Over the last couple weeks I have come across medical news headlines that sounded something like this: “Baking Soda — An Inexpensive Treatment Aid for Autoimmune Diseases Like Arthritis”
I won’t even get into the fact that arthritis is most commonly understood to mean osteoarthritis which is NOT an autoimmune disease, but let’s not digress too much.
The slightly more reasonable news outlets sounded at least a little skeptical: “Drinking baking soda could be an inexpensive, safe way to combat autoimmune disease”
The headlines seemed alluring, and the news articles themselves seemed to at least represent some interesting findings from a recently published study in a well respected journal: The Journal of Immunology.
But medical news headlines in general are often very deceiving and there are many well respected researchers and writers such as Stephan Guyenet PhD, Sarah Ballantyne PhD and Denise Minger who make a living deciphering research studies themselves, presenting accessible and accurate representations of the literature to an interested lay audience. We need people like them!
And we must recognize that medical news outlets, while very unlikely to be malicious in nature, will often NOT represent the real findings of a study or present them in the context in which the authors intended.
Needless to say, I was intrigued, curious and worried when I saw these headlines, so I did the first reasonable thing I could think of: get the paper itself.
Now this isn’t always easy as many academic papers are not open access, and as such, these papers require payment or an affiliation with some academic institution (payee) to obtain. I am lucky enough to have such an affiliation as part of my family medicine residency training, and was able to get the full paper itself.
This is where I would like to stop and make a few points to help you triage and understand the relative reliability of a medical news source making references to “recent study X”.
Red Flags for Misinterpretation of Research
- The study as referenced in the news article is not open access. You may ask why does this matter? If the paper isn’t open access or isn’t readily available then it is more likely to go unread by the author or news team reporting its findings. This is just common sense: if you make something harder to read, then mostly likely it won’t be read thoroughly.
- The title of the paper isn’t mentioned in the news article. Researchers in general do a very good job of trying to explain the primary purpose of a study in the title. If the title is rather technical or says something that may make the news headline confusing then it will likely be left out of the news article.
- The news article contains paraphrased comments taken from the abstract of the paper. Once again, a fairly obvious point related to point #1, but if the news article only has comments based on descriptions/text in the freely available abstract then you should be a little worried that they did not read the paper thoroughly. Abstracts are great and very helpful, but should not be treated in isolation.
I do not profess to be an expert of medical literature. I haven’t been alive on this planet long enough to be an expert in anything, but I want to share my curiosity and express some insights gleaned from reading numerous articles and specifically offer some reflections from the research study in question.
In order to try to facilitate a more accessible discussion, I have organized the remainder of this article into four sections:
- My concerns with the study
- What the study did not find
- What the study did find (for science geeks)
- Final reflections and recommendations
So without further adieu, shall will dig into the heart of this discussion?
CLICK TO EXPAND // The science behind how baking soda reacts in the body
(Definitely for "science geeks" but will help you understand why we care about baking soda -- or sodium bicarbonate -- and stomach acid.)
Baking soda is nearly entirely (outside of other elemental contaminants) made up of a compound call sodium bicarbonate.
Sodium bicarbonate in chemical lingo is written as NaHCO3: Na+ (sodium) and HCO3- (bicarbonate).
You are probably used to seeing baking soda as a white powder at room temperature. When you add this to water, however, something happens. The sodium bicarbonate NaHCO3 decides it is much happier, from a chemical standpoint, to break apart and interact with the atoms (electrons) of the water molecule. In chemistry terms we call this dissociation. And in chemical lingo it looks something like this:
NaHCO3 <--> Na+ & HCO3-
(I put the little pluses and minuses next to Na+ and HCO3- to tell you that they are now ions or charged particles in a solution.)
The HCO3- does many things for the body but its primary function is to enter into our body’s natural buffering system. Our natural buffering system in chemical lingo looks like this:
H2CO3 <--> H+ & HCO3-
H+ & HCO3- <--> H2O+ & CO2
These types of equations are known as equilibrium equations and represent the body’s primary buffering system, the means to balance acidity (pH) over a wide range of concentration or amounts of certain substances. Just think if we didn’t have this buffering system, a tiny change in CO2 could cause a massive change in acidity that is incompatible with life. BUT our body responds to changes in concentrations of each substance, bicarbonate: HCO3- from baking soda, for example, by increasing the concentrations of other substances (H+) to maintain this natural balance.
I will not get into the next level of how exactly the body regulates pH but simply steer those interested in the direction of one of the most elegant chemical equations known as:
The Henderson-Hasselbach Equation
In very rough terms, you can think that in order to maintain a balanced acidity (pH) when we increase (HCO3-) we must maintain our balanced ratios so we will have to increase our amount of H+.
This can be done in a number of ways, but the one we are most interested in is called the proton (H+) pump, which a specialized protein or pump on certain types of cells that requires energy in the form of ATP to secrete H+ ions against its normal gradient into one compartment of the body.
