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!

How Sweet It Is… Or Is It?

Thanksgiving is over and I thought I’d learn from that not so successful experience (as far as energy and proper eating only – it was a delicious experience having my step-daughter to ourselves), but I’m not so sure I have.  Hence, excerpts from two helpful articles.  When I scan the internet for articles to present on the blog, I usually end up finding some that help me with my own difficult areas.  Odd how the universe takes care of you, isn’t it?  I raised my children to believe that things happen for a reason whether we know the reason or not, and am so gratified to hear them remind me of that time after time.  You’ll understand as you read today’s blog.

Fructose Raises Risk for Kidney Disease, Hypertension

By David Liu, Ph.D.

 Saturday, Nov 19, 2011 (foodconsumer.org) — Eating too much fructose may cause a series of diseases including fatty liver, insulin resistance or diabetes, dyslipidemia, hypertension and kidney disease, according to a report in the Nov 2011 issue of International Journal of Nephrology. In the report, Marek Kretowicz of Nicolaus Copernicus University in Torun Porland and colleagues reviewed 62 studies and concluded that studies suggest that excessive fructose intake may be one of the causes for the current epidemic of obesity, diabetes and cardiorenal disease. Fructose is a monosaccharide present in sucrose (beet sugar, cane sugar etc), high fructose corn syrup (hfcs), honey and fruits.
 
The researchers cited studies as suggesting that not all fructose sources are the same.  Not all sources of fructose cause diabetes, kidney disease and cardiovascular disease. The researchers said natural sources of fructose such as fruits are rich in beneficial nutrients like antioxidants, vitamin C or ascorbic acid, polyphenols, potassium, and fiber that may counter the adverse effect of fructose. Previous studies found fructose intake was not correlated with increased risk of high blood pressure or hypertension in a population in which much of the fructose intake came from fruits.  However, the association was found significant when the fructose from fruits was excluded. According to the report, fructose can cause fatty liver and glycogen accumulation, insulin resistance and islet dysfunction, obesity, hypertension and vascular disease, and kidney disease.  {Me:  Get the message?  Fruit, not candy or cakes.  Now where have I heard that before?}
 
You can find the article at: http://www.foodconsumer.org/newsite/Nutrition/Food/fructose_kidney_disease_diabetes_hypertension_1119110936.html
 
The following is an excerpt, but it just might be worth your while to read the entire article at: http://www.kevinmd.com/blog/2011/11/living-chronic-illness-holiday-season.html?utm_medium=twitter&utm_source=twitterfeed  I know a great deal of my problem with celebrations is that, not only do others not understand that I don’t have the energy I used to (say, isn’t that true of a great many people who are not ill, simply aging?), but half the time I don’t, so the day of the dinner, party, etc. comes and I’m too tired from the preparations to enjoy it.  I’ve got to grow up and stop this ridiculous cycle.  Thank you, Toni.
 

Living with chronic illness during the holiday season

….Bottom line, suffering from a chronic condition can be an ongoing crisis—for you and for those you’re close to. That crisis can come to a head during the holidays when people’s expectations of one another are high and when stress levels for everyone are likely to be off the charts for any number of reasons—health, financial, relationship issues. ….when the holidays arrive, you’re suddenly thrust into the middle of a lively and chaotic social scene where you’re expected to participate in a range of activities, often for days in a row. A bit of advance warning to loved-ones can go a long way toward minimizing stress levels over unrealistic expectations….If you’re one of the many people with chronic health problems who don’t look sick, the initiative is with you to make your condition visible. Here are some suggestions for helping loved-ones understand what your life is like and for giving them a heads-up on what to expect from you during the holidays.

Share information with them from the Internet or from books

Often the best way to educate loved-ones about chronic pain and illness is to use a neutral source because it takes the emotional impact out of the communication….. Print out select pages or forward a few links to family and close friends. Alternatively, if you have a book about your condition {like mine!}, photocopy the pages that cover what you’d like them to know about you. In your accompanying note, keep it “light”—you could joke that “there won’t be a test.” But also make it clear that this favor you’re asking is important to you.

Write a letter

….Without complaining, express how difficult it’s been for you to adjust to this unexpected change in your life and how you wish you could be as active as you once were during the holidays….I would end by telling them what to expect from you during the holidays—that you may have to skip some events, that you may have to excuse yourself right after eating to go lie down, that you may have to come late and leave early. In my experience, spelling out my limitations ahead of time is helpful not just to others, but to me, because I find it much easier to exercise the self-discipline it takes to excuse myself from a room full of people if I know that at least some of them are already expecting it….

Find that ONE ally and enlist his or her help

….It’s so helpful for me to be “prompted” by my ally because, when I start to overdo things, adrenaline kicks in which fools me into thinking I’m doing fine. But using adrenaline to get by just sets me up for a bad crash later on. Your ally may be a close friend or family member who’s just waiting for you to enlist his or her help. Think long and hard before you decide there’s no such person in your life.

In the end, you may have to recognize that some loved-ones may never accept your limitations

….Just as you can’t force people to love you, you can’t force people to accept you. But getting angry at them just exacerbates your own symptoms. That’s why it’s important to protect yourself from allowing their lack of understanding to continually upset you. Think of it as protecting yourself from another chronic condition: chronic anger….

Thank you to both contributing authors for helping me understand my life at this time of the year.

Shifting gears here, all.  Libre (see the blog roll) has asked me to host a tweet chat on January 9th from 8-9 p.m. EST. I’ll throw out some topics and you tweet your feelings or thoughts about them.  This is a first for me, so thank you Mandy from Libre for making certain my other foot followed me into the 21st century.  But wait!  That’s not all! (Do I sound like 3 a.m. tv commercials?), there have been book signings in the east valley and the west valley – locals will understand I mean the Valley of the Sun or Phoenix and the surrounding areads, everyone needs to make plane reservations – but not in the south valley.  That will soon be remedied: I’ll be signing at Bookmans, 1056 S. Country Club Dr., Mesa on January 14th from 1-3.

Have a wonderful holiday, whether you celebrate Christmas, Chanukah (tonight is the first candle lighting), Kwaaza or another I haven’t discovered yet.  How incredible it is that it’s already this time of year.

Until next week,

Keep living your life!