**1.3 Application of CSA**

Our own experience of CSA application ranges from investigations into the behaviour of teachers, students, triathletes, aircraft pilots, bungee jumpers, military combat groups, special police units, rescue teams, sleep deprivation, free radical research, patient's stress in rehabilitation clinics to the impact of wellness treatments, even to the exhaustion of farmers providing holidays for tourists additionally to their usual tasks.

The following four applications that will be discussed in the course of the chapter form a concentrated substrate, presented to make the reader think about own, customized applications:


which, by CSA application, we were able to link up with the deterioration of other metabolic disturbances.

4. Qualification and quantifications as well as predictions of success chances in competing animals like horses or camels and also prevention of cruelty to animals by stress documentations are one our next step of development.

### **ad 1: Determination of the impact of sport training or training of so called "first responders", like military training units, special police groups, fire fighters and others**

Up to now the decision about a persons' fitness for a certain competition mainly rests upon the trainers' subjective adjudication, bolstered by lactate tests or even more demanding workout procedures and a more or less profound experience. Thus the availability of a hardly molesting, objective, in depth assessment of competitors and first responder personnel concerning their momentary ability to perform a certain task (3, 4, 5) comes in useful. Investigations in that area revealed not unexpectedly, that the metabolic situation of a person before a contest contributes decisively to the degree of the later success. Therefore it could be advantageous if we would be able to quantify the metabolic turnover before the contest in each case. Because, by quantifying pre contest metabolic situations, both the individual position within a group of contesters could be determined and eventually significant deviations of possible group outsiders could be marked down, understood and subsequently discussed with the person in question. That e.g. exhausted soldiers or sportsmen are no more able to perform satisfactorily is a truism. However, there are unsatisfactory performances which are less well explainable. The most common reasons are mostly privately known to the performer but not eagerly revealed to the trainer or group commander like lack of sleep due to entertainments during the previous evening.

But also unexpected bouts of good or bad performances occur, unexplainable to both performer and trainer. Moreover, the very same scores obtained easily by performer A could have been demanding for performer B, so that equal scoring may not mean equal potential at all. Even slight influences during the pre contest situation which are hardly felt and therefore frequently ignored, like temperature differences or even the changing of a routine can be reasons for a significant shift in interdependencies of electrolytes and metabolic parameters with measurable impact upon the performance to follow. Especially correlative changes between Mg, K, the Ca/Mg quotient or, to a lesser extent Ca alone with H+ donors like lactate and the consecutive pH and blood buffer situation react rather sensibly to changes of the sympathoadrenal situation in man and even in horses (3,4,5,6). Since in our experience the demand for such determination focuses upon comparatively small groups and their individual members, we tried to offset the comparatively small number of experiments by software immanent statistics from diverse points of view to keep results controlled as strictly as possible.

Since our assessment provides us with at least 24 interconnected data per person (from determinations before and after workload), a more comprehensive description than that by the widely used lactate test or by catecholamine assay alone is possible.

It is remarkable, that nearly the same small amount of capillary blood which is still routinely used for lactate tests could easily yield eleven times more information instead of the single lactate determination. As an example we would like to show an investigation of 14 Ensigns of the Theresianische Militärakademie in Wiener Neustadt, Austria before and after a demanding military obstacle race of 3 – 5 minutes duration. It turned out that the metabolic changes in the experiments due to that military obstacle race were considerable, although the overall duration did not exceed five minutes:

4. Qualification and quantifications as well as predictions of success chances in competing animals like horses or camels and also prevention of cruelty to animals by stress

**ad 1: Determination of the impact of sport training or training of so called "first responders", like military training units, special police groups, fire fighters and others**  Up to now the decision about a persons' fitness for a certain competition mainly rests upon the trainers' subjective adjudication, bolstered by lactate tests or even more demanding workout procedures and a more or less profound experience. Thus the availability of a hardly molesting, objective, in depth assessment of competitors and first responder personnel concerning their momentary ability to perform a certain task (3, 4, 5) comes in useful. Investigations in that area revealed not unexpectedly, that the metabolic situation of a person before a contest contributes decisively to the degree of the later success. Therefore it could be advantageous if we would be able to quantify the metabolic turnover before the contest in each case. Because, by quantifying pre contest metabolic situations, both the individual position within a group of contesters could be determined and eventually significant deviations of possible group outsiders could be marked down, understood and subsequently discussed with the person in question. That e.g. exhausted soldiers or sportsmen are no more able to perform satisfactorily is a truism. However, there are unsatisfactory performances which are less well explainable. The most common reasons are mostly privately known to the performer but not eagerly revealed to the trainer or group

commander like lack of sleep due to entertainments during the previous evening.

from diverse points of view to keep results controlled as strictly as possible.

the widely used lactate test or by catecholamine assay alone is possible.

the overall duration did not exceed five minutes:

But also unexpected bouts of good or bad performances occur, unexplainable to both performer and trainer. Moreover, the very same scores obtained easily by performer A could have been demanding for performer B, so that equal scoring may not mean equal potential at all. Even slight influences during the pre contest situation which are hardly felt and therefore frequently ignored, like temperature differences or even the changing of a routine can be reasons for a significant shift in interdependencies of electrolytes and metabolic parameters with measurable impact upon the performance to follow. Especially correlative changes between Mg, K, the Ca/Mg quotient or, to a lesser extent Ca alone with H+ donors like lactate and the consecutive pH and blood buffer situation react rather sensibly to changes of the sympathoadrenal situation in man and even in horses (3,4,5,6). Since in our experience the demand for such determination focuses upon comparatively small groups and their individual members, we tried to offset the comparatively small number of experiments by software immanent statistics

