Sodium Bicarbonate, Anyone?

I belong to a number of social media Chronic Kidney Disease support groups. Time and time again, I’ve seen questions about sodium bicarbonate use. I never quite understood the answers to members’ questions about this. It’s been years, folks. It’s time for me to get us some answers.

My first question was, “What is it used for in conjunction with CKD?” Renal & Urology News at https://www.renalandurologynews.com/home/conference-highlights/era-edta-congress/sodium-bicarbonate-for-metabolic-acidosis-slows-ckd-progression/ had a current response to this. Actually, it’s from last June 19th.

“Sodium bicarbonate treatment of metabolic acidosis in patients with chronic kidney disease (CKD) improves renal outcomes and survival, researchers reported at the 56th European Renal Association-European Dialysis and Transplant Association Congress in Budapest, Hungary.

In a prospective open-label study, patients with CKD and metabolic acidosis who took sodium bicarbonate (SB) tablets were less likely to experience a doubling of serum creatinine (the study’s primary end point), initiate renal replacement therapy (RRT), and death than those who received standard care (SC).”

It may be current but what does it mean? Let’s start with metabolic acidosis. Medline Plus, part of the U.S. National Library of Medicine which, in turn, is part of the National Institutes of Health at https://medlineplus.gov/ency/article/000335.htm explains it this way:

“Metabolic acidosis is a condition in which there is too much acid in the body fluids.”

But why is there “too much acid in the body fluid?”

I like the simply stated reason I found at Healthline (https://www.healthline.com/health/acidosis), the same site that deemed SlowItDownCKD among the Best Six Kidney Disease Blogs for 2016 and 2017.

“When your body fluids contain too much acid, it’s known as acidosis. Acidosis occurs when your kidneys and lungs can’t keep your body’s pH in balance. Many of the body’s processes produce acid. Your lungs and kidneys can usually compensate for slight pH imbalances, but problems with these organs can lead to excess acid accumulating in your body.”

In case you’ve forgotten, pH is the measure of how acid or alkaline your body is. So, it seems that when the kidneys (for one organ) don’t function well, you may end up with acidosis. Did you know the kidneys played a part in preventing metabolic acidosis? I didn’t.

I went to MedicalNewsToday at https://www.medicalnewstoday.com/articles/263834.php in an attempt to find out if metabolic syndrome has any symptoms. By the way, AHA refers to the American Heart Association.

“According to the AHA, a doctor will often consider metabolic syndrome if a person has at least three of the following five symptoms:

  1. Central, visceral, abdominal obesity, specifically, a waist size of more than 40 inches in men and more than 35 inches in women
  2. Fasting blood glucose levels of 100 mg/dL or above
  3. Blood pressure of 130/85 mm/Hg or above
  4. Blood triglycerides levels of 150 mg/dL or higher
  5. High-density lipoprotein (HDL) cholesterol levels of 40 mg/dL or less for men and 50 mg/dL or less for women

Having three or more of these factors signifies a higher risk of cardiovascular diseases, such as heart attack or stroke, and type 2 diabetes.”

Well! Now we’re not just talking kidney (and lung) involvement, but possibly the heart and diabetes involvement. Who knew?

Of course, we want to prevent this, but how can we do that?

“You can’t always prevent metabolic acidosis, but there are things you can do to lessen the chance of it happening.

Drink plenty of water and non-alcoholic fluids. Your pee should be clear or pale yellow.

Limit alcohol. It can increase acid buildup. It can also dehydrate you.

Manage your diabetes, if you have it.

Follow directions when you take your medications.”

Thank you to WebMD at https://www.webmd.com/a-to-z-guides/what-is-metabolic-acidosis#2  for the above information.

Let’s say – hypothetically, of course – that you were one of the unlucky CKD patients to develop metabolic acidosis. How could you treat it?

I went directly to the National Kidney Foundation at https://www.kidney.org/atoz/content/metabolic-acidosis to find out. This is what they had to say:

“We all need bicarbonate (a form of carbon dioxide) in our blood. Low bicarbonate levels in the blood are a sign of metabolic acidosis.  It is a base, the opposite of acid, and can balance acid. It keeps our blood from becoming too acidic. Healthy kidneys help keep your bicarbonate levels in balance.  Low bicarbonate levels (less than 22 mmol/l) can also cause your kidney disease to get worse.   A small group of studies have shown that treatment with sodium bicarbonate or sodium citrate pills can help keep kidney disease from getting worse. However, you should not take sodium bicarbonate or sodium citrate pills unless your healthcare provider recommends it.”

