A case report on the successful use of inositol hexaniacinate for the treatment of achlorhydria: its possible mechanism of action upon the central nervous system and parietal cell-adenosine Triphosphate-dependent [K.sup.+]/[H.sup.+] pump
Jonathan E. Prousky
Achiorhydria is a gastrointestinal disorder where the parietal cells no longer function and acid secretion does not occur. We report on a case where the therapeutic use of inositol hexaniacinate (IHN) was effective for the treatment of Achlorhydria. The patient presented to the Robert Schad Naturopathic Clinic with complaints of bloating, intermittent diarrhea, gas, chronic throat irritation, perianal swelling and back pain related to maldigestion. The patient’s initial fasting gastric pH was 7, indicative of achlorhydria. The patient was instructed to take 650mg three times daily of IHN, a form of niacin (nicotinic acid). After approximately three weeks of use, the pH returned to 1, which is considered normal. A little more than three weeks later, the gastric pH continued to be within the normal range, but did increase to a 3. IHN might enhance the production of hydrochloric acid (HCl) in a manner that cannot be explained by it simply being an acid. The benefits of IHN might be due, in part, to its stress-mo derating properties upon the central nervous system. We further postulate that IHN works by priming the parietal cells for the production of mitochondrial adenosine triphosphate (ATP). This priming action provides the cellular energy necessary to drive the process of generating HCl from the parietal cells. These mechanisms of action might be responsible for the therapeutic change in gastric acidity as demonstrated by repeated fasting gastric pH measurements, and by the relief of gastrointestinal symptoms as noted by the patient.
Hypochlorhydria is a condition where the parietal cells of the stomach secrete insufficient amounts of hydrochloric acid (HCl). Achlorhydria is simply a more severe form of hypochlorhydria where the parietal cells no longer function and acid secretion does not occur. The consequences of hypo- and achlorhydria include an increased susceptibility to gastric bacterial overgrowth, (1) enteric infections, (2,3) hypergastrinemia that might lead to enterochromaffin-like cell hyperplasia and neoplasia, (4-7) and malabsorption of various nutrients (e.g., calcium, iron and zinc) and amino acids. (8,9) The proper production of HC1 is therefore essential for optimal health. It renders the stomach sterile against pathogens, prevents fungal and bacterial overgrowth of the small intestine, facilitates the flow of bile and pancreatic enzymes, and enables the proper absorption of protein and a variety of nutrients. When HCl production is insufficient or absent, the gastric pH will not be sufficiently acidic, digestion will be impaired, and numerous signs and symptoms develop. Table 1 lists the most common signs and symptoms associated with deficient or absent HCl production.
We report on a case where the therapeutic use of inositol hexaniacinate (IHN), a form of niacin (nicotinic acid), wasydrate diet. Results of this study showed that the Atkins diet was more effective at improving serum levels of HDL and triglycerides. In this study, the Atkins Diet increased HDL levels by 11% compared to a 1% improvement for people on the low-fat, high carbohydrate diet. Furthermore, triglycerides decreased 49% on the Atkins Diet. There was no significant change in the LDL marker between the two groups. (14) Evidence is mounting that a low-fat diet and/or a diet high in only polyunsaturated fatty acids may be detrimental to one’s health.
