Rheumatoid Arthritis Treatment by Potassium
Is Potassium a possible treatment for Rhematoid Arthritis.
by Charles Weber, MS
It is my contention that potassium deficiency is either causing, or greatly making worse, rheumatoid arthritis, which I will shorten to “arthritis” in these articles. In assessing the possibility of this hypothesis people have little to go on. Virtually any textbook in the past would devote no more than a paragraph to potassium which would state that potassium is never deficient in the diet, or give one exception to the dozen or more known, or in some only under clinical conditions…
The reason for this careless treatment of potassium is probably because potassium is present in almost all foods as grown in large quantities. Professionals think about it as if it were air or water. However even air and water can be deficient and if voluminous texts are not written about these deficiencies, it is because both deficiencies can be detected by our senses. Extremely powerful emotions and instincts impel people to correct these deficiencies immediately and at any cost. Potassium is odorless, colorless, and, in the usual concentrations, tasteless. There is no way to detect a deficiency and cell content can not even easily be assessed in the body by modern analytical procedures. Whole body cell content is virtually “invisible”.
There is not any indication in the literature that potassium has ever been tried by scientists as an arthritis corrective. A rather exhaustive search of the medical literature has failed to disclose any experiment. This includes Exerpta Medica 1947 to 1974, and a computer search by the Central Library of the American Medical Association from 1965 on back. In addition no search of mine since has revealed an experiment.
I will discuss potassium physiology and nutrition and what can be done to remove an actual deficiency and thus heal any tissue which has not actually been destroyed. Please keep in mind, though, that potassium ramifies through every cell and process in the body, has no storage, and has a dangerous dependence on its precise control for nerve impulse transmission. This makes it a mineral to be cautious about. In particular I recommend getting as much as possible from food. Even food requires some care because it has a wide range of concentrations. You must take responsibility for your own intake and I assume no liability for the correctness of advice in this article. You use this information at your own risk.
Getting potassium from food is reasonably safe for normal people with reasonably sound kidneys. Even if you doubt my thesis of a connection between arthritis and potassium, you have nothing to lose by getting all the potassium that was originally in your food. It will even taste better. It will, in addition, help protect you from potassium’s known link to heart disease. As the 12th century physician Maimonides expressed it: “A doctor should begin with simple treatments, trying to cure by diet before he administers drugs. No illness that can be treated by diet should be treated by any other means” or as Hippocrates expressed it in 460 – 377BC “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
Anything a doctor or dietitian can learn about nutrition, you can also. If you do not know the meaning of a
word in these articles, for a definition click on http://www.m-w.com
(Mirriam-Webster), – or a medical encyclopedia or better a search for abstracts of journal references, “Gateway”. For those which have abstracts available, click on “expand” or for definitions click on “find terms” may do for unknown words.
INTRODUCTION
Arthritis or rheumatism is the number one crippling disease in America, limiting activities for millions of Americans [from a CDC article with graphs]. Those estimates probably include arthritis like diseases other than rheumatoid arthritis and estimates elsewhere are very variable, probably because the severity of the disease varies very much. It is estimated that 2.1 million people in the USA have rheumatoid arthritis. A Brazilian study indicates that one half a per cent have rheumatoid arthritis as opposed to about 4% for osteoarthritis in that country, and 2% for rheumatoid has been estimated for the USA [Rasch] The CDC says that at least 65 billion dollars are lost each year for medical costs and loss of productivity, but that figure does not a even begin to measure degradation of quality of life. There is an estimate that individual costs average $5700. Two thirds of the victims are women, most of them over 45 [Rodman]. The terrible pains associated with arthritis, reminiscent of and similar to the medieval torture racks must surely be among the top causes of contemporary misery. These pains along with the actual physical disability, weak joints, loss of energy, and other systemic ——— symptoms or this site that accompany them, cause an enormous loss of productivity. Arthritis may be a considerable part of the cause of increasing welfare roles. Even industrial accidents are related to this monstrous and onerous burden that society carries. Small jolts and falls which should do little more than bring out some colorful language results in loss of hours and even months. It is more than just the loss of time itself. It is also the super caution that blocks even fairly healthy people from making fast, risky moves when they see some of the debacles their friends get into.