The most well known compartment? The stomach!
Our bodies, being the amazing things that they are have different cells in the stomach (among other areas) with proton pumps that secrete H+ as well as other cells called mucus cells that secrete a substance primarily made of, you guessed it, HCO3-. The body naturally has its own buffering system and is capable of regulating the acidity of the stomach and intestinal contents in addition to the blood, by coordinating the secretion of either H+ or HCO3-.
In the case of this experiment, the authors chose to have participants ingest HCO3-, which you can already guess, using our understanding of the buffering system, will both neutralize some of the stomach acid (H+) and cause a resultant increase in stomach acid to maintain a state of equilibrium.
- We use buffers such as the H+ and HCO3 system to maintain pH over a wide range of ion concentrations.
- The body has intrinsic systems to secrete both H+ and HCO3- to maintain an ideal blood pH, but to also selectively acidify stomach contents.
- The research study in question involved ingesting an extra amount of NaHCO3 which readily breaks about in solution to become Na+ and HCO3-.
My Concerns with the Study
First things first, what was the actual title of the article referenced in all of the medical news outlets?
“Oral NaHCO3 Activates a Splenic Anti-Inflammatory Pathway: Evidence That Cholinergic Signals Are Transmitted via Mesothelial Cells”
Whoa, that’s a mouthful.
Revisiting our red flags, I already mentioned this study is not open access and it has a title that is nearly indecipherable to most in a common lay audience (and even medical) — a pretty good reason to keep the title out of the news article wouldn’t you think? So yes, the title was not in many news articles for a now obvious reason.
Before we go further, another point I should make is that the title of this paper and the title of most news headlines are rather different — another red flag that should make you a little suspicious of the medical news report.
So what does the title even mean? Let’s break it down.
- NaHCO3 is the chemical formula for sodium bicarbonate- essentially baking soda.
- Oral: simply refers to something taken by mouth.
- Splenic: refers to the spleen, a multi-faceted organ in the human body responsible for immune function and recycling of red-blood cells amidst many other functions.
- Anti-inflammatory: this may seem obvious, but like its counterpart inflammation, is often misrepresented and misunderstood. We will revisit this in detail shortly.
- Cholinergic: refers to the neurons or parts of the nervous system that utilize acetylcholine as its primary neurotransmitter or communicating molecule.
- Transmitted: communicated, usually by nerves, but there are other ways that cells communicate with each other too.
- Mesothelial cells: these cells are epithelial cells (barrier cells) that act as a lining for most organs in the body, heart, lungs, abdominal cavity (including spleen), etc.
CLICK TO EXPAND // The science behind cholinergic neurons and mesothelial cells
Cholinergic neurons are often also associated with the Autonomic Nervous System (ANS) and even more specifically with a BRANCH of the ANS called the Parasympathetic Nervous System (PNS) or the “Rest and Digest” system. Interestingly, the Sympathetic Nervous System (SNS) or “Fight or Flight” system ALSO utilizes acetylcholine as a signaling molecule, but in a different location and slightly different way that we might see again.
They are called mesothelial because they are derived embryologically (back when you were only a collection of developing cells in your mother’s womb) from the mesodermal layer of cells that surround the original “body cavity.” Yes, in general you were developed and elaborated elegantly from an original tube!
So now that we have deciphered the title, what exactly is the title trying to say or what can we reasonably infer from the title as presented?
I would suggest the following:
Baking Soda (sodium bicarbonate) at some unknown amount when taken by mouth (by unknown subjects, perhaps mice, rats, or humans) initiates a presumed anti-inflammatory immune response originating in the spleen via a signaling pathway that involves cholinergic neurons/nervous tissue and a specialized subset of cells (mesothelial cells).
Seems reasonable enough.
I hope you see from the title and my summary, (and I know it’s just the title) that conclusions reporting baking soda to be a significant aid to autoimmune disease are more than a bit of a stretch and should elicit at least some form of a pause and curious inquiry.
We will come back to the title when we describe in more detail the main findings of the study, so just keep this tucked away for later. Back to my main concerns.
1. The study was initially designed to explore mechanisms of immune system modulation (pro-inflammatory vs. anti-inflammatory responses) related to kidney disease, both acute kidney injury and chronic kidney disease (CKD). Also, the initial description and study is in rat models, not humans.
Just within the introduction of the paper, the authors begin to explore some potential pathways of immune system activation or pathways that can be activated (possibly by sodium bicarbonate) to create an anti-inflammatory response to help prevent damage to the kidney as part of an acute injury or as part of a progressive chronic disease state.
This is incredibly important research and valuable to study, but this is not directly studying any mechanisms of autoimmunity in humans, and additionally the authors make very general and perhaps vague statements such as:
As inﬂammation has been associated with CKD progression, we speculated that NaHCO3 may act to protect the kidneys by reducing inﬂammation.
