Last week we covered glucose factors, as well as the importance of interpreting blood chemistry functionally, rather than pathologically. We also discussed the topic of laboratory reference ranges being statistical averages, rather than being reflective of normal or healthy values. To briefly review, the 3 quadrants of blood chemistry analysis includes:
- Identify biomarker function – Know the function of individual markers. Understand ALL of the potential relevancies of each biomarker. Know the associated organ/physiological/biochemical pathways for each biomarker.
- Identify individual biomarkers in relationship to other biomarkers (pattern analysis) – Understand the relationship of individual biomarkers with other biomarkers. Example: Insulin, Glucose, Hemoglobin A1C, LDH are all related. Understand significances of these relationships. Example: When glucose is elevated but Hemoglobin A1C and Insulin are low/normal it suggests adequate glucose control, but some other factor is affecting/increasing glucose.
- Clinical correlation of biomarkers and patterns to individual patient – How does the biomarker or pattern relate to the patient? Example: The underlying etiology and significance of an elevated ALP and HDL cholesterol in a 26-year old male is likely quite different than for a 70-year old female. Knowing how a pattern relates to the individual is significant, because of differences in age, gender, inter-individualistic genetics, and biochemical individuality. In these cases, the 70-year old female likely has some degree of osteoporosis, and the body’s attempt at osteogenesis by raising the level of ALP in bone. A dexa scan confirms the osteoporosis. The 26-year old male most likely does not have osteoporosis, and his elevated ALP is caused by something else. In which case, you investigate further by looking at the other metabolic enzymes, to see if there are hepatic issues of some kind causing the rise in ALP. You also can choose to run an electrophoresis on the ALP to determine which of the iso-enzymes is elevated. Similar results for 2 patients, 2 different causes and courses of action.
This week we are going to discuss and address electrolytes and blood level minerals.
Electrolytes Charge Cells & Facilitate Energy Production
I am going to provide blood chemistry factors first and their functional reference ranges that I use, and then talk about them more in-depth.
- Sodium 137-143
- Potassium 4.0-4.5
- Chloride 100-106
- CO2 (bicarbonate) 24-27
- Calcium 9.2-10.0
- Phosphorous 3.0-4.0
The electrolytes of the body provide the cells with the electrical charge needed in order to function and produce energy in the cells. There is arguably nothing more essential to the physiological function of the human body than electrolytes, cell hydration and charge.
It is essential to assess electrolytes in relation to other electrolytes. Sodium and potassium should be viewed in concert because of their intrinsic relationship. Calcium and phosphorous should be viewed in concert because of their relationship, and the same is true for chloride and Co2.
Sodium is the most prevalent extra-cellular cation that exists mostly outside of the cell. Sodium is the primary base in the blood. Potassium is the primary intracellular cation. Sodium and potassium together make up the sodium/potassium pump, which functions to regulate the amount of sodium that stays outside of the cell versus how much potassium stays inside the cells. Together, sodium and potassium (along with other electrolytes) regulates and influences:
- The body’s pH
- Nerve conduction
- Cardiac function
- Blood pressure & cardiac activity
- Hormone function, including adrenal activity
Sodium & Potassium
When sodium is elevated at or above the top of its range, and simultaneously potassium is at or below the bottom of its range, it is likely there is excess adrenal output. Conversely high potassium and low sodium tend to indicate adrenal insufficiency.
The body does its best to maintain the proper balance between sodium and potassium in order to maintain homeostasis. The kidney retains sodium and causes potassium excretion under normal circumstances. When there is excess adrenal output from mineralcorticoids such as aldosterone and glucocorticoids such as cortisol, there may also be an increase in sodium because of the fact that aldosterone retains sodium and increases potassium excretion. Common patterns of adrenal hyperfunction:
- High blood pressure
Conversely, if adrenal function is diminished, there will tend to be a loss of sodium and increased potassium in the serum. Common patterns associated with low adrenal output:
- Low blood pressure
- Salt cravings
- Weakness, fatigue
Chloride & Co2
Chloride and Co2 together are highly reflective of the body’s pH tendencies. Chloride is the body’s primary extracellular anion. Chloride and sodium levels tend to move functionally in the same direction. When sodium is decreased in serum, chloride often is as well. The opposite also tends to be true.
