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Volume 10 Number 4

Guy R. Schenker, D.C.
April, 1999

Dear Doctor,

               WORN OUT, STRESSED OUT, AND

     That describes your typical Electrolyte Insufficiency 

     What ails these patients, anyway?  Quite simply, they 
are depleted in electrolytes and drained of plasma volume 
(hypovolemic) in association with some combination of 
fundamental metabolic imbalances and the accompanying 
hormone insufficiencies.

     To help you clearly envision where the body chemistry 
is breaking down in your EI patients you are given in this 
Letter a chart which parrallels the chart we gave you in 
December depicting the essence of electrolyte stress 
imbalance.  This EI chart is presented in the same manner, 
such that you can see the two principle sub-categories of 
EI patients.  For convenience we have enclosed another 
copy of the ES chart so that you can put the two side by 
side for comparison.  We have also given you another copy 
of the diagram illustrating water/electrolyte dynamics in 
the various body fluid compartments.

     To prepare for the discussion of your EI patients 
that follows, take just a minute and review the water/
electrolyte dynamics illustration.  Recall that the major 
body fluid compartments are the plasma, the interstitial 
fluid, and the intracellular fluid.  (The intracellular 
fluid can be further broken down into the parenchymal 
cells, the RBCs, and the endothelial cells.)

     Recall also that each body fluid compartment 
corresponds to a different level of biological 
organization.  The plasma is part of the blood which 
corresponds to the systemic level of biological
                          - 2 -

organization.  The interstitium relates to the tissue 
level of biological organization; and the intracellular 
fluid compartment relates to the cellular level of 
biological organization.

     The interstitium is the one that seems to create some 
confusion.  When we say, for instance, that an anaerobic 
patient is acid at the tissue level of biological 
organization, or that a dysaerobic patient has alkaline 
tissues, we are referring to the abnormal pH of the 
interstitial fluid.  It is the abnormal biochemistry at 
the tissue level of biological organization (i.e., at the 
inter-face between cells) that is responsible for many of 
the symptoms that bring patients to us -- including pain 
sensitivity, allergies, emotional symptoms, digestive 
disorders -- not to mention vertigo, itching, and the 
various other dualistic symptoms and conditions.

     Note on this illustration that the pores between the 
endothelial cells allow solute to pass between the plasma 
and the interstitial fluid, but allows the passage of 
almost no albumin (nor globulin nor other macro 
molecules).  This is important because it is the oncotic 
pressure of the albumin in the plasma that helps hold 
water, and thus maintain normal plasma volume.  
Understanding the importance of oncotic pressure due to 
albumin is essential when we make the distinction between 
the two sub-categories of EI patients.

     Let us now examine the EI imbalance chart.  You will 
note the sub-category headings for your electrolyte 
insufficiency patients are "EI (A-)" (Low Aldosterone), 
and "EI (R-)" (Low Renin).  The first section of each 
column deals with the hormonal factors associated with 
each EI sub-category.  Next, you will find the NUTRI-SPEC 
fundamental metabolic imbalances that are typical of each 
EI sub-category.  Note how this chart parallels the 
analogous chart for the ES sub-categories.

     In the metabolic imbalances section of the chart you 
will see a respiratory alkalosis listed under EI (R-), and 
a renal/potassium excess acidosis in the EI (A-) column.  
Let us elaborate on these acid/alkaline shifts.

     A respiratory alkalosis is always caused by low blood 
pressure (which you find in all your EI patients), since 
low blood pressure induces hyper-ventilation (via 
baroreceptors) which blows off carbon dioxide (and 
carbonic acid).  This tendency to a respiratory alkalosis 
in all people with low blood pressure is particularly 
pronounced in your EI (R-) EI patients since they have a
                          - 3 -

tendency to be systemically alkaline anyway.

     Now consider the potassium excess acidosis tendency 
in your EI (A-) EI patients.  This acidosis is not so much 
due to a primary excess potassium intake as much as it is 
associated with a decrease in adrenal corticoids, which 
causes excess renal retention of potassium, as sodium and 
other minerals are lost via the urine.

     Here we have a patient with an acidosis tendency due 
to the weak adrenals, while at the same time there is an 
alkalosis tendency due to the low blood pressure.  What 
does this do to the NUTRI-SPEC test results?  It means the  
patient will rarely show a clear-cut acidosis pattern.  
But the beauty of your revised Quick Reference Guide (QRG) 
protocol is that the analysis and treatment of this acid 
tendency is built right into the EI QRG page.  Likewise, 
the tendency toward an alkalosis in your EI (R-) EI 
patients is picked up and handled automatically with your 
QRG analysis.  In other words, though virtually all your 
EI patients are vacillating continuously between acidosis 
and alkalosis, you will be able to manage those stressful 
swings in body chemistry with the proper NUTRI-SPEC 

     The next section on your chart describes the fluid 
distribution pattern typical of each sub-category of EI 
patient.  The universal finding among all EI patients is, 
of course, that they are hypovolemic.  But though the 
plasma volume is low, the fluid distribution in the 
interstitium and the intracellular fluid varies depending 
on which metabolic imbalances predominate.

