Questions about Acid/base, Oxygen Imbalances

[Goshawk]

Mojo,

This was an awnser from one google group at sci.med.cardiology.

Got it.

sci.med.cardiology
Diabetes & Hypertention

link.

Jim Clements Dec 26, 9:36 am show options

Newsgroups: sci.med.cardiology,sci.med,alt.support.diabetes,misc.health.diabetes
Followup-To: sci.med.cardiology
From: Jim Clements <cleme...@xmission.com> - Find messages by this author
Date: Sun, 26 Dec 2004 10:36:35 -0700
Local: Sun, Dec 26 2004 9:36 am
Subject: Re: Diabetes & Hypertention
Reply | Reply to Author | Forward | Print | Individual Message | Show original | Report Abuse

Kumar wrote:



> Can there be some other reasoning of persistant hyperglycemia that low
> insulin level & insulin resistance?


What most people refer to as insulin resistance, I think is a misnomer. I
think that insulin is probably doing its job but getting blamed for the
results.

Glucose transfers from the blood into cells by a process called facilitated
osmosis. Insulin facilitates in this transfer by opening the door which
glucose may flow into the cell. When this door is opened, the transfer of
glucose into the cell is done via osmosis, a substance flowing from an area
of greater concentration to lesser concentration.


In a health body, the cell rapidly burns glucose so when insulin opens the
door, a concentration gradient exists, there is less glucose inside the
cell than outside the cell, so glucose flows to the area of lesser
concentration, inside the cell.


What happens when metabolism becomes impaired? Glucose is not burned as
rapidly in the cell. Insulin opens the door, but becuase there is still a
lot of glucose that has not yet been burned, there is still almost as much
glucose inside the cell as outside the cell, a strong concentration
gradient does not exist, glucose can not move as rapidly into the cell.
The result is that blood glucose levels remain elevated for a longer time.


Over time, the cell gets weary of insulin opening the door and letting in
more glucose that it reduces the number of doors that insulin can open.


Insulin gets the blame but insulin was doing its job.


On possible cause of impaired metabolism is a block in the mitochondria.
Mitochondria processes are aerobic, they require oxygen to function. In
the lack of oxygen delivery they cannot operate.


A too alkaline pH blood can interfere with the transfer of oxygen into the
cell. (Do a google search on "Bohr Effect") I believe that this alkaline
blood pH is a contributing factor for people with CFS-FMS and that that
condition is probably leading that group into type 2 diabetes.


Do you know what your blood pH is?


All the best,
Jim

And, get this: Two messages above this, Kumar posted a JREF smilie as a Merry Xmas message.

Kumar Dec 24, 8:50 pm show options

Newsgroups: sci.med.cardiology, sci.med, alt.support.diabetes, misc.health.diabetes
From: "Kumar"
Date: 24 Dec 2004 20:50:55 -0800
Local: Fri, Dec 24 2004 8:50 pm
Subject: Re: Diabetes & Hypertention

BEST SEASONS GREETING TO YOU & OTHERS.

Reply

Look at the URL-- http: //forums.randi.org/images/smilies/christmas.gif

Getting it off the JREF's server...

Isn't there a word for that? Hotlinking, or something?

 

[Zep]

Also note that Kumar then goes on to put the cart before the horse on the subject in order to try and get some mileage on one of his fave subjects, as evidenced by his subsequent questions here.

 

[Goshawk]

And he's using a sock puppet over there.


Thread started by someone logged in as "Kumar", says, "From: lordshiva5...@rediffmail.com (Kumar)".

Many posts in thread by someone logged in as "lordshiva5...@rediffmail.com", says, "From: lordshiva5...@rediffmail.com".

Uh huh.

Dunno how GoogleGroups work. Zat kosher?

 

[materia3]

duplicate-deleted-see below

 

[materia3]

Hello all,

I came across with some concepts as under:-



The above effects indicate that acidic/low blood pH improves Oxygen availabilty to tissues.

How can this concept be related diabetes, Insulin resistance & hypertension?

Best wishes.

Human arterial blood is normally slightly alkaline (7.40). Venous blood is slightly less alkaline but still alkaline at 7.35 to 7.38.

Uncontrolled/untreated diabetes causes metabolic acidosis, NOT the other way round. The fact that oxygen dissociates from hemoglobin more easily if the blood is acidotic is a coping
mechanism. There are a number of conditions which cause
acidosis.....

Respiratory acidosis. This is caused by hypoventilation or breathing at a level insufficient to maintain the carbon dioxide level at about 40 to 45 mmHg. This has nothing to due with diabetes.