Nor is arthritis confined to North America. Countries at such extremes of latitude as Finland and Jamaica have even higher rates than we do [Kellgren]. The simple life is not any guarantee against misery either . The Masai tribesmen of Africa have high rates [Best p768]. Nor is a simple life a guarantee of good nutrition. Political or economic ideologies are not barriers. Arthritis crosses the iron curtain, is also present in nomadic hunters, and cave men, cave bears, and ancient Egyptians are thought to have had it [Bach][Crain]. It shows no obvious clear association with any culture even though it is very variable, with low rates in tribes near the Masai (including villages in Nigeria [Silman] ) and Laplanders near the Finns in Finland, as well as insane people in Massachusetts [Allander p260] and an absence of arthritis on the island of Triton da Cuhna [Kellgren]. There is no evidence of rheumatoid arthritis among early Australian aborigines [Roberts-Thompson]. The rates are very variable within regions of North America, within ethnic and economic groups, and age groups 15.2% of white people. 15.5% of black people, 11.3% of Hispanics, and 7.3% of Asian Pacific islanders have rheumatic conditions [Helmick].
Most of the people who have pains in the joints have them because of arthritis (but see symptoms of other types of joint pains). The pains usually strike first in the outer joints like wrists, carpels, fingers or joints with a history of injury. Load bearing joints are also vulnerable. The pain is most likely in the early morning. It is often accompanied by stiffness. It is not to be assumed that the disease is localized because the pain is, Arthritis is present throughout the body and can affect kidneys, pericardium of the heart, and connecting tissue [Strukov][Ropes]. It is a disease largely associated with humans [LaMont-Havers], probably partly because animals can not talk (or in the case of rodents possibly because they make no use of cortisol), but I suspect primarily because animals usually do not have access to refined food. Arthritis has few externally observable symptoms, especially in early stages. There are no known consistent biochemical changes in arthritis (which word in these articles will be equated with “rheumatoid arthritis” or RA) except a lower cellular potassium content than normal [LaCelle][Sambrook], and a somewhat higher plasma copper content along with a protein which binds the copper in the serum [Schubert]. However there are reports of some changes, which show up in a high proportion of arthritics. There have been reports of low potassium (the only consistent difference from normal they found) [Syrjanen], calcium, phosphorus, lysozyme, and IgA peptide in the saliva of juvenile arthritics [Siamopoulou et al] (which form of arthritis could be similar to the adult form). The sodium/potassium ATPase activity is lower in erythrocyte (red blood cell) membrane [Masoon-Yasinzai] and lower than in normal, osteoarthritis, or gout [Testa]. The steroid hormone dehydroepiandrosterone sulfate (DHEA) is statistically lower in arthritics [Dessein] as is cortisol and pregnanediol, even though ACTH is higher, as is aldosterone [Khetagurova]]. The aldosterone being higher suggests that there is something besides the low potassium itself that is involved in the cause of arthritis since aldosterone stimulates excretion of potassium and has a positive feedback. The ratio of IL6 peptide immune hormone to cortisol is statistically correlated to number of swollen joints and low grip strength. There has been an effort to use changes in some of the body’s other proteins in diagnosis, but with limited success so far, although some of the other rheumatic diseases can be almost diagnosed from blood proteins alone [Waller]. As nearly as I can tell most of the above seemed to be the consensus for arthritis at the 1982 Pan American Conference on Arthritis and largely remains so today. Erythrocyte sedimentation rate (ESR) is poor for diagnosis [There are significant correlations between IgM RF and IgA immune proteins and a higher disease activity [Chen] but the correlations are not perfect. There is lower glycosylation of immune peptides (addition of sugar molecules) during arthritis [Axford]. I do not know what the significance of this is although addition of sugars may prevent the peptides from being normally active. C3 and C4 compliments are said to be the best of the other discriminators [Sari, et al]. In epithelial sodium channels, alpha and beta subunits are higher than normal in rheumatoid arthritis but not present in osteoarthritis [Trujillo, et al]. There is high activity of collagenase and elastase in the synovial fluid of patients with rheumatoid arthritis, which is about 30 times higher than that found in the synovial fluid of patients with osteoarthritis [Bazzichi]. Arthritis sometimes has fatigue associated with it. The settling rate of red blood cells is different in arthritis.