The kidneys and the lungs are the 2 primary organs that work to regulate the body’s pH.
On a blood test, Co2 is not a measurement of carbon dioxide (acid), but rather a measurement of bicarbonate (which is alkaline). Co2 on a blood test measures CO2 “content” rather than the gasseous form of Co2. Hence an increase in Co2 content tends to indicate a movement towards alkalosis, and a decrease in Co2 content tends to indicate a move towards acidosis.
When chloride levels are depressed (<100) and Co2 is elevated (105>), there is the likelihood of metabolic alkalosis. Alkalosis is defined as a loss of H+ and increased levels of bicarbonate (alkaline). In alkalosis, there are inadequate levels of hydrogen which may tend to result in a condition called “Hypochlorhydria”, low levels of HCL (hydrochloric acid). If there are inadequate levels of HCL, digestive functions are impaired. Numerous minerals and nutrients are dependent upon sufficient levels of HCL for assimilation.
In addition to this, alkalosis favors the precipitation of cations such as calcium and magnesium out of body fluids and will tend to result in the deposition of these electrolytes into body tissues. An interesting correlation can be made between alkalosis in blood chemistry analysis and elevated tissue calcium and magnesium in HTMA (hair tissue mineral analysis). A common pattern on HTMA is that of high calcium. More often than not, both calcium and magnesium are found together elevated on HTMA.
In my experience, the patterns of alkalosis usually corrects quickly when adequate H+ and acidifiers (such as ammonium chloride, HCL, phosphoric acid) are added supplementally.
Metabolic acidosis is seen when Co2 is decreased and chloride is increased. In acidosis, there are increasing levels of hydrogen (H+). Also in acidosis, potassium is driven out of cells and into serum. Because of the accumulation of carbon dioxide in the blood in acidosis, the lungs will attempt to excrete as much as possible. Thus, the “resting” respiration rate will tend to be increased in a state of metabolic acidosis. The lungs may compensate further by attempting to make the inhalation longer in duration than the exhale.
Sodium bicarbonate, being the most powerful base salt is capable of powerfully neutralizing excess acidity.
Calcium & Phosphorous
Ionized calcium is a primary electrolyte, a secondary hormonal messenger, is essential for muscle contraction and nerve conduction. Active, ionized calcium is also essential for cell membrane permeability. Phosphorous is essential for DNA and RNA, forming the structural framework of the genetic material. Phosphorous in the form of phospholipids is an essential component of cell membranes. Calcium and phosphorous together are reflective of autonomic nervous system function. The great nutritionally-oriented dentist, Melvin Page, DDS made significant discoveries regarding the Calcium/Phosphorous ratio and nervous system activity.
According to Dr. Page’s research, calcium tends to have a stimulating effect upon the sympathetic nervous system. Phosphorus tends to initiate parasympathetic activity.
Simply stated, the only form of calcium the body can use is ionized calcium. Ionized calcium is synonymous with dissolved calcium. In order for calcium to be assimilated, there must be sufficient stomach acid present. Calcium, among many other minerals is dependent upon adequate HCL. Calcium is also dependent upon other nutrient co-factors for assimilation such as Vitamin D, zinc and copper. Therefore low serum calcium can be associated with low HCL (hypochlorhydria), if correlative with other more sensitive variables. High levels of calcium can reflect excessive parathyroid gland output.
Calcium is also a major component of the interstitial matrix. Calcium has a regulatory effect upon cell membrane permeability. It is largely responsible for what goes in and out of cells. Elevated serum calcium can therefore be used to determine a person’s oxidative, free radical stress.
Phosphorous is the acid antagonizing mineral to calcium. Both blood calcium and phosphorous levels are regulated by the parathyroid gland. Typically when calcium levels in the blood rise, phosphorous levels fall. If serum phosphorous levels are decreased (<3.0), it is associated with digestive inadequacies such as low HCL (hypochlorhydria). Low levels of phosphorous can also result in poor breakdown of dietary fats. This is due to the fact that phosphorous is a major component of lecithin, a primary lipid emulsifier. If phosphorous levels are elevated, it can be indicative of low parathyroid gland function.
This concludes part 2 of ‘Secrets of Blood Chemistry Analysis’. Stay tuned for the following weeks for more.