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The pitfalls of Bicarbonate

Over the centuries human diets have evolved from being alkaline to acidic, which can lead to detrimental health effects. The body uses endogenous (made by the body) bicarbonate to buffer this acidity, but supply is limited. This has lead to the belief that simply replacing bicarbonate as an alkalising supplement will support the body. However, it’s not as simplistic as that. 

Sub-clinical acidosis stems predominantly from factors including dietary imbalances, stress, medication use and the metabolic pressures of inflammation and chronic disease. Research clearly shows the impact of acid load on many common clinical presentations including bone loss in postmenopausal women.4

The acid-base balance, or pH balance, of the body is tightly maintained at the correct levels by intricate regulatory mechanisms. One of these, and the most important in the blood, is the ability of naturally produced bicarbonate to neutralise acidic hydrogen ions.  Bicarbonate accounts for 52% of the buffering capacity in the body, absorbing the hydrogen ions to produce excretable carbon dioxide and water.

However, the body cannot produce an infinite supply of bicarbonate. So, when buffering mechanisms are overwhelmed with acid increasing foods, stress, medications and other acid forming factors, the body is simply unable to compensate, which leads to acidosis and negative health effects.  This often leads to the consideration of increasing bicarbonate stores by ingesting  bicarbonates, such as sodium bicarbonate. However, while this may increase the body’s alkalinity in the short term, it is far from the ideal solution.

Bicarbonate supplements are not ideal

Research indicates that appropriate oral doses of sodium bicarbonate offer only gentle, short acting antacid action with little to no impact on gastric pH and no adverse effects – when used intermittently to relieve mild reflux

Concerns arise with long term supplementation. Sodium bicarbonate, for example, leads to an increase in stomach carbon dioxide, which increases the pH of the stomach acid (reduces acidity and increases alkalinity). Over a prolonged period, this can be detrimental to the digestive process. Without adequate hydrochloric acid (HCl), vitamins and minerals from food and supplements are poorly absorbed and assimilated. This is especially problematic in those with already diminished HCl acid levels, such as the older population. It may also cause imbalances in the gut microbiota, leading to bacterial overgrowth, such as SIBO. After taking it there is a fast increase in bicarbonate blood concentration, which is rapidly excreted through the kidneys, losing the bicarbonate through the urine. Therefore, the ingested bicarbonate is not available to buffer the excess acidity in the blood.

Side effects with bicarbonate supplementation

Not only does sodium bicarbonate taste very unpleasant, it also comes with significant gastrointestinal side effects, including nausea, stomach pain, diarrhoea, and vomiting. Table 1 shows the more serious side effects with sodium bicarbonate therapy, including intracellular acidosis, increases in sodium levels and reductions in potassium levels.

Table 1:  Side effects of sodium bicarbonate therapy

  • Hypokalemia or low potassium levels
  • Ionised hypocalcemia or insufficient calcium
  • Prolongation of the QTc interval (heart rhythm)
  • Hypercapnia or elevated carbon dioxide in the blood
  • Hermodynamic instability during haemodialysis
  • Increase in urinary sodium excretion resulting in insufficient sodium essential for body functions
  • Potential progression of vascular calcifications

Side effects of sodium bicarbonate with uncertain clinical significance

  • Impairment of tissue organs
  • Intracellular acidosis
  • Cerebrospinal fluid acidosis
  • Hyperosmolar state or dehydration
  • Increased lactate production creating more acidity
  • Slight blood pressure reduction

Source: Side effects of bicarbonate therapy. Adapted from Adeva-Andany, Maria M. et al. Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis. The Scientific World Journal 2014 (2014): 627673.

An Individualised Approach – there’s rarely only one answer

A recent systematic review on the impact of sodium bicarbonate consumption and human health concluded that there was no evidence of harmful effects at low oral doses.1   A meta-analysis of sodium bicarbonate used for athletic performance echoed these findings and demonstrated that no detrimental effects were reported with single doses of up to 0.3g per kilogram of body weight (21g for a 70kg person).5  

Sodium bicarbonate has been used in high doses for patients in critical conditions including septic shock, acute trauma, advanced cardiac life support and metabolic acidosis.3 

The best way to truly alkalise

Increasing the fresh vegetable and fruit content of your diet is essential as your diet forms the pillar of overall health, including excess acidity.  Avoiding excessive intake of high acid-forming foods and beverages is also essential.  However, until the diet can be adjusted, supplementing with a quality product* may help achieve balanced pH.

As stated, endogenous bicarbonates are effective at buffering the acidic hydrogen ions; however, taking supplemental  bicarbonate is not the best way to increase body alkalinity, in fact it could be detrimental to health. Citrates are ideal for alkalising the body in food and supplemental form.  Citrates are always absorbed as a salt, with magnesium, potassium, calcium citrate etc, and are found naturally in fruits and vegetables. Supplementing with these citrate salts provides alkalinity with the added benefits of increased minerals. They also have minimal impact on HCL, with negative impact on digestion and their effect is also longer lasting with a steadier overall alkalisation, compared to bicarbonate supplementation.

Citrate bound minerals are the most efficient and safest way to alkalise the body’s tissues and protect the kidneys from the harmful effects of excess acid.

Call us at True Medicine – 07 5530 1863 – for your individualised assessment and qualified advice.

* Never self-prescribe or obtain inferior products, especially through MLM sources.  Consult a qualified Naturopath for quality products that are safe and scientifically proven to be safe.



  1. Fakhri, Y. et al. Association between sodium bicarbonate consumption and human health: A systematic review. Int. J. Med. Res. Heal. Sci. 5, 22–29 (2016).
  2. Verove, C., Maisonneuve, N., El Azouzi, A., Boldron, A. & Azar, R. Effect of the correction of metabolic acidosis on nutritional status in elderly patients with chronic renal failure. J. Ren. Nutr. 12, 224–228 (2002).
  3. Adeva-Andany, M. M., Fernández-Fernández, C., Mouriño-Bayolo, D., Castro-Quintela, E. & Domínguez-Montero, A. Sodium bicarbonate therapy in patients with metabolic acidosis. Sci. World J. 2014, (2014).
  4. Gregory, N. S. et al. Potassium citrate decreases bone resorption in postmenopausal women with osteopenia: A randomized, double-blind clinical trial. Endocr. Pract. 21, 1380–1386 (2015).
  5. Peart, D. J., Siegler, J. C. & Vince, R. V. Practical recommendations for coaches and athletes: Ameta-analysis of sodium bicarbonate use for athletic performance. J. Strength Cond. Res. 26, 1975–1983 (2012).
  6. Maton, P. N. & Burton, M. E. Antacids Revisited. A Review of Their Clinical Pharmacology and Recommended Therapeutic Use. Drugs 57, 855–870 (1999).
  7. Lindberg JS, Zobitz MM, Poindexter JR, P. C. Magnesium bioavailability from magnesium citrate and magnesium oxide. J Amer Coll Nutr 9, 48–55 (1990).