The incidence (or detection) of hyperuricemia, as well as gout, is increasing every year. The seafood-eating and beer-drinking nightlife of coastal city residents during the summer months has made gout attacks common. Many patients have co-existing metabolic diseases such as obesity, hypertension, hyperglycemia, and fatty liver.
Since hyperuricemia is asymptomatic and gout attacks are recurrent, many patients do not pay attention to it and "eat and drink, no pain, no medicine". There are also many patients who, after reading the instructions of commonly used uric acid-lowering drugs (benzbromarone, febuxostat, allopurinol, etc.), are afraid to use them for fear of adverse reactions to the drugs. In contrast, baking soda, which is recommended by doctors and commonly used for making porridge and noodles, has become the most common ingredient used by many patients.
Baking soda, whose scientific name is sodium bicarbonate, is an alkaline substance that has many familiar uses in daily life, such as cooking porridge and making noodles. Baking soda has also been used for a long time for medical purposes. In the past, it was commonly used to relieve heartburn, stomach pain, acid reflux, and other discomforts caused by excessive stomach acid. Today, it is commonly used by doctors in treating patients with high uric acid and gout to alkalize urine.
The acidity of urine affects the metabolism of uric acid
Hyperuricemia is a type of disease caused by abnormal purine metabolism in the body, resulting in excessive blood uric acid. Excessive uric acid forms crystalline deposits, which are deposited near the joints and can cause gout.
Seventy percent of blood uric acid is excreted through the kidneys, and 80 to 85 percent of patients with hyperuricemia are caused by inadequate excretion by the kidneys. Therefore, increasing uric acid excretion becomes the main treatment route. Blood uric acid flows with the blood through the kidneys and is first filtered from the glomerulus to form primary urine.
If blood uric acid is too high and exceeds the peak of renal tubular reabsorption, it results in more uric acid being eliminated from the final urine. The pH of urine (also known as acidity) is the main factor affecting uric acid in the final urine. When the urine is too acidic, the solubility of uric acid decreases, and less uric acid is eliminated, while uric acid is more likely to crystallize and precipitate for deposition.
If such tiny crystals are deposited in the renal medullary interstitium or deposited in the distal collecting duct, renal calyces, etc., they are often difficult to detect by ultrasound and other imaging examinations, and will appear as proteinuria, hematuria, edema, etc., as the damage to renal tubular function increases, and are clinically and customarily called uric acid nephropathy. If such stones are larger and are found in the renal calyces, pelvis, or ureter, they also fall under the category of uric acid nephropathy and are often referred to as urinary stones. While urinary stones often attract attention because of their pain, the former type of uric acid nephropathy, which is a hidden and small area, is more dangerous and should not be ignored.
To increase the excretion of uric acid in the blood, the most common non-pharmacological treatment is to drink more water. It is recommended that patients with hyperuricemia or gout drink at least 1500 to 2000 ml of water daily. Drinking more water can dilute urine and uric acid, thus raising the pH of urine. The next thing is to add foods that can alkalize urine appropriately, and baking soda is the first choice.
Baking soda alkalizes urine and prevents crystals from precipitating
Maintaining a certain urine pH is conducive to the maximum solubility of uric acid elimination, thus having a certain effect of reducing uric acid. Among the drugs for hyperuricemia and gout, baking soda is not a uric acid-lowering drug, and its role in lowering uric acid is negligible. Its main role is to alkalize urine and prevent the precipitation of uric acid crystals, thus reducing the health risks of uric acid nephropathy.
Uric acid-lowering drugs are mechanistically divided into two categories: inhibition of uric acid synthesis and increase in uric acid excretion. Alkalinization of urine becomes more important when treated with drugs that increase uric acid excretion. The classic drug that increases uric acid excretion is benzbromarone. Before using this class of drugs, it is important to monitor for urinary (uric acid) stones and to make it a contraindication to the use of this drug. This is because, with drugs that increase uric acid excretion, uric acid excretion increases, and urine pH will be lower, making it more likely that stones will form and worsen the damage of uric acid nephropathy. Therefore, in patients who do not have urinary stones and use the drug benzbromarone, which increases uric acid excretion, it is more important to focus on alkalinizing the urine. As opposed to whether to alkalinize the urine when using uric acid-lowering drugs that inhibit uric acid synthesis, it depends on the patient's condition.
It has been found that when the pH of urine is between 6.2 and 6.9, the solubility of the urate is high and most conducive to excretion from the urine. When the pH of urine is 5, 90% of uric acid is in a bound state, which can easily form urate stones and affect excretion; when the pH of urine is over 6.75, more than 90% of uric acid is in a free state, which can be easily excreted. For patients with hyperuricemia and gout, to maximize the dissolution and elimination of uric acid and prevent crystallization, it is necessary to actively monitor urinary pH and make adjustments to alkalize urine in this way, and also to avoid over-alkalization (pH ≥ 7).
How to use baking soda
The protocol for the use of baking soda is simple: 0.5 to 1 gram per dose, 3 times/day. The following points are suggested for your reference: the dose is not dead, and the urine pH should be actively monitored to maintain it at 6.2-6.9; during nighttime sleep, the blood flow to the kidneys is abundant, and the urine pH at this time may be different from daytime, plus there is no exercise and less water to drink at this time, which may be more conducive to uric acid crystals deposition, therefore, do not neglect the first urine pH monitoring before bedtime and in the morning, and consider adjusting the dosing time and For patients with gout who are not suitable for taking sodium bicarbonate, potassium bicarbonate can be used, as the latter has a lower sodium content and is more suitable for patients with cardiac insufficiency and hypertension.