Pancreatitis is one of the deadliest conditions, not only because it’s so difficult to diagnose from biochemical serum markers that are often misleading, but also due to the fact that inflammation from the pancreas can radiate to other organs, so symptoms of this conditions can be felt differently than what’s medically known and may lead to wrong diagnosis.

As its name suggests, pancreatitis is an inflammatory condition of the pancreas. As the condition gradually worsens so does the capacity of the organ to perform exocrine and endocrine functions (this condition or rather a symptom of pancreatitis is called an exocrine pancreatic insufficiency). Similar to hepatic stellate cells in liver fibrosis, pancreatic stellate cells (PSCs) play a major role in the start of the fibrosis and its pathogenesis. Stellate cells are cells that are activated to facilitate repair in response to damage to the organ. If left untreated, chronic pancreatitis results in permanent damage to the parenchyma (functional tissues) of pancreas and thus loss of function. Upon coming into contact with TGF-ß1 (transforming growth factor beta-1) and PDGF (platelet-derived growth factor), pancreatic stellate cells produce extracellular matrix (ECM) composed of collagens, fibrinonectin, laminin and other substances. These stellate cells are easily identified by the high levels of alpha-smooth muscle actin (α-SMA) and ECM proteins such as collagen type I-α and fibronectin 1-FN1. Specifically, TGF-ß stimulates the synthesis and secretion of type-1 collagen, fibronectin, laminin and MMP-2, 3 and 13.

Several herbs or constituents listed here aim to alleviate pancreatitis through antifibrotic effects or by affecting the inflammatory cascade. On the other hand, inhibition of iNOS may also prove to be fruitful as elevated levels of NO have been implicated as one of the leading factors of pancreatitis.

Ethanol and its metabolite acetaldehyde (acetaldehyde is also a byproduct of candidiasis) is one of the main culprits of activated stellate cells. They activate PSCs through ERK 1/2, p38 kinase, c-jun amino terminal kinase, phosphatidylinositol 3-kinase and protein kinase. Herbs affecting these kinases may be beneficial for treating pancreatic symptoms.

As chronic pancreatitis is often associated with development of fibrosis, do have a look at my other list targeted at liver fibrosis. Many of herbs / compounds listed there may be beneficial for pancreatic fibrosis as well.

When healing pancreas, it’s important to maintain the function of both acinar (producing digestive enzymes) and islet cells (producing glucagon, insulin, somostatin, amylin, and others). For herbs protecting beta cells of islet cells, check out this list!

Emodin

  • has antifibrotic effects and may help treat pancreatitis,
  • downregulates α-SMA,
  • reduces expression of TGF-ß1,
  • lowers serum hyaluronic acid and laminin,
  • inhibits proliferation and activation of stellate cells,
  • inhibits lipid peroxidation.
  • Best source of emodin would be Japanese knotweed (Polygonum cuspidatum).
  • Be careful with emodin as large doses are toxic to organs, especially towards renal tubules!

Curcumin

  • inhibits activation of PSCs, NF-κB and AP-1,
  • lowers proinflammatory IL-6, TNF-α, iNOS,
  • inhibits α-SMA expression, IL-1ß, MCP-1, type I and III collagen.
  • Look for curcumin in turmeric species, especially Curcuma longa.

Rhein

  • may help treat pancreatitis,
  • decreases ECM synthesis (α-SMA, FN1, type I collagen).
  • There is a potential for toxicity, similar to emodin.
  • You will find plenty of rhein in rhubarb roots.

Resveratrol

  • lowers the levels α-SMA, fibronectin 1 (FN1) and type-I collagen,
  • reduces PSC activation, ECM deposition.
  • Once again, a good source of resveratrol is Japanese knotweed (Polygonum cuspidatum).

Scoparone

  • Isolated from Artemisia capillaris, but found in other plants as well.
  • It inhibits expression of α-SMA and collagen type I while also inhibiting PSC proliferation.
  • It reduces oxidative stress and inhibits PSC activation.
  • Do be wary as most of the sources of scoparone are toxic.

Amygdalin

  • This cyanogenic glycoside found in many fruit kernels lowers TGF β-1, α-SMA, ET-1, EGCG, and increases CGRP.
  • Amygdalin inhibits the production of pro-fibrotic cytokines (α-SMA, TGF-β1, and PDGF-BB) and suppresses the activation of PSCs.
  • It may also down-regulate endothelin-1 (ET-1) and up-regulate calcitonin gene-related peptide (CGRP).

I don’t recommend poisoning yourself with cyanogenic glycosides as amygdalin would most likely needed to be injected to the diseased tissue.

Salvianolic acid B

  • reduces lipid peroxidation,
  • decreases MDA in pancreas,
  • alleviates morphological damage to pancreas,
  • inhibits activation of PSCs,
  • reduces serum levels of HA, LN, type IV collagen and procollagen III peptide,
  • inhibits COL I-1α and α-SMA.
  • The best source is the root of red sage (Salvia miltiorrhiza).

