Comprehensive Guide to Managing Autism - 11

Negative Effects of Secretin

Let’s stop and think what secretin does to lipid (fat) metabolism. Autistic kids are universally deficient in the fatty acids. Secretin is a pro-oxidant hormone. The metabolic impact of Secretin is that it stimulates the arachidonic acid cascade (contraindicated in seizure disorders) and bicarbonate production, oxidizes or burns off (beta oxidizes) fatty acids (including both essential fats, insulating fatty acids, and very long-chain, fatty acids), increases the metabolism of bile acids, and, theoretically, may stimulate Cholecystokinin-B (CCK-B) that plays a neuromodulatory role in the regulation of GABAergic neuronal activity perhaps (theoretically) stimulating speech. When a child receives secretin over and over again without replenishing the lipids (fatty acids) and catalysts (vitamins and minerals), then the impact could ultimately be quite negative.  

On the other hand, children with autistic spectrum disorder tend to have a buildup of very long-chain, fatty acids (VLCFA) indicative of suppressed, peroxisomal, beta oxidation. Characteristically, plasmalogen synthesis and beta-oxidation of very-long-chain fatty acids (VLCFAs) are affected. It’s been found that patients with generalized peroxisomal disorders have a profound brain deficiency of docosahexaenoic acid (DHA; 22:6n-3) and low DHA concentrations in all tissues and the blood. Supplementation with DHA-EE normalized blood DHA values within a few weeks. Plasmalogen concentrations increased in erythrocytes in most patients and after DHA concentrations were normalized, amounts of VLCFAs decreased in plasma. Liver enzymes returned almost to normal in most cases. From a clinical viewpoint, most patients showed improvement in vision, liver function, muscle tone, and social contact. In 3 patients, normalization of brain myelin was detected by magnetic resonance imaging. In 3 others, myelination improved. In a seventh patient, myelination is progressing at a normal rate. Curiously, DHA is a VLCFA.  

The use of secretin stimulates the burning off of these aberrant, excess lipids (VLCFAs) that irritate the brain (and many other systems of the body); thus, in that degree, secretin is of immediate benefit. The administration of secretin, DHEA, pregnenolone, or thyroid hormone stimulates the beta-oxidation (burning within the mitochondria for energy) of VLCFAs, as would pro-oxidant nutrients and oxidative therapies. Excess VLCFAs indicate a deficiency of cytochrome p450 (Phase I) liver enzymes, and pregnenolone increases Phase I activity by conserving existing Phase I enzymes.  Stimulating beta-oxidation, however, concurrently stimulates the burning off of essential fatty acids (EFAs) as we said. Children with ASD most often present with acidosis, low CO₂/Bicarbonate, and low oxygen. (Dr. Patricia Kane, Ph.D.). The spacy, dreamy, lack of clarity state you observe in most autistic children is often associated with a low bicarbonate and disturbed electrolyte status. Insufficient oxygen in the brain can lead to a spacy, confused, non-alert quality also. Infusions of Secretin will correct the acidosis that most children with ASD present ultimately impacting their hyperammonemic states that may be stabilized with the increased bicarbonate production (bicarbonate released from the pancreas plus ammonia yields urea that can be excreted). Sulfur containing amino acids become ammonia and remain ammonia without adequate folic acid, B₁₂, zinc, and molybdenum. Excess ammonia in the blood is associated with excess lysine. 

“Peroxisomes are organelles within cells that are pivotal in the biotransformation of endogenous compounds in lipid metabolism such as fatty acids, steroids, prostaglandins, the formation of myelin, neurotransmission, detoxification of exogenous compounds and xenobiotics (phenols and other compounds discussed under the section PST). VLCFAs are fatty acids with 22 or more carbons. Normally, these are oxidized down to C20 or less by p450 oxidase enzymes in the peroxisome organelles in the liver. Normally, the C20s are then shuttled by carnitine to the mitochondria for further metabolism. However, mitochondria cannot metabolize VLCFAs so they then accumulate in the nerve cells where they have toxic effects. This is almost universally true in autistic children, but is also seen in Alzheimer’s patients, chronic fatigue, Zellweger’s, and cardiovascular disease. The accumulation of VLCFAs [Docosahexaenoic (DHA), Docosapentaenoic w3, Behenic, Lignoceric, and Nervonicinside] inside the cell membrane represents defects in peroxisomal, beta-oxidation rather than a mitochondrial disturbance. This accumulation may be used to profile the deleterious effects upon the brain, endocrine, gastrointestinal, and immune systems, as well as the cytochrome P450 liver enzyme derangement involving nitric oxide synthase (NOS) characteristic in autistic spectrum disorder due to autoimmune presentation. Therefore, the toxic aspect so often described in autism may be defined clearly through examination of Red Blood Cell lipids with elevation of VLCFAs being a reflection of blocked detoxification mechanisms”—Patricia Kane. 