Since our assessment provides us with at least 24 interconnected data per person (from determinations before and after workload), a more comprehensive description than that by

It is remarkable, that nearly the same small amount of capillary blood which is still routinely used for lactate tests could easily yield eleven times more information instead of the single lactate determination. As an example we would like to show an investigation of 14 Ensigns of the Theresianische Militärakademie in Wiener Neustadt, Austria before and after a demanding military obstacle race of 3 – 5 minutes duration. It turned out that the metabolic changes in the experiments due to that military obstacle race were considerable, although

documentations are one our next step of development.

metabolic disturbances.

which, by CSA application, we were able to link up with the deterioration of other

Changes in group averages before and after the obstacle race (*military steeplechase, Hindernisbahn - HIB*) are shown in table 1: An expected significant change in stress dependent parameters like pH, pCO2, BE, HCO3 and K, due to severe exertions was visible. The averages of Mg and Ca however did not change significantly.


Average group values before and after sports +/- standard errors of means (SEM). Changes in pH, pCO2, BE, HCO3, pO2, O2sat., K, Ca, lactate and blood glucose are highly significant ( two sided t- tests (p<0,01), (7))

Table 1. CSA outprint, example of the change of group averages due to a military obstacle race (HIB).

Beyond the information which the average group values provide, we were able to uncover four different facts by correlating appropriate parameters of the pre- contest situation.


In other words, the answers to those four points provide the trainer with comprehensive information about the individual pre contest situation of each group member, whether the adrenergic arousal before contest remains within beneficiary boundaries or already uses up too much energy which would be more profitable employed later during the contest. They detect outsiders and even provide the trainer with scoring - chance predictions for the contest to follow. How is it done? First of all we have to become familiar with the usual state of affairs before a contest, the knowledge of which seems to be not usual at all. We call it "overcompensation". Different group members tend to express it in differing quantities.

### **a. Overcompensation**

Slight to moderate mental or physical load frequently results in metabolic overcompensation. Simplified, the well known respiratory compensation of metabolic acidity can become over efficient, so that persons with increased lactate or other H+ donors end up with a more alkaline pH brought about by a disproportionally increased breathing frequency, connected of course with an equally disproportional loss of CO2. The benefit of this seemingly wasteful behaviour is a kind of run up into higher pH regions to premeditate a later fall into dangerous acidity by an eventually more demanding workload in the immediate future which the organism seems to prudently forestall. Accumulation of O2 in the blood because of the more alkaline conditions points the same way. A good example of such a reaction is the pre contest situation before the military steeplechase concerning pH/pCO2 relationship. (fig. 4). This figure deals with and quantifies an "over successful" removal of acidity from the blood by increased breathing frequency.

Abscissa: pH Ordinate: pCO2 in mmHg P< 0,05, significant Situation before the military steeplechase contest.

Fig. 4. Situation before contest: Increased breathing frequency leads to diminishing pCO2 and consecutive pH increase.

The highest breathing frequency, borne out by the most pronounced loss of CO2 leads to the most alkaline pH. This means, that here the most pronounced metabolic activity, expressed by the highest breathing frequency, paradoxically yields the highest pH values (fig. 4) The picture is completely contrary to the familiar concomitant fall in pH and pCO2 during pronounced physical action (contest), which is shown in the next graph to underline the striking differences between the "warming up"(fig.4) and the real contest situation (fig.5): pH / pCO2 after workload

Abscissa: pH Ordinate: pCO2 in mmHg P< 0,01, highly significant Situation after the military steeplechase contest.

Fig. 5. During the demanding military exercise pH/pCO2 relation turns around, CO2 release is now unable to prohibit the fall in pH (note the extremely low pH and pCO2 values due to the heavy workload).

pH/pCO2 HIB before contest

7,38 7,39 7,4 7,41 7,42 7,43 7,44 7,45 7,46 7,47 7,48

Fig. 4. Situation before contest: Increased breathing frequency leads to diminishing pCO2

The highest breathing frequency, borne out by the most pronounced loss of CO2 leads to the most alkaline pH. This means, that here the most pronounced metabolic activity, expressed by the highest breathing frequency, paradoxically yields the highest pH values (fig. 4) The picture is completely contrary to the familiar concomitant fall in pH and pCO2 during pronounced physical action (contest), which is shown in the next graph to underline the striking differences between the "warming up"(fig.4) and the real contest situation (fig.5):

> pH/pCO2 after competition

7,1 7,15 7,2 7,25 7,3 7,35 7,4

Fig. 5. During the demanding military exercise pH/pCO2 relation turns around, CO2 release is now unable to prohibit the fall in pH (note the extremely low pH and pCO2 values

R2 = 0,2832

Situation before the military steeplechase contest.

Situation after the military steeplechase contest.

Abscissa: pH

Abscissa: pH

Ordinate: pCO2 in mmHg P< 0,01, highly significant

due to the heavy workload).

Ordinate: pCO2 in mmHg P< 0,05, significant

and consecutive pH increase.

pH / pCO2 after workload

Overcompensation R2 = 0,2537

The adrenaline induced slight, individually different lactate increase in the pre contest situation should lead to a concomitant decrease in pH. But since at the same time H ions are indirectly got rid of by increased breathing, proportional pH decrease along with lactate increase is counteracted. Consequently, in the pre contest situation, pH and lactate do not correlate positively any more – as they do during the contest – due to the increased loss of CO2 during the said overcompensation, as shown in fig.6.

