Clinically Trialled Alkalising Minerals - Technical Data Bio-Practica

Clinically Trialled Alkalising Minerals Technical Data Acid-Base Balance Everything around us depends on the right balance of acid and alkalinity. The ocean, the soil, plants, animals and humans, all require the correct pH level for life. Nearly every biological process in the human body requires the appropriate acid-base balance;1 human life requires a tightly controlled pH to survive.2 However, because of the agriculture revolution and industrialisation, the world has changed and so has the pH levels. The ocean pH has changed from 8.2 to 8.1, which impacts on ocean life, including coral reefs. The soil pH has changed so that now dolomite and manure are added to raise the pH from an acidic state to a pH above 6.2-4 Ultimately, this affects the availability of nutrients within the food consumed and the environment in which we live and breathe every day.

Prehistoric Diet to the Diet of Today The prehistoric hunter-gatherer diet was rich in nutrients and low in acid forming foods; it is the diet best suited to the human physiology, even today.5,6 Plants were a major part of their diet; it is estimated that the Paelolithic diet was made up of 35% meat and 65% plant matter.5 Additionally, they consumed plants that were rich in the alkalising nutrients and metabolisable anions, such as potassium, calcium, magnesium, and citrates.4 In fact, a hypothetical analysis showed the hunter-gatherers diets’ were 87% alkaline producing.3

Today, the human diet contains high amounts of acidic animal protein and cereal grains and low levels of alkalising plant matter, which are also lower in nutrients than our predecessors’ fruits and vegetables.5,7 Another important change has been the decrease in potassium to sodium ratio and an increase in chloride compared to bicarbonate.2 Previously the ratio of potassium to sodium was 10:1; our modern diet is 1:3;2 a dramatic difference, which contributes substantially to the acid-base imbalance . We are consuming diets low in magnesium, potassium, fibre, but high in saturated fat, simple sugars, sodium and chloride.2 This is the result of the agricultural and industrial revolutions. The progress of the modern world has meant humans generate an acid load that is not balanced with adequate, nutritionally rich fruit and vegetables.4

‘Generally, the Western diet induces a chronic, low-grade metabolic acidosis.’8

What is Acid-Base Homeostasis? Acid-base homeostasis is the intricate balance between an acidic environment and a base, or alkalising environment. Part of the human body’s role in maintaining homeostasis is the tight regulation of pH balance inside and outside of every cell; this is critical for any enzyme-controlled metabolic process.7 The measurement of acidity and alkalinity is the pH, which can be defined as an abbreviation for potential hydrogen, a scale representing the relative acidity (or alkalinity) of a solution, in which a value 7.0 is neutral, below 7.0 is acid, and above 7.0 is alkaline. The numeric pH value indicates the relative concentration of hydrogen atoms in the solution compared with that of a standard (one molar) solution; it is equal to the negative log of the hydrogen ion concentration expressed in moles per litre.9

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A slightly more complex definition of acids and bases is that an acid is a proton donor and a base is a proton acceptor. Generally speaking, acids contain positively charged cations and bases contain negatively charged anions.

1 2 3 4 5 6 7 8 9 10 11 12 13 14

neutral increasingly acidic increasingly alkaline

Acids yield excess Hydrogen (H+) ions Bases yield hydroxide (OH-) ions when dissolved in water when dissolved in water

Disturbances in the acid-base balance include acidosis or alkalosis.1 Acidosis is the process or trend towards acidaemia.3 It indicates an excess of hydrogen ions and can be categorised as metabolic, latent or respiratory acidosis.1 When the body’s compensatory measures for dealing with the excess hydrogen ions are exhausted, acidosis becomes acidaemia.3 The opposite of acidosis is alkalosis. This is the process towards a reduction in hydrogen ions and a more alkaline environment.1

Metabolic versus Latent Acidosis Metabolic acidosis is when there is a measurable decrease in blood pH6 and is usually associated with a condition, such as diabetic acidosis or kidney disease; however diet-induced metabolic acidosis is now evident.4 Latent acidosis, on the other hand, often involves only a slight shift in the blood pH, nearer the lower end of the normal range. It is more common than metabolic acidosis and is a chronic situation, without acute symptoms.6 This is less severe than metabolic acidosis but even a low degree of acidosis is significant and slight deviations in the blood’s pH value can lead to severe metabolic disturbances.3,6 The long-term physiological consequence of a chronic low-grade acidosis, or latent acidosis, has potential to be very detrimental on health.6 Additionally, as it affects a wide cross-section of the population,6 most of us may be living with latent acidosis on a daily basis, without even knowing it.

pH of Selected Fluids, Organs, and Membranes.

