From: Guy R. Schenker, D.C. May, 1999 Dear Doctor, Patients by the dozens drag themselves into your office every day with the following complaints: - chronic fatigue - muscular weakness - anemia - postural dizziness - decreased libido - poor circulation - deficient self assurance - osteoporosis - accelerated aging You realize from reading the last several issues of this Letter that many of these patients have an electrolyte insufficiency (EI) imbalance. You know that this imbalance is all about two things: - poor mineral retention - fluid dynamics out of control Review the charts and diagrams from last month's Letter to refresh your memory on the three primary body fluid compartments. Fluid and electrolytes must be maintained in proper quantity and proper pH in each of these fluid compartments. These compartments represent the three clinically testable levels of biological organization -- the systemic, tissue, and cellular levels. What must you do to put the wind back in the sails of these flaccid patients? One of the first things you must do is ... PLEASE PASS THE SALT. - 2 - Please pass it among your own family members at meal time -- but by all means pass it to your electrolyte insufficiency patients. We have cited several studies in this letter over the years highlighting the essentiality of sodium chloride. Probably the most fascinating of these was the study done at Johns Hopkins University and published in the September 1995 Journal of The American Medical Association. This study demonstrated a treatment for chronic fatigue syndrome that resulted in improved energy levels in 76% of the patients. I have never seen another study that achieved such dramatic symptomatic improvement in this devastating clinical condition. What was the keystone of this phenomenally successful treatment for chronic fatigue syndrome? Sodium chloride. These patients virtually all had low blood pressure accompanying their chronic fatigue and responded dramatically to an increased intake of common table salt. In NUTRI-SPEC terms, of course, these patients had an electrolyte insufficiency imbalance. Research done at Hartford Hospital in Connecticut and reported at the American College of Cardiology Conference in Anaheim in March of 1997 also studied chronic fatigue syndrome. It was found that more than half the patients achieved symptomatic improvement by increasing their salt and water intake. In the March 14, 1998 issue of The Lancet, a study was published showing the harmful affects of restricting salt intake. The data for this study was collected from over 11,000 subjects over a period of over 25 years beginning in 1971. There was an inverse relationship discovered between salt intake and mortality. In other words, the length of your life is directly proportional to how much salt you eat. I remember reading an interview with a medical physician from India several years ago. As you might expect the doctor bemoaned the still outrageously high incidence of malnutrition and poor hygiene in his country. To make matters worse there are many areas of the country where medical care must be provided with deplorably inadequate medical supplies. At this point in the interview the doctor was asked, "If you could choose just three therapeutic agents to use exclusively in a clinic in a disease-ridden impoverished area of India, which three would you most value?" - 3 - He answered unhesitatingly, "Morphine to control the pain of my terminal patients; a broad spectrum antibiotic to deal with the rampant spread of bacterial disease; and salt to administer to virtually every patient for its favorable impact on adaptative capacity." Never lose sight of the clinical importance of sodium chloride. There is a small segment of your patient population who have an electrolyte stress imbalance and fall into the low renin category (refer to the ES (R-) column of the Electrolyte Stress Chart provided in the last Letter) who must restrict sodium intake. Most of the rest of your electrolyte stress patients need to be careful about salt intake because of its chloride (not its sodium) content. All the rest of your patients must be careful to obtain adequate salt. This is not a problem for most, because our need for salt is accompanied by an appetite that is almost certain to meet our needs. In your EI patients, however, the taste for salt -- even a craving for salt -- may not provide adequate intake, at least until you have corrected the fundamental metabolic imbalance. The problem with your electrolyte insufficiency patients is not just with sodium chloride but with poor mineral retention in general. Once your EI patients have lost the ability to retain electrolytes, they are left without the strength to handle most any kind of stress load -- either physical or emotional. These patients are your hypo-volemic, hypo-tonic weaklings. They are a deflated balloon begging for you to pump them up. Why have these electrolyte insufficiency patients lost their ability to retain minerals, and why are they likely to suffer from one or more of the conditions listed at the top of this Letter? The short answer is, they have "weak kidneys." The complete answer is that the patient has lost kidney control of electrolyte balance because of a combination of metabolic and endocrine imbalances. As illustrated in the electrolyte insufficiency chart provided for you last month, there are two sub-categories of endocrine dysfunctions. One represents a renin insufficiency and one represents an aldosterone insufficiency. These represent the two major sub- categories of EI patients -- EI (R-) and EI (A-). What is the association between renin and "weak kidneys?" Via renin, the kidney works with the liver and lung to form angiotensin, which has much to do with vascular tone and with the retention of mineral salts. - 4 - You also learned last month that the EI (R-) EI patient typically has one or more of anaerobic, ketogenic, parasympathetic, or respiratory alkalosis imbalances. Your other basic category of EI patient consists of those whose adrenal aldosterone output is generally in- adequate. This results in further loss of sodium and chloride, along with citrates, bicarbonates, and calcium. The low aldosterone output is also reflected in the decreased pulse pressure, and