The above statement was made in between more specific statements regarding potential cellular mechanisms of immune activation and anti-inflammatory pathway activation such as:
Oral NaHCO 3 intake promotes M2 macrophage polarization by activating splenic anti-inﬂammatory pathways.
Inflammation is not a monster or something you “catch” like a virus. Let me explain.
Inflammation is actually an intricate but coordinated system of neural (nervous tissue) and molecular signaling both locally and systemically employed by the body with the main purpose of detecting, assessing and responding to a perceived local disturbance or disruption in homeostasis. This disturbance, for example, could be a traumatic injury: mechanical disruption of cellular tissue, the presence of a non-self entity (bacteria, virus) or the loss or cessation of normal homeostatic signaling.
We can categorize this system of signaling in primarily two ways
- The primary immune cells involved
- The duration or “time course” of signaling (aka: acute vs. chronic)
The acute inflammatory response occurs over a short time scale, usually days to a week or two while the chronic inflammatory response occurs over weeks to months and even years.
The body also utilizes different cell types to carry out the acute and chronic inflammatory responses. This is a perfect example of specialization as well as the important structure and function relationship.
CLICK TO EXPAND // The science behind the acute inflammatory response
To quickly summarize, the acute inflammatory response is mainly responsible for making it even possible for the acute immune cells to make it to the disturbed or affected tissue. This is an important point because we often forget about the dynamic connection of blood vessels, the highways carrying the immune cells and the tissue, organizations of cells carrying out a specific task (eg: muscle tissue). Under normal conditions, immune cells do not consistently reside in muscle tissue or liver tissue, so the acute inflammatory response essentially creates an environment such that the “acute” immune cells can go from the blood vessel into the affected tissue. To do this, the blood vessel undergoes significant changes such that it is able to marginate the immune cells (get them from the center of the blood vessel flow to the edge), slow down the immune cells now moving along the edge of the vessel, and make them finally stop and move through the blood vessel wall into the affected tissue.
This is pretty amazing when you think about it! We would die without such an incredible and coordinated response.
Acute inflammation can end in one of four ways:
- Healing/scar formation
- Formation of an abscess (walled-off area of infection/inflammatory cells)
- Initiation of chronic inflammation
I will refrain from going into a detailed description of chronic inflammation, but will simply reiterate that chronic inflammation differs from acute inflammation by the types of immune cells involved and the duration of activity. You can think of it as the acute inflammatory response saying we haven’t figured this out and need some help chronic inflammation. The chronic inflammatory response like the acute response is still trying to resolve the disturbance and protect vital tissues at the same time, but this isn’t always possible.
Inflammation is a response that can be characterized by the activation of different immune cell types as well as an incredibly intricate set of signaling molecules or systems attempting to tell the immune cells where and how to respond.
So you see, inflammation is not a monster, but a complicated and often misrepresented response, not a disease.
Okay, back to my main concerns with the paper.
2. The authors appear to have mistakenly misrepresented the baseline data (before ingestion of bicarbonate solution) by the human subjects and do not provide the raw data for the human subjects after ingestion of either bicarbonate or control solution.
This is a big problem. Let’s explore why.
I will point out first the issue with misrepresented or “incorrect” baseline data.
Taken from the study itself:
Baseline ﬂow cytometry values of all subjects, before ingesting NaHCO3 or NaCl in solution, are presented in Table IV. Prior to any treatment, the percentages of blood leukocytes that were TNFa + neutrophils, M1 macrophages, or M2 macrophages were all signiﬁcantly higher in the NaHCO 3 TXT group when compared with baseline values obtained in the NaCl TXT group (Table IV).
Basically what this is saying is that at baseline there was actually a difference in the percentages of certain immune cells between the baking soda group and the salt (NaCl) group. While the authors state this clearly, this is a major confounding variable as the two populations they are seeking to compare- those who drink a baking soda solution and those drinking a NaCl or salt water solution are different at baseline with respect to some of the key immune cells being followed.
But there’s even more that doesn’t fully add up.
In that statement they say that the immune cell percentages are higher in the baking soda group when compared to the salt group, but what does their table show?
Taken from the paper:
I bring your attention to the values in question:
Now I am not a maths whizz but it looks to me like the percentages in the baking soda group are lower, not higher, as the authors state, in all categories when compared to the NaCl group including the two noted as statistically significant (TNF-alpha, and M1 macrophages). Now this could be a simple reversal mistake, I am not sure, but it is a big mistake nonetheless. If we assume that this data is correct, however, by having significantly different baseline levels of certain immune cells, we still cannot reliably draw conclusions on whether any changes witnessed from before ingestion to after between the group are statistically significant or meaningful.
Additionally, as previously mentioned before, there is no table showing the post-ingestion raw data or values for immune cell types. The authors provide multiple graphs of percentage change in different immune cells, but percentages are unitless values and in this case were standardized from a zero baseline that wasn’t originally statistically equivalent. This brings me to concern three, which you may have already picked up from the screenshot.