In the past arthritis was associated with old age in people’s minds and there was a tendency to suffer it stoically as inevitable. While the medical profession has intellectually abandoned an assumption that only people in old age are affected, many laymen still assume this is the case. The concept that this is “old age” is pervasive, even creeping into common cultural media as modern as “Star Trek”. This is not to indicate that the victims did not often attempt to do something. Arthritis has a long history of quack nostrums and screwball procedures. These quack remedies were assisted by the numerous spontaneous remissions that occur with arthritis or by pain deadening chemicals. It was not necessary to cure everyone, since those who were “cured” were very grateful and those who were not were fatalistic, since their doctors could do nothing either.
It is my contention that arthritis is either a potassium deficiency or is strongly affected by one. I suspect that some poison or some infections or decline in kidney function with age degrades our ability to concentrate potassium and thus makes it impossible to get adequate potassium from food from which almost every processing procedure removes potassium these days. Arthritics characteristically have poor nourishment [Morgan et al] [Stone] including magnesium, which is necessary for potassium absorption [Kremer]. One such poison, which I suspect, is the very poisonous bromine gas, since it probably affected me that way 50 years ago. It is possible that the glucocorticosteroid response modifying peptide hormone (GRMF) to be discussed in the cortisol chapter may be the system involved in the case of infection triggers.
One technique, which seemed to have some success, was the use of spas. At least their popularity would seem to indicate some success. The Dead Sea water has a reputation for healing arthritis and has been successfully investigated with healing lasting up to three months [Sukenik]. It has two and a half to ten times as much potassium chloride by weight as sodium chloride and an even greater ratio of magnesium chloride.That king-sized spa, the ocean, has been given credit for anti-arthritic tendencies also. This is plausible because the ocean contains potassium in about the same concentration as blood fluid. Sea mud is also given credit for curative properties [Veinpalu]. The spa at Bath, England, has potassium content less than one tenth that of ocean water [Riley]. If it is typical of spas, then unless they were drinking the water, it is hard to see how it could have helped.
There have been closer associations with potassium. At one time sulfurated potash was used to combat arthritis [Osol p1092]. It is not surprising that it fell into disfavor associated with such a poisonous anion. An anion is a negatively charged substance which neutralizes the positive charge of an ion like potassium. The first person to definitively link potassium to arthritis in no uncertain terms was DeCoti-Marsh in a book published in England in 1957 [deCoti-Marsh]. He claimed numerous case histories. He recommended a whole pot-pouri of anions to go with the potassium, some of them not nutritional, and some even poisonous. He attributed magical properties to these anions. His approach was reminiscent of the writings of ancient alchemists. More recently potassium supplements in connection with other drugs gave a good response [Casatta].
A more successful technique was the raw vegetable diet described by Holbrook in Europe during the forties [Holbrook]. This diet became quite popular, even though most people must have found it fairly unpalatable. Eppinger hinted that the success of this diet might have been due to its high potassium content [Eppinger]. It might have become more popular if a recommendation to use fried vegetables, soup, or to drink the boil water had been made, which would have permitted the same potassium intake. There have been experiments with vegetarian diets in recent years but they have been changed merely by removing meat from the diet which is probably why only moderate success has been attained. However recently improvement has been noted using a diet that had increased amounts of vegetable juice and unpolished rice [Fujita]. There also has been a study which showed a strong negative correlation with cooked vegetables in Greece [Linos] and in Italy [[LaVecchia]. Dr. Saul has described a case in which vegetable juice and vegetables healed a woman. Kjeldsen-Kragh explored the affect of a vegetarian diet [Kjedsen-Kragh]. He found that fasting followed by a vegetarian diet has a favorable influence on disease activity in some patients with rheumatoid arthritis. This effect cannot be explained entirely by psychobiologic factors, immunosuppression secondary to energy deprivation, changes in the plasma concentration of eicosanoid precursors, or changes in antibody activity against dietary antigens.
That diet is deeply involved in arthritis seems almost certain since when people migrate from areas with very low arthritis rates and start eating processed food, they come down with arthritis.