Organ, fluid or membrane pH Function of pH

(1) Skin Natural pH is between 4 and 6.5 [17] Barrier protection from microbes (2) Urine 4.6 to 8.0 [18] Limit overgrowth of microbes (3) Gastric 1.35 to 3.5 Break down protein (4) Bile 7.6 to 8.8 Neutralize stomach acid, aid in digestion (5) Pancreatic fluid 8.8 Neutralize stomach acid, aid in digestion (6) Vaginal fluid <4.7 [13] Limit overgrowth of opportunistic microbes (7) Cerebrospinal fluid 7.3 Bathes the exterior of the brain

(8) Intracellular fluid 6.0 - 7.2 [19] Due to acid production in cells (9) Serum venous 7.35 Tightly regulated (10) Serum arterial 7.4 Tightly regulated

Table1: PH of selected fluids, organs and membranes. From Schwalfenberg GK. The Alkaline Diet: Is There Evidence That an Alkaline pH Diet Benefits Health? J Environ Public Health 2012;Epub [ahead of publication]

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How Nutrients Affect Acid-Base Balance Fruit and vegetables contain high levels of potassium salts of metabolisable anions, including citrate, and other alkalising minerals, such as magnesium. These anions consume hydrogen ions when they are metabolised and by doing so increase the alkalinity of the environment. Citrate bound minerals are highly effective at neutralising acidosis. Citrate is very alkalising and has high bioavailability. Additionally, plant matter contains high levels of glutamate, which also consumes hydrogen to bring the environment to a neutral position. Animal proteins and cereal grains, on the other hand, contain sulphur containing amino acids, which when metabolised produce the highly acidic non- metabolisable anion, sulphate.4 Therefore, those on animal-based diets have more acidic urine and higher kidney net acid, sulphate, phosphate, chloride and uric acid excretion than those on a vegetarian diet.4

The Benefits of Mineral Citrates Minerals bound to citric acid (for example potassium citrate) contrary to what their name suggests, have a powerful buffering effect in the body. This is due to the fact that citric acid consumes hydrogen ions (H+) when metabolised and

is then converted to water and carbon dioxide (C02). We exhale the acidic C02 and only the alkaline components are left, leaving a net alkaline effect on the body and why citrates have been shown to increase urinary pH.6

Unlike bicarbonates, citrates do not dissociate in the stomach and do not neutralize gastric acid function. Citrates have a long lasting, intense basic effect where as bicarbonates have fast but not continuous basic effects.

Organically bound Sodium citrate

minerals Na3(C6H5O7)

Dissociation

3- + Organic anion (C6H5O7) + 3 Na + H+ + H+

Protonation

Organic acid H3(C6H5O7)

Break Down

Carbon dioxide H2O + CO2 + water

Elimination

Figure 1: Function of organically bound minerals in the elimination of acids as shown for the example of sodium citrate. From: Vormann J, Goedecke T. Acid-Base Homeostasis: Latent Acidosis as a Cause of Chronic Diseases. Swiss Journal of Integrative Medicine 2006;18:255-66.

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Causes of Acidosis

• A diet high in animal protein and cereal grains and low in alkalising minerals and nutrients • Excess intake of sodium chloride • Inflammation • High anaerobic exercise • Dieting and fasting • Gastroenteritis • Phosphoric acid containing soft drinks • Diabetes • Aging • Menopause • Androgen deficiency • Diarrhoea • Pancreatic and biliary disease • Fractures • Renal and respiratory disease • Tumours10

The main causes of latent acidosis are advancing age, and the subsequent decline in kidney function, and diet.3

Kidney Aging Diet Acidity function +

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Regulation of Acid-Base Homeostasis The body has numerous buffering and compensatory systems within the blood, bone, kidneys extracellular matrix and within cells to bind and neutralise any additional hydrogen or hydroxide ions.6

The kidneys play an important role in maintaining the acid-base balance. As stated earlier, the intake of excess animal protein increases the excretion of sulphates, phosphates and chlorides. The excretion of these non-metabolisable anions is an adaptive process by the kidneys to restore ionic balance. During this process, calcium is lost in the urine and the urinary excretion of citrate, a hydrogen consuming anion, is decreased.6 This necessary attempt to compensate for the low pH level may have adverse consequences.