3. The study involved 12 human subjects.
Now I don’t know about you, but even for something as seemingly innocuous as baking soda, no matter what the authors concluded, I would be very hard pressed to start recommending baking soda to my patients after a trial starting from a rat model that then involved 12 human subjects.
I know we have to start somewhere, but this is an incredibly small sample size.
What the Study Did NOT Find
1. There was a misrepresentation and association of rheumatoid arthritis with the findings of this study.
Note: This is not the fault of the authors, but of news media outlets and shows you why you cannot just accept the medical news summaries.
The first time rheumatoid arthritis is mentioned in the study is on page 12:
Inﬂammatory macrophages and excessive TNF-a production have been implicated in the pathology of a broad range of disease states, including rheumatoid arthritis (17), cardiovascular disease (18), atherosclerosis (19, 20), irritable bowel disease (21), type 2 diabetes (22), and neurodegenerative diseases as well as others (23–26).
The second time rheumatoid arthritis is mentioned in the study is on page 13:
Furthermore, in humans, efforts to stimulate the cholinergic anti-inﬂammatory pathway chronically by implanting stimulating electrodes on the vagal nerves have shown promise in patients with rheumatoid arthritis (17).
This excerpt has nothing to do with what was actually done by the authors in this study. While the authors provide speculation that they are able to stimulate some aspect of this cholinergic “anti-inflammatory” response (a broad and vague statement), in this study they did not test human subjects with rheumatoid arthritis and did not induce this pathway via electrode stimulation of the vagus nerve.
Yet, despite this, nearly all major news outlines took this language and made statements about how this intervention would be a helpful intervention for autoimmune diseases like rheumatoid arthritis.
2. This study involved healthy subjects consuming baking soda (sodium bicarbonate).
This was not a therapeutic intervention. We cannot draw reliable conclusions from this study that this will help people with relative states of chronic inflammation such as chronic autoimmune disease.
CLICK TO EXPAND // Further explanation on the lack of evidence for using sodium bicarbonate as a therapeutic intervention
The evidence for sodium bicarbonate as a therapeutic intervention is mild if any, and it appears to be limited to (with our current understanding) to states of chronic kidney disease where individuals are no longer able to regulate the pH (acidity) of their blood as well as many other electrolytes like potassium, and possibly in states of acute sepsis with metabolic acidosis -- “significantly abnormal-low blood pH.” The only other situation were sodium bicarbonate is occasionally used currently is in cardiac arrest and like all the medicines that are used the is no evidence that any of them actually works.
CLICK TO EXPAND // A detailed explanation of the study's findings
What the Study Found
I will be perfectly honest and say this study was quite interesting and while rather technical, there were indeed plenty of ideas worth noting and exploring. This section will be a little technical and is not essential to read to understand our key points about the red flags to be aware of in medical news stories and the major issues with this research paper, but I will summarize the main findings below for those who are interested.
From the author’s discussion:
Given their close anatomical arrangement, we speculate that mesothelial cells may release paracrine factors, such as acetylcholine, that alter the signaling of these capsular ([perhaps sympathetic (57)]) nerves, which may then modulate the anti-inﬂammatory response within the splenic parenchyma. Such a signaling pathway could potentially explain why sympathetic denervation of the spleen results in loss of cholinergic antiinﬂammatory responses, as sympathetic denervation has been demonstrated to abolish acetylcholinesterase staining in the region in which these underlying nerves are located (57).
What does this mean and what are the practical results?
1. The mesothelial (specialized “epithelial” cells) residing in the spleen appear to be responsible for mediating a change in immune response initiated in the spleen.
(Note: The “anti-inflammatory” response noted by the authors is actually a change in immune cell type and density in the peripheral blood after ingesting baking soda. I will say it is a bit of a leap to say more broadly that this change truly represents an “anti-inflammatory response, but the authors are using our current understanding of the acute and chronic inflammatory responses and the previously noted cell type - function relationship to say that since there were MORE immune cells who primarily dampen the acute inflammatory response after ingesting baking soda that this represents a broad “anti-inflammatory” response. This was also not a measurement of immune cells within any specific tissue and at best we can speculate and make the assumption, a somewhat reasonable one, that since there was a change in immune cell types and amounts in the blood, that this represents a response to a disturbance in a tissue, but we cannot exactly say -- remember the blood vessel and highway analogy?)
2. The mesothelial cells appear to communicate by the release of local signaling molecules also known “paracrine” communication.