Metabolic acidosis: this is caused by a relative increase in the hydrogen ion concentration of the blood. This can be caused
by diarrhea which results in loss of base, uncontrolled diabetes due to incomplete metabolism of glucose resulting in ketone
build up (diabetic keto-acidosis), certain diuretics causing urinary excretion of base, kidney failure, and hypoxemia which results in anaerobic metabolism and accumulation of acid metabolites (lactic acidosis).

The above represents the only relationship between diabetes and
pH. The body nomally is slightly alkaline so alkalinizing it
through medicinal means is only indicated if it becomes acidotic.
Generally at blood pH levels below 7.30, sometimes a bit lower
depending on the cause. And even then controlling the diabetes through diet, exercise and medication is preferred except under emergency conditions for which diabetics are hospitalized.

Alkalinizing the pH above its normal alkaline level, your implication, is a harebrained idea since overly alkalotic blood and tissues result in muscle fasiculations and tremors, seizures and cardiac tachyarryhthmias, some of which are fatal (ventricular tachycardia and ventricular fibrillation).e.h. Ph above 7.50.

The blood pH is controlled and balanced as described by the Henderson-Hasselbalch Equation which proves the effects of base (HCO3) and acidic (H) ions on the pH. This is a delicate balance based on sound homeostatic functioning. I seriously suggest you understand the elucidation of this math.

So Kumar, it would be a good idea if you go somewhere else with this and also understand what you are talking about or suggesting which you obviously do not; this is the only reason I was compelled to re-enter the loop. I will leave now.

 

[Zep]

Re: Re: Questions about Acid/base, Oxygen Imbalances

...[much snip]... I will leave now.

Not before we are thanking you!

Kumar, perhaps you might care to go and do some study on this subject, perhaps even some MEDICAL study. And keep your questions ready for when you are finished doing that.

 

[Kumar]

materia3,

Sorry, I think people don't understand the logic. You are not explaining differantly. It may be a natural body's mechnism in diabetes to enhance sugar metabolism in acidic atmosphere.

Any how, thanks & "Good Bye".

 

[Mojo]

Modern lifestyle & environment is said to be a cause of epidemic type spread of diabetes, hypertension etc. in modern times, which probably can be due to excess gastric acid secretion & lower oxygen intake(shallow breathing) due to polluted environment?

Actually, this is a classic sCAM approach. Whereas a real doctor will tell a mature onset diabetic: "you must lose weight. Eat less and get some exercise," the sCAM approach is to say: "It's not your fault, it's all that nasty pollution."

 

[Zep]

materia3,

Sorry, I think people don't understand the logic. You are not explaining differantly. It may be a natural body's mechnism in diabetes to enhance sugar metabolism in acidic atmosphere.

Any how, thanks & "Good Bye".

I think this is the fastest that Kumar has ever got to this stage - just the first page, and barely halfway down. Is he learning, perhaps?

Kumar, materia3 has explained this to you in terms that fit in precisely with two other separate sources that describe the Bohr Effect, one of which was your own original source. That's why he is "not explaining differantly". The facts are what they are, and your "it may be" ideas won't change them.

 

[materia3]

materia3,

Sorry, I think people don't understand the logic. You are not explaining differantly. It may be a natural body's mechnism in diabetes to enhance sugar metabolism in acidic atmosphere.

Any how, thanks & "Good Bye".

The enhanced unloading of oxygen by the hemoglobin to the tissues and cells, one last time, is a coping ora cellular survival mechanism.

Severely acidotic people in a state of shock are at imminent risk of cellular death due to cellular oxygen starvation. The Bohr effect is one of the body's defense mechanisms. It doesn't always work but it may buy some time.

Giving supplemental oxygen is SOP in such cases based on this as well.

Now, to your additional assertions.....


Patients, and I emphasize the word patients, in shock including shock from severe metabolic acidosis are rapidly depleted of their blood glucose and need sugar which is why elemental sugars such as intravenous glucose and dextrose are used to support such subjects until they recover. This is not something you can play with in the field except by trained medics in battlefield conditions perhaps. You can easily kill yourself or someone else with your empirical notions. Responding to the depletion of glucose and the body's need for it requires close attention to the frequent analysis of blood serum electrolytes, glucose levels and arterial blood gases. Again, if you are getting these notions because of some theory that they can somehow prevent diabetic crisis is just plain wrong. Diabetics cannot enhance sugar metabolism if they do not have insulin to do so;
managing this condition medically becomes that more complicated.