Acidic urine is linked to uric acid stone formation, while low levels of citrate and high levels of calcium in the urine are linked to calcium kidney stone formation.4 The intake of magnesium and potassium greatly reduces the risk of calcium kidney stones.11 In addition to the calcium loss, acidosis also blocks the reabsorption of magnesium in the kidneys causing an increased magnesium loss.8

Another important fact is that the elderly, regardless of health or diet, may be affected by latent acidosis; one of the main causes of acidosis is reduced renal function, which occurs as we age.11

This information reiterates the need for adequate mineral intake, on a daily basis, to reduce the acidogenic load and prevent the potential side effects of the kidney’s compensatory mechanisms.

Compensation Mechanisms of Latent Acidosis

Urine Kidney Blood Bone + + blood pH 2+ 3- 1. [NH4 ] 1. NH4 formation 1. Ca /PO4 release - + 2. [H2PO4 ] 2. H secretion 2. osteoblast activity + +

2+ H H 3. [Ca ] 3. citrate reabsorption Alkali 3. osteoclast activity release Elimination + 2+ Elimination - 4. [H ] 4. Ca reabsorption [HCO3 ] 5. [citrate3-]

Protein break down Muscle

Figure 2: Compensation mechanisms for latent acidosis. From: Vormann J, Goedecke T. Acid-Base Homeostasis: Latent Acidosis as a Cause of Chronic Diseases. Swiss Journal of Integrative Medicine 2006;18:255-66.

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The bone, once thought to be a passive buffer of pH levels, has been discovered to play an active role. Acidosis (increased extracellular hydrogen ions) has been shown to increase the activity of the osteoclasts and decrease the activity of the osteoblasts.3 Only very small changes in pH are required to have this effect; pH reductions of ≤ 0.1 can be sufficient to double resorption pit formation.3,12 Latent acidosis places a chronic drain on bone function and health, with research stating that acidogenic diets increase calcium and bone matrix excretion; however, this can be decreased with alkalising food or supplements.3,5 In fact, a lower acidogenic diet has been linked to greater spine and hip bone mineral density, with supplementation beneficially affecting bone resorption.3

In response to acidosis, the muscles release nitrogen (N) and ammonia (NH3+) to aid in the excretion of hydrogen H+ via the kidneys known as H+ trapping. NH3+ combines with H+ ions in the primary urine to form ammonium (NH4+). This process consumes nitrogen containing amino acids such as glutamine and increases the activity of protein-degradation in the muscular system leading to sarcopenia.6

pH > 7.4 pH = 7.2 pH < 7.0

BLOOD NORMAL TISSUES TISSUES BLOOD ACIDOSIS ACIDOSIS

net bone formation bone maintenance bone loss, no mineralization

2+ 3- - 2+ 3- - Ca PO4 OH Ca PO4 OH

Figure 3: Summary of the effects of extracellular pH on bone formation and resorption. From: Arnett T. Extracellular pH regulates bone cell function. The Journal of Nutrition. 2008; 138: 415S-418S.

Acidity and the Extracellular Matrix ‘The ratio of acids to bases is not only important for a healthy metabolism, it also determines the structure and function of proteins, the permeability of cell membranes, the distribution of electrolytes, and the function of connective tissue.’6

The extracellular matrix (ECM) is the ground or gel-like substance, which sits between the extracellular space and the cells in the body. It contains capillaries, nerve endings, proteoglycans, collagen, elastin, laminin, fibronectin, osteoblasts, fibroblasts, defense cells and more. In fact, the gel of the ECM makes up 20% of the human body weight. It is an active site for interaction between the cell and the extracellular space. Capillaries and nerve endings terminate in the ECM and metabolic waste and mediators interact through the ECM, not directly with the venous or lymphatic system. It is the transmission area and pathway for metabolic products and is directly related to the health of the cell. Intracellular detoxification and cell viability depends on the healthof the ECM.13