3. It is speculated that the signaling molecule released is the neurotransmitter acetylcholine.
4. It is speculated that sympathetic (SNS) nerves innervate this region of the spleen and utilize the acetylcholine to signal to other nerves in order to initiate a “cholinergic anti-inflammatory response”
The authors used specialized stains to essentially detect neurons utilizing “acetylcholine” as the communicating molecule and through some cleverly designed techniques of manipulation/ disruption of splenic tissue and denervation of splenic tissue, concluded that the process most likely begins with the secretion of acetylcholine locally by mesothelial after some initiating event (in this case ingestion of baking soda) that then allows for the communication between SNS neurons and the immune system, resulting eventually in an altered immune response (anti-inflammatory response).
From the author’s conclusion:
To our knowledge, this is the ﬁrst evidence that mesothelial cells may have a role in transmitting cholinergic signals to distal sites and, combined with evidence that gastric acid secretion is required to promote an anti-inﬂammatory response to NaHC03 , raises the possibility that there may be no direct interface between the nervous and immune systems.
I really do like this statement from the authors and this is exactly what we should focus on and pursue in further research. You see, what the author’s appear to have found through some rather elegant studies is a potentially novel communication pathway connecting nervous and immune tissue initiated in the spleen after the body’s (stomach’s) response to buffer ingested HCO3-.
Final Reflections and Summary
If you have stuck with me for this crazy journey, I believe we have arrived at some final, primary conclusions.
- I will not recommend individuals with autoimmune disease to start taking baking soda.
- Taking a whole body systems approach, I will choose to start instead with a dietary intervention such as the Paleo Autoimmune Protocol combined with a thorough investigation into any underlying gut disturbances.
- This study involved only 12 subjects and contained some flaws in the reporting of their data that limit our ability to make reasonable conclusions.
- I encourage everyone to remain cautious about medical news stories and look for our red flags to identify sources that may be distorting the findings of the study.
Thanks for sticking with me and I hope that you can see the forest through the trees and begin to use some of the techniques provided here to cultivate a greater awareness of the distortion within medical news media and how to become your own curious and not cynical citizen scientist.
Wow that was an incredible breakdown of what the news was about. Thank you! Calling something good for rheumatoid arthritis but the study’s subjects not having been rheumatoid arthrtis patients, does appear to be a stretch. Irresponsible fishbait journalism at the expense of hopeful rheumatoid arthritis sufferers.
Thank you Kenny for your kind words!
Thank you for this article. I really was considering this.
“elicit”, not “illicit”
Thank you, will fix the typo
Agreed explanation, but will consuming said amount of baking soda actually hurt anyone? I have heard of the same being used as an “adrenal cocktail”
Good question Monica, the amount they used here 2 grams in 250 mL of water is fairly innocuous. There are case reports of people having major gastrointestinal issues, perforations and severe acid base imbalances by ingesting too much, so I worrry about the some is good more must be better mentality. At least for now I won’t be recommending it to people but if they ask will this hurt me I will say it is very unlikely.
Excellent analysis and good summary writing Thank you so much. Very helpful.
You are very welcome Andria, appreciate your message and support!
Thanks for breaking it down! I read about this baking soda “treatment” in a newspaper and had to look into it.
You are very welcome Amanda and good for you for wanting to look more into the headline!
Please pardon me but after reading all of that information….you should have just said That there is not enough significant evidence to prove that baking soda will help cure autoimmune disorders…that’s all!!!….. people reading here are just looking for a simple answer…in short, your summary should have been at the beginning of your article…..
Appreciate your message Pat. I certainly will consider having better summary points in the beginning in the future. I will say my intention in writing the article was yes to share that conclusion but was also to provide people with the tools to be able to explore and critique medical news stories. I see it has trying to helping teach a man to fish rather than just giving them the fish (information). I will certainly do my best to summarize things as succinctly as possible in the future.
To the contrary, I really appreciated your thorough and investigative approach to this topic. The detailed breakdowns and commentary made me feel like I could trust this information because you addressed the discrepancies and truly read between the lines just as meticulously as I would have wanted to– better, even.
That was a very thorough article – I always appreciate when I get to see the science behind health claims. I believe that we have control over our health through proper eating and whole foods and that the shortcut is to eat healthy. Having supplements is an important part of that when those supplements or in this case baking soda have been shown scientifically to he a healthy addition to a whole food plan.
Keep up the good work and thanks for your extensive explanation!
Thanks Jack, really means a lot to read your message and get your support. Will certainly do my best to continue providing acceptable articles with enough science to keep things interesting and balanced.
I wish I could have a breakdown like this of every medical article. I’m so impressed with how thorough your analysis was and appreciate the way you made all of the information so much easier to understand. Thank you so very much for the work you put into it! Welcome to the Autoimmune Wellness community! I look forward to reading more of your contributions in the future.
Thank you LC what a tremendously kind comment and welcome. I will certainly continue to try my best to provide material that is both educational and empowering. Appreciate your support.
The only thing that matters is the data. Science has become corrupted across the entire spectrum. So has the data pushed by faulty testing methods and self-interest of pressured researchers or the involvement of personal benefit. Retraction rates for published research are sky high and likely just the tip of the iceberg. Doctors are not immune to pushing phony science in their practices. No pun intended.