At the present time there are several books relating diet to arthritis. Jarvis stresses honey and vinegar in his book [Jarvis]. Since honey is extremely low in potassium, it would be counter productive. The vinegar could be very beneficial if well fed people are failing to metabolize [Winegrad] all of the acetate ion or the acetate is being excreted by the kidneys before it has a chance to enter the cells because the acid hydrogen ion interferes with potassium at the excretion site as will be developed later. I know of no tests reported in the literature testing this concept. Jarvis hints at other dietary changes also, which if followed, would increase potassium intake inadvertently. Kombucha, a vinegar like ferment, is said to be helpful for arthritis.
Dong and Banks prescribe a diet free of chemicals, milk, meat and sugar, and low in fat [Dong]. If his diet were followed it would definitely increase potassium intake, especially since he stresses unprocessed vegetables. However, he attributes its success to freedom from allergens and chemicals, so that philosophically he tends to be in the same general physiological category as the autoimmune hypothesis is in, to be discussed in Chapter II. I am fairly certain that those who have success with his diet do so because of the lucky quirk that potassium increases at the same time. I think a good case could be made for keeping chemicals out of food. Some, like sulfite, which destroys vitamin B-1, are known to be harmful (except to people low in potassium, where it is protective against heart and kidney disease [Folis] ), some like dyes are fraudulent and/or harmful. I doubt if removing them would have more than a small affect on arthritis though. Alexander recommends vitamin D against arthritis. However like Dong he also speaks of low sugar and raw vegetables [Alexander]. It has been proposed that vitamin D has an affect dampening the immune system. [Cantorna] although apparently this concept has not been followed up on. Those using Alexander’s diet must have had less trouble with tooth decay, tuberculosis [Wilkinson], muscle cramps, and rickets. Also vitamin D is necessary for magnesium reabsorption in the kidneys [Ritchie] which magnesium in turn is necessary for powering some of the electrolyte pumps, so it could easily be having an indirect affect on potassium in many cases. This may be the reason why women taking vitamin D have less arthritis than those who do not.[Merlino].
Allergy has been proposed as a possible cause but stressing allergens naturally present in food. It is quite conceivable that allergens damage the kidneys’ ability to retain potassium. However, no one has established this yet. More likely is that the decline in cortisol during a potassium deficiency [Mikosha (in guinea pigs) ] stimulates the allergic response. It is also suggested by an experiment in which cortisol was increased by potassium chloride given to people [Ueda]. There is good evidence, though, of beneficial results from defeating allergy in specific cases. It is possible that allergens affect that part of the immune system involved in arthritis.
Evidence from individual case histories that I have seen myself and the known characteristics of potassium physiology supports the proposal that arthritis is either a potassium deficiency or that a deficiency is its most important symptom. The replete body contains about 75 times as much potassium or more as is usually in the processed diet, so if it is increased, it will still take quite awhile to come up to normal if it as much as 30% low. However there should be satisfying initial results in a month or two or even less if the other nutrition is adequate, especially magnesium [Kremer][Schoner] and maybe inositol [Charalampous] and probably less time yet if potassium is taken as the chloride (the chloride is probably not a good idea if you have high blood pressure or suffer from chronic fatigue syndrome (CFS or CFIDS).
I have been almost alone in proposing potassium as being central to rheumatoid arthritis (but see Dr. Jan de Vries’ article). . Also Das has recently suggested that glucose-insulin-potassium (GIK) therapy might suppress tumor necrosis (TNF) which is thought to produce some of the symptoms of arthritis [Das]. However there is no substitute for an experiment, which has never been reported in a journal, since scientists are specialized and sometimes have trouble being interested in simple approaches, as are their funding agencies. A doctor has reported to me that potassium and magnesium had inconclusive results, but it is possible that the subjects had osteoarthritis or chronic fatigue syndrome so I am unwilling to accept this as negative evidence yet. While you are waiting patiently for such an experiment there is nothing stopping you from eating nutritious food and making sure you do not lose any of the potassium by your own preparations. I am virtually certain that you will be healthier and will certainly have less risk of stroke, high blood pressure, and kidney stones. . I wish you good health.
Chapter II, will
describe current and past research.
Other chapters will follow after
that which discuss potassium nutrition and physiology, derivation of requirements, etc., links for which as shown at
the beginning of this site.
The Potassium
in Food chapter is especially practical.
REFERENCES are below
.
