Glucocorticoid activity and metabolism with NaCl-induced low-grade metabolic acidosis and oral alkalization: results of two randomized controlled trials.
Study Goal
The researchers aimed to investigate the effects of alkaline supplementation and sodium chloride (NaCl)-induced low-grade metabolic acidosis on glucocorticoid activity and metabolism.
Results Summary
Alkaline supplementation (KHCO3) reduced markers of adrenal glucocorticoid secretion and bioactive-free glucocorticoids, but NaCl reduction did not show the expected fall in glucocorticoid activity when net acid excretion increased. Diet-induced acidification/alkalization affects glucocorticoid metabolism, potentially contributing to bone degradation and cardiometabolic risks.
Population
Eight young, healthy, normal-weight men.
Effective Dosage
High NaCl diet (32 g/day in Study A, 31 g/day in Study B), low NaCl diet (3 g/day in Study B), supplemented with 90 mmol KHCO3/day in Study A.
Duration
10 days per intervention in Study A, 14 days per intervention in Study B.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
high dietary acid load | increase | bone and protein catabolism | - | - | has been shown to increase | #1 |
sodium chloride (NaCl) intake | increase | bone and protein catabolism | - | - | has been shown to increase | #2 |
supplementation of 90 mmol KHCO3 | decrease | marker of total adrenal GC secretion (THF + 5α-THF + THE) | eight young, healthy, normal-weight men | - | dropped | #3 |
supplementation of 90 mmol KHCO3 | decrease | potentially bioactive-free GCs (urinary-free cortisol + free cortisone) | eight young, healthy, normal-weight men | - | reduced | #4 |
NaCl-reduction | no change | GC secretion | eight young, healthy, normal-weight men | - | did not exhibit the expected fall | #5 |
NaCl-reduction | no change | potentially bioactive-free GCs | eight young, healthy, normal-weight men | - | did not exhibit the expected fall | #6 |
NaCl-reduction | increase | net acid excretion | eight young, healthy, normal-weight men | 30 mEq/d | was raised | #7 |
Diet-induced acidification/alkalization | neutral | GC activity and metabolism | - | - | affects | #8 |
long-term ingestion of habitually acidifying western diets | increase | bone degradation and cardiometabolic diseases | - | - | may constitute an independent risk factor for | #9 |
Low-grade metabolic acidosis (LGMA), as induced by high dietary acid load or sodium chloride (NaCl) intake, has been shown to increase bone and protein catabolism. Underlying mechanisms are not fully understood, but from clinical metabolic acidosis interactions of acid-base balance with glucocorticoid (GC) metabolism are known. We aimed to investigate GC activity/metabolism under alkaline supplementation and NaCl-induced LGMA. Eight young, healthy, normal-weight men participated in two crossover designed interventional studies. In Study A, two 10-day high NaCl diet (32 g/d) periods were conducted, one supplemented with 90 mmol KHCO3/day. In Study B, participants received a high and a low NaCl diet (31 vs. 3 g/day), each for 14 days. During low NaCl, the diet was moderately acidified by replacement of a bicarbonate-rich mineral water (consumed during high NaCl) with a non-alkalizing drinking water. In repeatedly collected 24-h urine samples, potentially bioactive-free GCs (urinary-free cortisol + free cortisone) were analyzed, as well as tetrahydrocortisol (THF), 5α-THF, and tetrahydrocortisone (THE). With supplementation of 90 mmol KHCO3, the marker of total adrenal GC secretion (THF + 5α-THF + THE) dropped (p = 0.047) and potentially bioactive-free GCs were reduced (p = 0.003). In Study B, however, GC secretion and potentially bioactive-free GCs did not exhibit the expected fall with NaCl-reduction as net acid excretion was raised by 30 mEq/d. Diet-induced acidification/alkalization affects GC activity and metabolism, which in case of long-term ingestion of habitually acidifying western diets may constitute an independent risk factor for bone degradation and cardiometabolic diseases.