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Effects of dietary protein-load and alkaline supplementation on acid–base balance and glucose metabolism in healthy elderly

European Journal of Clinical Nutrition volume 74, pages 48–56 (2020)Cite this article

Abstract

Background/Objectives

Metabolism is controlled by macro- and micronutrients. Protein-rich diets should lead to latent acidosis at tissue level with further negative implications. Food supplements with alkaline salts are available and popular pretending to prevent these changes.

Subjects/Methods

Within a randomised double-blind placebo-controlled trial we tested the hypotheses that (1) a 4-week protein-rich diet induces a latent tissue acidosis and (2) an alkaline supplement can compensate this. Acid–base balance and important metabolic parameters were determined before and after 4 weeks of supplementation by peripheral blood samples, indirect calorimetry and muscle microdialysis before and after a protein-rich test meal.

Results

Fourty volunteers were randomised 1:1 to either verum or placebo supplements. Protein-rich diet by itself did not significantly affect acid–base balance. Alkaline supplementation increased plasma bicarbonate concentration without changing pH. Postprandial increases in serum glucose and insulin tended to be lower for verum vs. placebo. Resting and postprandial energy metabolism, and carbohydrate and fat oxidation did not differ significantly before and after supplementation in both groups. In muscle, postprandial glucose uptake and aerobic glucose oxidation were significantly higher for verum. In addition, verum significantly increased serum magnesium concentrations.

Conclusions

Four weeks of protein-rich diet did not significantly influence acid–base balance. However, alkaline supplementation improved systemic and tissue acid–base parameters and oxidative glucose metabolism.

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Fig. 1
Fig. 2
Fig. 3: Serum glucose and insulin response after a protein-rich test meal before (V1) and after (V2) 4 weeks on a protein-enriched diet and with supplementation of alkaline salts (Verum) or placebo.
Fig. 4: Absolute (top) and relative (middle) changes in energy expenditure (EE) and also changes in respiratory exchange ratio (RER, VCO2/VO2, bottom) after a protein-rich test meal before (V1) and after (V2) 4 weeks on a protein-enriched diet and with supplementation of alkaline salts (Verum) or placebo.
Fig. 5: Muscle dialysate glucose, lactate and pyruvate response after a protein-rich test meal before (V1) and after (V2) 4 weeks on a protein-enriched diet and with supplementation of alkaline salts (Verum) or placebo.

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References

  1. Bushinsky DA. Acid-base imbalance and the skeleton. Eur J Nutr. 2001;40:238–44.

  2. Pizzorno J, Frassetto LA, Katzinger J. Diet-induced acidosis: is it real and clinically relevant? Br J Nutr. 2010;103:1185–94. https://doi.org/10.1017/S0007114509993047.

  3. Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC, Jr. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr. 2002;76:1308–16. https://doi.org/10.1093/ajcn/76.6.1308.

  4. Frassetto LA, Todd KM, Morris RC, Jr., Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr. 1998;68:576–83. https://doi.org/10.1093/ajcn/68.3.576.

  5. Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr. 1994;59:1356–61. https://doi.org/10.1093/ajcn/59.6.1356.

  6. Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995;95:791–7. https://doi.org/10.1016/s0002-8223(95)00219-7.

  7. Remer T, Dimitriou T, Manz F. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. Am J Clin Nutr. 2003;77:1255–60. https://doi.org/10.1093/ajcn/77.5.1255.

  8. Susantitaphong P, Sewaralthahab K, Balk EM, Jaber BL, Madias NE. Short- and long-term effects of alkali therapy in chronic kidney disease: a systematic review. Am J Nephrol. 2012;35:540–7. https://doi.org/10.1159/000339329.

  9. Jeong J, Kwon SK, Kim HY. Effect of bicarbonate supplementation on renal function and nutritional indices in predialysis advanced chronic kidney disease. E&BP. 2014;12:80–87. https://doi.org/10.5049/ebp.2014.12.2.80.

  10. Berkemeyer S, Vormann J, Gunther AL, Rylander R, Frassetto LA, Remer T. Renal net acid excretion capacity is comparable in prepubescence, adolescence, and young adulthood but falls with aging. J Am Geriatr Soc. 2008;56:1442–8. https://doi.org/10.1111/j.1532-5415.2008.01799.x.

  11. Mähler A, Steiniger J, Bock M, Klug L, Parreidt N, Lorenz M. et al. Metabolic response to epigallocatechin-3-gallate in relapsing-remitting multiple sclerosis: a randomized clinical trial. Am J Clin Nutr. 2015;101:487–95. https://doi.org/10.3945/ajcn.113.075309.

    Article  PubMed  CAS  Google Scholar 

  12. Ferrannini E. The theoretical bases of indirect calorimetry: a review. Metab Clin Exp. 1988;37:287–301.

  13. Paddon-Jones D, Leidy H. Dietary protein and muscle in older persons. Curr Opin Clin Nutr Metab Care. 2014;17:5–11. https://doi.org/10.1097/MCO.0000000000000011.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Ceglia L, Harris SS, Abrams SA, Rasmussen HM, Dallal GE, Dawson-Hughes B. Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. J Clin Endocrinol Metab. 2009;94:645–53. https://doi.org/10.1210/jc.2008-1796.