The author, Charles Weber,, has a degree in chemistry and a masters degree in
soil science. He has researched potassium for 45 years, primarily a
library research. He has cured his own early onset arthritis (33 years old). He has published articles on allied subjects in; The Journal of Theoretical Biology (1970, 1983), The Journal of Applied Nutrition (1974), Clinical and Experimental Rheumatology (1983), and Medical Hypotheses (1984, 1999).
While it is not the policy of this author to use testimonials, you may, if you wish, tell of the outcome of health strategies to
a new site which archives such experiences .
There is an
ticle which proposes some speculation about diabetes.
You may find useful a search for abstracts of medical journal references, “Gateway”. For those which have abstracts available, click on “expand” or for definitions click on “find terms”. or a list of medical
.
search engines .
Google is a large, general
search engine which lists the most informative articles first. Google has a free program which enables you to put a tool bar on your screen which at the click of a button enables you to perform a search of the web right from the window you are viewing or the article itself, determine its rank, find anyone linking to it, find similar articles, translate it into English, and bring up its lead articles. It also will mark any word in the article you wish and search within the article. It is something else. .
There is a free program available which tells on your site what web site accessed you, which search engine, statistics about which country, statistics of search engine access, keywords used and their frequency. It can be very useful.
There is a news system that scours the Internet once a day for arthritis (RA and osteo) related news stories from thousands of state, national and international publishers, including all of the major media outlets. The articles discuss medications primarily.
In addition there are the following medical sites although none are especially good for potassium or arthritis:
1. HON
2. National Institute of Health
3. Medscape
4. WebMD
5.DrKoop
6. med411.com
7. British Medical Journal
8. Intelihealth
9. Mayo Health System
10. Center for Disease Control.
REFERENCES (for Chapter. I above, only)
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Arthritis Foundation 1978 Arthritis the Basic Facts. Arthritis Foundation, Georgia
Axford JS,. 2000 Glycosylation and rheumatic disease. Proceedings of the Royal Society of Medicine’s 5th Jenner Symposium (Glycobiology and Medicine conference),10-11, July 10-11, 2000. 2001
Bach TF editor 1947 Arthritis and Related Conditions. FA Davis Co., Philadelphia
Bazzichi L Ciompi ML Betti L Rossi A Melchiorre D Fiorini M Giannaccini G Lucacchini A 2002 Impaired glutathione reductase activity and levels of collagenase and elastase in synovial fluid in rheumatoid arthritis. Clin. Exp. Rheumatol. 20; 761766.
Best CH & Taylor NB 1960 The Physiological Basis of Medical Practice, 5th ed. Williams & Wilkins Co.
Baltimore
Blumberg BS et al 1961 A study of the prevalence of arthritis in Alaskan Eskimos. Arthritis and
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Cantorna, M., Hayes, C. and DeLuca, H.,1998a, 1,25-Dihydroxycholecalciferol inhibits the progression of arthritis in murine models of human arthritis. Journal of Nutrition, v. 128, p. 68-72.
Casatta L Ferraccioli GF & Bartoli E 1997 Hypokalaemic alkalosis, acquired Gitelman’s and Barter’s syndrome in chronic sialoadenitis. British Journal of Rheumatology 36;1125-1128
Charalampous FC 1971 Metabolic functions of myoinositol: VIIII – Role of inositol in Na+-K+ transport and in Na+ and K+ activated adenosine triphosphate of KB cells. Journal of Biol. Chem> 246; 455 & 461
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Linos A et al. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am J Clin Nutr 1999; 70: 1077-82.
Masoom-Yasinzai M 1996 Altered fatty acid, cholesterol. and Na/K ATPase activity in erythrocyte membrane of rheumatoid arthritis patients. Zeitschrift fur Naturforschung, section C, Bioscience 51;401-403 (from the abstract)
Merlino LA JR Cerhan JR, LA Criswell LA, TR Mikuls TR, KG Saag KG 2004 Vitamin D is Associated With a Lower Risk of Rheumatoid Arthritis in Older Women: Results from the Iowa Women’s Health Study. Arthritis and Rheum. 50; 72-77.
Mikosha, A.S.; Pushkarov, I.S.; Chelnakova, I.S.;
Remennikov, G.Y.A. “Potassium Aided Regulation of Hormone Biosynthesis in Adrenals of Guinea Pigs Under Action of Dihydropyridines: Possible Mechanisms of Changes in Steroidogenesis Induced by 1,4, Dihydropyridines in Dispersed Adrenocorticytes.” Fiziol. [Kiev] 37: 60, 1991.
