In 2018, these researchers introduced the concept of the acini–islet–acinar (or ‘AIA’) axis: a two-way communication loop between the digestive and hormonal parts of the pancreas. Insulin, they proposed, stimulates amylase production, while amylase dials insulin back down. It is a self-regulating feedback system – and when it breaks down, the consequences may be serious.

In obesity and type 2 diabetes, this balance appears to go wrong. Chronic high insulin levels can exhaust the amylase-producing cells, causing exocrine pancreatic insufficiency. Without enough amylase, the gut loses its ability to regulate glucose absorption – pushing the body toward ever more insulin production and deepening the cycle.

A 2023 follow-up paper, by Pierzynowska, Pierzynowski and their colleague Christine Stier, adds another dimension. Examining bariatric surgery – procedures that rearrange the digestive tract to treat obesity – the team found that outcomes may partly be explained by changes in amylase activity. By disrupting food’s usual passage through the digestive system, these operations reduce the hormonal signals that drive insulin release, while letting amylase’s natural braking effect come forward.

Further experiments, in which the researchers infused amylase directly into the pancreas of pigs, have added further weight to the theory, showing that amylase can regulate insulin production from within the organ itself.

Pierzynowska and Pierzynowski suggest that amylase could one day be taken orally to ease the burden on insulin-producing cells and slow the progression of type 2 diabetes. If the AIA axis proves as important as they believe, the humble digestive enzyme may be due a significant rethink.