Abscissa: pH Ordinate: lactate in mM/l p>0,05, not significant Situation before the military steeplechase contest.

Fig. 6. Due to successful CO2 control of pH before contest, pH/lactate relationship vanishes.

Consequently again, all our following correlative graphs of pre contest situations dealing at least with either pCO2 or pH have to be interpreted as situations, when the highest pH and the lowest pCO2 occur in the person with the most clearly increased metabolism. Having ourselves used those automatic correlative evaluations regularly, we came across overcompensation surprisingly frequently, mostly in pre contest situations or other moments of sympathoadrenal arousal. Therefore we would like to forward the supposition that overcompensation is a general feat of adaptation to probable demands in the future and thereby possibly an important part of evolutionary survival strategy.

### **b. Quantification of pre- contest conditions and characterization of outliers**

Following up our suppositions of a possible impact of the pre- contest situation upon the contest proper, we checked as a first step the K/pH proportions of the experimentees, because a possible sympatho – adrenal arousal in expectation of the contest may well lead to an individual increase of lactate values (the average increase being only a slight one, see tab.1), consequently to increased H ions, which would be exchanged with K ions from the tissue in a rate presumably proportional to the H ion production and therefore proportional to catecholamine impact. Indeed, a highly significant, but negative correlation between pH and Ionized K ensues, positioning the most pronounced K loss along with the highest metabolic turnover, characterized in this overcompensating situation by the highest pH and lowest K values. A combination of electrolyte- and metabolic parameters therefore are seemingly able to characterize typical group idiosyncrasies (overcompensation in this case) as well as the individual position of the participants within the group (fig.7):

Abscissa: pH Ordinate: K in mM/l, p<0,001, highly significant Correlation between pH and potassium before sports.

Fig. 7. Sympathoadrenal arousal before contest incites overcompensation, also shown by significant inverse pH/K relationship.

In such an adrenergic state of expectation, a further correlation can be expected, namely a proportional behaviour of pH and ionized magnesium, because adrenaline increase changes of pH via the mechanism mentioned above and can also increase ionized Mg in blood (8,9).

However, no significant correlation could be found. This could have been due to two outliers which are marked by an oval inclusion in the graph below (fig.8):

Abscissa: pH Ordinate: Mg in mM/l,

p>0,05, not significant

points within the elliptic figure: presumptive outliers

Fig. 8. Positive pH/Mg correlation is disturbed by two outliers.

When the outliers are removed, a highly significant positive correlation between ionized Mg and pH in the blood of the pre-contest experimentees evolved (fig.9):

**obstacle run pH/K basal situation**

7,38 7,4 7,42 7,44 7,46 7,48 **pH**

Fig. 7. Sympathoadrenal arousal before contest incites overcompensation, also shown by

In such an adrenergic state of expectation, a further correlation can be expected, namely a proportional behaviour of pH and ionized magnesium, because adrenaline increase changes of pH via the mechanism mentioned above and can also increase ionized Mg in

However, no significant correlation could be found. This could have been due to two

**obstacle run pH/Mg basal situation**

7,38 7,4 7,42 7,44 7,46 7,48 **pH**

When the outliers are removed, a highly significant positive correlation between ionized Mg

outliers which are marked by an oval inclusion in the graph below (fig.8):

3,5

Correlation between pH and potassium before sports.

significant inverse pH/K relationship.

0,46 0,48 0,5 0,52 0,54 0,56 0,58

points within the elliptic figure: presumptive outliers

Fig. 8. Positive pH/Mg correlation is disturbed by two outliers.

and pH in the blood of the pre-contest experimentees evolved (fig.9):

4

4,5

**K (mmol/l)**

Abscissa: pH Ordinate: K in mM/l, p<0,001, highly significant

blood (8,9).

Abscissa: pH

Ordinate: Mg in mM/l, p>0,05, not significant

Mg (mM/l)

5

R2 = 0,5369 r = 0,7327 p < 0,0001

> R2 = 0,0017 r : 0,04123 p = not sign.

Abscissa: pH Ordinate: Mg in mM/l, p<0,001

Correlation between pH and magnesium before sports without outliers.

Fig. 9. Removal of the outliers leads to restored pH/Mg correlation.

Similar as in fig.8, the highest Mg turnover (here Mg increase) goes along with the most pronounced metabolic turnover, again characterized by pH increase, due to overcompensation, provided the outliers have been removed. However, to characterize and/or remove the outliers out of purely statistical reasons is not correct, although it seems obvious, that they are not part of the sample. They both show high Mg values at concomitantly low pH which does not fit the group behaviour at all. On the contrary, this combination of parameters points towards an already most active metabolism before sports, which may not be able any more to meet the subsequently further increased energy turnover, necessary for high scoring. It follows, that they do not develop any sign of overcompensation, as does the rest of the group, since their high Mg values exist concomitantly with low pH, a feat that does nowhere occur in the rest of the overcompensating group. The pre – contest diagnosis of a prematurely increased metabolism of the outliers is consistent with some of the outliers' values *after* sports, forming a different multi parameter pattern:


According to this additional information, we felt justified to separate those two participants from the other members of the group, which – without those two - forms the mentioned well definable, highly significant pH/Mg relationship (fig.3). At least for practical reasons the information of their outlying position - which is only shown by the correlation analysis and would never have come forth by group average calculations alone - should on no account be discarded and at least used for closer observation and extended interviews with the two experimentees.

