From: Guy R. Schenker, D.C. November, 1998 Dear Doctor, In last month's Letter we introduced not only sweeping new changes in your NUTRI-SPEC analysis, but two exciting new products as well. Since you were flooded with a tidal wave of new material, we promised in that last Letter to spend the next few months giving you the "why" behind all these exciting improvements. Let us pause for a moment and ask ourselves what is our objective in putting a patient on the proper NUTRI-SPEC regimen? Our goal is simply to achieve in that patient metabolic balance with respect to the five fundamental metabolic control systems. In so doing we will have done everything nutritionally possible to help that patient increase their adaptative capacity to its maximum potential. In other words, the patient's ability to restore and maintain vitality such that functional and pathological symptoms can be overcome will be maximized. And what specifically does this metabolic balancing enable each of your patients to do? Each of the one or more metabolic imbalances found in a patient disables that patient in their ability to perform the following essential functions: A. Maintain glycemic control B. Maintain normal oxidative metabolism -- neither insufficient oxidation nor excessive free radical oxidation and glycation C. Maintain ideal pH at each of the levels of biological organization D. Maintain ideal concentrations of biologically active water and electrolytes at each of the levels of biological organization - 2 - What we are saying is that if a person can maintain glycemic control, normal oxidation, normal pH, and normal flow and concentration of water and electrolytes, they are in a state of health. Their adaptative capacity and vitality will be at a level approaching their innate potential. If you can so empower your patients, you will have done everything for them you could possibly want to do and everything they could possibly need or want. You probably understand that each of your five metabolic balance systems relates to each of these four essential components of health. Your Quick Reference Guide (QRG) analysis gives you the most direct route to maximum empowerment for each individual patient. Let us now look closer at the last two of these essential functions -- pH control and water/electrolyte dynamics. First, what do we mean by the various levels of biological organization? This subject is covered in your "Analytical System of Clinical Nutrition," but just very briefly, we mean the hierarchy of organizational levels from the systemic level down to the tissue level down to the cellular level down to the nuclear level down to the sub-nuclear level and so on. Each of those levels of biological organization is represented schematically by a fluid compartment. The systemic level has as its fluid compartment the plasma; the tissue level is represented by the interstitial fluid and the lymph; and the cellular level is represented by the cytoplasm. The best way to gain an understanding of the significance of your revised NUTRI-SPEC test procedures, and an appreciation for the power of your two new supplements, Formula EW and Sodium Glycerophosphate, is to talk about the movement of water and electrolytes throughout these fluid compartments. Look at the enclosed diagram and think of the human body as a series of well mixed fluid compartments. The intracellular fluid is divided into three compartments: - the blood cells, - the vascular endothelial cells - and the parenchymal cells of the various organs The extracellular fluid compartments consist of: - the plasma - the interstitium - the lymph - 3 - Under normal conditions extracellular fluid can move freely between the interstitium and the plasma, but they must be considered separate compartments since the plasma contains a higher protein (principally albumin) concentration. Keep in mind that we are presenting a model that applies to the dynamics of whole body fluid and solutes, but the actual exchanges of water and solutes occur exclusively in the micro circulation, i.e., the capillaries and post capillary venules of each organ. All the membranes separating these compartments are permeable to water but have different permeability for other substances. Cellular membranes are semipermeable, allowing only water and no solute to pass through them. The capillary walls that divide the plasma from the interstitium consist of two identical endothelial membranes, but which have intercellular pores. The pores are the only pathway for solute transport between the plasma and the interstitium. These pores can be visualized as an open membrane that freely passes water and sodium chloride and many other electrolytes, but almost completely restricts albumin and complex carbohydrates and most other macro molecules. The flows of water and solute across membranes are a function of three driving forces: - the gradient of hydrostatic pressure - the gradient of osmotic pressure - the concentration gradient The positive direction of fluid and solute flow is shown by the arrows in the diagram. There are fluid shifts into the plasma volume that occur across membranes. Fluid is also returned to the plasma via the lymphatic system. Fluid is eliminated from the plasma volume by the kidneys (and also by hemmorhage). The parenchymal cell membrane does not support a difference in hydrostatic pressure, so intracellular and adjacent interstitial hydrostatic pressures are equal and fluid is driven only by an osmotic gradient. The exception to this is the albuminal endothelial membrane of the capillary wall which supports a hydrostatic pressure difference between the interstitium and the plasma. The compliance of the interstitium, the change in interstitial volume for each unit change in interstitial pressure, limits how much water the interstitium can take in or give up. - 4 - The oncotic pressure in the plasma, i.e., the osmotic pressure exerted by the impermeable protein (albumin) molecules is a function of the total protein concentration. Because albumin does leak slowly across the capillary