Additionally, a recent study shows another disturbing aspect of this fatty acid imbalance on cell walls: Red blood cell fatty acid compositions in a patient with autistic spectrum disorder: a characteristic abnormality in neurodevelopmental disorders? J. G. Bell, J. R. Sargent, D. R.Tocher, J. R. Dick Nutrition Group, Institute of Aquaculture, University of Stirling, Stirling UK 

“Summary: The fatty acid compositions of red blood cell (RBC) phospholipids from a patient with autistic spectrum disorder had reduced percentages of highly unsaturated fatty acids (HUFA) compared to control samples. The percentage of HUFA in the RBC from the autistic patient was dramatically reduced (up to 70%) when the sample was stored for 6 weeks at (-) 20 degrees C. However, only minor HUFA reductions were recorded in control samples stored similarly, or when the autistic sample was stored at (-) 80 degrees C. A similar instability in RBC HUFA compositions upon storage at (-) 20 degrees C has been recorded in schizophrenic patients. In a number of other neurodevelopmental conditions, including ADHD and dyslexia, reduced concentrations of RBC HUFA have been recorded.  

“Evidence suggests that the HUFA instability observed in a patient with ASD and found in other neurodevelopmental disorders may be caused by increased phospholipase activity, perhaps in conjunction with increased auto-oxidative stress. The evidence available suggests that autistic spectrum disorder involves an aberration in lipid metabolism that results in alterations in cell membrane phospholipid structure and function, and that these alterations are similar in a number of other neurodevelopmental disorders. The tryptophan metabolite indole acroyl glycine (IAG) has been found in the urine of the majority of patients with ASD, and has also been identified in numerous other neurodevelopmental disorders. The precursor of IAG, indole acrylic acid, when added to cells in culture affects the cellular PUFA compositions and the production of PGE.” 

Autism is said to often involve a demyelination of the myelin sheath of nerves, disrupting nerve transmission. Brain autoantibodies to myelin basic protein and neuron-axon filament protein have been found in autistic children. The perineuronal nets around neurons, which modulate their function, are primarily composed of chondroitin sulfate. Low sulfur would thus yield less modulation of neurons. Hepatitis B vaccine was found to inhibit sulfation chemistry for at least one week in typical people. When TNF (tumor necrosis factor) is elevated (frequently in autism), it can inhibit the conversion of cysteine to sulfate. This could be a contributing factor in PST.    

Mercury and other heavy metals (such as lead) can cause progressive myelin degeneration with the development of antibodies to myelin basic protein (MBA) and glial fibrillary acidic protein (GFAP). Recent discovery of herpes virus-6 in the damaged areas of the brains of a 73% of Multiple Sclerosis sufferers is impulse disturbing. The nervous system, once the insulation is stripped, can be likened to your home with bare wires inside the walls—a dangerous situation. In the body, symptoms may be many and varied:

         1) tremors, shaking, “palsy” due to malfunction of nerve transmissions.

         2) uncoordination in walking, writing and other automatic physical movements,

         3) slurred speech,

         4) excessive salivation,

         5) deterioration of memory and thinking processes

         6) blurred vision,

         7) difficulty urinating, incontinence,

         8) environmental sensitivity, allergic to smells, food, clothing, electrical equipment,

         9) breathing problems, short of breath,

        10) nervousness or nervous breakdown,

         11) numbness and tingling in extremities,

         12) heart problems/arrhythmia’s.  

Some have found Sphingolin™ most helpful (Ecological Formulas 800-888-4585). Vitamin B₁₂ is often lacking, and it is essential to sheath formation. These benefit the myelin sheath, increasing perception and response. Dr. Jeff Bradstreet, however, reports that children who took oral, myelin-basic protein (Sphingolin™) seemed worse when they were infused with secretin. The secretin burned off the fats (needed to make myelin and prostaglandins, both the insulating fats and the very long chain fats). It is a big “no no” to stimulate with peptides (secretin) with Sphingolin™ without fats! (Patricia Kane) If you choose to infuse, you must supplement generously with Evening Primrose oil (EPO); and always with fatty acids, you must supplement with the antioxidants vitamin C and vitamin E with selenium, preferably before beginning the EPO. A failure to do so may promote seizures, neurological disorders, and increased cancer risk due to increased free radical activity. Additionally, Dr. Woody McGinnis, MD, of Tucson, Arizona, USA, has reported investigating two seizures that occurred during or immediately following secretin infusion. One was near fatal. Make sure the one infusing is ready for any emergency. It is probably inadvisable to infuse one who is subject to seizures. Dr. McGinnis tells of a doctor whose son started having seizures (not immediately, but delayed) after secretin. She found the urinary pH really alkalotic, gave him generous unbuffered vitamin C, and says the seizures abated. Perhaps, before infusion, one should check for an overly alkaline urine, and do so again after the infusion to anticipate and forestall any possible seizures.  