Baking soda is an old remedy for many ailments. While I have no opinion about this research or this article, because neither present compelling data, we often find that science eventually validates some value that humanity intuitively understood for hundreds or thousands of years. That doesn’t mean baking soda is a miracle cure for anything. But given its history, I would not be surprised to see beneficial aspects to its use.
Some good points Barry. I think we recognize the limitations of science but I see that it’s a tool if used properly to iteratively help explain and gain a better understanding of our world.
Thanks for the info and your concern…it’s nice to know there are honest Dr.’s out there going above and beyond…
You are most welcome!
Thanks for the tips on how to evaluate stories like this. There is so much out there that is false and misleading.
You are very welcome and I agree it is sometimes disheartening but with enough vigilance and a curious mind you can be a pretty good citizen scientist. Appreciate your message and support!
Great article. I learned a lot. Please keep writing more articles like this. There’s so much more to debunk out there with regard to autoimmune disease and all of the vitamins, supplements and other various methods, foods & tests that are supposed to help us. I’m grateful for having a new reliable source to read.
You are very welcome Lola, I really appreciate your thoughtful message and am glad to know you found this helpful.
Vichy-Célestins mineral water, a great source of it! I found a .gov PDF from 1927… not a new idea although healthy skepticism is called for, I would certainly not discard this research! To follow.. and a little Vichy water here and there wouldn’t hurt. There is a lot we don’t know about the microbiome and I suspect this is all
connected. So I respectfully disagree with this general sweeping. Thank you for the good work!
So…….it works. What baking soda does is alkalize the body which in turn reduces inflammation and reduces pain. I have osteoarthritis and it helps me tremendously.
Hey Diedre, I am glad you have found baking soda to be helpful for your joint pain. I certainly hear from people about different remedies and compounds like baking soda helping people with their joint pain.
Thanks for the breakdown! I enjoyed the science geek breakdowns as well.
I really wish more studies weren’t behind a paywall. Especially ones reported in the news media.
Thank you for your thoughtful message. I do believe one day we will get to freely available open access science, it will just take some time. Appreciate your support!
The full study is available here: https://sci-hub.tw/10.4049/jimmunol.1701605
Thanks Angela for sharing. At this point despite my personal beliefs for free access science I cannot endorse SciHub as a legal way to read literature. Appreciate you sharing this resource, however, as I know people use it with meaningful intention
So good (and rare!) to get a good scientific breakdown of a supposed silver bullet fix. Thanks for taking the time to get and analyse the full original article. I try and do this myself when I have time but as you say, some articles are inaccessible.
Appreciate your kind words Fiona! It certainly can take, time, effort and also a little luck to get access to article and to really thoroughly explore what they are saying.
I can’t express to you how much I loved this article! So rarely are we given the opportunity to understand the details, research and reasoning behind such claims. I’m sharing this with my high school son who just finished (and loved!) AP Chemistry so he can see the application and relevance of his learning.
Mandy I also don’t have words to tell you how grateful I am for hearing your thoughts and for your kind words. Tell your son AP chemistry was my start some 12 years ago as a junior in high school- still really doesn’t feel that long ago though, but some great foundations were set in that class, good for him for exploring the sciences with a an open mind! Take care
Hello Dr. Abbott,
It’s great that you read this and tried to make it simpler for readers of this site. But you created a misleading and negative context for it. MOST academic articles are published by companies that demand payment or university affiliations to get them. To do otherwise means to spend $2500-5000. Some grants make free publication obligatory and others not. You should know better than this, but maybe you bet the readers will not.
Obviously this is a research study, and it may have been overinterpreed by the media. But if something fairly innocuous like baking soda can mitigate various immune disorders, one loses nothing by taking it. For sure one ought to read the SC Ray in Augusta. Her email must on the university website. Most researchers reply.
What is weirder about your response is the touting of a paleo diet. And what evidence exists for that? Do you consult, see patients, get them to follow a ‘paleo’ diet? What conflict of interest do you have?
Anyone who has studied even a bit of paleolithic-related research realizes that those people ate meat, cooked meat, and were in a host-parasite race. Do you advocate semi-cooked meat and parasites for your patients????
The readers of this site should not just obey the voice of male with MD credentials. Some of the kookiest medical opinions on the web come from MDs.
For the readers, there is a caveat on baking soda. It may deplete potassium levels. Experientially speaking, it may be useful to take for 2 weeks and then let a week pass. Or after two weeks or so, take every other day. It would be useful to get a sense from the original researchers about this.
I appreciate you message and inquiry. I will apologize if my response does not fully address your questions and concerns as it can be difficult to fully understand in text. I will attempt to address a few of your thoughts below.
1. I do not feel I put baking soda in a negative light or context, I presented my evaluation of a research study involving baking soda that had some inconsistencies. I was more concerned with the medical news articles than the researchers and acknowledge on my article the pioneering work of the authors as well as my questions regarding some of the inconsistencies with the data.