an increased urinary specific gravity. Your EI (A-) patients are typically found to be either dysaerobic, glucogenic, or sympathetic and will likely have a renal or potassium excess acidosis. What else goes wrong with the kidneys of your EI patients? Kidney dysfunction can be associated with anemia. A normal kidney splits erythropoeitin from plasma protein, thus stimulating bone marrow RBC production. The kidney also produces the active form of vitamin D. Renal endocrine insufficiency thus results in calcium deficiency, osteomalacia, and osteoporosis. The protein anabolism of testosterone and DHEA is partially mediated by the kidney. There is a reciprocal relationship between androgens and the kidney, as androgens are renotrophic. They increase the size and weight of the kidneys. Androgens are extremely anabolic. This anabolic property is partly under renal control. Your EI patient will often be emaciated in association with poor protein metabolism. Your Formula EI contains kidney, adrenal and heart, along with vitamin D and calcium glycerophosphate to support the osteoblastic role of the kidney, as well as RNA to help with protein anabolism. Your revised QRG protocol for this imbalance has given you the first comprehensive and effective approach to patients suffering the debilitating fatigue and stress and hormonal imbalances associated with EI imbalance The ability to retain electrolytes and the ability to control electrolyte and water composition in the three body fluid compartments is such a critical part of maintaining health. A failure of this metabolic balance system pulls the plug on a patient's personal power. The list of possible symptoms is endless, but will in each of your EI patients include one or more of those listed at the top of this Letter. Only with NUTRI-SPEC can you find and correct the fundamental cause of these symptoms. - 5 - With your QRG analysis it takes no more than 10 seconds to determine if your patient has an electrolyte insufficiency. The essential clinical signs are orthostatic systolic failure, orthostatic diastolic failure, and clinostatic pulse failure, plus a tendency to bradycardia when recumbent. Nothing could be simpler. Once found, the imbalance is easily and effectively treated by working through the EI Supplements page of your QRG. The EI supplement page does a nice job of distinguishing for you between those patients who are primarily EI (R-) and those who are EI (A-). You have a powerful arsenal of supplements available for your EI patients. Let us consider just a few: Phenylalanine has a dramatic impact on many patients with chronic fatigue -- and many patients with chronic fatigue have an EI Imbalance. The only study I have ever seen that rivals the success achieved by the Johns Hopkins study with sodium chloride was a study that assessed the levels of essential amino acids in chronic fatigue sufferers. This study did nothing more complicated than supplement chronic fatigue patients with the amino acids in which they were low according to serum levels. More than 75% of the test group showed either very good or excellent improvement in symptoms with nothing more than amino acid supplementation. Furthermore, of all the amino acids studied, Phenylalanine was by far the most clinically significant. Fully 72% of the chronic fatigue sufferers were found to have low levels of phenylalanine. Many of the patients in this study also suffered from depression. Both the fatigue and depression resolved in most of these patients with phenylalanine supplementation. The amino acid glutamine is used for many of your EI patients. Glutamine is more important than any other amino acid in maintaining nitrogen balance. Glutamine plays an anabolic role in that it stimulates muscle glycogen synthesis following exercise, and reverses the catabolic effect on muscles due to excess glucocorticoids or to low levels of androgens. In other words, adequate glutamine is essential to prevent protein wasting. In this regard glutamine works with the RNA which is an important ingredient in your Formula EI. Glutamine is also essential for the acid/alkaline component of many electrolyte insufficiency problems, particularly those with the renal/adrenal/potassium excess acidosis. - 6 - Complex P is essential for many of your EI (R-) patients. Giving these patients Complex P (assuming it was indicated by your objective findings) will increase the tone of their vascular system; it will increase their blood pressure and pulse pressure; and it will strengthen the heart and adrenals. Perhaps the most important supplement for your EI (A-) patients is Formula EW. It has a powerful impact on the movement of electrolytes and water from one body fluid compartment to another. It not only influences fluid dynamics but influences membrane permeability as well. In the October Letter we closed with a long list (which you may want to review) of the clinical benefits of using Formula EW. All the clinical benefits of Formula EW (which consists of glycerol plus vitamin E) are attributable to the two major actions of glycerol: - It quickly permeates all three body fluid compartments, carrying electrolyte buffers and other solutes, along with biologically activated water to meet physiological demand. - Glycerol also binds with and neutralizes the free fatty acids that are the primary cause of the aging process that results form free radical peroxidation -- particularly the abnormal fatty acids with conjugated double bonds which most accelerate the aging process. Most of the rest of your EI supplement page consists of sodium combined with various anions. The combination of anions that each patient needs depends on whether they are EI (A-) or EI (R-), and on what other NUTRI-SPEC imbalances they may have. Notice that one of the supplements is sodium combined with glycerophosphate, which gives all the same benefits of glycerol with the additional benefits of the minerals sodium and phosphorous. You may also note that your Formula EI contains calcium glycerophosphate. Give the specific supplements indicated for your EI patients, including their electrolyte tonic before breakfast and perhaps another mix consumed throughout the day, and you will empower them like no one else can. Sincerely, Guy R. Schenker, D.C.