In the case of inadequate HCl production, infusion or transdermal supply of secretin may indeed help, but it does not fully address the most basic need—that of necessary digestion and utilization of food. The proper course for many seems not to be secretin infusion, but a supplementing of hydrochloric acid to the degree necessary to trigger release of the secretin so vital to proper digestion and hormonal response. In at least a minority of these children, the gut will be able to release adequate secretin. The supply of adequate acidity to the chyme would then “Kick Start” secretin production. One mother reports, “Since I followed your suggestion, and supplemented HCl, my son has the same responses he had to his secretin infusion!”

Hydrochloric Acid May be a Solution

In view of the above, I think it better to address the need for HCl first. Low HCl production is associated with many problems. Iron deficiency anemia, owing to poor iron absorption or to lead or cadmium poisoning, and osteoporosis, resulting in part from decreased calcium absorption, are two important problems. General allergies and, specifically, food allergies are correlated with low HCl. Poor food breakdown and the "leaky gut" syndrome are associated with food allergies. More than half the people with gallstones show decreased HCl secretion compared with gallstone-free patients. Diabetics have lower HCl output, as do people with eczema, psoriasis, seborrheic dermatitis, Vitiligo, and tooth and periodontal disease. With low stomach acid levels, there can be an increase in bacteria, yeasts, and parasites growing in the intestines. You may obtain Betaine Hydrochloride or Glutamic Hydrochloride, 10-grain capsules from the health food store. If allergic to beets, choose Glutamic Hydrochloride. If sensitive to sulfites [MSG—Chinese restaurant syndrome, or diagnosed as suffering from phenol-sulfotransferase deficiency (PST)], choose Betaine Hydrochloride. Glutamic acid hydrochloride is only mildly acidic, and does not work as well as betaine hydrochloride. Betaine may be used alone, in supplements, or along with pepsin or other digestive agents. A child should get good results with one to five, 10-grain capsules, adults with five to ten (a predominantly pasta meal would need less than a high protein one). Start with one, and increase gradually. For children who will not swallow a capsule, it may be mixed with the food, or mixed in a small amount of drink that will be consumed completely. Woodlands Healing Research Center reports an older autistic boy showed marked improvement in digestive function, and a dramatic reduction in agitation when the mother began mixing betaine hydrochloride with pepsin into meat, poultry or other protein foods before meals. 

Low stomach acid can be corrected by eating a balanced diet of wholesome foods, and by reducing our daily levels of stress. Niacin stimulates HCl production. This can be taken before meals, as can magnesium chloride and pyridoxal-5-phosphate (the active form of vitamin B₆) to help stimulate the body’s own HCl output. Zinc is essential to HCl production. Drinking the juice of half a lemon squeezed in water or a teaspoon of apple cider vinegar in a glass of warm water 30 minutes before meals helps, and supplements taken during or after meals should be swallowed using the lemon or vinegar treated water. Use of Swedish Bitters or gentian has been helpful in improving digestion. 

We are talking acid here. One 10-grain tablet of HCl in 1-1/2 ounces of water will have a pH of about three. This is not nearly as strong as what you may have experienced when you burped, and the acid really burned your throat; but, when HCl is mixed with food, it must be swallowed right down without chewing. Do not leave this food in the mouth. It could damage the enamel on the teeth. Additional food should be eaten immediately to clear the throat. If mixed with a drink, drink it with a straw to protect the teeth. Rinse the mouth, and swallow to clear the throat. Try it yourself, Mama. You may be surprised to learn that a Coke™ is even more acid (2.8 pH)! As with all such matters pertaining to your child’s health, consult with your medical professional. 

If the hydrochloric acid is sufficiently strong, and the gut is able to release secretin, and the pancreas is functioning, the use of an enteric-coated, alkaline tablet will not be needed to neutralize the acid in the intestine. The pancreas will normally release enough bicarbonate based on the strength of the secretin signal. The amount of secretin released is dependent on the amount of hydrochloric acid in the chyme entering the gut.  

