Bicarbonate Supplements? Is It The Best Way To Alkalize in Kidney Disease?

Throughout the ages, human diets have undergone a significant transformation, shifting from an alkaline to an acidic nature, which can have adverse effects on our well-being. The human body employs its intrinsic bicarbonate reserves to counteract this acidity, but these resources are limited. Consequently, some believe that simply replenishing bicarbonate through alkalizing supplements could provide support to the body. However, there may be better solutions than the long-term intake of bicarbonate.

The body meticulously regulates its acid-base balance, or pH levels, through intricate mechanisms. Among these mechanisms, the most vital one in the bloodstream is the body’s ability to produce bicarbonate, which neutralizes acidic hydrogen ions naturally.

Bicarbonate plays a crucial role, accounting for 52% of the body’s buffering capacity, as it absorbs hydrogen ions and generates excretable carbon dioxide and water.

However, it’s essential to recognize that the body cannot produce an infinite supply of bicarbonate. When confronted with an excess of acidic foods, stress, medications, and other factors that promote acidity, the body simply cannot compensate adequately. This leads to acidosis and various adverse health consequences.

In response to this, there’s often consideration given to increasing bicarbonate reserves by consuming bicarbonates like sodium bicarbonate. Yet, while this may temporarily raise the body’s alkalinity, it falls short of being the ideal solution.

The Issues with Bicarbonate Supplementation

The challenges with bicarbonate supplementation are primarily linked to its impact on stomach acid and the discomforting side effects it brings about. For instance, sodium bicarbonate raises stomach carbon dioxide levels, thereby reducing acidity and increasing alkalinity, which can be detrimental to the digestive process.

Insufficient hydrochloric acid (HCl) due to bicarbonate intake hampers the absorption of vitamins and minerals from food and supplements. This issue is particularly troublesome for older individuals who may already have reduced HCl levels. Furthermore, it may disrupt the balance of gut microbiota, potentially leading to bacterial overgrowth such as SIBO. Additionally, the rapid increase in blood bicarbonate concentration following ingestion is swiftly excreted through the kidneys, rendering the ingested bicarbonate ineffective in neutralizing excess blood acidity.

Bicarbonate supplementation also comes with its fair share of side effects. Not only does sodium bicarbonate have an unpleasant taste, but it can cause significant gastrointestinal discomfort, including nausea, stomach pain, diarrhea, and vomiting.

Some more severe side effects include intracellular acidosis, elevated sodium levels, and reduced potassium levels, as illustrated below:

https://biopractica.com.au/clinical-tools/

Side effects of sodium bicarbonate therapy, adapted from Adeva-Andany et al.’s research in 2014.

In light of these challenges, it becomes evident that the most effective way to achieve alkalinity is not through supplemental bicarbonates. In fact, such an approach may be detrimental to one’s health. Instead, citrates offer an ideal solution for alkalizing the body, both in dietary and supplemental forms.

Citrates for Alkalizing

Citrates are always absorbed as salts, often in the form of magnesium, potassium, calcium citrate, and so on, and can be found naturally in fruits and vegetables. Supplementing with these citrate salts not only promotes alkalinity but also provides the added benefit of increased mineral intake.

Furthermore, they have a minimal impact on HCL, making them favourable for digestion. Citrates offer a more sustained and steady alkalization compared to bicarbonate supplementation, ensuring a healthier approach to maintaining the body’s acid-base balance.

Acid-Base Balance Recap

Before we explore magnesium citrate’s benefits, it’s crucial to understand the body’s acid-base balance. The pH scale measures acidity or alkalinity, ranging from 0 to 14, with 7.0 being neutral, above 7.0 considered alkaline, and below 7.0 acidic. Our bodies operate optimally with a slightly alkaline blood pH, ideally between 7.35 and 7.45. Deviations from this range can disrupt enzyme function and lead to illness.

Clues That You May Be Too Acidic

Each part of the body needs different levels of acidity for optimal health. For example, our stomach naturally produces acids and needs to be highly acidic to digest our food; however, the blood cannot be too acidic. Long-term acidity of the blood causes a condition known as Chronic Metabolic Acidosis, which is associated with symptoms such as:

• Tiredness, fatigue and/or exhaustion
• Increased sensitivity to stress
• Anxiety, insomnia, and/or nervousness
• Trouble concentrating
• Frequent and/or long-lasting colds and ‘flus
• Muscle and joint pain
• Changes in skin, hair and nails

Chronic Metabolic Acidosis (CMA) is a common condition where the body experiences subtle shifts towards acidity, causing metabolic and endocrine disturbances. To maintain the pH within the normal range, the body employs various mechanisms:

• The Kidneys: They directly excrete acids and bases through urine. In the process, valuable alkaline minerals like calcium, magnesium, and potassium may be lost if the body becomes too acidic.
• The Lungs: They expel acidic carbon dioxide through exhalation.
• Buffering Systems: These exist in various tissues and continually regulate pH. The most critical ones operate in the blood and rely on carbon dioxide, water, and alkaline minerals such as calcium, potassium, and magnesium. When blood becomes too acidic, these minerals are drawn from sources like bones and muscles to offset the acidity.

Mineral citrates, like magnesium citrate, are preferred for alkalization as they support a healthy pH balance without disrupting normal digestion. Minerals like magnesium, calcium, and potassium inherently have alkalizing effects on the body, and when combined with citrate, as in magnesium citrate, the alkalizing effect is even more pronounced.