There are numerous articles with many different studies cited on the benefits of saturated fats which are heart protective. (6,11,13,15,16) In a study comparing many types of fats, palm kernel oil appeared to be the most protective against the development of cardiovascular disease. Furthermore, platelet aggregation was reduced by palm kernel oil and increased by sunflower oil, which is high in the polyunsaturated w6 fatty acids. (17) In another study, cardiac necrosis caused by unsaturated fats was prevented by the addition of cocoa butter to the subject’s diet. (18) Cocoa butter is composed of 35% stearic acid (C18) and 25% palmitic acid (C16), which are both saturated fatty acids. It also appears that cocoa butter has a neutral effect on cholesterol, (19,20) which is thought to be due to the high content of stearic acid. (21)
Shorter-chained saturated fats have been used by physicians as conjunctive treatment in liver disease. Short and medium chain saturated fatty acids, unlike the longer chain fatty acids, are directly absorbed into the bloodstream and utilized by the liver. Their short chain length allows these fats to be directly converted into energy. This reduced metabolic load allows the liver to optimize its function of detoxifying, producing bile, and maintaining optimal blood sugar levels. Studies have shown that the short and medium chain saturated fatty acids found in coconut oil provide protection against carcinogenic compounds. (15) In a study comparing the benefits of fatty acids in protecting against ethanol-induced liver damage, one group of animals was fed ethanol and tallow (saturated fat from animals) and a second group was fed ethanol and the unsaturated fatty acid linoleic acid. Results concluded that the animals fed tallow were protected from ethanol induced liver damage, whereas, animals fed linoleic acid d eveloped fatty liver necrosis and inflammation. (15)
Fatty acids are particularly important in the developing neonate. Palmitate is a long chain saturated fatty acid that is present in large amounts in phospholipids of lung surfactant. One study suggests that a maternal diet high in unsaturated fatty acids can potentially cause breathing problems for the newborn. In another study, pregnant mice were fed saturated fat in the form of coconut oil, as opposed to another group of mice fed unsaturated fats. Upon comparison, the pregnant mice fed saturated fats were found to produce offspring with normal brains and higher intelligence. (15) Furthermore, it is interesting to note that the composition of fats in coconut oil is similar to the fats found in human mother’s milk. (22)
Unsaturated fats have been shown to be immunosuppressive. (16) In the past, to prevent the deleterious effects of cachexia, cancer patients were given IV unsaturated fat in efforts to increase their caloric intake. In actuality, these unsaturated fats made their condition worse, by causing immunosuppression and increasing the risk for metastasis. (15) Cancer cells have been found to preferentially use unsaturated fats for fuel, because of their inhibiting effect on proteolytic enzymes that would otherwise degrade the cancer cell’s protective connective tissue capsule. (15) The protective connective tissue capsule is one of the reasons that cancer cells are able to escape recognition by the body’s immune system. Coconut and butter stimulate the differentiation of cancer cells, allowing recognition by the immune system and the potential reduction in metastasis. (15) In other words, unsaturated fatty acids appear to promote tumor growth, whereas saturated fats do not. Short and medium chain saturated fatty acids have proven beneficial for those suffering from cachexia of cancer, since they are a quick, high calorie energy source that doesn’t promote cancer growth.
Saturated fats in coconut oil, such as capric acid (C10) and lauric acid (C12), have been found to actually boost the immune system. In fact, coconut oil has been shown to be antiviral, antibacterial, antifungal, and antiprotozoal. (11) Lauric acid and its monoglyceride, monolaurin, have been shown to reduce viral load in HIV patients. (23) Monolaurin has also shown antiviral activity against most lipid-coated viruses. Both capric and lauric acids in coconut oil have been shown to be active against Candida albicans. (24)
Saturated fats also have an important role in maintaining optimal kidney function. The kidneys have been found to preferentially use saturated fats for protective cushioning and as a quick energy source. Commonly occurring saturated fats in the kidney storage depots include: myristic (C14), palmitic (C16), and stearic (C18) acids. Kidney function can be enhanced by the high content of myristic acid found in coconut oil. (25) Myristolation is a process where myristic acid is added to the end of a signaling protein, such as a G protein. (26) The addition of myristic acid allows for signaling across the kidney cell membrane, hence the importance of saturated fats in cellular communication.
As practitioners of medicine, we strive to do the best we can for our patients. We do this by looking at each patient as an individual within the context of our current understanding of health and wellness. This includes removing obstacles to cure, recommending therapeutic interventions that do not cause harm, stimulating the body’s innate power to heal itself, and to promote prevention through education.
When the above medical principles are utilized and applied in the context of treatment with therapeutic oils, a practitioner of natural medicine would consider the many benefits of using saturated fats in the treatment of chronic degenerative disease. An initial approach could simply be through dietary supplementation with natural sources of these oils. Recommendations could include cooking with coconut oil instead of the polyunsaturated vegetable oils or indulging in macaroons once in awhile. Furthermore, consider giving antioxidants, such as Vitamin E, when polyunsaturated essential fatty acids are therapeutically indicated.