### **c. Prediction of success chances by quantitative evaluation of pre- contest conditions**

Investigations into interdependencies between basal K and awarded scores (fig.10).For the first time we introduce non CSA values in our correlative interpretations – the awarded scores for the obstacle run, which are nearly identical with ranking of the period of time needed for its absolvation.

Abscissa: Basal K in mM/l Ordinate: awarded scores p<0,001

Fig. 10. Blood K levels before contest possibly predict chances of scoring at the contest proper.

Pre contest K concentrations and the scores awarded after steeplechase correlated negatively in a highly significant manner, meaning that persons with lowest pre- contest K values cherish the best chances for high scoring in the subsequent contest. Lowest K concentrations on the other hand coincide with highest pH levels in the overcompensating group (fig.1), which – under those circumstances – mark high metabolic activity. Within reason therefore, those who have been most successfully mentally "warming up" themselves, stand to be rewarded with better scoring chances. It is important, not to be led astray by the high scoring of contestants with an alkaline starting position, Slightly alkaline pH in this context is definitely not a sign of low metabolic turnover, but, as we have already been able to demonstrate, a feat of increased energy turnover by sympathoadrenal arousal, what we just called "mental warming up". Summing up the information of the graphs hitherto presented, the pre contest metabolic pattern of a presumable high scorer seems to be:


This multi parameter pattern shows, that increased metabolism characterized by the most pronounced loss of CO2, increases Mg clearance from the tissue and also increase blood pH. Since pre- contest pH is already increased by excessive CO2 loss, there is no urgent need for cation exchange, which is underlined by the low blood K values. Roughly spoken, K seemingly is allowed to stay put within the tissue, regardless of increased metabolism. Such a tissue reserve of readily exchangeable K ions however, could facilitate a more successful H ion removal into tissues later, during the demanding contest expected. That lactate values did not enter our multi parameter pattern more prominently can be explained by the failing

scores for the obstacle run, which are nearly identical with ranking of the period of time

**obstacle run K/scores**

3,7 3,9 4,1 4,3 4,5 4,7 4,9 **K (mmol/l)**

Fig. 10. Blood K levels before contest possibly predict chances of scoring at the contest

Pre contest K concentrations and the scores awarded after steeplechase correlated negatively in a highly significant manner, meaning that persons with lowest pre- contest K values cherish the best chances for high scoring in the subsequent contest. Lowest K concentrations on the other hand coincide with highest pH levels in the overcompensating group (fig.1), which – under those circumstances – mark high metabolic activity. Within reason therefore, those who have been most successfully mentally "warming up" themselves, stand to be rewarded with better scoring chances. It is important, not to be led astray by the high scoring of contestants with an alkaline starting position, Slightly alkaline pH in this context is definitely not a sign of low metabolic turnover, but, as we have already been able to demonstrate, a feat of increased energy turnover by sympathoadrenal arousal, what we just called "mental warming up". Summing up the information of the graphs hitherto presented, the pre contest metabolic pattern of a

This multi parameter pattern shows, that increased metabolism characterized by the most pronounced loss of CO2, increases Mg clearance from the tissue and also increase blood pH. Since pre- contest pH is already increased by excessive CO2 loss, there is no urgent need for cation exchange, which is underlined by the low blood K values. Roughly spoken, K seemingly is allowed to stay put within the tissue, regardless of increased metabolism. Such a tissue reserve of readily exchangeable K ions however, could facilitate a more successful H ion removal into tissues later, during the demanding contest expected. That lactate values did not enter our multi parameter pattern more prominently can be explained by the failing

R2 = 0,5074 r = 0,7123 p < 0,0001

needed for its absolvation.

**scores**

Abscissa: Basal K in mM/l Ordinate: awarded scores

p<0,001

proper.

presumable high scorer seems to be:

1. Low potassium (fig. 7 ) 2. High pH (fig 1)) 3. High Mg (fig. 9) 4. Low pCO2 (fig. 4 )

correlation between lactate and pH. Increased breathing frequency obviously buffers direct lactate impact. Also – during the predominantly mental stress before contest – a participation of free fatty acids from catecholamine induced beta oxidation is to be expected and can indeed be roughly calculated by subtracting lactate values from baseexcess (both in mM/l)

### **d. Characterization of success/effort relationships**

The role of certain electrolytes in blood, changed by the psychic arousal of the pre- contest situation could be shown already by correlating them with metabolic parameters like pH or pCO2. But they play a further role – again together with metabolic parameters - as indicators of competition success, part of which we have already exemplarily shown by the predictive power of K changes before competition. During our investigations of blood samples before and after the military obstacle run (HIB), however, we found connections of lactate and Mg changes with running times and scoring which contributed substantially to a better understanding of a contestants' attitude to the task. This may come in useful for basic research about the role of Mg in energy turnover but also has practical importance in such cases when one wants to check effort and performance of tasks where other means of objectivation cannot be applied or one is simply not present.

Therefore let us have a look into the Mg/lactate relationship, which we purport to be especially apt to reveal the individual attitude towards the contest: Although individual Mg+ changes were rather pronounced, no corresponding *average* Mg+ increase or decrease was visible because Mg+ changes often pointed in opposite directions. This individual behaviour of the Mg+ changes however correlates highly significantly with lactate changes. Fig.11 shows, that sometimes more information can be gained by using the – also automatically compilated – delta values, the changes between the values before and after workload and not the measured values themselves. Thus clear proportionalities between effort and electrolyte turnover could be shown.