Tanshinone IIa

  • protects pancreatic tissues,
  • reduces pain resulting from chronic pancreatitis by downregulating HMGB-1 and TRL4 expression.
  • Once again, red sage root reigns superior over other herbs.

Eruberin A

  • Eruberin A exerts antifibrotic effects through suppression of the expression of α-SMA, FN and COL I-1α
  • Source: Pronephrium penangianum (may be a little bit hard to come by)

Taurine

  • Supplementation with the amino acid taurine may actually be beneficial when treating pancreatitis as taurine has been shown to decrease MDA in tissues and reduce pancreatic edema.

Epigallocatechin gallate (EGCG)

  • could suppress activation and inhibit proliferation and migration of PSCs,
  • also notably impacts collagen deposition and overexpression of TGF-β1 and α-SMA
  • it supposedly has a strong impact on the expression of Smads, inhibiting Smad3 expression while enhancing Smad7 expression.
  • Mostly found in tea leaves, but it’s toxic to liver in high doses just like most tannins.

Berberine

  • protects pancreas and lowers activities of pancreatic lipase and amylase, helping to alleviate pancreatitis,
  • inhibits pro-inflammatory cytokines (TNF-α, IL-1ß, and IL-6) and iNOS,
  • inhibits JNK pathway,
  • decreases MMP9 and HMGB-1,
  • decreases TUNEL positive cells,
  • decreases acinar cell death,
  • it’s also effective against several pancreatic cancer cell lines.
  • High doses may be counterproductive, so do use it with caution and in small doses.

Paeoniflorin

  • Paeoniflorin isolated from Paeonia species (mostly Paeonia lactiflora / alba) improves necrotizing pancreatitis, but be careful as it’s quite estrogenic and blocks out testosterone.

Melatonin

  • was shown to induce pancreatic regeneration following acute pancreatitis.
  • I wonder if there’s a link between melatonin content and occurrence of pancreatitis.

Embelin

  • the compound found in vidanga (Embelia ribes) inhibits PSCs, but I don’t recommend this herb due to its irritating nature.

Retinoic Acid

  • may inhibit PSC activation,
  • may also help with replenishing fat droplets inside PSCs that are gradually lost as pancreatic fibrosis continues, this helps PSCs secrete less α-SMA and ECM proteins.
  • Could vitamin A have a major impact for pancreatitis?

Patrinia scabiosaefolia / villosa

  • lowers amylase and lipase values along with TNF-α and IL-ß.
  • It’s a very safe herb that I recommend to anyone for other benefits, especially for regeneration of renal tubules that are damaged as the result of inflammation of the pancreas.

Siberian ginseng root (Acanthopanax senticosus)

  • decreases serum amylase and improves pathological state of pancreas

Tripterygium glycosides

  • may improve pathological state of pancreas, but sadly this is only after injection, so I wouldn’t give this toxic herb much of a chance.

Sanchinoside

  • isolated from Panax notoginseng, this compound inhibits pancreatic amylase and inflammatory response.
  • This herb may be quite irritating, so use it with caution.

Piper wallichii

  • Injection of the stem extract may improve pancreatic tissue and help with endotoxins when suffering from pancreatitis

Anisodus tonguticus

  • intravenous supply of alkaloid anisodamine may target Ca2+ flow and thus help with the overload of calcium

Tetrandrine

  • isolated from Stephania tetrandra,
  • reduces calcium overload.
  • Stephania tetrandra is considered toxic towards the kidneys, so use it with caution.

Tetramethylpyrazine

  • improves histopathology of pancreas and pancreatic ascites.
  • Ligusticum chuanxiong is an excellent source.

Rutin

  • targets iNOS and NO,
  • blocks Ca2+ uptake in pancreatic tissues.
  • Rutin has a very promising application considering food is a rich source of this compound.

Oxymatrine

  • reduces amylase, ALT and creatinine

Gentiopicroside

  • found in Gentiana manshurica,
  • reduces elevated serum amylase and lipase activity.
  • I don’t recommend using any gentian.

Cordyceps

  • protects pancreatic beta cells, but it’s also toxic to other organs.

Gardenia jasminoides

  • compound geniposide attenuates chronic pancreatitis,
  • improves survival odds for acinar cells,
  • inhibits JNK and ERK activation,
  • reduces pancreatic fibrosis and activation of PSCs.
  • This herb is sadly hepatotoxic.

Baicalein

  • found in Scutellaria baicalensis,
  • may be effective as a PSC blocker, but it’s also toxic.

Note: It feels like most of these herbs are toxic, so use them in small doses and be wary of the side effects. I highly recommend using gurmar (Gymnema sylvestre), although it’s not listed here because there are not enough studies related to pancreatitis and gurmar. It’s an excellent beta cell protector and may even repair beta cells of the pancreas.

References

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