pyruvate ( the final step in glycolysis) to lactate and back, as it converts NADH to NAD+ and back.
A dehydrogenase is an enzyme that transfers a hydride from one molecule to another.
When sugar and water (fatty acid metabolism) are exchanged across a muscle cell interface, a by-product called lactic acid is produced.
When lactic acid combines with the carbon dioxide of the venous blood you have a hydrogen displacement. Lactic acid now becomes lactic acid dehydrogenase.
Lactic acid dehydrogenase, therefore, is a glycolytic enzyme that functions as a catalyst in carbohydrate metabolism to produce energy.
The pancreas via insulin and the posterior pituitary via ADH are responsible for this sugar and water exchange across the muscle cell interface. Lactic acid dehydrogenase indicates the active exchange of sugar across the membrane (muscle cell interface) utilizing chloride, zinc, and selenium.
The utilization of these minerals creates glycolysis.
LDH then from a physiological perspective determines pancreatic function regulating the amount of glucose into muscle.
It is also important to note that sugar metabolism is very complex and does involve a series of other organs.
Ranges for LDH are between 0-220; again it is rather obvious that LDH is a by-product of sugar metabolism and a 0 figure could not be construed as a low normal range. I feel that the range should start at 80.
You will find many patients with a low LDH having problems with decreased function causing heart, skeletal muscle (weakness, loss of strength, muscle wasting), kidney and liver dysfunction, and eventual wasting away of these organs.