Information and studies on acid-base balance in medicine and research.

Alkaline therapy

Alkaline therapy

pH regulation is an essential prerequisite for the functioning of numerous metabolic processes in the body. A large number of epidemiological and clinical studies have shown that an acid-base imbalance, and the latent acidosis associated with it, is increasingly being implicated as a risk factor for the onset and progression of a variety of chronic diseases today. Offsetting latent acidosis can therefore lead to a marked improvement in the symptoms of many health problems.

Influence on the bones

In latent acidosis, basic minerals such as calcium and magnesium are released from the bones to neutralise excess acid in the body. In addition, there is evidence of direct intervention in the activity of bone cells: acid inhibits the activity of osteoblasts, which formate bone, and stimulates the activity of osteoclasts, which deplete bone.

This is because, when there is a slight shift in the pH towards acid, RANKL (receptor-activated NFkB ligand) and TNFa are produced in the osteoblasts and in turn bind to osteoclasts, in this way increasing their activity. This shifts the balance between bone formation and bone resorption towards bone resorption. In the long term, this leads to loss of bone mass with a marked increase in the risk of osteoporosis.

As numerous epidemiological and experimental studies show, consumption of a high-alkaline diet containing a large proportion of fruit and vegetables can achieve positive effects on bone metabolism, as can targeted supplementation with alkaline minerals.

Daily citrate ingestion reduces the excretion of typical biomarkers of osteoporosis (hydroxyproline, cross-links) and in this way reduces bone resorption in postmenopausal women.

Supplementation with alkaline citrate, when consumed together with vitamin D and calcium, has a positive effect on bone density in postmenopausal women with osteopenia. The effect of alkaline potassium citrate (30 mmol/day) on this was compared with the effect of neutral potassium chloride. Whereas bone density continued to decrease during the study period when potassium chloride was consumed, it increased significantly again when potassium citrate was ingested. The effect was therefore not dependent on potassium intake but was clearly based on the alkaline citrate compound. These results have also been confirmed in healthy male and female study subjects, who took either potassium citrate (60 mmol/day) or a placebo in addition to calcium/vitamin D replacement for a period of 2 years. This showed that citrate supplementation leads to a significant increase in bone density (+ 1.7%) even in healthy subjects.This is confirmed by a meta-analysis, which concluded from a total of 14 studies that administration of alkaline-forming substances leads to improved calcium balance and decreased bone resorption.

Latent acidosis in chronic pain

Pain receptors are sensitive to acids. Even mild acidosis leads to a considerable increase in pain intensity because pain receptors respond to acids with increased activity. In Japanese students who were injected subcutaneously with fluids with different pH levels, the pain triggered at a pH of 5.5 was already rated as the most intense. In patients with chronic pain, too, increased extracellular buffering capacity can raise the threshold for the triggering of pain. Alkaline supplementation for a 4 week period in patients with chronic back pain of unknown origin led to a significant pain reduction. At the same time, mobility and general well-being improved significantly and the taking of painkillers was markedly reduced.

Alkaline replacement in rheumatic disorders

Rheumatic disorders are encouraged by chronic acidosis. The chronic inflammation in patients with rheumatic disorders brings about a marked shift in the pH of the synovial fluid towards acid. Patients with rheumatoid arthritis have the lowest pH-value. In a study with patients with rheumatoid arthritis, 12 weeks of alkaline supplementation led to a highly significant reduction in pain. At the same time, the DAS 28 (Disease Activity Score 28) had improved significantly at the end of the study. Mobility was significantly improved and painkiller consumption was significantly decreased. By comparison, no significant changes occurred in the control group during the observation period.

Kidney stones and hyperuricaemia

Acidosis can also lead to greater calcium excretion and thus increase the risk of calcium oxalate kidney stones developing. A high alkaline intake in the form of citrates can counteract this effect because citrates bind calcium in the pre-urine and thus prevent the sparingly soluble calcium oxalate from forming. The use of alkaline salts (e.g. citrates) constitutes standard treatment in the prophylaxis of calcium oxalate kidney stones.

However, a urine pH that is too alkaline can also lead to kidney stones because, above a urine pH of 6.8, there is an increased risk of insoluble calcium phosphate being produced. Urine that is alkaline for a prolonged period of time can therefore pose a risk of calcium phosphate stone development. However, if this alkaline pH occurs as a result of a high intake of citrate-containing foods or alkaline supplements, the negative effect is offset because – as described above – citrates bind calcium in the pre-urine and thus prevent stones from forming.

In hyperuricaemia, the uric acid level in the blood is increased. If the uric acid concentration exceeds a critical level, this leads to an acute gout attack. Uric acid crystallises. The body needs alkalis to excrete uric acid. Additional administration of citrates is recommended in chronic gout to prevent precipitation of sodium urate crystals. Combined treatment with allopurinol and an alkaline mixture of citrate-based minerals led to a significant increase in urine pH, greater excretion of uric acid in the urine (uric acid clearance) and thus a significantly greater reduction in the uric acid level compared with the control group (=allopurinol mono therapy).

Alkaline replacement during weight-loss diets and fasts

Weight-loss diets and fasts can also encourage acidosis in the body. Catabolism increase the obtaining of energy from fatty acids, which creates more keto acids. If alkaline intake is inadequate at the same time, this leads to ketoacidosis. Besides the production of keto acid during fat reduction, high-protein diets lead to additional acid loading due to metabolism of the dietary protein. Acidosis caused during fasts can be minimised or prevented by consumption of an alkaline preparation. In addition, the typical symptoms of a healing crisis during a fast (headaches, tiredness, exhaustion) can be significantly improved. The additional administration of an alkaline supplement also has a positive influence on weight reduction during a combined regimen of a sports programme and intermittent fasting.

Alkaline intake in sport

During physical exertion, increased acid is produced by the metabolism and in the muscles. The consequences are waning strength as well as muscle tension, which can increase the risk of injury. Even relatively moderate physical exercise can bring about marked changes of pH in muscle fibres. Comparative studies show that pH changes were only very small, at the same loading, when citrate was administered orally. Additional administration of alkaline citrate also showed positive results in patients with chronic tendinitis and/or Achilles tendon inflammation; by comparison with the control group, pain-induced training downtimes were significantly reduced.