Abscissa: Mg+ changes (delta values: Mg+ before exercise minus Mg+ after exercise) Ordinate: Lactate changes (delta values: lactate before exercise minus lactate after exercise) P< 0,001, highly significant

Fig. 11. Documentation of delta values sometimes are better able to reveal parameter interactions than absolute concentrations.

Higher lactate increases beyond 11 mM/l correspond with Mg+ increase, lactate changes below that value corresponds with Mg+ decrease in blood. That lactate changes do not correlate with both awarded scores and running time is not surprising, since it is common knowledge that subjects with better fitness may score higher with less lactate increase than less well trained subjects with higher lactate increase (3). But unexpectedly, Mg+ changes (automatically computed delta values) did correlate with awarded scores and running times as well, highly significantly in a polynomial curve of the 2nd order. Fig. 12 shows, that Mg changes not only correlate with lactate changes (effort) but also with awarded scores, but now in a different, polynomial manner.

Abscissa: Mg+ changes (delta values) Ordinate: scores awarded P< 0,001, highly significant

Fig. 12. Mg delta values this time plotted against scores, once more prove their usefulness.

Since changes in blood Mg+ are to be considered as subtractions of Mg+ influx from tissue and Mg+ redistribution (10) by clearance from the blood, people with the best balanced Mg+ in- and efflux show nearly zero deviation. And it is exactly this group that has been shown to have the best chances for highest scores and shortest running times. Moreover, the supposed unpredictability of positive or negative Mg+ changes, at least during short term exercise with high energy turnover, may be qualified by the existence of this polynomial correlation between both scores and running times and the Mg+ changes in question.

Distinctly increased Mg+ blood concentrations therefore, went along with the high lactate increases beyond 11 mM/l, mostly in participants with low scores. Contrarily, low scores and long running times went together with pronounced decreases in Mg+ along with comparatively low lactate increases otherwise seen in high scorers, but then with hardly any Mg+ changes.

Thus, a typical combination of lactate and the obviously quicker Mg changes is characteristic not only for a certain score, but also provides more information about the reason for low scoring, when one combines the information of fig.4 and fig.5: High Mg+ increase is mostly associated with pronounced lactate increase and pronounced Mg+ decrease with a relatively small lactate increase for this demanding kind of exercise. All the high lactate increases therefore are on the side of Mg+ increase and vice versa. Moderate lactate increase, along with moderate Mg+ change seem to characterize the reaction of a well trained subject.

Higher lactate increases beyond 11 mM/l correspond with Mg+ increase, lactate changes below that value corresponds with Mg+ decrease in blood. That lactate changes do not correlate with both awarded scores and running time is not surprising, since it is common knowledge that subjects with better fitness may score higher with less lactate increase than less well trained subjects with higher lactate increase (3). But unexpectedly, Mg+ changes (automatically computed delta values) did correlate with awarded scores and running times as well, highly significantly in a polynomial curve of the 2nd order. Fig. 12 shows, that Mg changes not only correlate with lactate changes (effort) but also with awarded scores, but

**Mg+ changes vers. awarded scores in military steeplechase**


Fig. 12. Mg delta values this time plotted against scores, once more prove their usefulness. Since changes in blood Mg+ are to be considered as subtractions of Mg+ influx from tissue and Mg+ redistribution (10) by clearance from the blood, people with the best balanced Mg+ in- and efflux show nearly zero deviation. And it is exactly this group that has been shown to have the best chances for highest scores and shortest running times. Moreover, the supposed unpredictability of positive or negative Mg+ changes, at least during short term exercise with high energy turnover, may be qualified by the existence of this polynomial correlation between both scores and running times and the Mg+ changes in question. Distinctly increased Mg+ blood concentrations therefore, went along with the high lactate increases beyond 11 mM/l, mostly in participants with low scores. Contrarily, low scores and long running times went together with pronounced decreases in Mg+ along with comparatively low lactate increases otherwise seen in high scorers, but then with hardly any

Thus, a typical combination of lactate and the obviously quicker Mg changes is characteristic not only for a certain score, but also provides more information about the reason for low scoring, when one combines the information of fig.4 and fig.5: High Mg+ increase is mostly associated with pronounced lactate increase and pronounced Mg+ decrease with a relatively small lactate increase for this demanding kind of exercise. All the high lactate increases therefore are on the side of Mg+ increase and vice versa. Moderate lactate increase, along with moderate Mg+ change seem to characterize the reaction of a well trained subject.

R2 = 0,4092

now in a different, polynomial manner.

**awarded scores**

Abscissa: Mg+ changes (delta values)

Ordinate: scores awarded P< 0,001, highly significant

Mg+ changes.

One is tempted to deduce, that in our short and demanding exercise the mark of an average delta value of 11mM/l of lactate may be the turning point between a preponderance of Mg+ clearance from the blood during the first stages of the exercise and a consecutively increased Mg+ influx into the blood, overcoming the clearance rate, because of considerably increased demand upon muscular tissue.