2. With regards to your comment about publishing I do not fully understand what you are trying to say. I will say first and foremost I am a physician and clinician, I do not perform research full time, so I cannot comment on your comments about publishing costs. In my article I simply pointed out that the article was published in a journal that is not open access, while I cannot speak for specific institutions and their relationships with journals, in general researchers can choose to publish in journals that are open access versus those that are not. Costs vary and there are pros and cons to both but in general viewership is higher and cost is lower with open access journals. With regards to your statements about why I didn’t comment on this in the article, it was not because i didn’t think people would know or understand this, it was simply because it is not relevant to the information I presented.
3. I agree that baking soda is a seemingly innocuous substance but there are case reports of people using too much and causing major problems, I would rather remain cautious and avoid people overdosing because of the thought some might be good more must be better. I am certainly open to the thought that baking soda may be helpful and it likely will help some individuals in the right context.
4. With regards to your concerns for my touting of the paleo diet, I do not see how one could have a conflict of interest by recommending real whole, foods, there aren’t exactly patents on apples and vegetables. I am quite confused by your comments about meat and parasite races? I don’t advocate for eating semi cooked meats and parasites, I tell my patients to eat sustainably raised grass fed meat and free range humanely raised chicken, nuts, seeds, vegetables, tubers, fruits, fats such as olives, avocado and coconut products. There is quite a significant body of evidence supporting this way of eating for metabolic health- diabetes and blood pressure and more specifically, this way of eating was studied for patients with IBD, which curiously showed greater efficacy than any other drug for the condition by a long shot. I believe there is a wealth of rigorous research and anthropological data supporting this way of eating.
5. With regards to your comments about readers obeying the comments of a white male with MD credentials. I agree that people should not simply listen to someone based on the letters after their name and should engage in a respectful and thoughtful inquiry with the person and material. I do not, however, agree or tolerate your comments targeting a male with an MD. People with all kinds of letters or no letters after their names can say hurtful or harmful things, sure there are “kooky” mds just as there are “kooky” lawyers, and fast food workers, and bloggers and on and on. I think most people can agree that people with MD after their name also did not wake up with the letters after their name, and having the title informs an individual that they have performed quite a rigorous and standardized education. Now I cannot speak to your background or about you as a person based of your initials, I will simply state that I think it is ill advised to leave anonymous medical advice in the comments of articles regarding how you feel people should take baking soda for their condition.
I would appreciate in the future that you not leave such unsupported anonymous comments no matter how innocuous they may be.
Hopefully this was helpful
All the best
Had very active RA for 7 years with almost continual flare ups until i read months ago a double blind study done by Tehran university on using baking soda as an adjunctive with etanercept patients and there were some dramatic improvements in most cases, As i had to stop etanercept before an operation i decided to take the bicarb in the hope i could avoid any flare up and i am astounded by the results of my experiments , i decided to halt my etanercept as things have improved so much, it has been 3 months and for the first time in 7 years i have experienced no flare ups ,my energy levels have increased dramaticly, my skin looks healthy again and some of the large lumps i have vanished within 5 weeks something the regular meds have not been able to do, , I added magnesium,borax, to my own preperations 2 months ago and again more improvements in my overall condition, as i’m still on methotrexate ( 10 mg weekly) i have decided to lower my dose by 2.5mg every few weeks and observe the results,,,so far so good, i’m keeping the hospital informed of my progress,
I don’t know the science behind it all, but I have psoriatic arthritis, and have been suffering severe pain for several years. Yet when I started drinking a tsp of baking soda in 8 oz of water every day, I felt relieve within the first 24 hours. The amount of pain medication I needed just to function dropped by 75% eithin the first 24 hours as well. After several days, I was able to get dressed with almost no pain, and could even do household chores like sweeping and vacuuming without being in so much pain I could do nothing else the rest of the day. I’m still at the beginning of this, but my sister (who has detmatomyocitis) is almost completely off pain medication after 1week of this, and a friend of hers (also with DM) is now completely off her medicines. So in spite of your incredibly detailed breakdown of this study, I feel that it was still missing a very important factor: an evaluation of the tremendous difference this “treatment” has made in the lives of the participants. Considering this, it would at least be worth digging deeper for more information. It could be the difference between just being alive and truly living for your patients. Do you really want to just throw that possibility away based on only 1 study?
Hi Suzanne! I look forward to Rob’s input here, but I am really happy you’ve found something that works for you. I’d be curious to get an update in a few months since you say you are at the beginning – I would be concerned on the long-term impact on digestion since the baking soda would be buffering your natural stomach juices.
