Can You Live Without a Pancreas?

There are 78 known organs in the human body, and it’s hard to picture yourself living without any of them. But as vital as your heart and brain are, there are several organs that you can manage – albeit more challenging – without. Common examples include your spleen, gallbladder, appendix, colon, uterus and kidneys.

Considering how important the pancreas is to digestive health and blood sugar regulation, living without this organ may seem impossible. But it's actually feasible and more common than you may think. This blog will detail how you can survive without a pancreas and how to manage this condition.

What is the function of the pancreas?

The pancreas is a small (the size of your hand), spongy organ located behind the stomach. The pancreas serves two purposes as part of the body’s digestive system: an exocrine function and an endocrine function. In short, the pancreas creates enzymes to digest fats and produces hormones to regulate blood sugar levels. Most of the organ’s cells (about 80 percent) aid in digestion.

Enzymes

The pancreas houses thousands of small structures that secrete enzymes, also called pancreatic juices. Each time you eat and digest food, the enzymes travel through pancreatic ducts before meeting up with bile in the duodenum, the first part of the small intestine responsible for breaking down fats, proteins and carbohydrates. The pancreas produces as much as 8 cups (64 ounces) of digestive juices each day.

The pancreas makes three main types of enzymes:

• Lipase: Breaks down triglyceride fats into fatty acids and glycerol
• Protease: Breaks down proteins (amino acids) into peptides
• Amylase: Breaks down carbohydrates into maltose, which has two glucose molecules

Hormones

The pancreas is also home to tiny cell clusters called islets of Langerhans, which produce and release important hormones to regulate blood sugar levels and your appetite. Islets of Langerhans consist of two main hormone-producing cells: alpha cells and beta cells. Beta cells account for about 80 percent of hormone production, while alpha cells account for 20 percent of hormone production.

The pancreas makes three main types of hormones:

• Insulin: Produced by beta cells, insulin helps your body use blood sugar (glucose) as fuel for energy. Too much insulin causes low blood sugar, while not enough insulin results in high blood sugar.
• Glucagon: Produced by alpha cells, glucagon helps balance out insulin by producing glucose to prevent hypoglycemia.
• Gastrin: Gastrin is a hormone that tells your stomach to make gastric acid. The pancreas only creates a small amount of gastrin – the stomach is the primary producer.
• Amylin: Located in beta cells, amylin inhibits food intake and delays stomach emptying.
• Somatostatin: Produced by delta cells, somatostatin regulates the endocrine system by inhibiting the release of insulin and glucagon. 

Reasons to remove your pancreas

The complete removal of your pancreas occurs via a surgical procedure called a total pancreatectomy. In addition to the pancreas, a hepatobiliary (liver, pancreas and bile duct) surgeon will also often remove the following organs:

• Entire gallbladder
• Entire spleen (in most cases)
• End of the common bile duct
• Entire duodenum 
• Portions of your stomach (called the pylorus)

Upon removal, your surgeon will then reconnect the stomach and whatever is left of the bile duct to the jejunum, the middle part of the small intestine below the duodenum and above the ileum. The entire procedure takes about three to four hours.

There are two main reasons your surgeon may remove the pancreas.

Chronic pancreatitis: Pancreatitis occurs when digestive enzymes cause inflammation of the pancreas. While many cases are acute, chronic pancreatitis can bring about severe long-term pain and digestive issues. A total pancreatectomy to treat chronic pancreatitis is often performed as an end-of-the-line option when other treatments are exhausted.

Pancreatic cancer: In many cases of pancreatic cancer, your surgeon will perform a Whipple procedure in which they remove only a portion of the pancreas (the head), the duodenum and the bile duct. However, doctors may recommend a total removal if there are multiple tumors present or if the tumors are present in most of the pancreatic tissue. As with chronic pancreatitis, a total pancreatectomy for pancreatic cancer is often viewed as a last resort. There are also some patients with genetic conditions or who develop precancerous cystic tumors called intraductal papillary mucinous neoplasm (IPMN). Sometimes, a total pancreatectomy is performed preventatively to eliminate future cancer risk.

What happens if your pancreas is removed?

Two main things occur when your pancreas is removed: your body no longer produces enzymes to digest food or hormones, such as insulin, to regulate blood sugar. 