    Article  PubMed  CAS  Google Scholar 

  15. Mardon J, Habauzit V, Trzeciakiewicz A, Davicco AM, Lebecque P, Mercier S. et al. Long-term intake of a high-protein diet with or without potassium citrate modulates acid-base metabolism, but not bone status, in male rats. J Nutr. 2008;138:718–24. https://doi.org/10.1093/jn/138.4.718.

    Article  PubMed  CAS  Google Scholar 

  16. Harris SS, Dawson-Hughes B. No effect of bicarbonate treatment on insulin sensitivity and glucose control in non-diabetic older adults. Endocr. 2010;38:221–6. https://doi.org/10.1007/s12020-010-9377-6.

    Article  CAS  Google Scholar 

  17. Graf S, Egert S, Heer M. Effects of whey protein supplements on metabolism: evidence from human intervention studies. Curr Opin Clin Nutr Metab Care. 2011;14:569–80. https://doi.org/10.1097/MCO.0b013e32834b89da.

    Article  PubMed  CAS  Google Scholar 

  18. Blottner D, Bosutti A, Degens H, Schiffl G, Gutsmann M, Buehlmeier J, et al. Whey protein plus bicarbonate supplement has little effects on structural atrophy and proteolysis marker immunopatterns in skeletal muscle disuse during 21 days of bed rest. J Musculoskelet Neuronal Interact. 2014;14:432–44.

    PubMed  CAS  Google Scholar 

  19. Garibotto G, Russo R, Sofia A, Sala MR, Sabatino C, Moscatelli P, et al. Muscle protein turnover in chronic renal failure patients with metabolic acidosis or normal acid-base balance. Min Electro Metab. 1996;22:58–61.

  20. Dawson-Hughes B, Harris SS, Ceglia L. Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr. 2008;87:662–5. https://doi.org/10.1093/ajcn/87.3.662.

  21. Volpe SL. Magnesium, the metabolic syndrome, insulin resistance, and type 2 diabetes mellitus. Crit Rev Food Sci Nutr. 2008;48:293–300. https://doi.org/10.1080/10408390701326235.

  22. Barbagallo M, Dominguez LJ. Magnesium metabolism in type 2 diabetes mellitus, metabolic syndrome and insulin resistance. Arch Biochem Biophys. 2007;458:40–47. https://doi.org/10.1016/j.abb.2006.05.007.

  23. Dong JY, Xun P, He K, Qin LQ. Magnesium intake and risk of type 2 diabetes: meta-analysis of prospective cohort studies. Diabetes Care. 2011;34:2116–22. https://doi.org/10.2337/dc11-0518.

  24. Song Y, He K, Levitan EB, Manson JE, Liu S. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23:1050–6. https://doi.org/10.1111/j.1464-5491.2006.01852.x.

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Acknowledgements

The excellent technical assistance of Mrs. Gabriele Frank is gratefully acknowledged.

Funding

The trial was financed by Protina Pharmazeutische GmbH, Ismaning, Germany, producer of Basica® Direkt. This article is published as part of a supplement sponsored by NuOmix-Research k.s. The conference was financially supported by Protina Pharmazeutische GmbH, Germany and Sirius Pharma, Germany, and organized by NuOmix-Research k.s. Neither company had any role in writing of the paper.

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Authors and Affiliations

  1. Experimental and Clinical Research Center (ECRC) – a joint co-operation between Charité - Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany

    Michael Boschmann, Nikoletta Kaiser, Anja Klasen, Lars Klug & Anja Mähler

  2. Berlin Institute of Health, Berlin, Germany

    Michael Boschmann, Lars Klug & Anja Mähler

  3. DZHK (German Centre for Cardiovascular Research), Berlin, Germany

    Anja Mähler & Rainer Stange

  4. Department for Internal and Integrative Medicine, Charité - Universitätsmedizin Berlin and Immanuel Krankenhaus, Berlin, Germany

    Andreas Michalsen & Rainer Stange

  5. Institut für Prävention und Ernährung, Ismaning, Germany

    Juergen Vormann

  6. NuOmix Research k.s. Applied Nutriomic Research, Martin, Slovakia

    Tanja Werner

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  1. Michael Boschmann
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Contributions

MB, AMi, and RS developed the study protocol and wrote the paper; LM and AMä recruited and screened the probands; MB, NK, AK, and LK conducted the study; MB, NK, and RS analyzed the data; JV, TW, and RS reviewed and edited the paper.

Corresponding author

Correspondence to Rainer Stange.

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Conflict of interest

JV received consulting fees from TW and owns equity in NuOmix k. s. The authors declare that they have no conflict of interest.

Ethical approval

Approval was given by the ethical committee of Charité - Universitätsmedizin Berlin (EA1-292-12).

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Boschmann, M., Kaiser, N., Klasen, A. et al. Effects of dietary protein-load and alkaline supplementation on acid–base balance and glucose metabolism in healthy elderly. Eur J Clin Nutr 74 (Suppl 1), 48–56 (2020). https://doi.org/10.1038/s41430-020-0695-3

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