Where HCl is adequate, but secretin is not being adequately produced, or the pancreas is not functioning well, the proteolytic enzymes may not be released; or, because of a lack of bicarbonate of soda, they will be destroyed by the acidity of the chyme. This can result in incomplete breakdown of proteins. These “foreign” protein molecules may be absorbed into the bloodstream, and circulated throughout the body. These “peptides” can cause all types of allergic (autoimmune responses) or toxic reactions, in particular those relating to breathing and skin irritation. Taking an alkalizing substance (an enteric coated pill) in that case, will neutralize the stomach acid in the gut, prevent the destruction of the proteolytic enzymes if any are available, and maintain an environment for the flora of the gut. If a tablet is not available, taking 1/2 teaspoon of bicarbonate of soda in a glass of water after the stomach begins emptying (about 2-1/2 hours after eating) can be just as effective. Without sodium being present glucose cannot be absorbed. Picture a revolving door in the wall of the gut with two segments. Without these two substances filling the segments, the door won’t turn. Mercury causes excessive sodium excretion, as shown in studies of dental amalgam placed in monkeys and sheep (Lorscheider et al, 1995). 

Do not take any water, tea, or other nonfood drink with a meal or within two hours as that will dilute the HCl and hinder digestion. If you must drink water to take pills, put a tablespoon or more of lemon juice or apple cider vinegar in the water to help preserve stomach acidity. A convenient way to overcome gastric reflux that affects so many is to take the HCl with meals, or to drink a glass of warm water with one teaspoon of raw, unfiltered, apple-cider vinegar when you experience it. You may sweeten it with some honey if you must. 

As to the amount of acid in the capsules, you will not begin to administer as much as a normal stomach produces for an average adult meal (estimated to be equivalent to 30 capsules). It is the quantity as well as the degree of acidity that is important. Normal pH must be below three (preferably two) to convert pepsinogen into pepsin (needed to digest protein). It is often as low as one (the strongest acid). 

If there is burning or pain, or if the digestive distress experienced previously (bloating, belching, heartburn, reflux) becomes worse, discontinue the use of the hydrochloric acid. Sensitivity of the stomach to acid (especially a burning pain just below the sternum) may indicate an ulcer. However, it likely indicates the person is dehydrated, or using aspirin or NSAID for pain. Everyone should drink a large glass of water 30 minutes before eating. That will rehydrate the mucus lining of the stomach, and protect the stomach from the acid. If there seems to be adverse reactions other than pain or burning, an allergy to Betaine (beets) Hydrochloride may be the cause. Try Glutamic Hydrochloride instead.  

HCl production is controlled by the zinc-dependent enzyme carbonic anhydrase. Toxins of bacterial overgrowth, gluten-casein peptides, metabolic acidosis, and lack of zinc all depress this enzyme. An inflamed, irritated gut present in autism will not absorb zinc well. You must supplement zinc, balance your zinc-copper ratio, and restore the proper body pH to restore HCl production. This pH can be improved by supplementing ionic calcium—that autistics are universally lacking. When there is adequate calcium, the saliva will be near pH 7.0 between meals, anything less than pH 6.5 is cause for concern.  

There are some simple tests that may help determine if you or your child lack HCl. There is a hydrochloric acid reflex present on the bottom of the lowest rib approximately one inch lateral to the midline. If this area on the rib is tender to palpation there is a strong likelihood the person is deficient in hydrochloric acid, and would benefit from supplementation. Additionally:

      1. Drink four ounces of beet juice on an empty stomach. If this turns the next urine red, suspect low HCl for there isn’t enough acid to break down the red pigment—but, you could be iron deficient.

    2. Check the pH of the urine—drink four ounces of grapefruit juice, or a lemon–orange juice mixture, on an empty stomach. Test the pH of the urine one hour later. If it is significantly more acid (lower pH number), suspect low HCl. The citric acid should have been broken down.

    3. If you have heartburn or a too–acid feeling, swallow a tablespoon of fresh lemon juice. If it makes the symptoms worse—you have more than enough hydrochloric acid. If the symptoms are relieved, you need HCl.

    4. If it appears that you may need additional HCl, obtain a bottle of 10-grain HCl (with pepsin) in capsule form from the health food store; “Adults...take five...of such a product with a meal. If you do not suffer the usual burps and belches, you have proven in one hour that you have need for digestive support. If five...solve your problem, then try four the next meal, then three...you will finally have a recurrence of the old symptoms. Slowly increase the dosage each meal to find the dosage needed to prevent symptoms. Continue that dosage indefinitely.”—Indigestion by Doctor Kurt W. Donsbach.  

You may need more than five, usually ten is enough for an adult; however, if your symptoms worsen, you are overproducing HCl. To aid in restoring vibrant health, strength, and normal weight, utilize that number of capsules of HCl with each meal. Be sure to take the HCl after the meal, so as to allow starch digestion to proceed for the first 45 minutes, and so as not to discourage the stomach from supplying all the HCl that it can. The Betaine can be discontinued once the reflex point is non-tender to deep palpation, or the other tests show no further need.