From: Guy R. Schenker, D.C. July, 1999 Dear Doctor, What can you do that no other doctor can do? You can take any total stranger and within minutes begin to restore that person's ability to perform the following essential functions: a. Maintain glycemic control b. Maintain normal oxidative metabolism c. Maintain ideal pH d. Maintain ideal concentrations of electrolytes and biologically active water How important are these four essential functions? They are the whole story. If you are talking about health vs. disease -- they are the difference between living stronger-longer and being sicker-quicker. Yet while these functions are virtually the essence of life, you (and only you as a NUTRI-SPEC practitioner) have the power of control over them. And where do you derive your power to control these vital functions? From your objective system of analysis -- a system which allows you to appraise in just minutes any individual's status with respect to the metabolic control systems which govern those four essential functions. You refer to these metabolic control systems as the NUTRI-SPEC fundamental balances. There are 5 of these fundamental control systems. You have come to learn that these control systems are the engines that drive body and mind. When these engines are working efficiently one can move through life with strength and vitality. When one or more of these control systems loses efficiency, body and mind simply cannot perform at their best. Yes, you have the power of control -- and objectivity is intrinsic to your power. But while an objective means to analyze the 5 fundamental metabolic control systems - 2 - does give you the ability to favorably influence the four essential functions, does that mean that your job is an easy one? Usually not. You are often working against tremendous odds. And your most likely adversary is the person you are trying to help. That brings us to a discussion of the Glucogenic/Ketogenic control system. Of all the five NUTRI-SPEC imbalances, glucogenic/ ketogenic is the one that is the most self-inflicted. In other words, it is the imbalance that is most associated with the miserably inadequate diet and sedentary lifestyle that typifies most of your patients. It is thus the imbalance that is most totally responsive to diet and exercise, and thus the one that can be most easily sabotaged by your patients' self destructive lifestyle choices. Of the four essential functions listed above, the two that are most intimately and directly associated with glucogenic/ketogenic imbalances are the maintenance of glycemic control and the maintenance of ideal pH, (particularly the systemic pH). Is your glucogenic/ketogenic patient your ally or your adversary in achieving metabolic balance and restoring essential function? Think of it this way. The average American consumes 100 pounds of sucrose each year. That amounts to an astounding 20% of our caloric intake in the form of refined sugar. That does not even include the additional "natural" sugars that are additionally consumed in the forms of juices and fruit. Now, if your average person consumes that much sugar, and if the loss of glucogenic/ketogenic control is largely associated with loss of glycemic control -- you can well imagine that your typical glucogenic/ketogenic patient consumes sickening (literally) quantities of sugar. Furthermore, in people that have an inborn tendency to either a glucogenic or ketogenic predominance in their metabolism, even the "ordinary" grotesque sugar intake of the average person is enough to push them into a devastating state of imbalance. What are the clinical effects of glucogenic/ ketogenic imbalance? Symptomatically speaking, your most common major complaints among these people would be: - fatigue - overweight or underweight - hypoglycemia or diabetes (and all sequelae) - anxiety, depression and mood swings - premature aging - 3 - At the core of this imbalance is a patient's inability to access the energy production pathway that is apropos of the moment. Your glucogenic patient is deficient in oxidative energy metabolism from fats and ketogenic amino acids via the beta hydroxy butyric acid cycle. At the same time that patient has an over- dependence on glucogenic energy production associated with metabolism of carbohydrates and glucogenic amino acids, largely via the citric acid cycle. Conversely, your ketogenic patients are deficient in glucogenic energy production, and have an over-dependence on ketogenic metabolism. You can easily imagine how glucogenic/ketogenic patients are continuously struggling with glycemic control. Their blood sugar and brain sugar levels tend to be quite erratic. Then, having lost the essential function of glycemic control, the sky is the limit as far as both physical and mental symptoms are concerned. While much of the fatigue, weight problems, high and low blood sugar and the emotional symptoms associated with glucogenic/ketogenic imbalances directly result from the erratic sugar levels and the hormones associated with these sugar levels (such as excess catacholamines in your glucogenic patients, and excess cortisol as well as insulin resistance in your ketogenic patients), there is another component of this imbalance that leads directly to symptoms. There is a loss of pH control at the systemic level associated with glucogenic/ketogenic imbalances. Largely associated with the production of carbon dioxide as a metabolic end product, we find that glucogenic patients tend to be somewhat acid at the systemic level. Ketogenic patients tend to be alkaline. Watson (upon whose work our glucogenic/ketogenic paradigm is based) showed that aberrations in serum pH were more directly correlated with patients' symptoms than any other quantifiable factor. Foods and nutrition supplements which increased the systemic pH were immediately beneficial for glucogenic patients and devastating for ketogenic patients. Acidifying foods and supplements had the reverse effect. With the deficiencies in oxidative energy metabolism, the inefficiencies in drawing upon appropriate energy reserves, the abnormal carbon dioxide and pH levels and the virtually unlimited chain reaction of symptoms and conditions that can be associated with glucogenic/ - 4 - ketogenic imbalances, how