From: Guy R. Schenker, D.C. November 1997 Dear Doctor, Do you have any patients who: 1. suffer from fatigue? (You undoubtedly have countless patients who lack the power to meet the routine demands of life -- perhaps pushing themselves with stimulants, but still falling far short of the happy life they used to dream of.) 2. are under weight or over weight? (You could build an entire practice doing nothing more than helping people achieve their ideal weight.) 3. have high or low blood sugar? (The typical American eats 100 pounds of sucrose per year. This works out to be (believe it or not) fully 20% of our caloric intake from sugar. No wonder most of your patients are riding the blood and brain sugar roller coaster.) 4. suffer from anxiety or depression? (And wouldn't you love to help these people get off their Prozac and their Xanax?) 5. are showing the effects of premature aging? (This breakdown of body structure and function that results from a shut down of metabolic processes is evident in your patients in many ways -- as fatigue, as joint deterioration, as memory loss, loss of muscle mass, loss of skin tone, loss of bone density, loss of libido, and the list could go on and on.) 6. are chronic complainers? (How many patients would you like to restore to health for no other reason than to put a stop to their incessant whining?) Fatigue, weight problems, blood sugar problems, anxiety or depression, premature aging, and chronic complaining are all conditions with one thing in common -- they are frequently found in your glucogenic/ketogenic patients. For your patients suffering from one or more of these conditions ... - 2 - YOU ARE THEIR ONLY CHANCE AT REGAINING HEALTH ... because only you can find and fix the cause of their condition. Identifying and correcting your patients' glucogenic/ ketogenic imbalances is as simple as following the protocol on the third page of you Quick Reference Guide (QRG). In a minute we will look at that QRG page and explain how and why each of the tests fits into a glucogenic or ketogenic test pattern. But first, let us discuss in very general terms what exactly is going on in your glucogenic/ketogenic patients. Typically, these patients are physically, mentally, and emotionally depleted. Why? Their total depletion results from nothing more complicated than ... INADEQUATE ENERGY PRODUCTION. Without enough energy to push the thousands of metabolic pathways, nothing works properly in these patients. Our NUTRI-SPEC Glucogenic/Ketogenic balance system is based upon the paradigm developed by George Watson. Watson was, to my knowledge, the only person before NUTRI-SPEC who looked at nutrition from a patient-specific rather than from a disease-specific point of view. Through his fascinating research (I encourage you to get a copy of his book written in the early 60's, "Nutrition and Your Mind") he defined what we at NUTRI-SPEC call a dualistic, diphasic metabolic balance system. The two phases of his imbalance related to the two primary types of energy production -- glucogenic and ketogenic energy production. Here is a simple model to help you conceptualize what glucogenic/ketogenic metabolism is all about. Glucogenic energy production is energy produced from carbohydrates and glucogenic amino acids, largely via the citric acid cycle. Ketogenic energy production is energy derived from fats and ketogenic amino acids via the beta hydroxybutyric acid cycle. The healthy person produces energy throughout the day and night from both glucogenic and ketogenic sources. In a state of health we have the capacity to utilize which ever of those energy production pathways is appropriate at the moment. Your glucogenic/ketogenic patients have lost the ability to selectively utilize the most appropriate energy production pathway. If the patient is glucogenic it means they have deficient oxidative energy metabolism from ketogenic sources, with an over-dependence on glucogenic energy production. - 3 - Conversely, your ketogenic patients are deficient in glucogenic energy production, and have an over-dependence on ketogenic metabolism. To describe these patients we have used the analogy of a car engine not firing on all cylinders. In a glucogenic patient the misfiring cylinders relate mainly to fat metabolism; in a ketogenic patient the cylinders not firing mostly relate to carbohydrate metabolism. So, both glucogenic and ketogenic patients have deficient oxidative energy metabolism. The glucogenic are more deficient in energy production from fats, while ketogenic patients are more deficient in energy production from carbohydrates. THE IMPORTANCE OF DIETARY RECOMMENDATIONS 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 typical of most people. It is thus the imbalance that is most totally responsive to diet and exercise. The ideal food choices for your glucogenic and your ketogenic patients are given on pages 76-77 of your NUTRI-SPEC manual, and are also presented for your patients' benefit in the glucogenic and ketogenic imbalance descriptions that you hand out to your patients. The essence of these food choices is that glucogenic and ketogenic patients must strictly adhere to the NUTRI-SPEC Fundamental Diet (that you give to all your patients as part of their Report of Findings). Additionally, the glucogenic and ketogenic diets differ from the fundamental diet in two ways -- as regards the ratio of protein to carbohydrate, and as regards the type of protein. For a typical patient who is neither glucogenic nor ketogenic but particularly has weight control in mind, an ideal ratio between protein and carbohydrate is offered by the NUTRI-SPEC Fundamental Diet. That ratio is 10 carbohydrate points per ounce of protein. Your glucogenic patients need slightly more emphasis on the protein -- that ratio shifting from 10:1 to 9:1. Your ketogenic patients still need the required serving of protein at each meal but can handle a little higher quantity of carbohydrate -- an 11:1 ratio. Regarding the type of protein -- glucogenic patients need the high adenine meats and vegetables listed on the hand-out you give your glucogenic patients. Ketogenic patients need proteins that are lower in adenines and nucleic