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Volume 9 Number 5

Guy R. Schenker, D.C.
May, 1998

Dear Doctor,

     Imagine you are a Chiropractor --- gently lifting 
your patient's head to examine her cervical spine,      
when ...


     Pretty Scary!

     This happened with one of my patients about 12 years 
ago.  It was the first office visit of this young woman 
who had a history and a list of bizarre symptoms a mile 
long.  She desperately needed both NUTRI-SPEC and 
chiropractic.  I was just beginning my chiropractic exam 
when her face "spazzed out."

     What was going on?

     This woman had ...

                  ACID/ALKALINE BALANCE.

     I was witnessing a classic demonstration of 
Chvostek's sign, indicating a facilitated facial nerve 
associated with tetany.  In NUTRI-SPEC terms, this woman 
was totally overwhelmed by a respiratory alkalosis 
(hyperventilation). As we continued our exam and 
consultation on that day she experienced the facial 
twitching many more times even without the stimulus of 
touch.  She was suffering such acute anxiety that the 
twitch was triggered spontaneously just from speaking.

     I learned a lot from this case.
                          - 2 -

     (And I continue to learn a lot from her, as she is 
still a patient today.  Her history is now two miles long 
and her list of symptoms is shorter, but just as bizarre.)  
The most important thing I learned in this case is how 
quickly and powerfully NUTRI-SPEC can resolve even the 
most severe acid/alkaline imbalance.

     With proper supplementation using phosphoric acid, 
di-sodium phosphate, and occasionally a little ammonium 
chloride, the tetany and much of the anxiety associated 
with it was corrected very quickly.  If this extreme 
degree of acid/alkaline imbalance can respond dramatically 
to NUTRI-SPEC supplementation so can the more ordinary 
acid/alkaline imbalances you see in your patients on a 
routine basis.

     Each time you test a patient you consider 
acid/alkaline balance as question number five in your 
Quick Reference Guide (QRG) protocol.  In this Letter you 
will be given the rationale behind the QRG protocol for 
finding and treating acidosis and alkalosis in your 
patients.  If you want a more comprehensive discussion of 
this important metabolic balance system it is suggested 
that you review Chapter 8 of your "An Analytical System of 
Clinical Nutrition".  That chapter gives a nice over-view 
of the factors influencing pH balance.  It also describes 
in some depth each of the six acid or alkaline imbalances, 
listing both the causes and the effects of each.

     You will learn as you review Chapter 8 that 
acid/alkaline balance is reactive as often as causative.  
In other words, pH imbalances are often secondary to more 
primary causes -- most particularly secondary to other 
NUTRI-SPEC imbalances and their associated endocrine 

     It is no coincidence that acid/alkaline is number 5 
out of your five metabolic balance systems for consider-   
ation on each patient.  The truth is that you are 
favorably influencing pH balance with your correction of
each of the other four NUTRI-SPEC metabolic balance 
systems which you evaluate in each patient.

     The percentage of your patients who show an acid or 
alkaline imbalance as per page five of your QRG is not 
that high.  Most patients do have pH abnormalities, but 
those pH abnormalities are either associated with one or 
more of the other imbalances, or, those pH imbalances are 
compensated to some degree such that they are not apparent
as a pure acid or alkaline imbalance.  When your patient 
tests positive on page five of the QRG you know ...
                          - 3 -


No matter what other imbalances they have, the acidosis or 
alkalosis needs specific therapeutic attention.

     In describing the impact on patients of an acid or 
alkaline imbalance I like to use the analogy of a person  
with a 20 pound weight strapped to their right shoulder.   
The weight may be light enough that the person is not 
devastated by it nor even experiencing acute symptoms 
because of it.  But so much of their reserves are 
preoccupied with trying to compensate for this load that 
they have difficulty performing even the most routine 
daily functions.  Hour after hour they carry this burden 
which completely alters their ability to work, to eat, to 
rest, or to perform any other function.

     Such is the metabolic burden associated with acid/     
alkaline imbalance.  Nothing else will work metabolically, 
nothing else will balance biochemically, as long as the 
load must be carried.  The "weight" itself may be an 
anaerobic imbalance or a glucogenic imbalance or whatever, 
and will eventually have to be removed.  But suppose you 
could remove 15 of those 20 pounds, immediately boosting 
the patient's vital reserves.  Such is analogous to what 
you are doing with your phos drops, your di-sodium 
phosphate and so forth.  You have not yet removed the 
weight (the other metabolic imbalances in this patient), 
but you have relieved the burden enough that the person 
can begin some semblance of function.

     Your NUTRI-SPEC system has identified six types of 
acidosis and alkalosis.  Each of these abnormal test 
patterns affects different parts of the body, and each has 
a different effect on  urine and saliva pH's.  There are 
those who would try to convince you that the urine and 
saliva acidity or alkalinity varies directly with the 
acidity or alkalinity of the entire body.  If you have 
looked at your Chapter 8 at all you know that this is 
simply not true.  The various patterns of acidosis and 
alkalosis may vary either directly or inversely with the
urine pH and/or the saliva pH.

     To understand how the urine or saliva pH can vary 
either with or against the pH imbalance of the body 
requires that you know the simple clinical facts of life 
with respect to acidosis and alkalosis:

- acid/alkaline imbalances always involve respiratory       
- acid/alkaline imbalances always involve renal function
                          - 4 -

The respiratory and renal involvement in an acidosis or 
alkalosis may be either part of the cause of, or part of 
the compensation for the acidosis or alkalosis.

     Consider now the respiratory system in acid/alkaline 
imbalances.  The respiratory system may be the primary 
cause of the imbalance, or, it may be the primary defense 
in compensation for the imbalance.