Diabetes is listed as a cause of death. It does kill. Juvenile or Type I diabetics have no choice in the matter. But it is beyond me why 250-300+ pound adults (and that includes obese 14 year olds whose parents should be charged with child abuse) who refuse to keep their weight down, through diet and the simplest of exercises, want to insure they will develop adult onset type II diabetes. This is a preventable cause of death in every sense.
It is particularly tragic since children of 14 who weigh over 300 pounds (yes, I have seen them) will have a greatly shortened lifespan. I have seen 8 year olds weighing 150 and 12 year olds at 200. I just have to shake my head...lazy fat kids blow my mind.
Their parents/caregivers should be doing something about them but most are oblivious to the problem and keep stuffing them with high calorie diets and drinks.

Environmental pollution has nothing to do with it unless you count all the high cal junk foods and beverages marketed to us as pollution. Yes. It is the obese type II diabetic or their parents (in the case of kids) who can blame themselves.


The reason for hypoglycemia or wide swings in blood glucose levels in diabetics is the the effect of the insulin or anti-diabetes agent they are taking. Most diabetics learn to associate how they feel when this happens and then require a carbohydrate based snack to remedy it. If they don't get it they can go into shock from sugar depletion (e.g. insulin shock, even coma). Excessive insulin can kill and has even been used to murder people. Does this mean if you are diabetic that you should not use insulin or anti-diabetes agents? No. It means they must be used as prescribed, carefully titrated against the patient's needs. Too much, too little or none at all in a diabetic are all the cause of problems to be dealt with.

get me out of this loop ....

 

[Goshawk]

It's okay, Materia, generally when Kumar posts a "mad" emoticon, it means he really is annoyed with us and won't be back for a while.

But you can swallow the blue pill and leave the Kumar Matrix anytime, if you like...

 

[materia3]

Thanks for the pill ....pretty big to swallow but I will try.

Kumar:

The following is one of the top sites from a Google page, of which there are over 10,000 on the inviolate, no ifs, ands or may be's about acid base balance in humans and other animals. As you may discern this is one of those rare instances where a mathematical certainty and truth operate within a living organism. There are, to be sure, pathologies which cause the results (pH) to change but the relationships remain the same. When theorizing about acid-base matters, always keep the certainty of the H-H equation in mind:

THE FOUR MOST IMPORTANT EQUATIONS IN CLINICAL PRACTICE

... 2. The Henderson-Hasselbalch Equation. Of the four equations in this paper, the
Henderson-Hasselbalch is the one with which physicians are most familiar. ...

www.mtsinai.org/pulmonary/papers/eq/eqhen.html

You also bring up some notions about oxygenation, another area governed by inviolate rules and mathematical certainty (no ifs, ands or buts) so I reccommend you study the following page also by Dr.Larry Martin:

http://www.mtsinai.org/pulmonary/ABG/PO2.htm

 

[Goshawk]

[shakes head sadly as Materia disappears down rabbit hole]

 

[Kumar]

Maeria3,

Thanks for providing several details. I shall try to undertand it. Anyhow, I asked about Bhor effect because it seems to be much related to diabetes complications in legs extremeties & other senstive parts. Some diabetes oral sentizers as "Metformin" can cause lactic acidosis. I can't say other oral medicines & insulin, if these are also linked to acid production in system(as mosts are sulphur containing). Does sulphur is related to acid production in body as some protiens are constituted with sulphur.

Furthur, we can/should see long terms/chronic/progressive effects of all spontaneous but relevant hammerings-continiously for long time.

Thanks.

"Happy New Year with best wishes for progressive & dynamic
thoughts & discussions in New Year to all. New Year Gift: "May be less troubling to most as per their desire, probably".

I shall/may be 'bit less visiting' for some time in future due to several personal & other considerations. Meantime, you may continue to discuss thoughts about 'acid, base, water & Oxygen' imbalances--related to all, most or sevearal disorders, bit dynamically & positively. You may mention all/other such effects as "Bhor effect" related to 'acid, base, water & Oxygen' imbalances because some very ancients studies (one being ayurvedic types constitutions) indicate smewhat like it.

 

[materia3]

Thanks for providing several details. I shall try to undertand it. Anyhow, I asked about Bhor effect because it seems to be much related to diabetes complications in legs extremeties & other senstive parts. Some diabetes oral sentizers as "Metformin" can cause lactic acidosis. I can't say other oral medicines & insulin, if these are also linked to acid production in system(as mosts are sulphur containing). Does sulphur is related to acid production in body as some protiens are constituted with sulphur.

Furthur, we can/should see long terms/chronic/progressive effects of all spontaneous but relevant hammerings-continiously for long time.

