"The Primary Sources Of Acidity In The Diet Are Sulfur-containing AAs, Salt, And Phosphoric Acid"

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Amazoniac

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- Long-term continuous renal replacement therapy and anticoagulation with citrate in critically ill patients with severe liver dysfunction

"In this retrospective evaluation, we demonstrate that in critically ill patients with severe hepatic dysfunction, regional anticoagulation with citrate for CRRT is possible, even for long-term dialysis. Although patients showed pronounced impaired liver function, citrate accumulation occurred in only one of four patients and was far less dramatic than expected."

"Under physiological conditions, citrate is metabolised by the liver and to a lesser extent by the skeletal muscle [5]. Therefore, RCA [Royal College of Art] is considered as contraindicated in cases of impaired liver function resulting in accumulation of citrate [6, 15–18]. Increased citrate plasma levels are indirectly detected, as described by Hetzel and colleagues [14], through an increasing ratio of total serum calcium (tCa/iCa). The limit of this ratio varies in the literature from 2.1 to ≥ 2.5 [19–21]. Under physiological conditions, tCa ranges from 2.2 to 2.6 mmol/L and iCa ranges from 0.90 to 1.20 mmol/L. The resulting ratio (tCa/iCa) ranges from 1.8 to 2.4. Thus, a tCa/iCa ratio > 2.4 was considered a sign of accumulation of citrate. This threshold was also previously chosen by Link and colleagues [21]. Although all patients included showed pronounced impaired liver function, in almost half of these patients any aspect of metabolic or electrolyte disturbance occurred, and only one of four had signs of citrate accumulation. Furthermore, slight changes in the dialysate and blood flows mostly allowed correction of looming signs of metabolic disorders. These results are in contrast to the conventional wisdom in the literature. However, there is anecdotal evidence that the use of citrate in patients with impaired liver function would be possible [3, 22, 23]. Of note, some studies have reported RCA after liver transplant [8, 24]. However, liver function normally improves after transplant. Furthermore, the described mean dialysis periods were quite short at 5–8 days [8, 24]."

"[..]hepatic function seems not to be exclusively or predominantly responsible for citrate metabolism. We therefore hypothesise that in critically ill patients with impaired liver function a part of citrate metabolism is shifted into muscle cells or any other cells. This also would explain why the duration of dialysis with consecutive high cumulative doses of citrate does not result in accumulation and metabolic disorder."

"Metabolism of administrated citrate can induce metabolic alkalosis. Under physiological conditions citrate is cleared by the citric acid cycle (tricarboxylic acid cycle), resulting in 3 mmol of NaHCO3 − per 1 mmol of trisodium citrate [29]. In the literature the incidence of alkalosis during RCA with citrate is reported in 23–55% of patients [30, 31]. Different citrate formulations and HCO3 − concentrations of the dialysate or replacement solutions may partially explain these different incidences of alkalosis. However, the occurrence of alkalosis also depends on rapid metabolism of citrate. This is thought to be dependent mainly on liver function [8]. In one-fourth of patients in our study, metabolic alkalosis occurred, in line with other reported incidences. Of note, in contrast to studies reporting on alkalosis, all of our included patients had severely impaired liver function. We interpret this fact as a further indication of our former described hypothesis that an adequate citrate metabolism must be possible also outside the liver."

"In the literature, citrate metabolism is primarily associated with hepatic function. Therefore, baseline liver function parameters should be predictive regarding citrate accumulation during CRRT with RCA. However, most standard laboratory liver function parameters showed poor predictive capabilities [3, 6, 26]. This raises the question whether impaired hepatic function is really the main reason for accumulation of citrate. This poor prediction of citrate accumulation by parameters of liver function appears to be a further indication that an effective extrahepatic metabolism of citrate seems to exist. Our results are consistent with the recently published study by Slowinski and colleagues [9]. However, the reported observation period of CRRT was 3 days (first 72 h of CRRT). Thus, comparability with our study is limited."