I’m becoming a wee bit nervous now and I’d like to know when metabolic acidosis should start being treated if you, as a CKD (CKF) patient do develop it. Biomed at http://www.biomed.cas.cz/physiolres/pdf/prepress/1128.pdf reassured me a bit.

“Acid–base disorder is commonly observed in the course of CKF. Metabolic acidosis is noted in a majority of patients when GFR decreases to less than 20% to 25% of normal. The degree of acidosis approximately correlates with the severity of CKF and usually is more severe at a lower GFR…. Acidosis resulting from advanced renal insufficiency is called uremic acidosis. The level of GFR at which uremic acidosis develops varies depending on a multiplicity of factors. Endogenous acid production is an important factor, which in turn depends on the diet. Ingestion of vegetables and fruits results in net production of alkali, and therefore increased ingestion of these foods will tend to delay the appearance of metabolic acidosis in chronic renal failure. Diuretic therapy and hypokalemia, which tend to stimulate ammonia production, may delay the development of acidosis. The etiology of the renal disease also plays a role. In predominantly tubulointerstitial renal diseases, acidosis tends to develop earlier in the course of renal insufficiency than in predominantly glomerular diseases. In general, metabolic acidosis is rare when the GFR is greater than 25–20 ml/min (Oh et al. 2004).”

At least I understand why the sodium bicarbonate and I realize it’s not for me… yet.

Until next week,

Keep living your life!

Apple Cider Vinegar?

I woke up thinking, ‘apple cider vinegar.” Granted, that’s an odd thought for the first thing in the morning… or is it? Last week, I blogged about the Apple-Cider-Vinegarbenefits of drinking lemon juice in a glass of water first thing in the morning. Okay, you’ve read the blog; you know that.

What you may not know is that the blog is posted on a multitude of Facebook chronic illness sites. A reader on one of these sites commented on the blog. I don’t remember exactly what she said, but it had something to do with her taking apple cider vinegar every day to help keep her body in alkaline balance.

Ah, now that first thought of the day today is starting to make sense. Monday is blog day for me. It looks like my mind was providing me with a topic for today’s blog.SlowItDownCKD 2015 Book Cover (76x113)

I’ll bet the first question you have is why she would want to help keep her body in alkaline balance. Let’s do a little back tracking to answer that question. As per last week’s blog, Dr. Jonny Bowden, a nutritionist and health author, tells us, “Having a healthy alkaline balance helps fight germs.” No contest, I’m sure we all want to do that.

I know, I know, now you’d like to know why alkaline balance – as opposed to acidic body chemistry – does that.  I do, too.  An article on MedIndia, a respected medical site, at http://www.medindia.net/patients/lifestyleandwellness/alkaline-diet.htm explains this:

“A pH of less than 7 is acidic and a pH of more than 7 is alkaline, water being neutral with pH=7. Since one of the most important measurements of health is the pH of the body fluids, it is very important to have an acid-base balance. Any imbalance, especially those leaning towards acidic, could be associated with health disorders including obesity, tiredness, premature aging, heart disease, diabetes and cancer.”

Reminder: “The pH of a solution is a measure of the molar concentration of hydrogen ions in the solution and as such is a measure of the acidity or basicity of the solution.” Thank you, Hyperphysics at http://hyperphysics.phy-astr.gsu.edu/hbase/chemical/ph.html for the definition.

Did you catch diabetes in the MedIndia quote? That is the number one cause of Chronic Kidney Disease. This is what I wrote about that in my first What is itCKD book What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,

“In fact, the U.S. has the highest rate of CKD with 210 people per million having it, and two thirds of those cases caused by diabetes or HBP.”

And that was back in 2011. Two thirds of 210 people per million. .. and we don’t know how many of them developed CKD from HBP – or diabetes. Taking no chances, I’ll opt for alkaline balance in my body, even though I already have Chronic Kidney Disease.