Under acidic conditions, enzymatic processes may be hindered and waste products and toxins can become trapped in the ECM, leading to cell dysfunction and inflammation.6,13 Acidosis causes inflammation and inflammation causes acidosis. Additionally, the glucosaminoglycan component of the proteoglycans in the ECM, is affected in acidic conditions. Negatively charged groups, such as sulphate residues, cause water molecules to bind to the glucosaminoglycan, affecting function, elasticity and flexibility. It causes the connective tissue to swell, which may induce pain.6,14 Acidity also adversely affects the body’s cartilage, with acidosis of the synovial fluid decreasing cartilage elasticity.6

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Alkaline Mineral Supplementation Research At the beginning of the twentieth century Dr Ragnar Berg, a Swedish nutritional scientist, studied the mineral content of foods, and their absorption and excretion in humans. In doing so, Dr Berg became the first to document the evidence behind foods and acid-base homeostasis. With these investigations, he was instrumental in developing an alkalising supplement. This became the basis for formulations still used today.17

Recent human research has looked at the effect of alkaline mineral supplementation in bone mineral density, chronic low back pain, arthritis and its effect on blood and urinary pH, with favourable results. The supplementation used in the following studies involved a mixture of calcium, magnesium, potassium as citrates, lactates and carbonates, and trace minerals.

An alkaline mineral drink reduces symptoms in patients with chronic low back pain An observational study in 82 patients with chronic low back pain taking a specific alkaline mineral drink in addition to their usual medication for 4 weeks. Pain symptoms were quantified with the Arhus low back pain rating scale (ARS). This consists of different questionaires concerning back and leg pain, use of analgesics, disability, and physical impairment.

Arhus low backpain rating scale • Supplementation of an alkaline mineral 40 40 drink reduced pain symptoms of chronic Sum Total low back pain by more than 50%. 30 Pain Intensity • The use of analgesics could be reduced. Disability 22 21 20 Physical Impaitment • Physical impairment was improved. 11 10 7.3 9.9 • Alkaline minerals are an alternative 5.2 5.6 without side effects for chronic low back 0 pain caused by a disturbed acid-base Before After Before After Before After Before After homeostasis.

Figure 4: From: Vormann J, Worlitschek M, Goedecke, T and Silver B. Supplementation with alkaline mineralsreduces symptoms in patients with chronic low back pain. J. Trace Elem. Med. Biol. 2001:15; 179-183

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Rheumatoid arthritis sufferers benefit from an alkaline mineral drink

In a 12 week study involving 37 patients with Rheumatoid arthritis (RA) of at least Disease activity score DAS-28 (%) two years‘ duration. Rhuetamtoid arthritis sufferers were shown to benefit from supplementation with an alkaline mineral drink. Alkaline supplementation (n=19) Control (n=18) 110 At the end of the study, there was a significant decrease in the disease activity score (DAS-28) and in pain levels measured on a visual analogue scale (VAS) 100

in the group taking 30g daily of the alkalising mineral drink, with no change in 90 the control group. Only the group taking the alkaline mineral drink were able * * to reduce their steroid and NSAID medication. The results suggest an alkaline 80 mineral supplement could well represent an easy and safe complement to the 70 usual treatment of RA patients. 60

Figure 5: Pain level according to a visual analog scale in supplemented (first column) and unsupplemented (second 50 column) RA patients. From: Csuez RM, Barna I, Bender T, Vormann J. Alkaline mineral decreases pain in rheumatoid 0 4 8 12 arthritis patients: a pilot study. 2008: 2; 100-105 Time (weeks)

Beneficial effect on plasma pH following supplementation with an alkaline mineral drink

A 2009 study on 25 healthy subjects measuring urine and blood 7.416 pH levels before during and after morning supplementation with an alkaline mineral drink. 7.414

Alkaline 7.412

The alkaline mineral drink was given at 8:00am each morning 7.410 for 1 week with blood and urine pH measurements taken at 7.408 8:00am, 9:00am, 10:00 am and 11:00am. 7.406 pH in Blood The results of the study (a modified graph shown here showing 7.404

blood pH) indicate supplementation with alkaline minerals was 7.402 associated with a significant and rapid increase in blood (and Acid 7.400 urinary) pH and a long term increase in plasma (and urinary) 9AM 9AM after 9AM after 1 week of pH after 1 week of supplementation. Before supplementing supplementation

Figure 6: Alterations in blood pH before and following intake of the multi-mineral supplement in morning and after one week of supplementation. From: Konig D, Muser K, Dickhuth HH, Berg A, Deibert P. Effect of a supplement rich in alkaline minerals on acid-base balance in humans. Nutrition Journal 2009;8:23.