"Because in all cells citrate can be metabolised within the Krebs cycle (tricarboxylic acid cycle), we hypothesise that an impaired perfusion on the microvascular and cellular levels is critical to the metabolism of citrate. This hypothesis is supported by the observations of Schultheiss and colleagues, who described a baseline serum lactate level ≥ 3.4 mmol/L as a predictor of citrate accumulation [3], and of Link and colleagues, who showed that in patients with signs of citrate accumulation, mean arterial blood pressure was lower and dose of norepinephrine was higher than in those without citrate accumulation [21]. This hypothesis has also been suggested by recent studies, some of them pointing at hyperlactataemia [32] or, more specifically, at lactate kinetics during treatment [33] as a useful predictor for citrate accumulation. Disturbed microvascular circulation could also cause altered hepatic function, resulting in an association of impaired liver function and citrate accumulation. This hypothesis would also explain why in the literature inconsistent results exist concerning liver function and accumulation of citrate. Moreover, a correlation was described between the tCa/iCa ratio and hepatic clearance measured by the ICG-PDR and multi-organ dysfunction measured by SAPS II score during CRRT-RCA [21]. On the basis of our data, we cannot prove the hypothesis that shock and disturbed microcirculation are mainly responsible for disturbed citrate metabolism. However, patients developing citrate accumulation had a higher need for vasopressor therapy and showed lower ICG-PDR. In addition, reduced ICG-PDR is not only a sign of impaired liver function but also was recently shown to be correlated with impaired hepatic perfusion [34]."

"Our findings may serve to somewhat dispel the notions that RCA is contraindicated in critically ill patients with impaired liver function. Citrate metabolism seems not to be restricted to the liver. Therefore, liver failure in patients treated by CRRT with RCA does not automatically result in accumulation of citrate. However, caution and close monitoring of metabolic disorders are needed because wrong management of RCA can result in serious adverse effects in critically ill patients with impaired liver function. Further studies are warranted to confirm our findings."
 
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Amazoniac

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Using the species distribution as a function of pH, you can estimate how buffers must behave in the body.

Bioavailability of soil inorganic P in the rhizosphere as affected by root-induced chemical changes: A review

1644678587809.png
These are rough values just to give an idea.

Biorelevant Test for Supersaturable Formulation

- Impact of gastrointestinal tract variability on oral drug absorption and pharmacokinetics: An UNGAP review

The graph was fixed for clarity.
 
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YourUniverse

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@Amazoniac @Amarsh213 How do we reconcile this statement?

"You will likely immediately scoff that salt is neutral in pH and is not metabolized to anything that is acid—and you would be right. Nonetheless, research has clearly shown that—happily reversibly—NaCl accounts for 50% of the net acidity of the average American diet"

Sodium is alkaline, chlorine is acid, and the PRAL equation does not factor in NaCl because it is thus considered neutral. Clearly though, the chlorine seems especially acidic or starts some sort of acid cascade, if the above statement from the base post is true?
 
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@Amazoniac @Amarsh213 How do we reconcile this statement?

"You will likely immediately scoff that salt is neutral in pH and is not metabolized to anything that is acid—and you would be right. Nonetheless, research has clearly shown that—happily reversibly—NaCl accounts for 50% of the net acidity of the average American diet"

Sodium is alkaline, chlorine is acid, and the PRAL equation does not factor in NaCl because it is thus considered neutral. Clearly though, the chlorine seems especially acidic or starts some sort of acid cascade, if the above statement from the base post is true?
It's a mistake not to take edemium and chlorrorine into account:
- Alkalinity Vs Acidity 2012, KMUD : The Herb Doctors
 
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@Amazoniac @Amarsh213 How do we reconcile this statement?

"You will likely immediately scoff that salt is neutral in pH and is not metabolized to anything that is acid—and you would be right. Nonetheless, research has clearly shown that—happily reversibly—NaCl accounts for 50% of the net acidity of the average American diet"

Sodium is alkaline, chlorine is acid, and the PRAL equation does not factor in NaCl because it is thus considered neutral. Clearly though, the chlorine seems especially acidic or starts some sort of acid cascade, if the above statement from the base post is true?
Sodium Chloride is not and accounts for the acidity. It has a crazy high absorption rate is in everything/everywhere.
 

ww3not4me

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How do you explain the long lives and low rates of cancer and hypertension for instance among countries with insane levels of Sodium intake like a lot of Asia and Baltic countries?
 

ww3not4me

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Google "Average sodium intake Japan" and this is the first thing that pops.

"In Japan, salt intake of population has increased from 10.7g to 11g per a day in the latest data for the first time in ten years. Experts warn that the Japanese are becoming the most 'salt-friendly' people in the world and point out it is imperative to involve the food industry to reduce salt intake."