Next question: how does apple cider vinegar help keep a body in alkaline balance? Let’s go back to last week’s blog again.

“Body Ecology at http://bodyecology.com/articles/acidic-foods-and-acid-forming-foods-do-you-know-the-difference had exactly what I needed:

‘To clear up some of the confusion:

  • Acidic and alkaline describe the nature of food before it is eaten.
  • Acidifying foods and acid-forming foods are the same, making the body more acidic.
  • Alkalizing foods and alkaline-forming foods are the same, making the body more alkaline. ‘”

All right then, we get it that something acidic – like vinegar – could actually be alkaline once it’s ingested. And we understand that an alkaline balance can keep us healthier. But we have CKD. Is apple cider vinegar something we can take?

Kidney Hospital China at http://www.kidneyhospitalchina.org/ckd-healthy-living/961.html was helpful here, although I am still leery of websites that offer online doctor advice. They maintain that it can lower your blood pressure – a good thing since high blood pressure is not only a cause of CKD, but also can make it worse. They also consider it an anti-inflammatory, although I’m beginning to wonder if all alkaline foods are. Then they mention it helps prevent colds and removes toxins in the blood. Both will help relieve some of the kidney’s burden.

This warning was the first I’d seen in all the blogs and natural eating sites I perused for information about today’s topic… and it comes from Kidney Hospital China:

“Apple cider vinegar is high in potassium and phosphorus, so kidney disease patients who have high potassium and high phosphorus levels in blood need to avoid the intake of the drinks.”

In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, I referred to an article entitled Vegetarian diet helps kidney disease patients stay healthy in order to point out why we need to keep our phosphorous levels low:

“Individuals with kidney disease cannot adequately rid the body of phosphorus, which is found in dietary proteins and is a common food additive. Kidney disease patients must limit their phosphorous intake, as high levels of the mineral can lead to heart disease and death.”

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In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, I succinctly reminded us why we want to watch our potassium intake:

“But isn’t potassium good for you?  After all, it does help the heart, muscles, and our beloved kidneys function normally as well as dumping wastes from our cells. Here’s the kicker, an excess of potassium can cause irregular heartbeat and even heart attack.”

All in all, I think this might be a go. Do talk it over with your nephrologist or renal dietician before you start on a regiment of apple cider vinegar. I only research; they’ve been to medical school. By the way, many of these sites talked about the pleasing taste of this drink. I may have to try it just to see if any drink containing vinegar tastes good.

I have not forgotten that I promised to give you the link to the most recent podcast. I had thought the topic was going to be my Chronic Kidney Disease Awareness Advocacy, but the skillful interviewer – Mike G. – managed to cover every aspect of my life.

Until next week,

Keep living your life!

It’s Not Lemonade

Why drinking water with lemon is good for you screamed The Chicago Tribune at me today. Hmmm, I’d been wondering about that. Last week, happy birthdayI’d attended the 60th birthday celebration of my friend Naomi. She is studying nutritional counseling. That’s right: studying at age 60. As you can tell, no grass grows under the feet of the people in my social circle.

The celebration was held in one of the beautiful resorts out here in Arizona, The Sanctuary, in The Jade Bar to be exact. It was an odd location since this bar was long and narrow with couches and comfortable chairs lined up, but no place to mingle or chat in small groups. We ended up climbing over each other just to get to the rest room. Yet, my friend came running up to greet us.

Why? She wanted to know if I was drinking the water with lemon first thing in the morning as she’d suggested when I was a test case for one of her classes. She explained to me how important it was to people and her friends Lily and Patty leaned over to verify with their own personal anecdotes.

That, of course, got me to thinking. What was so special about this? Sure, it would warm up the vocal chords if you drank the lemon in warm water, but what else?

According to Tribune’s article at http://www.chicagotribune.com/lifestyles/health/sc-one-simple-thing-lemon-water-0420-20160415-story.html,

“Health experts say the acidity of the lemons improves digestion. Lemons contain potent antioxidants, which can also protect against disease, says Dr. Jonny Bowden, a nutritionist and health author. ‘It’s very alkalizing for the system,’ said the Woodland Hills, Calif.-based Bowden, whose lemonsbooks include “Smart Fat” and “The 150 Healthiest Foods on Earth.” Having a healthy alkaline balance helps fight germs.’”