     The pH abnormalities of the body fluid compartments 
are covered next in the chart.  Note that they are 
opposite between one sub-category and the other.  But note 
even more importantly that they are opposite within each 
sub-category between the systemic and tissue levels of 
biological organization.  If you have been doing NUTRI-
SPEC for any length of time you should by now have 
realized that there is almost no such thing as calling a 
patient either acid or alkaline.  Most often, patients 
with  pH aberrations are acid in one fluid compartment and 
alkaline in another.  Only with NUTRI-SPEC can you 
thoroughly analyze the dynamics of fluid movement and 
composition and the associated membrane dysfunctions.

     Sodium is an essential consideration for all your EI 
patients.  The sodium status of each EI sub-category is 
covered next in the chart.

                          - 4 -

     Now, let us look a little deeper into the mechanisms 
underlying the two major sub-categories of EI imbalance.  
First, look at the EI (A-) column.  Due either to excess 
hydrolysis in the blood, or to insufficient dietary 
protein, there is low albumin activity in the serum.  As a 
result, fluid leaks from the plasma into the interstitial 
fluid since colloids are designed to prevent interstitial 
fluid edema as their oncotic pressure keeps water in the 
plasma.  So -- in this sub-category of EI patient you will 
typically have interstitial edema and alkalosis.  (This 
interstitial edema applies to all tissues except the skin, 
as water accumulates in the upper GI tract at the expense 
of the skin.  The skin can be very dry.)

     The excess interstitial fluid may also pass into the 
cells (especially if there is a strong dysaerobic 
component to the patient's body chemistry) due to altered 
membrane function.

     Sodium is important in these patients because it is 
needed to absorb glucose, thereby decreasing excess nor-
epinephrine and epinephrine (and increasing ATP).  Sodium 
is also important because it removes excess calcium from 
the cells, thus having a good anti-dysaerobic and anti-
sympathetic effect in these patients.

     Now look over the EI (R-) column.  In these patients 
the interstitial fluid volume (and often the intracellular 
fluid volume) will decrease even more than the plasma 
volume.  This occurs since there is generally adequate 
albumin in the plasma to maintain enough oncontic pressure 
to hold water in the plasma at the expense of the 
intersitium.  The low interstitial fluid volume also 
occurs to some degree since the interstitial fluid 
translocates to the plasma as an adaptative response to 
the hypovolemia in an attempt to maintain somewhat normal 
plasma volume.

     In many of these patients there is so little ability 
to hold water at any level of biological organization that 
their hydration status is incredibly low.  The more water 
they drink, the more they urinate -- but none of that 
water can be held within the body.

     Even though these patients desperately need sodium at 
the systemic level and at the tissue level, they may have 
excess sodium at the cellular level.  The reason is that 
fatigued or over-stimulated cells absorb excess sodium and 
water.  The sodium entering the cells is anti-adrenergic 
-- which paradoxically exacerbates the EI (R-) imbalance.  
Only by correcting the fatigue and metabolic stress with
                          - 5 -

the proper NUTRI-SPEC regimen (which includes judicious 
sodium supplementation) will the cellular vitality be 
increased enough to release the excess sodium.

     Finally, look down through the Common Test Finding 
section of the chart for the NUTRI-SPEC test results that 
typify each sub-category of EI imbalance.  It is the 
abnormal fluid dynamics, the abnormal fluid pH, and the 
abnormal membrane permeability in these patients that 
accounts for the test findings listed in each column.

     One thing you must understand regarding the sub-
categories of EI imbalance is that many of your EI 
patients will not fall strictly within one column of the 
chart.  They will have elements of both sub-categories.

     In other words, they will be somewhat low in both 
aldosterone and renin.  They may have, for example, both a 
Glucogenic tendency and an Anaerobic tendency.  More than 
one mechanism is at work in these patients which is 
depleting them of electrolytes and destroying their 
control of fluid dynamics and pH.

     The best feature of your recently revised QRG 
protocol for EI patients is that it sorts through their 
test results, enabling you to choose exactly the 
electrolyte tonic and amino acids which must accompany 
Formula EI and Formula EW to restore strength to each 
individual.  Next month we will cover your EI QRG page in 
detail, describing the rationale for each supplement.

     Meanwhile ...                                      

                  HYPOVOLEMIC WEAKLINGS.

Pump them up-with NUTRI-SPEC.


                             Guy R. Schenker, D.C.


Nutri-Spec Letters