membrane, interstitial changes in osmotic pressure are directly dependent on albumin concentration. The lymphatic system is a single flow passage that transports fluid and solute from the interstitium to the plasma, with the flow dependent only on the hydrostatic pressure in the interstitium. The lymph has the same composition as the interstitial fluid. Imbalances in electrolyte concentration normally do not exist in the body, since they are quickly compensated by water movement. In the presence of many of the NUTRI-SPEC fundamental imbalances, however, there exist non-physiological states with severely altered plasma osmolarity that can generate enormous osmotic pressure gradients as well as non-physiological concentration gradients. One example of a water/electrolyte imbalance is your patient's who are hypovolemic. These would include all your electrolyte insufficiency patients and many patients with other imbalances as well. These patients have low plasma volume; many of them have low interstitial fluid volume and low cellular hydration as well. Many of them, however, have an excessive interstitial fluid volume but a decreased intracellular volume. Another variation on hypovolemic patients are those who have low cellular volume in parenchymal cells but actually have an increased volume of the vascular endothelial cells. How do you as a NUTRI-SPEC practitioner deal with all these many variations that can occur with a single condition -- hypovolemia? The answer is simple. Your QRG protocol automatically sorts through all these many variations of the hypovolemic theme. You will automatically be giving each of your patients just the supplements they need to supply electrolytes and move them, along with biologically activated water, to exactly where they need to be, while at the same time pulling excess fluid out of where it should not be. Consider now patients who are hypervolemic. These include all your electrolyte stress patients. Some of these patients will have low interstitial volume and low cellular volume. Many, however, will have elevated interstitial fluid volume and extreme edema. Some of these hypervolemic patients will have elevated serum pH and elevated tissue pH. Others will have elevated serum pH and acid tissue pH. Still others will have the reverse -- acid plasma and alkaline tissues. - 5 - How do you get just the right electrolytes in just the right quantity into the proper fluid compartment? How do you assure that pH is normalized in each fluid compartment? How do you move the excess fluid out of the plasma and into the parenchymal cells which are starved for biologically active water? Again, your QRG sets your course to maximize your patient's functional capacity. (Or, you can prescribe a diuretic to decrease the excess plasma volume -- which is about as logical and beneficial as the blood letting of days gone by.) Consider another example. You have a large portion of your patients who are suffering the effects of the abnormal fatty acids with conjugated double bonds (the ones which most accelerate free radical oxidation damage and associated catabolic and aging processes). These abnormal fatty acids in the parenchymal cells pull excess chlorides from the interstitium into the cytoplasm, fixing the chlorides irreversibly. The excess fixation of chlorides allows excess sodium and carbonate (and eventually potassium in many cases) to accumulate at the tissue level. These sodium, potassium, and carbonate compounds, (particularly in the absence of sufficient chloride) leave the tissues extremely alkaline. This tissue alkalinity is associated with an exaggerated sensitivity to all of the diphasic symptoms such as pain sensitivity, allergic sensitivity, vertigo, itching, etc. Patients suffering from this biochemical abnormality include many of your electrolyte insufficiency patients, some of your glucogenic patients, and almost all of your dysaerobic patients. Nothing other than Formula EW or Oxygenic D+ can reverse this destructive catabolic aging process: NO ONE BUT YOU, AS A NUTRI-SPEC PRACTITIONER, CAN EVEN TOUCH THIS PROBLEM. We could go on giving example after example of abnormal concentration gradients and abnormal osmotic pressure gradients that are associated with each of your NUTRI-SPEC Fundamental Imbalances. But we've probably given you enough already to make our point -- you have the power to control fluid and solute movements. Furthermore, you can exercise this power without a PhD-level comprehension of biochemistry. You have objective test procedures and step by step protocol to guide you to the needs of each individual patient. Next month our Letter will take a specific look at your electrolyte stress and electrolyte insufficiency patients -- those that are most directly associated with water and - 6 - electrolyte abnormalities. You will learn that your ES and EI patients are divided into sub-categories based upon their hormonal stress reaction and their pH aberrations. How do you make the differential analysis between these sub-categories within each imbalance? As you might suspect, your QRG does it for you. We will explain the how and why next month. In the meantime, please consider carefully a statement I have made many, many times in the past, and which I reiterate here: IF YOU DO NOTHING ELSE WITH NUTRI-SPEC, AT LEAST TREAT PATIENTS WITH CARDIOVASCULAR DISEASE. This has always been true, but all the more so now with our added understanding of the sub-categories of electrolyte stress patients. Your patients with high blood pressure, elevated cholesterol and triglycerides, atherosclerosis, cardiac arrhythmias -- all these patients will respond measurably. With your NUTRI-SPEC regimen they will live longer, and live better. Many will be able to reduce or delete medications, some going off medications altogether. If you are just getting started with NUTRI-SPEC, providing your services to a few CVD patients is a great way to build confidence and enthusiasm in you and your staff, and prove to yourself just how powerful NUTRI-SPEC is. Sincerely, Guy R. Schenker, D.C.