The need for insulin replacement

Without the necessary cells to produce insulin, you’ll become a permanent diabetic who needs to take insulin for life to manage your glucose levels.

Doctors use both rapid-acting insulin and long-acting insulin to replicate the pancreas’ function. Rapid-acting insulin works about 15 minutes after injection and peaks in one two two hours. A single injection can last two to four hours. Long-acting insulin, on the other hand, takes several hours to reach the bloodstream and can last up to 24 hours.

Alternatively, you may be a candidate for an artificial pancreas. This treatment combines a continuous glucose monitor with an insulin pump that can detect glucose and glucagon levels and adjust insulin levels accordingly.

The need for enzyme replacement therapy

Further, you’ll need to take an oral enzyme replacement with each meal.

Without key enzymes such as lipase or amylase, your body can’t break down fats or carbohydrates. When these compounds go undigested, they can lead to diarrhea or fatty stools. The absence of protease, an enzyme that breaks down proteins, you’re more at risk for infections and toxic substances forming in your intestines. That’s because proteases can help kill bacteria and other harmful germs.

There is one way to avoid becoming a diabetic, although it only applies to people who had their pancreas removed for non-cancer reasons. During a total pancreatectomy, your surgeon can also perform an islet autotransplantation in which islet cells – the cells that produce insulin – are separated from the pancreas in a laboratory and infused into the liver. The idea is these cells can mimic some of the pancreas’ function to help regulate blood sugar levels.

If you have cancer or are at risk of cancer, an islet autotransplantation isn’t available in the United States due to the chance that cancer cells may be transplanted into the liver.

Living without a pancreas

While it is possible to live without a pancreas, it takes time each day to ensure insulin levels are balanced and you take the necessary enzyme pills every meal. Keeping up with your medications and implementing lifestyle changes are the key factors that determine your health moving forward.

After your pancreas removal, you’ll receive a referral to see an endocrinologist who specializes in endocrine disorders such as diabetes and enzyme replacement.

You’ll learn how to manage your diabetes, use insulin pumps to regulate your blood sugar and recognize which foods are best for people without a pancreas. Your doctor can refer you to a registered dietician or nutritionist to come up with a meal plan. 

Typically, a diet for diabetes includes the following:

• Filling up half your plate with less vegetables (mushrooms, peppers, broccoli, Brussels sprouts, green beans, tomatoes)
• Fill up a quarter of your plate with a lean protein (chicken, fish, poultry, lean pork, lean meat)
• Fill up a quarter of your plate with a healthy carbohydrate (brown rice, quinoa, oats, beans, whole grain pasta)

Your doctor can also give you guidance on which enzyme replacement to take, either an over-the-counter supplement or a prescription drug. 

Pancreatic dietary supplements contain pancreatin, a mixture of several enzymes such as lipase, amylase and protease, along with other enzymes.

The prescription option is known as pancreatic enzyme replacement therapy (PERT) capsules, which is the only FDA-approved medication to treat people without a pancreas. PERT capsules also contain a mixture of lipase, amylase and protease. Both prescription and over-the-counter enzyme replacement drugs are made from a pig’s pancreas.

The dosage varies by person, so your doctor will instruct you how much to take. The capsules come in various doses that are based on the amount of lipase. For example, some brands start at 3,000 lipase units and increase to 36,000 lipase units per pill. Typically, people take 50,000 to 75,000 units during a meal and 25,000 units with a snack. These figures seem high, but a normal pancreas releases 750,000 to a million units of lipase during a meal.

Currently, there are six FDA-approved PERT capsules on the market: Creon, Pancreaze, Pertzye, Ultresa, Viokace and Zenpep.

How long can you live after pancreas removal?

The life expectancy after having your pancreas removed ultimately depends on the underlying condition. In other words, your chances of survival are much greater if you had your pancreas removed due to trauma versus it being removed due to cancer.

According to a small study published in the International Hepato-Pancreato-Biliary Association journal, a team of researchers found the overall survival rate of people who received a total pancreatectomy to be 80 percent one year after surgery, 72 percent two years after surgery and 65 percent three years after surgery. Notably, the survival rate plummeted to 63 percent, 43 percent and 34 percent, respectively, for people who had their pancreas removed due to pancreatic cancer.

Living without a pancreas is an uphill battle, but one that you don’t have to go through alone. Our team of endocrinologists can help you manage your condition regardless of what is thrown your way.