Morgan SL Anderson AM Hood SM Mathews PA Lee JY & Alarcon GS 1997 Nutrient intake patterns, body mass index, and vitamin levels in patients with rheumatoid arthritis. Arthritis Care Research 10; 9-17. (from abstract)
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1,25(OH)(2)D(3) stimulates Mg2+ uptake into MDCT cells: modulation by extracellular Ca2+ and Mg2+. Am J Physiol Renal Physiol. 2001 May;280(5):F868-78.
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Rodman GP editor. Primer on the Rheumatic Diseases, 7th edition. The Arthritis Foundation, NY
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Siamopoulou A Mavridis AK Vasakos AK Benecos P Tzioufas AG Andonopoulos AP 1989 Sialochemistry in juvenile chronic arthritis. British Journal of Rheumatology 28; 383-385 (from the abstract)
Silman AJ, Ollier W, Holligan S, Birrell F, Adebajo A, Asuzu MC, Thomson W, Pepper L. Absence of rheumatoid arthritis in a rural Nigerian population.1993 J Rheumatol. Apr;20(4):618-22.
Staub RH Pongratz G Scholmerick J Kees F Schaible TF Antoni C Kalden JR Lorenz H-M 2003 Long term anti tumor necrosis factor antibody therapy in rheumatoid arthritis patients sensitizes the pituitary gland and favors adrenal androgen secretion. Arthritis and Rheumatism 48; 1504-1512.
Stone J Doube A Dudson D Wallace J 1997 Inadequate calcium. folic acid. vitamin E zinc, and selenium intake in rheumatoid arthritis patients: results of a dietary survey. Seminars in Arthritis and Rheum. 27; 180-185
Strukov A 1964 General morphology of collagen diseases. Journal of Pathology 78; 409-420
Suarez-Almazor ME, Gonzalez-Lopez L, Gamez-Nava JI, Belseck E, Kendall CJ, Davis P. 1998 Utilization and predictive value of laboratory tests in patients referred to rheumatologists by primary care physicians. J Rheumatol. (10):1980-5.
Sukenik S Neumann L Buskila D Kleiner-Baumgarten A Zimlichman S Horowitz J 1990 Dead sea bath salts or the treatment of rheumatoid arthritis. Clinical Exp. Rheumatology 8; 353-357 (from the abstract)
Syrjanen S Lappalainen R Markkanen H 1986 Salivary and serum levels of electrolytes and immunomarkers in edentulous healthy subjects and in those with rheumatoid arthritis. Clinical Rheumatology 5; 49-55.
Testa I Rabini RA Corvetta A Danieli G 1987 Decreased sodium, potassium ATPase activity in erythrocyte membrane from rheumatoid arthritis patients. Scandinavian Journal of Rheumatology 16; 301-305.
Trujillo E Alvarez de la Rosa D Mobasheri A Gonzolez T Canessa CM Martin-Vasallo P 1999 Sodium transport systems in human chondrocytes II. Expression of ENaC, Na+/K+/2Cl cotransporter Na+/H+ exchangers in healthy and arthritic chondrocytes. Histol. Histopathol. 14; 1023-1031 (from the abstract)
Ueda Y, Honda M, Tsuchiya M, Watanabe H, Izumi Y, Shiratsuchi T, Inoue T, Hatano M. 1982 Response of plasma ACTH and adrenocortical hormones to potassium loading in essential hypertension. Jpn Circ J. 1982 Apr;46(4):317-22.
Veinpalu E Trink RF Veinpalu LE Pyder KhA 1992 The therapeutic action of the low water bulk of sea mud. Vopr.Kurortol. Fizioter Lech Fiz. Kult. Sep.-Dec.;(5-6);54-57.
Waller 1971 Present status of rheumatoid factor. Crit. Rev. Clin. Lab . Sci 2; 173-210
Wilkinson RJ Llewelyn M Toosi Z et al 2000 Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gyarati Asians in West London: a case controlled study. Lancet 355; 618-621.
Winegrad AT Reynold AE 1958 Effect of insulin on the metabolism of glucose, pyruvate, and acetate. Journal of Biol. Chem 233; 267.