In Northern Japan sodium intake is as high as 18g per day on average in that region.

Have you checked your sodium levels via blood tests and checked your ph and blood gases? Have you adjusted your intake and checked again? If not I would say your barking up the wrong tree.

Low sodium levels are far more dangerous than high sodium levels. Like typical Western Medical professionals most people in America are brain washed to believe salt is bad. On top of that the only thing that matters is Sodium Chloride no one eats pure sodium ions and sodium in it's raw form is explosive in contact with water. Humans eat sodium chloride and the body works it's magic. Diabetes, Metabolic Syndrome X and a long list of metabolic and health issues are caused by low sodium levels. Just like being partially dehydrated does not produce the obvious symptoms of medical dehydration does in the long term it damages the body likewise being low on sodium but not enough to cause obvious disease state causes damage over the long term with out most being the wiser!

If you think your dumping too many electrolytes aka minerals into your urine get a 24hour urine test after talking to your doctor. Then you will know. For every book or expert advice their are exceptions. Experts do not matter unless they produce results. So put these experts tot he test and get tested after following their advice for a while after first establishing a base line. Then instead of asking random people on this site you will have the data to back it up. Empirical evidence that applies to you!

Some things you can go by how you feel like mood and pregnanolone but other things like electrolyte, ph, and many other things you need to actual get some test's to know if the outcome is what you want! It has been my experience with humans and nutrition that you have general rules of thumb and then you have the exceptions. No one bothers to bring those up but they do exist and if you are an exception I guarantee it matters.
 

yerrag

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In Northern Japan sodium intake is as high as 18g per day on average in that region.
Interesting.

Is it a coincidence that in the hospital and given isotonic saline IV of 2 liters per day, a patient is taking just as much salt?

0.9% saline x 2 liters = .009 x 2000g = 18g

So, if you're a hospital patient who is sick enough to require IV, that much salt is good. And if you're not, that much salt is good or bad?
 

ww3not4me

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The question of what to give in a hospital setting can get complicated fast vs what is practical and time tested. All IV fluids have their potential problems but they are convenient and super easy to control and allow one to keep an IV open to rapidly give medications if needed. All of the various IV hydration fluids can fallout of suspension and crystalize in the body in places you do not want. You also have storage issues and convince.

The body no matter if it is via IV or oral route the body does not absorb much of the water you drink. Adding sodium chloride increases the rate at which the body will take the fluid up some even if you are not low on electrolytes initially.

As long as your kidneys are working right most people can handle increased sodium with little fuss especialy over the short term.

Only 1 person out 1000 people with hypertension have sodium sensitive hypertension so it is beyond ignorant, foolish and dangerous to preach "low sodium". Making sure people are low on sodium over their lifetime is a great way to set them up for diabetes and auto immune disease. Even your stomach acid and gastric juices depend on adequate and consistent intake of sodium. It is true that the body will fight to hold on to sodium it has it's limits.

Outside of my cup of tea and one cup of coffee I drink each day all of the water I drink per day which is about a gallon of water a day most days more in the Summer are all salted. For the last 8 years I can count on one hand the number of times I have drank water that does not have electrolytes in them. Into one gallon of water I mix 1-2 teaspoons of sodium chloride usually 1 during the Winter 2 during the Summer, 1 teaspoon potassium chloride, 1/2 teaspoon magnesium citrate, 1/3 teaspoon magnesium sulphate, 1/8th teaspoon borax, 1/32 teaspoon chelated zinc and once in a while 1/4 teaspoon sodium bicarb. I always take water with me on the road and only when I am going to be away for more than a day do I drink plain water. I have been doing this for about 8 years now and my blood work is great.

I feel so much better since I started doing this compared with before. I know I should work on getting my ratio of Magnesium and Potassium up in relationship to my sodium.

Generally when people have issues with sodium sensitivity it is normally a combination of chronic dehydration and sodium levels that less than ideal. If you try to raise them too fast you typically see swelling edema all over but especially in the legs, hands and feet. This assumes kidneys, heart, lungs are all working correctly. The trick to fixing this is to be slow, methodical and consistent So you would take an extra 2oz of water per day with just a pinch of salt added to it each day for a week or two over your normal intake. After say 2 weeks of that you would add an additional 2oz. Next week 3 times a day do that. Next week increase those 3 2oz servings with 3oz serving etc......You slowly titrate things. Before you know it you might for instance be drinking 1 extra gallon of water a day with a teaspoon of salt of your choice.