can you get an objective handle on this balance system? In other words, how can you quantify this imbalance as a means to analyze each patient? Your QRG does the job quite nicely. Since your adjusted saliva pH is directly influenced by C02 levels, and since a patient's respiratory rate, breath hold time and pulse are all influenced by pH changes, your QRG 4-Point Quick-Scan enables you to determine in just seconds whether your patient is likely to have a glucogenic/ketogenic imbalance. You see, since your glucogenic and ketogenic patients must make continuous compensation to their abnormal carbon dioxide and pH levels, there are no absolute generalizations that can be made with respect to their test results. Instead, it is necessary to define glucogenic/ketogenic imbalances in terms of abnormal ratios of the saliva pH, breath hold, respiratory rate and pulses. All these ratios are neatly worked into one concise chart in your QRG analysis. This is an appropriate time to alert you to one further refinement of your QRG analysis for glucogenic/ ketogenic imbalances. The additional improvement in your analysis relates to your analysis of children. The note you want to make on your QRG is that for a child make the following two allowances: 1. If the child's breath hold is less than 40 seconds, then count it as 40 seconds. 2. Instead of using the child's P4 in the analysis, use P1. These two changes will make your glucogenic/ketogenic analysis of children much more reliable. This is essential because this imbalance is extremely common in children. We have alluded many times in the past to the tremendous benefit to be derived from doing NUTRI-SPEC on children. Some of the most dramatic clinical responses in children are in those who are being treated as ADD or ADHD. You have learned that many of these children are glucogenic with a powerful sympathetic compensatory response to their blood and brain sugar instability. The resulting combination of crashing blood sugar and surging catacholamines is what causes these children to bounce off the walls with no ability to maintain focus on either academics or rules of behavior. - 5 - The quick response of ADHD children (or any children for that matter) to metabolic balancing with NUTRI-SPEC is sometimes astounding. You will rarely experience anything more gratifying than turning a child's life around. Once you have determined a patient to be either glucogenic or ketogenic you need only turn to the appropriate page of your QRG for the specific supplementation needed. Your Oxygenic G has all the amino acids, vitamins, minerals and trace minerals to push the patient out of an acid hypoglycemia into the ketogenic energy production pathways which are deficient. Your Oxygenic K contains all the amino acids, vitamins, minerals and trace minerals to push the patient out of alkaline insulin resistance into the efficient use of energy through glucogenic pathways. Your supplement selection page gives specific protocol for the use of many other supplements which will enhance the speed at which metabolic balance is restored, and also the speed at which symptoms respond. In summary, we would note that while your glucogenic and ketogenic imbalance represent opposite phases of a diphasic metabolic control system, they both have one thing in common ... SUGAR HANDLING STRESS. Quite simply -- some people succumb to a 100 pound annual sugar assault by getting stuck in a glucogenic rut. Others react to the overwhelming sugar load with a ketogenic metabolic response. This is the NUTRI-SPEC key concept of biological individuality displayed quite clearly. The same metabolic stressor can result in the exact opposite metabolic response in two different people. Never lose sight of the fact that if your patient is glucogenic or ketogenic, the perfect supplement regimen can only take the patient so far if the relentless stress of the 100 pound sugar load is not removed. That is to say that strict adherence to the NUTRI-SPEC Fundamental Diet is more important for patients of glucogenic/ ketogenic imbalance than any others. (That is not to say that it is not absolutely essential for all your patients -- just that your glucogenic/ketogenic treatment regimen is 100% doomed to fail without strict dietary compliance.) - 6 - Not only must sugar be deleted, but the proportion of carbohydrate in the diet is an essential consideration. For patients of these imbalances who are obese, you can decrease the carbohydrate percentage to far below the quantities called for by your NUTRI-SPEC Fundamental Diet. For your overweight glucogenic patients in particular, it can make all the difference in the world to put them on an extremely restricted carbohydrate diet, enough to push them into a state of ketosis and keep them there. Your obese ketogenic patients may follow the ketogenic dietary recommendations but also with aggressive carbohydrate restriction. You will find that it requires a less stringent diet too keep these patients in ketosis. When properly maintained on the NUTRI-SPEC Fundamental Diet with low carbohydrate emphasis (and accompanying increase in saturated fat and protein such that calories are not restricted) to enhance ketosis, the patient will not only see pounds melt away, but will see an immediate improvement in emotional status, energy levels and digestive efficiency. Even without special carbohydrate restriction, balancing any patient who suffers from a glucogenic or ketogenic tendency will ... HAVE AN IMMEDIATE AND AMAZING IMPACT ON ALL ASPECTS OF THEIR PHYSICAL AND EMOTIONAL WELL BEING. Sincerely, Guy R. Schenker, D.C. P.S.: One clinical manifestation of glucogenic/ketogenic imbalances that we listed above was premature aging. We listed it, then did not discuss it in the least. That will be the subject of an upcoming Letter which will deal with the topic of GLYCATION. While that discussion will take an entire Letter to cover, let me give you a quick preview of that coming attraction. There is only one food that rivals polyunsaturated fatty acids in its devastating capacity to accelerate the aging process. What is that food? The common sugar fructose which is the monosaccharide found in high concentrations in most fruit, and which constitutes 50% of the disaccharide sucrose.