This is because citrate binds acidic hydrogen ions in the blood, converting them into carbon dioxide and water, with only water being left after the carbon dioxide is excreted through breath.

Scientific studies have shown that supplements containing alkalizing mineral citrates can significantly increase both blood and urinary pH levels, effectively making them more alkaline. For instance, a study involving 25 healthy subjects found that supplementation with alkalizing minerals led to a rapid increase in blood pH, with pH levels becoming even more alkaline after a week of supplementation.

Acidity and CKD

​​Let’s delve into the consequences of acidity on kidney function, especially in the context of Chronic Kidney Disease (CKD).

Impact on Kidney Function:

• • Decreased Glomerular Filtration Rate (GFR): Acidity can impair the glomerular filtration rate, which is a measure of how effectively the kidneys filter waste products from the blood. When the blood becomes too acidic, it can lead to vasoconstriction of the blood vessels within the kidneys, reducing the GFR and compromising their filtering capacity.

• Impaired Tubular Function: Acidic conditions can disrupt the normal functioning of the renal tubules, where reabsorption of essential substances like sodium, potassium, and calcium occurs. This disruption can result in electrolyte imbalances and further kidney stress.

Formation of Kidney Stones:

• • Excess acidity can lead to the formation of kidney stones. Acidic urine can promote the crystallization of certain substances like uric acid and calcium oxalate, which can aggregate and form kidney stones. These stones can obstruct the urinary tract and cause pain and kidney damage.

Chronic Metabolic Acidosis (CMA):

• • As mentioned earlier, CMA is a condition where the body experiences chronic, low-level acidity. In individuals with CKD, CMA is relatively common and can exacerbate kidney damage. It can lead to muscle protein breakdown, bone demineralization, and impaired kidney function.

Hypertension (High Blood Pressure):

• • • Acidosis can contribute to hypertension, which is a risk factor for the progression of CKD. High blood pressure can strain the kidneys and further reduce their ability to filter waste and maintain electrolyte balance.

Progression of CKD:

• • • Chronic acidosis can accelerate the progression of CKD. It can increase inflammation and oxidative stress in the kidneys, leading to fibrosis (scar tissue formation) and worsening kidney function over time.

Altered Drug Metabolism:

• • • Acidic conditions in the body can affect the way medications are metabolized. This can be particularly problematic for individuals with CKD, as many of them require multiple medications. Altered drug metabolism can lead to reduced drug efficacy or increased risk of drug-related side effects.

Impact on Bone Health:

• • • Acidosis can leach alkaline minerals like calcium and magnesium from the bones in an attempt to neutralize acidity. This can weaken bones and increase the risk of fractures, a condition known as renal osteodystrophy, which is common in CKD patients.

Compromised Immune Function:

• • Prolonged acidity can weaken the immune system, making individuals more susceptible to infections. In CKD patients, who already have compromised immune function, this can be particularly concerning.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580168/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178750/

Magnesium Citrate for Alkalization

Now, let’s turn our attention to magnesium citrate as an excellent choice for alkalizing supplementation, especially for individuals with chronic kidney disease (CKD).

Magnesium citrate offers a unique advantage by combining the benefits of magnesium supplementation with the alkalizing properties of citrate. It is a well-absorbed form of magnesium that, when dissolved in water, allows citrate to transport magnesium efficiently through the acidic stomach environment to the intestines. Here, magnesium is easily released from the citrate carrier, facilitating absorption into the bloodstream.

Furthermore, the citrate component of magnesium citrate is available to bind with acidic hydrogen ions in the blood. This binding process converts the ions into carbon dioxide and water, making them readily excreted from the body.

Magnesium citrate not only provides the advantages associated with magnesium supplementation but also contributes to maintaining a healthy acid-base balance in the body. This dual benefit makes magnesium citrate an appealing option for those looking to promote alkalinity, particularly individuals with CKD.

If you want to explore the numerous benefits of magnesium supplementation for CKD further, you can check out our blog post here.

Mineral Citrates Might Not be Suitable For Everyone

Magnesium citrate is typically considered the most suitable form of alkalizing mineral citrate for individuals with an estimated glomerular filtration rate (eGFR) above 35. This preference arises because, in the later stages of kidney disease, particularly when eGFR falls below 35, it may be necessary to avoid high doses of magnesium. This precaution is because the kidneys are responsible for eliminating excess magnesium from the body. As kidney function declines, magnesium levels can accumulate to potentially harmful levels. However, this should always be confirmed via a blood test. Often, Magnesium can be beneficial in individuals in later stages of CKD if levels are shown to be low on a blood test.

For individuals with an eGFR below 35, it is advisable to opt for sodium bicarbonate as an alkalizing agent unless blood tests show normal or low levels of magnesium on a Red Cell Magnesium blood test, in which case magnesium citrate would be the preferred way to support alkalinity in the body.

Remember always to have a conversation with your healthcare provider before introducing any new supplements into your regimen. This step is crucial to ensure that the supplement is appropriate for your specific circumstances. Additionally, it’s worth noting that magnesium can interact with certain medications, underscoring the importance of seeking professional guidance before incorporating it into your routine.

Here are the Kidney Coach and Kygeneis we have two unique alkalising formulas that contain citrates to help support healthy kidney function and decrease the effects of acidity on kidney function, that you might want to take a further look at healthy kidney function is important to you:

Kygenesis Alkalizing Formula Stages 1-3

Kygenesis Alkalizing Formula Stages 4-5