Hi there
I am a genetics professor with polycystic kidney disease, and I do biomedical research at a major university. In the last few years I've had gout problems, and it is getting progressively worse. My diet has always been exemplary (low sodium, low protein), since my father had PKD and we always ate very healthily. My weight is also optimal. However, I haven't gotten enough input from my own physicians on this--they put me on allopurinol, but a low dose because the byproducts can harm the kidneys. It was only marginally helpful. And, as no surprise to you gout sufferers, I drink water like a fish (I estimate 140-160 oz/day).
When it got bad enough I started looking for alternative approaches that would still protect my kidneys, and I came across the baking soda treatment. I found the idea to be very appealing, because from a chemistry and physiology point of view, it makes a ton of sense that pushing the blood to a more basic pH would counteract uric acid crystal formation. I have tried it a couple of times, and it worked great for me.
But an obviously huge concern for a renal patient (and people with cardiac/circulatory disease or chronic hypertension) is the massive dose of sodium. A single Teaspoon of baking soda provides 48% of the USRDA of sodium, so the ârecommendedâ Tsp every 4 hours would lead to 2.5 times the USRDA daily sodium (assuming a missed dose at night), even if the patient is on an extremely low sodium diet otherwise. Such a sodium overdose is a bad idea for people with renal disease, as perpetuating renal function depends on keeping blood pressure low; higher blood pressure can accelerate the progress of renal disease. Given that one of the most common sources of gout is people with renal disease, it is critical to prevent them from ingesting too much sodium.
So I gave this much thought. I was convinced that the buffering activity of the bicarbonate was the critical factor. Further, I suspect that in a large number of gout patients, gouty arthritis is a combination of slightly lowered blood pH, elevated urate, decreased circulation and perhaps architecture of extremity joints. And perhaps certain medications can exacerbate some of these traits. This would explain why a horrendous diet can cause gout (but not necessarily!), but also explain why many (but not all!) renal patients experience gout, and furthermore why some non-renal patients with great diets experience gout.
After doing extensive research on blood buffering, I realized that baking soda is very much a sub-optimal agent to use, primarily because of the sodium (though the cost can't be beat!) There are other sources of bicarbonate; the simplest of these are different bicarbonate salts: potassium or magnesium bicarbonate should buffer just as well, and not be subject to anywhere near the risks of sodium bicarbonate (though I should note that high levels of any salt can be dangerous for certain people, especially those with complicating heart, circulation or kidney disorders. So consult your doctors!). Even calcium carbonate (i.e. Tums or other stomach antacids) is a possibility, though such a high percentage of the mass is calcium that one might get into issues of calcium over-dose without getting enough carbonate. From a pharmacological point of view, balancing the right amount of carbonate with the minimum potential side effects is the trick. Since no studies have been done, the right combination is still unknown, and one should proceed with great caution, and under the supervision of a qualified physician. But one possibility is to decrease the amount of sodium from baking soda by supplementing with other sources of carbonate buffer. To calculate the amount of any salt that is bicarbonate, refer to the periodic table or consult a physician.
I consulted a great friend of mine from graduate school who is now a nephrologist (he has an MD/PhD and is practicing medicine). As you may know, there are few who understand the flow of salts in the body better than a nephrologist, since kidney function is mostly an issue of salt and fluid flow. He pointed out that there are other, better bases than bicarbonate to use. For example, salts of citrate (sodium, potassium, or magnesium) should buffer just as well. In fact, potassium citrate is a mild base that is converted to bicarbonate in the liver, as are other salts of organic acids (for example, potassium lactate or potassium succinate), so essentially it is just another way of ingesting bicarbonate. In principle, any of these has the potential to counteract gout just as well as baking soda, and as long as non-sodium salts are used, the issue of sodium toxicity is avoided. My hunch is that a combination of salts is best: for example, low levels of baking soda supplemented by potassium or magnesium salts of citrate, lactate or succinate are the best bet. Personally, I am going to conduct an experiment on myself with potassium and magnesium citrate (since, as a renal patient, I should avoid sodium entirely). Obviously, as with any recommended treatment, I will consult my physicians first.
I should add one additional point. There is not a single effective dose for all gout sufferers, but instead people with different severity of gout probably need different doses. Consequently, I strongly recommend to all sufferers, especially those sticking with baking soda or other sodium salts, that you bring your dose down to the âas neededâ level. In other words, do what I am starting to do: use only the level and frequency of treatment required to deal with YOUR gout. Ingesting a large amount of any salt is a somewhat risky prospect, so to minimize your risk, it follows that you should limit your intake. By using far less baking soda than JJY2 recommends, I have greatly limited my gout. When I start feeling a little stiffness in my left ankle or right big toe (my typical gout spots), then I take some baking soda, and that seems to work fine for several days. By my calculation, I am taking more than 15 times less baking soda than recommended. But this is just my gout, and yours may be different. As always, CONSULT YOUR PHYSICIAN!!!
Furthermore, people should make sure to drink plenty of water. I know gout patients are used to this, but just because your gout is âcuredâ does not mean you are off the hook with regard to water. High intake of any salt functions as a diuretic, so you excrete a lot of water. Consequently, you can get dehydrated when pursuing a treatment like this, and it behooves people to make sure to get adequate fluid intake. And I recommend continuing the anti-gout lifestyle, including a low-purine diet and avoiding diuretics like caffeine, to minimize the amount of anti-gout agent you take. Finally, if you have advanced kidney disease, or other diseases sensitive to levels of various salts, please be very careful! Abnormal salt or water intake can be extremely dangerous, especially if you are on dialysis or getting to that stage. One should coordinate this treatment with your physician and monitor key signs as carefully as you would during treatment with a potent prescription drug. Just because things are sold without prescription, or in a grocery store, does not mean that they arenât dangerous when ingested at high levels!