Are weight loss injections and pancreatitis connected?

Gallstones are one of the most common causes of pancreatitis. They form in your gallbladder, a small organ below your liver that stores bile. Bile is produced by your liver, and helps to digest fats in your diet. Large amounts of cholesterol (fats) can cause an imbalance in the chemical makeup of bile, which leads to crystals forming in the bile stored in your gallbladder. These can grow over many years into solid stones.

If a gallstone moves out of your gallbladder it can block the opening to your pancreas, causing it to become inflamed. This is how gallstones cause acute pancreatitis.

Alcohol consumption is another common cause of pancreatitis, and can lead to pancreatitis in a couple of different ways.

1. The digestive enzymes made by your pancreas normally don’t activate until they’re in your digestive tract. But drinking alcohol can cause them to activate early, essentially causing the pancreas to ‘digest’ itself.
2. Alcohol can also make the fluids produced by your pancreas thicker. This can cause blockages in your pancreatic ducts, leading to inflammation.

High triglyceride (also known as hypertriglyceridemia) levels are the next most common cause of pancreatitis after alcohol and gallstones. We don’t fully understand how high triglyceride levels cause pancreatitis. One of the leading theories is that an interaction between triglycerides and the digestive enzymes released by your pancreas can produce substances that may damage the pancreas, leading to pancreatitis.

While rapid weight loss itself isn’t thought to increase the risk of pancreatitis, some approaches to losing weight quickly can. One of these is the ketogenic (keto) diet – which involves eating very few or no carbohydrates at all.

The reason this helps you lose weight is also the reason it increases your risk of pancreatitis: without carbohydrates to use for energy, the body enters lipolysis, where it breaks down stored fats to release energy. But this also releases free fatty acids into your bloodstream, which are converted into triglycerides by your liver. This can increase your triglyceride levels, which could lead to acute pancreatitis due to hypertriglyceridemia.

The keto diet involves eating more dietary fat and fewer carbohydrates, to switch the body’s preferred source of energy from carbs to stored fat. But because most dietary fat is in the form of triglycerides, if you unknowingly eat any carbohydrates, your body can switch back to processing carbs for energy – leaving you with elevated triglyceride levels.

While eating little-to-no carbs may increase your risk of hypertriglyceridemia – eating too many can also have a similar effect. Studies show that when you eat more than the recommended level of dietary carbohydrates (over 55% of your energy intake), the concentration of triglycerides in your blood can rise. So it’s really important to maintain a healthy balance of carbs and dietary fat (whether you’re using GLP-1 treatment or not), to minimize your risk of pancreatitis.

There’s also a chance pancreatitis could be caused by a medication you’re taking. In a 2005 US review of prescription drugs associated with pancreatitis, the following medications were each found to be linked to over 20 reported cases of acute pancreatitis:

• Didanosine (HIV treatment)
• Asparaginase (used in treatment of acute lymphoblastic leukemia)
• Azathioprine (used to manage rheumatoid arthritis)
• Valproic acid (epilepsy treatment)
• Pentavalent antimonials (leishmaniasis treatment)
• Pentamidine (antimicrobial used to treat pneumonia, pneumocystis, leishmaniasis, and trypanosomiasis)
• Mercaptopurine (used in the treatment of acute lymphocytic leukemia)
• Mesalamine (used to treat ulcerative colitis)
• Estrogen preparations (used in HT (hormone therapy) and contraception)
• Medications used to treat moderate to severe pain
• Tetracyclines (antibiotics used for chlamydia and stomach issues)
• Cytarabine (used in the treatment of acute myeloid leukemia)
• Steroids (used in many autoimmune conditions to treat inflammation)
• Trimethoprim/sulfmethoxazole (an antibiotic)
• Sulfasalazine (used to treat rheumatoid arthritis, colitis, and Crohn’s)
• Furosemide (a diuretic used to flush out water)
• Certain non-steroidal anti-inflammatory drugs (NSAIDs)

There’s evidence that pancreatitis can be hereditary, too. Hereditary pancreatitis tends to start with cases of acute pancreatitis in childhood, which then transitions to chronic pancreatitis in early adulthood. It’s thought that variations in the PRSS1 gene are the primary cause of acute pancreatitis, accounting for 60-85% of people with hereditary pancreatitis. But not everyone with hereditary pancreatitis will have an identifiable genetic cause, and variations in other genes that haven’t been identified yet could also be responsible.