“Bi-carb,” Buy Time: Sodium Bicarbonate

Authored by: Thomas Chun 

Art by: Julia Chen

Ever think that something in your kitchen can save someone’s life? No, I am not talking about the fruits and vegetables sitting in your fridge that keep the doctor away. I am talking about that familiar orange box of white powder that you always see on your shelf: baking soda. Yes, that same stuff that makes your volcano science project “blow up” when mixed with vinegar. Baking soda, also known as sodium bicarbonate, is one of most versatile products with the ability to clean, deodorize, or even cook, but its use case has expanded beyond household appliances.

Whenever you feel like you are pushing the physical limits of your body and have to catch your breath, you may notice a burning sensation throughout your body, almost like an acid boiling in your blood. For many of us, it is even a sign we are exercising properly. That is called lactic acidosis, a buildup of waste in your blood and letting your body know where it needs help. Recent studies have found that sodium bicarbonate, or more popularly known as “bicarb,” has the ability to buffer that feeling. It works by changing your blood pH to be more efficient at getting rid of the acid, allowing you to perform without fatigue for a little longer. It is increasingly being used  in endurance sports such as running and cycling, and there is substantial evidence that backs its capabilities of being a performance enhancer. 

That same science behind improving athletic performance has shown to save people suffering from kidney problems. Kidneys are an essential part of the human body that flush out waste from your blood and maintain the body’s internal balance, but in some cases, they gradually lose their ability to filter. This condition is known as chronic kidney disease (CKD), which is where kidneys are not functioning properly and acids start to build up in the blood, leading to a multitude of problems. Bone loss, muscle weakness, and faster decline in kidney function to name a few [1]. And it is more common than you might think with over 1 in 7 adults in the U.S. affected and up to 90% unaware that they are. [2,3]. With so many people affected, it’s concerning that there is no definitive cure.  However, one treatment approach involving sodium bicarbonate has emerged to help neutralize this problem. 

Addressing the root of the problem, since sodium bicarbonate is alkaline and makes your blood more efficient at clearing waste, it has shown promising results of correcting the acid buildup. [4] For patients with CKD, doctors may prescribe oral bicarbonate therapy to restore a healthier balance. While it is still a relatively new treatment, clinical studies over the past decade have shown that patients receiving the treatment experience slower decline in kidney function, reduced risk of progression to end-stage renal disease, improved nutritional status, and preservation of muscle mass [1,5]. Some randomized trials have demonstrated that patients receiving bicarbonate therapy had better estimated glomerular filtration rate (eGFR), which is the measurement of how well your kidney filters waste, trends compared to those who did not receive treatment [6]. Furthermore, what makes this treatment so polarizing is that it is cheap and easily accessible [7]. 

Despite a number of positive results supporting the use of bicarb, there are still drawbacks. Since sodium bicarbonate contains sodium as the name implies, clinicians must weigh benefits against risks, such as elevated blood pressure and fluid retention [8]. The most obvious drawback is that the therapy does not necessarily eliminate the disease. While it does not regenerate damaged kidneys, bicarb can help with correcting  key imbalances It can help protect muscle, support bone health, and delay more invasive treatments. 

Despite no cure for CKD, these findings reframe how we think about medical success ie. buying more time. It means preserving independence and allowing someone to keep walking, spend active time with family, or even lift groceries. 

References:

1. de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology, 20(9), 2075–2084. https://doi.org/10.1681/ASN.2008111205

2. National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Kidney disease statistics for the United States. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease

3. Centers for Disease Control and Prevention. (2023). Chronic kidney disease in the United States, 2023. U.S. Department of Health and Human Services. https://wwwn.cdc.gov/KDSS/Documents/CKD_FactSheet_2023.pdf

4. Goraya, N., Simoni, J., Jo, C.-H., & Wesson, D. E. (2013). A comparison of treating metabolic acidosis in chronic kidney disease with fruits and vegetables or sodium bicarbonate. American Journal of Kidney Diseases, 63(5), 737–744. https://doi.org/10.1053/j.ajkd.2013.01.017

5. Cheng, F., Li, Q., Wang, J., Wang, Z., Zeng, F., & Zhang, Y. (2021). The Effects of Oral Sodium Bicarbonate on Renal Function and Cardiovascular Risk in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Therapeutics and clinical risk management, 17, 1321–1331. https://doi.org/10.2147/TCRM.S344592

6. Melamed, M. L., Raphael, K. L., Hostetter, T. H., & others. (2024). Sodium bicarbonate treatment and clinical outcomes in chronic kidney disease with metabolic acidosis: A meta-analysis. Clinical Journal of the American Society of Nephrology, 19(8). 959–969. https://doi.org/10.2215/CJN.0000000000000487

7. Smith, T. (2024, January 11). Is baking soda (sodium bicarbonate) a friend to people who have kidney transplants? A study is underway. UCHealth Today. https://www.uchealth.org/today/study-does-sodium-bicarbonate-reduce-metabolic-acidosis-risk-for-kidney-transplant-patients/

8. Wu, Y., Wang, Y., Huang, W., Guo, X., Hou, B., Tang, J., Wu, Y., Zheng, H., Pan, Y., & Liu, W. J. (2024). Efficacy and safety of oral sodium bicarbonate in kidney-transplant recipients and non-transplant patients with chronic kidney disease: a systematic review and meta-analysis. Frontiers in pharmacology, 15, 1411933. https://doi.org/10.3389/fphar.2024.1411933