This turning point should be demonstrable by a polynomial curve, which indeed it has been. It furthermore may even serve as a kind of standardization mark, beyond which additional lactate increase (effort) does correspond less and less with effectiveness. A possible practical application of the combined information of fig.4 and fig.5 could be i.a. an objectivation of subjective adjudications of any persons' effort and success. Hitherto, mostly increases of Mg+ blood concentrations during short term exercise have been advocated, while Mg+ decrease has been mainly associated with longer lasting workloads (11, 12, 13) Biphasic Mg+ changes, at least during short term exercises have not been described up to now. As mentioned above, the results of such an investigation allow basic considerations about new aspects of the role of electrolytes as well as pave the way towards some practical progress in adjudication of success and effort relationship.

### **ad.2: Metabolic changes due to mental stress in depressive patients**

Having been able to show that the predominantly psychically induced change in metabolic parameters before a contest can be measured and thus quantification of psychical arousal by metabolic determinations can be attempted at least proportionally, we would like to show an application of this idea at psychiatric in - patients. Our clinical study included 19 patients (17 females and 2 males) with a mean age of 44 years (range from 24 to 65, with a median of 44). All of them were suffering from major depressive disorders (Hamilton depression scale from 18 to 33). We compared them with a group of .46 subjects (35 males and 11 females, nearly equally aged) Before and after a slight ergometric effort (60 watts for 6 minutes) capillary blood samples were drawn as described above and the resulting group averages

Abscissa: determination situations (see text) Ordinate: pH

Fig. 13.

for pH, pCO2, Basexcess and Magnesium are shown in the next four automatically generated graphs. The first two columns of each graph show the group averages before (col.1) and after workload (col.2) of the psychiatric patients, columns 3 and 4 show the group averages of the equally treated healthy group

Fig. 13: Figs. 13, 14, 15 and 16 deal with the average changes of pH (fig.13), pCO2 (fig.14), base excess (fig.15) and magnesium (fig.16) of psychiatric in – patients (blue and red column) and a matched control group from our data banks (yellow and green columns). Remark the much more sensible reaction of the patients to workload.

Abscissa: determination situations (see text) Ordinate: pCO2 in mmHg

Fig. 14.

Abscissa: determination situations (see text) Ordinate: Baseexcess in mM/l

Fig. 15.

Abscissa: determination situations (see text) Ordinate*:* Ionized Mg in mM

Fig. 16.

502 Biomedical Science, Engineering and Technology

for pH, pCO2, Basexcess and Magnesium are shown in the next four automatically generated graphs. The first two columns of each graph show the group averages before (col.1) and after workload (col.2) of the psychiatric patients, columns 3 and 4 show the

Fig. 13: Figs. 13, 14, 15 and 16 deal with the average changes of pH (fig.13), pCO2 (fig.14), base excess (fig.15) and magnesium (fig.16) of psychiatric in – patients (blue and red column) and a matched control group from our data banks (yellow and green columns).

**pCO2 Averages**

1-Pre 1-Post 2-Pre 2-Post

1-Pre 1-Post 2-Pre 2-Post

pCO2

**Base Excess Averages**

BE

group averages of the equally treated healthy group

27,000 28,000 29,000 30,000 31,000 32,000 33,000 34,000 35,000 36,000 37,000


**BE (mmol/L)**

Abscissa: determination situations (see text)

Ordinate: Baseexcess in mM/l

Fig. 15.

**pCO2 (mmHg)**

Abscissa: determination situations (see text)

Ordinate: pCO2 in mmHg

Fig. 14.

Remark the much more sensible reaction of the patients to workload.

With the exception of the baseexcess there were no significant differences in the basal situation between the depressive and the healthy group. Since the significantly lower buffer capacity, shown by the baseexcess values of the depressive group (fig. 15, col.1 and col. 3) cannot be due to acutely increased breathing, (fig. 14, col.1 and col.3) it has to be acknowledged as a chronic buffer diminishment of longer standing, developed in the course of the illness. This is underlined by the significantly and clearly more intensive reaction to the slight workload by the depressive patients. Their pCO2, their pH and their baseexcess react disproportionately sensitive to the moderate workload. Such an expected accumulation of over sensitive reactions to daily demands may well have been the reason for a chronic decrease of their total buffer capacity in the course of the illness. Accordingly, our investigations into the differences of metabolic reaction between depressive and healthy people yield – just by glancing at the automatically generated graphs and average statistics two general results:


### **ad 3: Idiosyncrasies of the diabetic metabolism, especially those due to the newly found importance of mineral deficiencies in type2 diabetics uncovered by CSA diagnosis**

The blood glucose status of diabetic in - patients is routinely checked by a daily glucose profile, which consists of glucose determination from capillary blood at three different times. With nearly the same small amount of blood and the same effort we could determine not only glucose but also 11 additional parameters. The results of those investigations have been published in some full papers and several congress abstracts. We could show i.a. that not only type1 diabetics but also about 36% of the nearly tenfold higher number of type2 diabetics suffer from severe loss of electrolytes, especially from hypomagnesemia. However, the magnesium state of type 2 diabetics has not been considered to be crucially important for the patients' wellbeing up to now, since only easily treatable cramps were thought to ensue from magnesium deficiency. But by correlatively combining of some of our simultaneously determined parameters, we could show, that diabetic hypomagnesemia seems to be responsible not only for the said cramps, but for a whole series of negative influences upon the already strained diabetic metabolism:

Let us direct, e.g. our attention to some differences in metabolic behaviour in patients with Mg levels below and above the hypomagnesemic threshold of 0,45mM/l ionized Mg in blood (hypomagnesemic threshold according to the Austrian Consensus Conference as well as the Deutsche Gesellschaft für Ernährung – German Society for Nutrition) and exemplarily look at some facts accompanying those differences: As already mentioned above, severe deficits in ionized blood magnesium became increasingly conspicuous during investigations into interactions of blood glucose, buffers and electrolytes during daily glucose profiles of type2 diabetic patients, since we had the opportunity of magnesium determination with ion sensitive electrodes (NOVA CCX, CSA). This fraction, according to our knowledge, has not been compared yet with blood glucose metabolism in type2 diabetic patients to any larger extent.