     The respiratory system is causative by hyper- 
ventilation in a respiratory alkalosis.  It is causative 
by hypoventilation in a respiratory acidosis.

     The respiratory system is compensatory by suppressing 
respiration to retain carbon dioxide in an alkalosis.  The 
respiratory system is compensatory by stimulating 
respiration to blow off carbon dioxide in an acidosis.

     In any of your patients with an acid or alkaline 
imbalance the respiratory rate will either be increased or 
decreased, depending on whether CO2 is being blown off or 
retained; and, the breath holding time will be increased 
or decreased, depending on whether CO2 is low or high.

     Now, consider the kidneys in an acid/alkaline 
imbalance.  The kidneys are causative when they have lost 
their ability to either excrete or retain acid.  The 
kidneys are compensatory in that they will do their best 
either to dump or to retain acids as needed.

     When we put together all the considerations regarding 
respiratory system involvement and renal involvement in an 
acid/alkaline imbalance, we come up with what we could 
call the NUTRI-SPEC rule of acid/alkaline evaluation:

The urine pH and saliva pH help you identify the type of
acidosis or alkalosis, but do not indicate the presence of 
an acidosis or alkalosis -- only the respiratory rate and 
the breath hold do that.

     In other words, no matter how outrageously high or 
low your patient's pH's are, you will only treat an 
acid/alkaline imbalance if these pH's are  accompanied by 
an abnormal respiratory rate and/or breath hold time.  If
respiratory parameters are within normal limits, then the 
high or low pH is due to something other than an acidosis 
or an alkalosis.

     Identifying and correcting your patients' acid/  
alkaline imbalances is as simple as following the protocol 
on the acid/alkaline page of your Quick Reference Guide.
                          - 5 -

This is perhaps the simplest of all the QRG pages, but is 
one about which questions frequently arise.  So -- let's 
get the procedure straight once and for all.

     Your Quick-Scan for an acid/alkaline imbalance 
requires that you only look at two tests, the respiratory 
rate and the breath hold time.  Carry these two tests to 
your QRG page and if neither of them is outside normal 
limits then you are finished.  The answer to question to 
number 5 is no, there is no acid/alkaline imbalance.

     If either the respiratory rate or breath hold time is 
above or below normal then you need to consider which ever 
of the six acid or alkaline patterns match that abnormal 
respiratory rate and/or breath hold time.  Find your 
patient's urine pH and adjusted saliva pH and carry them 
back to the columns under consideration.  You must find a 
perfect pH match.  If both pH's do not conform perfectly 
to one of the imbalances under consideration then, again, 
you have no acid or alkaline imbalance.

     If you do have a perfect pH match, then at this point 
consider any remaining confirmatory tests in the column or 
column's under consideration.  In other words, look at the 
first pulse and pulse 4 minus pulse 1, and if the columns 
you are considering relate to these pulses (many of the 
columns do not, and have X's next to these tests) then you 
must have confirmation from at least one of these two 
parameters -- either the pulse one or the P 4 minus P 1.

     Only after having met all these criteria does your 
patient qualify for treatment as an acid or alkaline 
imbalance.  Now you are prepared to move down through the 
column your tests have indicated and pick the supplements 
for your patient's acid or alkaline imbalance.

     Here are some additional pointers.  If one or more of 
the electrolyte supplements are indicated as acid/alkaline 
buffers for your patient, the dosage you will begin with
will generally be 1/4 teaspoon once daily.  (Only if you 
are seeking pain control or control of itching or vertigo 
would you use a higher dosage as a clinical trial to start 
with.)  You can then increase or decrease on follow-up 
tests based on the changes that your patient presents.

     In a few instances you have a choice between a sodium 
and potassium salt for your patient.  If the patient has a 
tendency to high blood pressure and/or fluid retention 
then use the potassium salt.  Otherwise, use the sodium.

                          - 6 -

     One other point of clarification needs to be made 
regarding the analysis of a respiratory acidosis.  You 
will note that your QRG designates either a high or a low 
respiratory rate as qualifying for a respiratory acidosis 
imbalance.  Make a note (write it in on your QRG) that the 
low respiratory rate -- i.e., 13 or less -- qualifies as a 
respiratory acidosis only when the patient has elevated 
blood pressure.  In any respiratory acidosis associated 
with normal or low blood pressure the respiratory rate 
will tend to be high.  Again, write into your QRG to never 
treat a respiratory acidosis based on a respiratory rate 
of 13 or less unless the patient has high blood pressure.

     The final note on your QRG page 5 concerns the notes 
at the bottom of the page.  Remember that your acid/       
alkaline imbalance is the 5th of your five imbalances to 
consider.  By the time you have found this imbalance you 
have already found all other imbalances.

     At the bottom of the page are listed many of the 
other imbalances with the particular supplements that are 
contraindicated in acid/alkaline patients who have any of 
these listed imbalances coexisting with their acid/       
alkaline imbalance.

     Let us consider an example.  If you find a patient 
tests as a respiratory acidosis but has also been 
determined to be glucogenic -- you see under the  
glucogenic note at the bottom of the page that this 
patient will under no circumstances be given citrates; 
magnesium chloride; or ammonium chloride.  That means you 
will delete the sodium or potassium citrate and the 
magnesium chloride from the supplements under 
consideration for this patient's respiratory acidosis.

     Once you have identified an acid/alkaline imbalance, 
your QRG gives you the buffers and amino acids your 
patient needs to relieve the unrelenting burden of their 
acidosis or alkalosis.  Both symptomatic improvement and 
objective changes in the test patterns are often immediate 
and dramatic -- allowing you the opportunity to pursue a 
thorough correction of whatever other imbalances are now 


                         Guy R. Schenker, D.C.


Nutri-Spec Letters