These are just my personal observations as they relate to me your mileage will vary. I did everything as I was taught growing up according to conventional Western Medicine and was a national and international athlete and ended up broken and diabetic with hypertension. So going the opposite direction of what I was taught has been in attempting to fix myself. Not fixed yet I am a work in progress but I can say with out a doubt that I am better now than I was with conventional thinking!

Funny though because conventional wisdom says I should be worse not better. How can someone live on salty water for 8 years??? I spent a week on regular water after my father in law died recently and I was fine as well.

When I was in the hospital with a nasty infection in my leg from 2 rusty nail punctures I was not getting my electrolyte water and was fine and all of my labs outside of what was going on due to infection were fine. You wait and see though people will object to what I have said her as if I am telling people to drink arsenic or hemlock! My labs prove it is fine and yet they will take issue with it. I also salt my food generously and I have only just managed to break into what is considered normal sodium level I only just make the bare minimum.
 

yerrag

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The question of what to give in a hospital setting can get complicated fast vs what is practical and time tested. All IV fluids have their potential problems but they are convenient and super easy to control and allow one to keep an IV open to rapidly give medications if needed. All of the various IV hydration fluids can fallout of suspension and crystalize in the body in places you do not want. You also have storage issues and convince.

The body no matter if it is via IV or oral route the body does not absorb much of the water you drink. Adding sodium chloride increases the rate at which the body will take the fluid up some even if you are not low on electrolytes initially.

As long as your kidneys are working right most people can handle increased sodium with little fuss especialy over the short term.

Only 1 person out 1000 people with hypertension have sodium sensitive hypertension so it is beyond ignorant, foolish and dangerous to preach "low sodium". Making sure people are low on sodium over their lifetime is a great way to set them up for diabetes and auto immune disease. Even your stomach acid and gastric juices depend on adequate and consistent intake of sodium. It is true that the body will fight to hold on to sodium it has it's limits.

Outside of my cup of tea and one cup of coffee I drink each day all of the water I drink per day which is about a gallon of water a day most days more in the Summer are all salted. For the last 8 years I can count on one hand the number of times I have drank water that does not have electrolytes in them. Into one gallon of water I mix 1-2 teaspoons of sodium chloride usually 1 during the Winter 2 during the Summer, 1 teaspoon potassium chloride, 1/2 teaspoon magnesium citrate, 1/3 teaspoon magnesium sulphate, 1/8th teaspoon borax, 1/32 teaspoon chelated zinc and once in a while 1/4 teaspoon sodium bicarb. I always take water with me on the road and only when I am going to be away for more than a day do I drink plain water. I have been doing this for about 8 years now and my blood work is great.

I feel so much better since I started doing this compared with before. I know I should work on getting my ratio of Magnesium and Potassium up in relationship to my sodium.

Generally when people have issues with sodium sensitivity it is normally a combination of chronic dehydration and sodium levels that less than ideal. If you try to raise them too fast you typically see swelling edema all over but especially in the legs, hands and feet. This assumes kidneys, heart, lungs are all working correctly. The trick to fixing this is to be slow, methodical and consistent So you would take an extra 2oz of water per day with just a pinch of salt added to it each day for a week or two over your normal intake. After say 2 weeks of that you would add an additional 2oz. Next week 3 times a day do that. Next week increase those 3 2oz servings with 3oz serving etc......You slowly titrate things. Before you know it you might for instance be drinking 1 extra gallon of water a day with a teaspoon of salt of your choice.

These are just my personal observations as they relate to me your mileage will vary. I did everything as I was taught growing up according to conventional Western Medicine and was a national and international athlete and ended up broken and diabetic with hypertension. So going the opposite direction of what I was taught has been in attempting to fix myself. Not fixed yet I am a work in progress but I can say with out a doubt that I am better now than I was with conventional thinking!

Funny though because conventional wisdom says I should be worse not better. How can someone live on salty water for 8 years??? I spent a week on regular water after my father in law died recently and I was fine as well.