Rebalancing the Acidic Imbalance Acidosis is part of the modern world, any inflammatory process increases acidosis; our dietary patterns increase acidosis; dieting and fasting increases acidosis; the simple act of aging increases acidosis. The following are crucial changes that need to made to reduce the risk of disease and ill health in the future:

• Change the dietary pattern to more alkaline forming foods • Increase plant fibre, plant protein and alkalising minerals • Include alkaline supplementation, which incorporates potassium, calcium & magnesium in citrate and carbonate forms. • Reduce sodium chloride intake.3

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The Varied Roles of Alkalising Nutrients

Key Nutrients Specific Alkalising Effects Mineral Benefits

Calcium Calcium acts as a potent alkalising mineral used by the body to Maintenance of bone and teeth (carbonate/lactate) maintain plasma pH. Calcium becomes displaced from the bone Normal function of digestive enzymes when buffering resources are diminished. Carbonates and lactate Neurotransmission and electrolyte bound minerals neutralise acid. balance

Potassium Potassium citrate is comprised of anions which consume hydrogen Maintains electrolyte balance (citrate) ions (H+) when metabolised and so increase the alkalinity of their Maintenance of normal blood pressure environment. Normal function of the nervous system

Magnesium Magnesium carbonate and citrate are comprised of anions which Electrolyte balance

(carbonate/citrate) consume hydrogen whem metabolised, yielding carbon dioxide (C02) Muscle function

and water. The C02 is then exhaled leaving a net alkaline effect. Normal neurotransmission Acidosis blocks reabsorption of magnesium in the kidneys which leads to decreased magnesium.

Selenium Prevents oxidative damage caused by pH imbalances. Selenium Healthy function of immune system (high selenium yeast) is an important component of the antioxidant enzyme glutathione Maintenance of normal hair and nails reductase. Latent acidosis causes reductions in glutathione Normal thyroid function peroxidase activity, leaving the body more susceptable to oxidative damage.

Molybdenum Molybdenum forms the cofactor molybdopterin, involved in Maintenance of amino acid metabolism (sodium molybdate) metabolising acid-forming purines and other nitrogen containing Co-factor for xanthine oxidase (uric acid compounds. metabolism)

Chromium Chromium chloride plays a role in normal healthy blood sugar Normal blood glucose concentrations (chloride) regulation, which assists in controlling acid levels in the body. The Component of the glucose tolerance negatively charged chloride anion, helps consume H+. factor Macronutrient metabolism

Vitamin B2 Riboflavin has been used for the treatment of acidosis (specifically Involved in the production of energy (riboflavin) analogue-induced lactic acidosis). This suggests that riboflavin within the body deficiency may be a cofactor in this kind of acidosis. Contributes to the reduction of tiredness and fatigue Metabolism of iron

Vitamin C The ascorbate anion, is the electron-donating, clinically active portion Healthy function of immune system (ascorbic acid) of vitamin C, which acts as an antioxidant, assisting the body cope Antioxidant with oxidative damage caused by latent acidosis. Normal physiological function

Zinc A zinc-dependant metalocoenzyme called‚ carbonic anhydrase plays Maintenance of skin, hair, nails (citrate) an important role in acid-base balance by facilitating the breakdown Cognitive function

of carbon dioxide (CO2 ) to it’s less acidic components. One of those Maintenance of normal vision components is bicarbonate, which can be used in buffering reactions.

Copper A citrate bound mineral which consumes hydrogen ions (H+) and Healthy function of immune system

(Cupric citrate) yields cabon dioxide (CO2) & water. The CO2 is exhaled leaving a net Function of the nervous system alkaline effect on the body. Involved in energy-yielding metabolism

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Compensatory Mechanisms for Acidosis (How alkalising minerals work)

Compensatory Mechanisms for Acidosis (How alkalising minerals work)

NB: Organically bound minerals (citrates Acidosis Glutathione peroxidase. helps reduce oxidative damage gluconates & lactates) contribute to Latent Acidosis Selenium the elimination of acid via metabolism to (Increased acidity in blood) carbon dioxide (CO2) & water (H20).