In general, saturated fatty acids are underutilized by medical practitioners. As described above, saturated fatty acids can be used to: boost the immune system, for weight management, as antimicrobials, to support the structure of gut mucosa, and as dietary adjuncts in cases of chronic degenerative disease, such as cardiovascular disease, liver disease and cancer. As far as the integrity of the gut mucosa is concerned, the use of short and medium chain fatty acids can reduce mucosal irritation characteristic of ailments such as: IBS, ulcerative colitis, and dysbiosis, to name a few. In particular, short chain fatty acids are antihistaminic and may find use in the treatment of allergic-type conditions, such as asthma, urticaria, and food sensitivities. Studies have also shown that short chain saturated fatty acids can be used in the treatment of: dental caries, peptic ulcers, BPH, genital herpes, and hepatitis. (22)
Coconut oil has been traditionally used, among other things, as: a skin moisturizer, sunscreen, for the treatment of head lice, for ulcers, wounds, burns, dissolution of kidney stones, and in the treatment of cholera. In Ayurvedic medicine, the palm tree is known as the Tree of Life — from which both coconut and palm kernel oils are derived. (22)
Many massage oils in use today are composed mainly of polyunsaturated fat, which may quickly oxidize whe effective for the treatment of achlorhydria. A previous report by Prousky, (10) and a subsequent report by Prousky & Kerwin (11) demonstrate that niacin is potentially an effective nutraceutical for the treatment of hypochiorhydria and achlorhydria. The strength of these reports might have been diminished, in part, for the following two reasons. First, niacin is an effective anti-stress agent (12) and therefore any reduction in gastrointestinal symptoms might simply be due to stress reduction rather than through the augmentation of gastric acid secretion. Second, niacin is itself an acid. Its acidic properties alone might be the reason for any improvement in gastrointestinal symptoms, especially, if they were initially related to a deficiency in gastric acid secretion.
We evaluated the effects that IHN has upon the gastric system by repeatedly using the Gastro-Test[R], a non-invasive diagnostic test for the immediate determination of gastric pH.” The Gastro-Test[R] compares well with gastric intubation in pH determination and in the diagnosis of achlorhydria. (13,14) We administered the Gastro-Test[R] under fasting conditions since fasting gastric pH is a reliable indicator of hypochlorhydria and achlorhydria. (15,16) As will be demonstrated in this patient report, IHN does appear to enhance the production of HCl in a manner that cannot fully be explained by it simply being an acid.
Materials and Methods
The Gastro-Test[R] indicates the presence of low acid (hypochlorhydria), no acid (achlorhydria) and bleeding (esophageal or gastric). The test consists of a weighted gelatin capsule with 70cm of highly absorbent cotton floss attached within the capsule. The floss is attached to one end of the capsule. The test kit also includes a surface marking pH stick and a pH color chart.
The patient was instructed to fast for eight to twelve hours prior to the administration of the Gastro-Test[R]. Water, but not food, was allowed anytime during the fast. The patient was seated and the floss-filled capsule was placed in the patient’s mouth, The protruding string, attached to the end of the capsule, was taped to the patient’s cheek. The patient then drank one-to-two cups (approximately 240-480 ml) of water and swallowed the capsule.
The patient then lay on his left side for ten minutes. Lying down allows for maximal contact between the floss and the gastric pool. After ten minutes, the patient was instructed to sit in a comfortable chair with his head slightly extended. The tape was removed from the cheek and the floss withdrawn from the mouth. The floss was then placed on a piece of white exam paper to augment visualization of the color change. The pH stick was rubbed along the moist end of the string and the resultant color change was then compared to the pH color chart. A pH of 3 or less on any part of the distal half of the floss indicates that the stomach is secreting hydrochloric acid properly. A pH greater than 3 indicates hypochlorhydria, whereas a pH of 5 or above indicates achlorhydria.
This procedure was performed three times on 8-27-02, once on 9-17-02, and again on 10-09-02. No complications were seen or reported during and after the administration of the Gastro-Test[R].
A 39-year old Caucasian male presented to The Robert Schad Naturopathic Clinic (RSNC) on 8-18-02 with chief complaints of bloating, intermittent diarrhea, gas, chronic throat irritation, perianal swelling, and back pain related to maldigestion. The gastrointestinal complaints had persisted for the previous 10 years, reaching a peak 4 years ago. At this time the patient quit smoking and regular coffee drinking. These dietary changes improved his symptoms but did not completely resolve them. The patient currently works as a custodian at a church and reports that there is little stress in his life. He has no family history of gastrointestinal disease. He had seen numerous family physicians for his complaints, but was never prescribed any medications. Physical examination revealed a well-nourished male, with normal vital signs and normal heart sounds. His skin was dry and pale, most notably along his face, upper thorax and legs. There was also mild right-lower quadrant tenderness without rigidity or rebound signs .