Similarly, investigations about the behaviour of ionized calcium in type2 diabetics seem at least to be rare. Its average values in our patients are, like those of magnesium, very low. Also remarkably low were the base excesses of the patients, though lactate concentrations in blood did not exceed normal elevations found on moderately busy days.

Abscissa. Ionized Ca in mM/l Ordinate: ionized Mg in mM/l

Fig. 17. Remarkable change of relationship of Mg and Ca in the blood of diabetics nearly exactly at the point of the hypomagnesiemic threshold.

Magnesium and calcium averages give the impression to be inversely proportional to the concomitant blood glucose values, a feat that has been already mentioned by others together with magnesium and blood glucose or insulin sensitivity (17). But when we put together all

not only type1 diabetics but also about 36% of the nearly tenfold higher number of type2 diabetics suffer from severe loss of electrolytes, especially from hypomagnesemia. However, the magnesium state of type 2 diabetics has not been considered to be crucially important for the patients' wellbeing up to now, since only easily treatable cramps were thought to ensue from magnesium deficiency. But by correlatively combining of some of our simultaneously determined parameters, we could show, that diabetic hypomagnesemia seems to be responsible not only for the said cramps, but for a whole series of negative

Let us direct, e.g. our attention to some differences in metabolic behaviour in patients with Mg levels below and above the hypomagnesemic threshold of 0,45mM/l ionized Mg in blood (hypomagnesemic threshold according to the Austrian Consensus Conference as well as the Deutsche Gesellschaft für Ernährung – German Society for Nutrition) and exemplarily look at some facts accompanying those differences: As already mentioned above, severe deficits in ionized blood magnesium became increasingly conspicuous during investigations into interactions of blood glucose, buffers and electrolytes during daily glucose profiles of type2 diabetic patients, since we had the opportunity of magnesium determination with ion sensitive electrodes (NOVA CCX, CSA). This fraction, according to our knowledge, has not been compared yet with blood glucose metabolism in type2 diabetic patients to any larger extent. Similarly, investigations about the behaviour of ionized calcium in type2 diabetics seem at least to be rare. Its average values in our patients are, like those of magnesium, very low. Also remarkably low were the base excesses of the patients, though lactate concentrations in

**Mg/Ca overall**

0,3 0,35 0,4 0,45 0,5 0,55 0,6 Mg ion in mM/l

Fig. 17. Remarkable change of relationship of Mg and Ca in the blood of diabetics nearly

Mg ion in mM/l

Magnesium and calcium averages give the impression to be inversely proportional to the concomitant blood glucose values, a feat that has been already mentioned by others together with magnesium and blood glucose or insulin sensitivity (17). But when we put together all

influences upon the already strained diabetic metabolism:

blood did not exceed normal elevations found on moderately busy days.

0,95 1 1,05 1,1 1,15 1,2 1,25

exactly at the point of the hypomagnesiemic threshold.

Ca ion in mM

n in mM/l

Ca io

Abscissa. Ionized Ca in mM/l Ordinate: ionized Mg in mM/l single values of all our patients, regardless of sampling times, there was no significant inverse correlation between ionized magnesium and blood glucose. Still, the pattern of the individual points in the Ca/Mg graph was exceptional (fig.6). Exactly at the Mg value of 0,45 mM/l (the agreed hypomagnesemic threshold) the Ca/Mg relationship seemed to switch directions. Fig.17 shows the turnaround of the relationship of ionized Ca with ionized Mg. Obviously, only from the hypomagnesemic threshold (0,45mM/l) upwards a significant, positive correlation has developed.

Even without indrawn regression lines one can observe, that the Ca/Mg ratio takes an opposite course nearly exactly above and below the hypomagnesemic threshold of 0,45 mM/l. We acknowledged this ambivalent behaviour by splitting the sample along this threshold of 0,45 mM/l into a high- and a low Mg subgroup. Consequently, we found a highly significant positive correlation between Mg and Ca in the higher Mg subgroup but no correlation at all in the lower subgroup. This finding encouraged us to look for more correlations, not within the overall sample but again within the subgroups above and below the hypomagnesemic threshold, trying to find at least some hints for the reason of the very low Mg values in our diabetics, where 36 % had Mg concentrations of 0,45mM/l and lower, since the mechanism of low magnesium values in NIDDMs seems to be unclear, Some authors (18,19) discuss a recurrent metabolic acidosis, along with episodes of osmotic diuresis as possibilities among others for magnesium diminishment in the diabetic patients, while stating that this diabetic hypomagnesemia seems to merit poor attention by physicians anyway. Shaffie et al (20) observed a lowering of bicarbonate along with low tissue pCO2 and hyperventilation.

Indeed, pCO2 values in our patient sample are low. Additionally, correlations between pH and pCO2 overall and in the subgroups showed a significantly inverse behaviour, most clearly expressed in the low Mg subgroup, with a slope more than double as steep (y=59x) as in the higher Mg subgroup (y=23,6x) , pointing to an increasing need for respiratory compensation along with diminishing Mg concentrations. Thus, pH seems to be kept at an average of 7, 43 by constant loss of CO2, obviously slightly overcompensating a steady input of anions.

