The relationship among Oxygen, Sodium, and Cancer

In 1931, the German physiologist, Otto Heinrich Warburg received the Nobel Prize for his explanation of how normal cells become cancerous cells. His famous Warburg hypothesis stated that cancer has many secondary causes, but its primary cause is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.

When most of us think of the fermentation of sugar, we envision of bowl of sugar and water mixed with yeast, bubbling and growing, causing bread to wine or changing fruit or grain into alcohol. The esteemed Dr. Warburg, however, was referring to something quite different. The “fermentation” of which he spoke was the process now more commonly termed anaerobic respiration, a natural adaptation of healthy cells and cancerous cells alike when they are under stress.

Dr. Warburg’s “fermentation” is the same thing as the “burn” you feel when you exercise with great intensity. The ability to “ferment” glucose is a mark of physical fitness. So what did Dr. Warburg mean when he said that cancer is caused by a fermentation of sugar?

Both healthy cells and cancerous cells use sugar. A healthy cell at rest uses glucose and oxygen to store energy in the form of adenosine triphosphate. This is the energy storage molecule better known as ATP. Glucose and oxygen are in effect the “slow food” of a healthy cell.

When a healthy cell needs to make a lot of energy fast, it does so without oxygen, by “fermenting” glucose. Sugar without oxygen is the “fast” food of a healthy food. Provided there is enough glucose in the bloodstream and enough insulin, the cell can make the energy it needs in a crisis through a process that does not require oxygen.

This “fast food” for a healthy cell, however, comes at a huge metabolic cost. Anaerobic or, as Warburg termed it, fermentative respiration requires 19 times as much glucose to make the same amount of energy as the cell can make when it uses oxygen. In addition, it is not just the enormous consumption of sugar that becomes a problem for a healthy cell under stress.

Consuming “fast food” changes the electrolyte balance of the cell. Every time the cell takes in a single molecule of glucose from the bloodstream, it expels two positively charged potassium ions. At the same time, it absorbs three positively charged sodium ions. The membrane lining the cell normally has a slightly negative charge so that it can attract positively charged amino acids and hormones.

When the cell makes energy through the relatively slow process requiring sugar and oxygen, it has time to get rid of the excess sodium, pump potassium back into the cell, and keep its membrane negatively charged. With oxygen-free energy production, however, the cell cannot keep up with sodium. The negative charge natural to the cell membrane is offset by the positive charge of the rapidly accumulating sodium.

Sodium does not build up so much that the cell membrane takes on a positive charge that it repels nutrients, but there is enough positively charged sodium inside the cell that it cannot take up essential nutrients as easily. The cell has to create new transporter molecules that are uniquely associated with cancer cells. It has to burn more and more sugar just to take in other forms of nourishment.

“Fast food” becomes the only kind of food the cell can use. The continual burning of sugar combined with the absorption of sodium makes a healthy cell sick. Moreover, the sodium in the sick cell has to be diluted with water. By the time a cell becomes so run down that it “catches” cancer, it is deluged with salty fluid.

There is a mythology that evil cancer cells lurk in hidden places in the body, stealthily surviving in low-oxygen conditions while they organize their attack on other tissues. This is not at all, what Dr. Warburg meant.

Cancer cells bloat because they absorb sodium, which the diet provides mostly in the form of sodium chloride, or table salt. The more sodium they contain, the more water they absorb to dilute it. As Nobel Laureate Otto Warburg discovered, the way cancer cells get their sodium is by burning glucose without oxygen. Every time they burn one molecule of glucose this way, they have to take in two sodium ions and expel three potassium ions.


However, the anaerobic process requires 19 times as much glucose to make the same amount of energy. This means the cell takes in 38 times as much sodium as a cell operating in an oxygen-rich environment, and it loses 57 times as much potassium. The cell can expend even more energy to get its electrolytes back in balance, but in cancer, the deficiency of potassium and the toxic surplus of sodium distort the shape and architecture of the cell.

Just how out of balance can a cell become? In any healthy cell, there is more potassium inside and more sodium outside. In a sick cell, there is more sodium inside and more potassium outside. When a cell is healthy, it contains seventeen times as much potassium as sodium. When it becomes cancerous, it accumulates four times as much sodium as potassium. When sodium content increases, water pours into the cell.

Moreover, as more and more sodium accumulates in the cell, all its microstructures substances lose their normal shape. They stop functioning normally. Although there are many more processes at work, as the cell bloats with sodium and water, it becomes cancerous. The longer the newly cancerous cell operates in low-oxygen conditions, the more sodium it accumulates, the more water it absorbs, and the easier it is for it to metastasize and form new tumors.