Metformin does not cause lactic acidosis as you state above. The product literature which I quote below says very clearly that patients on metaformin (glucophage) rarely may "develop" lactic acidosis. There is a huge difference in these subtle changes of wording so you need to consider very carefully how you read and interpret such material Kumar. I agree it is misleading, especially if English is not your first or native language.

Lactic acidosis occurs as a result of the body switching from aerobic or oxygen based metabolism to anaerobic metabolism. With respect to its ocurrence with glucophage (Metformin), you need to know that the studies that found this potentially fatal acidosis demonstrated it in about 3 out of every 100,000 people. Since it occurs in people with conditions that contribute to tissue hypoxia such as those with heart, liver and kidney problems and since many diabetics have heart and other problems, it isn’t surprising that it shows up on extremely rare occasion in glucophage users. This is like suicide showing up in small numbers in a group of people using anti-depressants. They were on anti-depressants in the first place because they were depressed so why should we be surprised if some of these folks relapse, perhaps stop taking the drug and then end up killing themselves? Don’t get me started on how lawyers are involved in this. I dont know where this will stop. If a drug company tests a 1000 people and one happens to die while they are on the drug does this mean the drug did it? The laweyers would like to say yes.


In short when a group of patients prone to certain conditions, e.g. lactic acidosis, take a drug for a related condition associated with condition lactic acidosis, it is not surprising that some members of that group develop the condition and it ends up as a warning, even a black-box warning, on the product literature. Is this a bad thing? No, not necessarily as it educates patients about what to lookout for and anyone taking metaformin may develop the problem. Lactic acidosis is treatable with bicarbonate infusion and oxygen. If the hypoxia is due to cardio-circulatory problems it may be more difficult to manage. If there is a bad thing attached to this it is scaring people off from good drugs that can help them with their primary problem. Such people who weigh the rare side effects (and lactic acidosis is not even a side effect in this case!) higher than the benefits then end up losing out as a result. Your brief annoucement that Metformin "can cause" lactic acidosis is an example of this behavior.

And even if it were a side effect which it isn't, 3 out of 100,000 in a group at risk of a particular side effect such as lactic acidosis anyway should not keep one from taking the drug if it will help them.

LACTIC ACIDOSIS. About 3 of every 100,000 people who take metformin will develop a medical emergency called "lactic acidosis". Lactic acid is a metabolic byproduct that can become toxic if it builds up faster than it is neutralized. Lactic acidosis is most likely to occur in people who with diabetes, kidney or liver disease, multiple medications, dehydration, or severe chronic stress.

Lactic acidosis can gradually build up. Symptoms to watch for include a need to breathe deeply and more rapidly, a slow, irregular pulse, a feeling of weakness, muscle pain, sleepiness, and a sense of feeling very sick. Treatment requires intravenous administration of sodium bicarbonate. Contact your doctor or go immediately to a hospital emergency room if you have these symptoms.

http://www.canadatrustrx.com/Glucophage-information-Glucophage-discount.htm

Lactic acidosis is more likely to occur in patients who: have heart failure, kidney or liver problems; are elderly; use alcohol excessively; are seriously dehydrated (lack body fluids); will undergo x-ray procedures that require an injectable contrast drug; will have surgery; develop a serious infection, heart attack or stroke; are over 80 years of age and have not had kidney and liver tests.

ref: FDA approved product literature

 

[Kumar]

Materia3,

Yes, it is rare to develop toxic/fatel condition. Another durg "phenformin" was banned due to this reason of possible development of Lactic acidosis. I give below some thoughts from your quotes:-

"LACTIC ACIDOSIS. About 3 of every 100,000 people who take metformin will develop a medical emergency called "lactic acidosis"."

It refers to "medical emergency" stage not to tollerable limits.

" Lactic acid is a metabolic byproduct that can become toxic if it builds up faster than it is neutralized"

It defines built up of LA regularily but got neutralized under normal circumstances.

"Lactic acidosis is most likely to occur in people who with diabetes, kidney or liver disease, multiple medications, dehydration, or severe chronic stress. "

It looks toxic levels of LA are accumulated on progression of disease/diabetes. In initial stage body is able to neutrlize it instantly which may be effected on progression/hammering.

"Lactic acidosis can gradually build up."

It shows it is a gradual process. On prodression, it may develop faster.

All these definitions indicate that this durg increases acid levels controlable in initial stages by body system. With this consideration, can we think about our topic consideration of 'Bhor effect' means, this durg causes increase of some acid in blood which may lead to better glucose metabolism due to "Bhor effect".