Abscissa. pH Ordinate: pCO2 in mmHg P<0,001 highly significant

Fig. 18. Increasingly lower pCO2 creates more and more alkaline pH in hypertonic diabetics.

Abscissa. pH Ordinate: pCO2 in mmHg P>0,05 not significant

Fig. 19. Normotonic diabetics do not show any relationship between pH and pCO2 (see fig. 18) at all.

Abscissa. Glucose in mg/dl Ordinate: ionized Mg in mM/l P<0,001 highly significant

Fig. 20. Above the hypomagnesiemic threshold blood glucose increases along with lower Mg levels – a good argument for substitution.

Such chronic processes accompanied by a moderately increased breathing frequency may slowly but successfully waste the magnesium (and calcium) resources of the patient. The interesting observation, that patients with Mg concentrations below 0,45mM/l do not

**pH/pCO2** 

7,36 7,38 7,40 7,42 7,44 7,46 7,48 7,50

**Bloodglucose / Mg> 0,45** 

0 50 100 150 200 250 300 350 400 Glucose in mg/dl

Fig. 20. Above the hypomagnesiemic threshold blood glucose increases along with lower

Such chronic processes accompanied by a moderately increased breathing frequency may slowly but successfully waste the magnesium (and calcium) resources of the patient. The interesting observation, that patients with Mg concentrations below 0,45mM/l do not

**overall** R2 = 0,0931

r = 0,305 p<0,001

Fig. 19. Normotonic diabetics do not show any relationship between pH and pCO2

0,44 0,46 0,48 0,5 0,52 0,54 0,56

Mg ion in mM/l

Mg levels – a good argument for substitution.

25,00 26,00 27,00 28,00 29,00 30,00 31,00 32,00 33,00 34,00

Abscissa. pH

Ordinate: pCO2 in mmHg P>0,05 not significant

Abscissa. Glucose in mg/dl Ordinate: ionized Mg in mM/l P<0,001 highly significant

(see fig. 18) at all.

**normotonic diabetics type2** R2

 = 0,0529 not significant seem to show correlations with blood glucose any more, may indeed point towards a certain exhaustion, for which low Mg concentrations are usually characteristic. But low Mg in those patients may be not only a marker of increasing metabolic exhaustion, but could actively contribute to wasteful anaerobic glycolysis by limiting ATP – ADP turnover. At least in non diabetic patients, we could show that low magnesium concentrations before extensive liver surgery deteriorate the prognosis about the final outcome significantly (21). The most important result concerning type2 diabetics is unquestionably the highly significant negative correlation between Mg levels and blood glucose above the hypomagnesemic threshold.

It means that diabetic patients with lower Mg levels are prone to higher blood glucose values.

Abscissa. Glucose in mg/dl Ordinate: ionized Mg in mM/l P 0,05 not significant

Fig. 21. Below the hypomagnesiemic threshold the calculable Blood glucose/ Mg relationship vanishes, but the number of patients with high glucose values is remarkable.

Therefore we think that Mg determination, especially, that of the more active ionized fraction, should be included into the monitoring at least of hospitalized diabetic patients. When interpreted together with blood glucose levels and other CSA parameters, it reveals a much deeper insight into the metabolic state of the patient. In our opinion, increased knowledge of physicians about the impact of Mg deficiency upon the diabetic (and also non–diabetic) metabolism would increase the demand for magnesium determination and also for magnesium medication.

Consequently, we can see, that without increased effort, just by substituting a more up to date measuring device coupled with appropriate software, the daily glucose profile, a routine diagnostic method of very long standing, could be changed into a much more sensitive investigative tool, capable of quickly unearthing new knowledge about metabolic dynamics for the benefit of the patients.

### **ad 4: CSA application in animals (outlook)**

About 15 years ago we investigated the catecholamine state of immobilized rats and of pigs in abattoirs. Immobilisation of animals led to dramatic increase in catecholamines and to vastly diminished stress compatibility (22, 23) Catecholamine levels of pigs before slaughtering in abattoirs have been found to be an incredible hundred thousand fold higher than normal.

Both, immobilisation and the pre- slaughtering situation are widely common in the treatment of pigs, since mother sows are often kept practically immobilized in very small cages. Objectivation of the effects of the demonstrated catecholamine increase upon the metabolic parameters provided by simple and scarcely molesting CSA testing could reveal at least electrolyte changes in blood, most probably vastly increased electrolyte input into muscle tissue. Low quality, watery meat could well be the outcome. In immobilized mother sows the metabolic effects of catecholamine elevation may also have a whole bunch of negative effects, easily imaginable (24). At the very least CSA metabolic investigation may provide prove, that cruelty to animals does not pay, in fact actually decreases profits of husbandry.

Concerning the application of CSA tests in the training of e.g. racing animals like horses, dogs or camels, it seems easy to adapt our methods and results from our investigations in humans.

It is obviously an asset for both animals and trainers to be able to adjudge the pre contest condition, thereby the contest chances and the metabolic changes during a given contest of a specific animal. The familiarity of a good trainer with animals in his care, by which up to now subjective judgement has been delivered, could be supplemented by objective testing. Hitherto surprising reactions during the contest may thus be more successfully avoided, momentary fitness state of the animal more correctly adjudicated, latent illnesses better anticipated as benefits for animal, trainer and owner.