The patient returned 1-week later, 827-02, for three consecutive fasting Gastro-Tests[R]. Each test administered 15 minutes apart. The first test revealed a fasting gastric pH of 7, indicating marked achlorhydria. A second Gastro-Test[R] was administered following a challenge with 500mg of non-sustained release niacin (Jamieson Laboratories). The distal 5cm of the string showed a pH of 3. A change of 4 pH points since the first Gastro-Test[R] clearly indicates that gastric pH can be made more acidic by taking oral niacin. A third Gastro-Test[R] was performed with an additional 1000mg of non-sustained release niacin. This time the result, once again, demonstrated a pH of 7. It is unclear why the pH reverted to a 7. Perhaps the parietal cells could no longer respond to the addition of more acid with the third Gastro-Test[R].
The patient was then prescribed 1000mg of non-sustained release niacin (Jamieson Laboratories) three times each day. It was also recommended that he reduce his intake of fried foods, especially bacon and fast-food hamburgers. He was further instructed to have one salad daily in addition to increasing his intake of fruits and vegetables (no exact amount was specified).
Two days after commencing the dietary and niacin treatment the patient felt a sense of well being, increased energy with significant improvement in his throat irritation and perianal swelling. However, by the end of the first two days of treatment the patient experienced a superficial rash with swelling and pruritis along the upper thorax, with the axilla and inner thighs being the areas most affected. He went to the emergency room of a local hospital and was given an oral antihistamine. He was also told to discontinue the niacin. Within 24 hours the superficial rash completely cleared.
The patient resumed his niacin treatment the next day, but was switched to the IHN form to reduce the potential for flushing. Each IHN capsule contains 150mg of inositol and 500mg of niacin. He was instructed to take one capsule three times daily. He came back to the RSNC on 9-17-02 for a fasting Gastro-Test[R]. The patient fasted seven hours and during the day of the test did not take any IHN. He drank as much water as he desired during the fast, but did not consume any food. The Gastro-Test[R] showed a pH of 1 at the distal 8cm of the string. The patient noticed a reduction in gastrointestinal bloating and claimed to have better-formed stools. The patient also reported an increase in energy. Objectively, the patient appeared more upbeat and his skin had less dryness and more of a pinkish color compared to our initial evaluation. The patient also remarked that his skin looked better.
The patient returned to the RSNC on 10-09-02 for a repeat Gastro-Test[R]. The patient fasted six hours and during the day of the test did not take any IHN. The Gastro-Test(r) showed a pH of 3 at the distal 6cm of the string. The patient once again remarked on his improved health and almost complete absence of gastrointestinal symptoms. A summary of the Gastro-Test[R] results for the three office visits are listed in Table 2.
By using the Gastro-Test[R] we were able to demonstrate that IHN might play a role in both the reduction of achlorhydria-related symptoms and in augmenting gastric acid secretion.
One question that was posed concerning IHN’s role in changing gastric acidity was whether or not the decrease in gastric pH could be accounted for solely by niacin’s inherent acidity. We referred to one of the basic chemistry equations, the Henderson-Hasselbach equation.
This equation relates pH to the dissociation constant of an acid, the [pK.sub.a], and the log of the concentration of the protonated acid, [HA] to its deprotonated conjugate base, [A-]n exposed to light and rubbed on the warm surface of the human body. Such commonly used massage oils include: almond, safflower, sunflower, and other vegetable oils. It appears that the use of saturated fats, like coconut oil, would be advantageous, not only because of its stability and that it is readily absorbed into the skin, but also for its immune enhancing and antimicrobial effects. Coconut oil and other saturated fats can also be used as a carrier oil for essential oils, which have many therapeutic applications, such as antioxidants, antimicrobials, anodynes, and vulneraries. For example, the use of coconut oil with cinnamon (Cinnamomum spp.) and clove (Syzygium aromaticum) essential oils in the treatment of fungal infections, or the use of coconut oil with Lavender (La vandula angustifolia) essential oil in cases of sunburn.
Healing effects from saturated fatty acids can be powerful if used appropriately. Naturopaths and other health care providers should not only be prescribing oils that are high in essential fatty acids, specifically the w-3 polyunsaturates, but also saturated fats found in food products like butter, coconut, palm kernel oil, and cocoa butter. Incorporating these foods into one’s diet appears to invigorate the life force that permeates the human body.
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Ten Johnson (ND Candidate)
John Keoni Teta (ND Candidate)
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