Written by Susan Sweeny Johnson, PhD, Biochem. In a test with 127 patients with pancreatitis, a test group received an antioxidant mix with vitamin E, vitamin C, selenium, beta carotene and 2 grams methionine. Researchers found 20% more pain free days in the test group compared to the controls.
Chronic pancreatitis (CP) is characterized as a persistent and progressive inflammation of the pancreas often caused by alcoholism but may also be of unknown origin. In the US, 86,000 people were hospitalized with CP in 2002 (1). The initial symptoms are intense pain followed by diabetes and digestive disorders due to lack of digestive enzymes and bicarbonate production as the pancreas is destroyed (2,3). Pain is poorly managed by pain relievers and although some pain relief occurs with consumption of digestive enzymes in a few cases, a better pain treatment is urgently needed (4,5,6).
Ingestion of toxic substances such as alcohol and nicotine have been implicated in the initiation of the disease. These substances are detoxified in the liver and pancreas via pathways that involve the formation of free radicals. If the detoxification pathways are overwhelmed, excess free radicals begin to oxidize or destroy surrounding tissue, potentially increasing pain and inflammation (7). Taking the supplemental antioxidants Vitamin E, Vitamin C and carotene; and cofactors selenium and methionine may eliminate the free radicals before they can cause further pancreatic tissue damage.
Researchers recently studied the effects of supplementation on pain levels of chronic pancreatitis patients who were experiencing substantial pain. The study included 20-40 year-old chronic pancreatitis participants who were currently requiring at least monthly medication for pancreatic pain.
The patients were assigned to one of two groups in the double-blind trial:
- Group A: Fifty-six patients received a placebo.
- Group B: Seventy-one patients received the following mix of supplemental antioxidants and cofactors – 600 mcg organic selenium, 0.54 gm ascorbic acid (Vitamin C), 9000 IU Beta carotene (Vitamin A), 270 IU a-Tocopherol (Vitamin E) and 2 gm methionine (related to SAM-E) per day.
Both groups were given analgesics (pain medicine) as requested as well as daily digestive enzymes.
The number of pain-free days as defined as days not requiring analgesics or hospitalization was measured for each patient for three months prior to the study and then for each month during the six month trial. Both the presence of oxidized blood fats and the levels of blood antioxidants (vitamin E, vitamin C and carotene) and cofactors (selenium and methionine) were measured by standardized assays (tests).
The number of painful days per month was reduced somewhat in Group A (Placebo Group), from 7.21 + 5.34 days at the start of the trial to 3.36 + 4.35 days at the end of six months. However, it was reduced significantly more in Group B, from 9.14 + 7.60 days at the start to 1.68 +2.80 days after six months ( p < 0.001 for the difference). The number of pain killers requested was similarly reduced. By then end of 6 months, about one third of those in Group B were pain-free, while only about 13% of those in Group A (Placebo) were pain-free.
The measures of oxidative stress at the start of the trial were about twice as high in patients with chronic pancreatitis, compared to those without chronic pancreatitis (p<0.001) and the antioxidant levels in with chronic pancreatitis patients were about half of those in healthy controls (p<0.001) except for Vitamin C status, which was the same. At the end of the trial, lipid oxidation products decreased from the initial levels 17% in the Group A (Placebo Group), but decreased 50% with supplementation in Group B (p<0.001).
Blood serum SOD (super oxide dismutatse, an enzyme the body produces as a response to increased oxidation products) levels decreased more in Group B also; 14% in group A and 44% in group B, although less significantly (p= 0.142). Also, the antioxidant levels (Vitamin A, C, and E) in the blood were raised significantly, approximately 33%, by supplementation while remaining essentially unchanged with placebo, a decrease of about 1.5%, (p<0.001). Glutathione levels (a measure of the ability of the patient’s ability to fight oxidation and therefore tissue damage) were about doubled in Group B while remaining unchanged in Group A (Placebo) (p<0.001).
Since no effective treatment for pain in chronic pancreatitis patients currently exists, this study suggests that antioxidant supplementation may be effective.
Source: Bhardwaj, Payal, et al. “A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis.” Gastroenterology 136.1 (2009): 149-159.
© 2009 AGA Institute. Published by Elsevier Inc
Posted March 10, 2009.
References:
- See the National Institute of Diabetic, Digestive and Kidney Diseases website.
- Witt H, Apte MV, Keim V, et al. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology 2007;132:1557–1573.
- Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120:682–707.
- Di Sebastiano P, di Mola FF, Buchler MW, et al. Pathogenesis of pain in chronic pancreatitis. Dig Dis 2004;22:267–272.
- AGA Technical Review: Treatment of pain in chronic pancreatitis. Gastroenterology 1998;115:765–776.
- Brown A, Hughes M, Tenner S, et al. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis: a meta-analysis. Am J Gastroenterol 1997;92:2032–2035.
- Braganza JM. The pathogenesis of chronic pancreatitis. Q J Med 1996;89:243–250.
