From: Guy R. Schenker, D.C. April, 1999 Dear Doctor, WORN OUT, STRESSED OUT, AND TOO WEAK TO FACE ANY CHALLENGE ... That describes your typical Electrolyte Insufficiency patient. 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 regimen. 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 ... YOUR PRACTICE IS FULL OF HYPOTONIC, HYPOVOLEMIC WEAKLINGS. Pump them up-with NUTRI-SPEC. Sincerely, Guy R. Schenker, D.C.