acids. - 4 - Structuring the diet in this way ensures that your glucogenic patients have everything needed to push them into the beta hydroxybutyric acid pathway where they are deficient; and your ketogenic patients will obtain all the nutrients necessary to facilitate energy production via the citric acid cycle. One of the most consistently gratifying aspects of correcting glucogenic/ketogenic imbalances is that ... OVERWEIGHT PATIENTS LOSE FAT AND WATER WHILE GAINING MUSCLE, AND, UNDERWEIGHT PATIENTS GAIN LEAN BODY MASS. Look now at your QRG analysis of Glucogenic/Ketogenic balance. What are the test results you need consider, and how do they relate to the aberrant energy production associated with each of these imbalances? Your 5-point quick scan for this imbalance includes the adjusted saliva pH, the breath hold time, the respiratory rate, the fourth pulse, and the second diastolic blood pressure. Most of these tests relate specifically to three things: - deficient oxidation activity - abnormal carbon dioxide levels - abnormal serum pH Here is a simple way to picture what is going on. If glucogenic/ketogenic means low energy production, what would you expect to find when you look for the normal end products of energy production? Decreased energy would mean decreased end products of energy production, right? And what is the major end product of energy metabolism? Carbon dioxide. So, glucogenic/ketogenic patients, being low in energy production, tend to have low carbon dioxide levels in their blood stream. Carbon dioxide is the major constituent of saliva which determines its adjusted pH. That is why the adjusted saliva pH is the keystone of your QRG analysis. Your ketogenic patients are low in carbon dioxide both quantitatively and qualitatively. What we mean by that is they are quantitatively low in C02 because of quantitatively low energy production. They are qualitatively low in C02 because they are particularly deficient in carbohydrate energy production (which produces C02 as its major end product) and relatively high in fat metabolism (which produces very little C02). The deficiency of carbohydrate metabolism also leaves the ketogenic patients with a somewhat elevated serum pH. - 5 - Your glucogenic patients are, like the ketogenic patients, quantitatively deficient in C02 because of an overall inadequate energy production. However, the glucogenic patient is qualitatively high in C02 because carbohydrate metabolism predominates over fat metabolism. The deficiency of fat metabolism in these glucogenic patients leaves their serum pH somewhat decreased. Because of the continuous compensation that glucogenic and ketogenic patients must make 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 (as per your QRG protocol). Urine surface tension is also critical in evaluating glucogenic/ketogenic patients. The surface active substances excreted in the urine which determine your patient's surface tension are the end products of oxidative metabolism -- particularly fat metabolism. Since the glucogenic patient is weaker in fat metabolism than in carbohydrate metabolism, while the ketogenic patient is weaker in carbohydrate metabolism than in fat metabolism -- it follows that both glucogenic and ketogenic patients will have elevated surface tension, but with the glucogenic surface tension tending to be even higher than the ketogenic. Next on your QRG page are the tests ketones and glucose. Blood sugar regulation is perhaps the most critical problem in your glucogenic/ketogenic patients. Your glucogenic patients are your classic hypoglycemics; ketogenic patients are suffering from dysinsulinism, insulin resistance, and can even develop adult onset diabetes. In your glucogenic patients there is extreme insulin sensitivity. Sugar is very quickly pulled out of the blood stream to either be stored as fat or pushed through the citric acid cycle to produce energy. Unless these patients have the capacity for a strong sympathetic compensation to their glucogenic imbalance, they will frequently run extremely low blood and brain sugar. There are literally no limits to the physical, mental and emotional hypoglycemic symptoms these patients can experience. Your ketogenic patients have developed insulin insensitivity. Many of them produce tremendous amounts of insulin in a desperate attempt to push the sugar out of the blood and into the tissues, but to no avail. The chronically - 6 - high insulin levels in these patients sets off a chain reaction of biochemical and endocrine disasters. Liver function is compromised; blood pressure begins to elevate (the Atkin's Institute estimates that more than 65% of all blood pressure problems are at least partly associated with elevated insulin levels and poor glycemic control); balance is lost in many other hormone systems and the patient begins to age prematurely. Note in your QRG that both glucogenic and ketogenic patients will often show bilirubin in their urine. The ketogenics show bilirubin resulting from their liver dysfunction. The glucogenic patients show bilirubin as a result of inadequate bile flow through the gall bladder (often accompanied by gall stones) and a back-up of bilirubin into the blood. Both imbalances tend to have low body temperature associated with insufficient oxidative energy production. Anxiety, depression, and "stress" are listed as frequent complications of both glucogenic and ketogenic imbalances. If you would like to read a fascinating description of how these imbalances relate to various abnormal emotional states read either Watson's "Nutrition and Your Mind," or his later book, "Psycho-Chemical Power." In next month's Letter we will take an in-depth look at the amazing power you have to reverse these two devastating metabolic imbalances. With your NUTRI-SPEC supplements, accompanied by the proper dietary recommendations, you can normalize energy production in these patients and thus reverse their fatigue, help them achieve normal body weight, regulate their blood and brain sugar levels, decrease their emotional stress and slow the aging process. In short, you can give your patients a whole new lease on life. Sincerely, Guy R. Schenker, D.C.