Thank you for this article. It’s very helpful. I have lupus and observed (3 times) that when I stopped eating meat, my kidney disease went into remission, and when I resumed eating meat, my kidney disease became active. My doctors dismiss my anecdotal evidence as coincidence. But you can probably see why claims of a baking soda fix is interesting to me. Any idea how I can contact any doctors/researchers who may be interested in proving/disproving what I’ve experienced as actual science? And what might actually help me in the future. Thanks!
Thank you for sharing a bit of your story. I hope you are still doing well. Often tomes it’s hard to know what certain researchers think is interesting and relevant to put into case reports. I would be happy to hear a little more about your story.
Maybe you missed the point. I see in the bicarbonate group a 50% reduction in TNFalpha and that in itself is a reason to try this (or at least for further investigations), as this peptide is a proinflammatory cytokine. The effect of several drugs is based on reducing TNFalpha in the blood.
And also the effects on the M1 and M2 macrophages seem to reduce inflammation.
The data seem to me very significant.
Appreciate your comment. The study as I mentioned in the article was indeed interesting and a degree complex. They showed some fairly compelling data in their graphs that appeared to show some positive changes in macrophage polarization as well as TNF, however, there was raw data lacking that made it very challenging to interpret the absolute changes to compare to the relative changes they reported. As I discuss in regards to inflammation, TNF is not an all bad thing, it had a number of wide ranging effects and has been used therapeutically for cancer such as soft tissue sarcoma. While I would love myself to simply jump on the let’s find anything and everything that decreases TNF bandwagon, it is still unclear whether the anti TNF drugs, for example, make individuals more susceptible to cancer because of the forced immune modulation. This is all simply to say it’s complex and nuanced. I would very much like to see a larger study on humans looking at a combination of blood and chemical markers to help us unpack some of this complexity. Thanks again for sharing your thoughts.
I appreciate your analysis as I was speculative. I suffer from Sjogren’s, RA, and Dermatomyositis. During my recent flare my CK was at 196 and shot to 350 within the week. They wanted to start me on high dose steroids to combat the inflammation but I refused as I hate the side effects and just got off of it after being on it over a year. So, taking the “what can it hurt approach” I tried the baking soda for a week. Not only was my IBS symptoms relieved, which is to be expected, but my CK was decreased to 128 and has continued to decrease, as well as the BUN/Cr numbers having improved. Coincidence on the CK? We may never know but I’m curious to see during the next flare if the same thing happens. I remain skeptical of it because the study just doesn’t support it and I’d like to see more done on it. And it’s not something I would take on a regular basis, nor increase the dosage on, as risks of electrolyte imbalance and dehydration were always on my mind. Furthermore, I had to take it by gelatin capsules, because trying to drink the stuff made me gag.
Thanks for this thoughtful comment and for sharing a bit of your story. Certainly very hard to say what caused the positive changes in CK and kidney function, but like everything people’s individual responses will vary and it’s nice to see you taking a cautious approach. Some people speculate, in addition to that the authors in this study examined, that people can see an increade in stomach acid in an effort to buffer the baking soda and perhaps this helped with certain aspects of IBS and digestion. Certainly would love to hear how things unfold for you and what other therapies you find helpful. Thanks again for sharing your comments.
Yes, anything that is harmless, cheap and possibly addresses the real cause of autoimmunity is nixed. Yes, we’ve all heard this before. Not enough subjects, etc.etc. This was a ground-breaking discovery; the nervous tissue in the surface of the spleen has control over auto-immune response. It passed peer review, just not Abbott review.
In my article I do actually acknowledge the groundbreaking nature of the study and the importance of its findings. I also point out how medical news media distorted these findings to address a different agenda and make conclusions not supported by the data. It appears that your work is certainly in support of dietary and alternative therapies and I, like you, believe in utilizing low risk and low cost interventions for complex chronic disease, but the authors findings did not have to do with controlling an autoimmune response specifically and I’m not sure I understand what is the root cause of autoimmunity? Perhaps you can help me to better understand this. I will say I hold more rigorous standards for research than typical peer review as evidenced by the number of studies one can find on Pubmed with poor methodology asking questions that are clinically irrelevant. Thank you for your contributions to the integrative health movement. I wish you the best in your journalistic and writing endeavors.
Thanks for the breakdown of this article. Sample size is crucial as are peer review studies to determine if the results can be replicated. I look forward to more studies on this. RA is a painful and debilitating condition and the prescriptions given for it have numerous side effects which can be much more dangerous than baking soda (if taken in small doses). I appreciate the additional information you provided. The better informed we are, the better choices we are able to make. Please continue to share. Thank you.
Just to add my experience, after I had been on a strict AIP diet for a few months I felt much better but didn’t have all my energy back. (My main conditions are Crohn’s, psoriatic arthritis and psoriasis.) I saw the news about baking soda and decided to try a little. Remarkably I felt my energy come back by the next day. In my research I discovered that it may work by improving the acid/alkaline balance. I still use it, although to help maintain my blood pressure in a normal range, instead of using sodium bicarbonate I use potassium bicarbonate.