Inorganically bound minerals (carbonates & Release of bases to oxides) neutralise acid. buffer acid

Citrate utilisation of acid Hydrogen (H+) to carbon dioxide (CO ) & 2 elimination Water (H20) Bone demineralisation, Calcium loss Osteoblast activity ELIMINATION Osteoclast activity A zinc-dependant metalocoenzyme‚ (carbonic anhydrase) facilites the breakdown of carbon dioxide to it’s less acidic components. Kidneys - eliminate acid citrate reabsorption Muscle/Protein calcium reabsorption break down + NH4 (ammonium) production (Sarcopaenia) acid (H+) excretion

Muscles release nitrogen (N) & ammonia Acidosis blocks reabsorption of magnesium in (NH3+) in response to acidosis, to help the kidneys which decreases magnesium levels. kidneys excrete acid (H+). Nitrogen & ammonia trap additional H+ forming Lungs + + NH4 for excretion. Eliminate acidic hydrogen (H ) as CO2 and H2O

Urine Acid is eliminated via urine.

Figure 7: Summary of compensatory mechanisms for latent acidosis showing how alkalising minerals work.

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References

1. Wynn E, Krieg MA, Lanham-New SA, Burckhardt P. Postgraduate Symposium: Positive influence of nutritional alkalinity on bone health. The Proceedings of the Nutrition Society 2010 Feb;69(1):166-73. 2. Schwalfenberg GK. The Alkaline Diet: Is There Evidence That an Alkaline pH Diet Benefits Health? J Environ Public Health 2012;Epub [ahead of publication]. 3. Pizzorno J, Frassetto LA, Katzinger J. Diet-induced acidosis: is it real and clinically relevant? The British Journal of Nutrition 2010 Apr;103(8):1185-94. 4. Adeva MM, Souto G. Diet-induced metabolic acidosis. Clinical Nutrition 2011 Aug;30(4):416-21. 5. Frassetto L, Morris RC, Jr., Sellmeyer DE, Todd K, Sebastian A. Diet, evolution and aging--the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet. European Journal of Nutrition 2001 Oct;40(5):200-13. 6. Vormann J, Goedecke T. Acid-Base Homeostasis: Latent Acidosis as a Cause of Chronic Diseases. Swiss Journal of Integrative Medicine 2006;18:255-66. 7. Vormann J, Remer T. Dietary, metabolic, physiologic, and disease-related aspects of acid-base balance: foreword to the contributions of the second International Acid-Base Symposium. The Journal of Nutrition 2008 Feb;138(2):413S-4S. 8. Rylander R, Remer T, Berkemeyer S, Vormann J. Acid-base status affects renal magnesium losses in healthy, elderly persons. The Journal of Nutrition 2006 Sep;136(9):2374-7. 9. Anderson K, Anderson LE, Glanze WD. Mosby’s medical, nursing, and allied health dictionary. St. Louis: Mosby; 1994. 10. Arnett TR. Acidosis, hypoxia and bone. Archives of Biochemistry and Biophysics 2010 Nov 1;503(1):103-9. 11. 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. Journal of the American Geriatrics Society 2008 Aug;56(8):1442-8. 12. Arnett TR. Extracellular pH regulates bone cell function. The Journal of nutrition 2008 Feb;138(2):415S-8S. 13. Smit A, O’Byrne A, Van Brandt B, Bianchi I, Kuestermann K. Introduction to bioregulatory medicine. Stuttgart; New York: Thieme; 2009. 14. Vormann J, Worlitschek M, Goedecke T, Silver B. Supplementation with alkaline minerals reduces symptoms in patients with chronic low back pain. Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements 2001;15(2-3):179-83. 15. Cseuz R, Barna I, Bender T, Vormann J. Alkaline MIneral Supplementation Decreases Pain in Rheumatoid Arthritis Patients: A Pilot Study. The Open Nutrition Journal 2008;2:100-5. 16. Konig D, Muser K, Dickhuth HH, Berg A, Deibert P. Effect of a supplement rich in alkaline minerals on acid-base balance in humans. Nutrition Journal 2009;8:23. 17. Christian Rummel, Ragnar Berg. European University Studies, Series VII, Vol 10th Peter Lang, Frankfurt, 2003.

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