You have not considered my other points as indicated in the last posting.

 

[materia3]

Lactic acid is dealt with continuously as part of the body's buffering system. If you have any condition which impairs this it then gradually builds up and becomes problematic if not fatal.
Glucophage does not do this, the pre-existing diseases which cause problems with the buffering system does this. People who take glucophage may have these pre-existing conditions, thus they develop lactic acidosis -- it is a testament to the treatment this does not occur more opften than a few times in every 100,000 people. I think you missed this important distinction in trying to implicate glucophage as a cause. Again, it is not a cause but the problem occurs in people who take it. These people also may drink weak tea or eat strawberries. Can I say the tea or the strawberries is causing lactic acidosis? I think not.

The Bohr Effect which pesumably is the other issue is a coping or defense mechanism that operates in ANY kind of acidosis, whether it is due to diabetes, kidney failure, severe diarrheal disease such as cholera or dysentary, circulatory failure and shock and in hyperhermia. It supplies the cells with oxygen more readily as a defense mechanism which prevents cellular death. It is not in any way exclusively linked to diabetic acidosis.

As a result of the hemoglobin releasing more oxygen to the tissues, a vicious cycle sets in causing a desaturation or shortage of oxygen in the blood/hemoglobin. The O2 saturation of the blood therefore declines. A routine procedure would be for a patient to receive supplemental oxygen during this as a way of preventing blood desaturation and keeping up with the increased demands for oxygen by the cells during he crisis. Correction of the acidosis causing this problem is standard and almost always possible. It is done in the hospital with frequent blood tests as a guide. Yes, if you are not hospitalized and this continues untreated you will probably be found dead. This happens. I had a dear friend who was a christian scientist who died this way in spite of protests and arguments by myself and his friends and family to get non-faith based medical treatment.

On the subject of phenformin, guanidene was found to lower blood glucose levels in animals in 1918. However, it was found to be toxic preventing its use in routine medicine. Some guanidine derivatives, including synthalin A and B, were less toxic than guanidine were introduced without success. In the 1950s phenformin was found to have antidiabetic properties. Two other biguanides, metformin and buformin, were also introduced though not in the US market until 1995.

Yes, phenformin was believed to have the potential to cause lactic acidosis, the increase in blood lactic acid levels. In the US, the death rate among phenformin users was about 50 to 700 deaths per year. This led to complete suspension of phenformin marketing in the US in the late 1970s. However I have been unable to find out what% these deaths represent of total users (and probably never will) and still maintain that uncontrolled diabetics including those with other conditions prediposing to lactic acidosis may be involved.

It is believed that glucophage may cause very small increases in peripheral lactate but has a lacttic acid- associated mortality rate of only about 0 to 0.084 per 100 patient/year. This death rate is about an order of magnitude lower than phenformin. By using only in patients not susceptible to renal insufficiency and cardiovascular disorders, the incidence of lactic acidosis is eliminated. Patients with cardiovascular and hypoxic pulmonary disease die of lactic acidosis even if they are not diabetic and even if they are diabetic and not taking a biguanide. So this is wherein my arguments lies.

In the sole interest of keeping the lactic acid associated mortality rates down for biguanides, they should be used only in stable type II diabetics who are free of liver, kidney and cardiovascular problems and who cannot be controlled with diet. Failure to consider these caveats probably results in the small # of lactic acid related deaths seen in thse users.

 

[Rolfe]

Just a quick vote of thanks to Materia3. I have totally had it with Kumar, but I do appreciate seeing someone with the patience to post the truth in his mad, self-centered threads.

Rolfe.

 

[Kumar]

materia3,

Thanks for explaining in detail. But I have no intention to oppose metformin or any other durg. All drugs can benefit provided if prescribed correctly to correct person. But I want to just understand that;

Whether diabetic oral medicines(senstizers & hypoglycemic esp. sulphur based) & insulin create some acid in system or not (toxic & not toxic is a differant matter)? Whether sulphur has any role in creating acid in system or not?

It is very important to understand since LA, DKA, Uremic, metabolic & respiratory acidosis are linked to diabetes.

Rolfe, we are talking bit differantly. You can also contribute. I want to know some other effects as Bhor effects related to acid/base, fluid & Oxygen balances/imbalances.

 

[Zep]

Perhaps if you read the references you have been given already, Kumar, you might understand that you are getting this all backwards, failing badly to understand what has been given to you in abundence (i.e. quality information), and are looking and acting like a real idiot while you persist with this course.

Do you WANT to keep looking and acting like an idiot? Really? Are you actually as idiotic as you behave here?