Now this confused me. How can lemon – an acidic fruit – alkalinize your system?  Body Ecology at http://bodyecology.com/articles/acidic-foods-and-acid-forming-foods-do-you-know-the-difference had exactly what I needed:

“To clear up some of the confusion:

  • Acidic and alkaline describe the nature of food before it is eaten.
  • Acidifying foods and acid-forming foods are the same, making the body more acidic.
  • Alkalizing foods and alkaline-forming foods are the same, making the body more alkaline.”

I know, now you’re wondering what each of these terms mean. So am I…and I thought I knew. I turned to Online Biology Dictionary at http://www.macroevolution.net/biology-dictionary-aaaf.html:

“Acid – a sour-tasting compound that releases hydrogen ions to form a solution with a pH of less than 7, reacts with a base to form a salt, and turns blue litmus red…. An acid solution has a pH of less than 7.”

I used the same dictionary for the definition of alkaline, which referred me to the definition of alkali.

“Any metallic hydroxide other than ammonia that can join with an acid to form a salt (or with an oil to form soap).”

I didn’t find that very helpful so I turned to my old buddy The Merriam-Webster Dictionary at http://www.merriam-webster.com/dictionary/alkali

“a soluble salt obtained from the ashes of plants and consisting largely of potassium or sodium carbonate; broadly:  a substance (as a hydroxide or carbonate of an alkali metal) having marked basic properties”

Okay, that’s a little better, but not much. Let’s try this another way. I perused site after site. What I gleaned from these is that lemons are, indeed, acidic before they are eaten, but the body metabolizes them into alkaline. There was plenty of specific science to explain this, but I didn’t understand half of it and prefer to keep it simple.

Of course, then I wanted to know why I was even bothering to research this at all. LifeHacks at http://www.lifehack.org/articles/lifestyle/11-benefits-lemon-water-you-didnt-know-about.html, a new site for me, made it abundantly clear.

  1. Gives your immune system a boost.
  2. Excellent source of potassium.
  3. Aids digestion.
  4. Cleanses your system.CoffeeCupPopCatalinStock
  5. Freshens your breath.
  6. Keeps your skin blemish-free.
  7. Helps you lose weight.
  8. Reduces inflammation.
  9. Gives you an energy boost.
  10. Helps to cut out caffeine.
  11. Helps fight viral infections.

Now, you do have Chronic Kidney Disease, so be aware that lemons are a high potassium food. Potassium is one of the electrolytes we need to limit. Also, if you are prone to kidney stones, you’ll be very interested to know lemons are full of vitamin C, something you may need to avoid.

So far, it sounds like lemon juice in water upon waking is a good thing if you keep the two caveats above in mind but I think I’ll just check into this a bit more.

I looked in my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, and discovered this succinct explanation of why you want to keep the potassium levels under guard as a CKD patient:What is it

“Potassium is something you need to limit when you have CKD despite the fact that potassium not only dumps waste from your cells but also helps the kidneys, heart and muscles to function normally. Too much potassium can cause irregular heartbeat and even heart attack. This can be the most immediate danger of not limiting your potassium….

Keep in mind that as you age (you already know I’m in my 60s), your kidneys don’t do such a great job of eliminating potassium. So, just by aging, you may have an abundance of potassium. Check your blood tests. 3.5-5 is considered a safe level of potassium. You may have a problem if your blood level of potassium is 5.1-6, and you definitely need to attend to it if it’s above 6.  Speak to your nephrologist (although he or she will probably bring it up before you do).”

If you’re in the normal potassium range on your blood tests as I am, I say go for the lemon juice in water first thing in the morning. Of course, I’m not a doctor and – even if I were – I’m not your doctor, so check with him or her first.

Oh, hopefully by next week, I’ll be able to give you the address for the Edge Podcast I was interviewed on last week. It wasn’t just about CKD, much to my surprise… and maybe that of the Mike G’s (the interviewer), too.SlowItDownCKD 2015 Book Cover (76x113)

Until next week,

Keep living your life!IMG_1398