When I was in the hospital with a nasty infection in my leg from 2 rusty nail punctures I was not getting my electrolyte water and was fine and all of my labs outside of what was going on due to infection were fine. You wait and see though people will object to what I have said her as if I am telling people to drink arsenic or hemlock! My labs prove it is fine and yet they will take issue with it. I also salt my food generously and I have only just managed to break into what is considered normal sodium level I only just make the bare minimum.

Yes, salt is not bad.

But why do you need to drink a gallon of water a day? Do you have a condition or do you feel that drinking that much electrolyte water contributes to optimal health for a typical person?

As far as blood go, what blood tests are you referring to?

I also have to point out that while blood tests are very helpful to have, blood tests don't tell us much when the amount or concentration of the substance being tested is not well represented in the blood test. An example is magnesium. Even the potassium in blood does not represent the potassium stories in the whole body, as present in the cells, the ecf, and in blood. Same goes with calcium, and with sodium. The amount of electrolytes in the blood is influenced by many physiological factors in the body's constant process of achieving balance. Just one aspect of it is in achieving acid base balance.
 

FitnessMike

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i wonder if i could somehow neutralize the acidity of the salt that im consuming as a constipation solution, have to switch from baking soda to normal salt due to lowering stomach acid.

The problem with salt is that it indeed is very acidic as over time it makes my blader very weak with the amount I'm using, making my bladder so weak to the point where i have to void my blader every 30 min no matter what the amount of urine.

Any suggestion on how to neutralize acidic load? would just eating alkaline foods afterward be good enough?
 

Motorneuron

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So, is Buteyko-style breathing that involves suspending the breath (attention I didn't say holding) is globally negative because it puts organs and tissues in an acidic environment? CO2 is needed to transport oxygen and thus avoid hypoxia.

Thank you
 

yerrag

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So, is Buteyko-style breathing that involves suspending the breath (attention I didn't say holding) is globally negative because it puts organs and tissues in an acidic environment? CO2 is needed to transport oxygen and thus avoid hypoxia.

Thank you
If you are not acidic because you have good sugar metabolism, you don't need Buteyko. Poor sugar metabolism begets an acidic internal environment because plenty of metabolic acids such as lactic and keto acids are produced instead of CO2, which is a vital part of the body's system of buffering its pH. CO2 can be made into carbonic acid to increase acidity and into bicarbonate to increase its alkalinity. Lacking CO2 and having a lot of lactic and keto acids is a prescription for an acid base imbalance that creates an environment for disease.

Buteyko is not for people already healthy from good sugar metabolism. It is for people who do not know how to have a good sugar metabolism either by ignorance either from not knowing about his poor sugar metabolism or from not knowing how to improve his sugar metabolism to a tolerable if not optimal state.

That said, Buteyko is helpful if practiced correctly for such people. The increase in acidity in the blood from increasing CO2 in the blood (in the form of carbonic acid) should not be too much that it tips one from acidosis into acidemia which can easily become an ER event. Hence, there is a need to be properly trained in Buteyko.

That said, how Buteyko makes one improve his acid base balance is by causing the temporary increase in acidity from a session of Buteyko to eventually be resolved by the kidneys. The kidneys will excrete the excess acidity in the form of lactic and keto acids. In this way, the carbonic acid in the blood that came about from practicing Buteyko is still retained, while the lactic and keto acid in blood is lessened.

This way, if Buteyko is practiced regularly as in daily, gradually the acidity in blood will be heavily influenced more by the carbonic acid content than by the lactic and keto acid content (also have to consider effect of food intake and of drugs and supplements for sure).

With a large amount of carbonic acid content in blood, it is much easier for the body to lower it's acidity when needed as it's merely a matter of excreting the excess carbonic acid thru the lungs by breathing it out in the form of CO2 as a gas. The lungs is a rapid response system while the kidneys is a slow response way of the body in regulating acid base balance.

There is more to this than a long post like this would cover, but I hope you get the idea.
 

Motorneuron

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If you are not acidic because you have good sugar metabolism, you don't need Buteyko. Poor sugar metabolism begets an acidic internal environment because plenty of metabolic acids such as lactic and keto acids are produced instead of CO2, which is a vital part of the body's system of buffering its pH. CO2 can be made into carbonic acid to increase acidity and into bicarbonate to increase its alkalinity. Lacking CO2 and having a lot of lactic and keto acids is a prescription for an acid base imbalance that creates an environment for disease.

Buteyko is not for people already healthy from good sugar metabolism. It is for people who do not know how to have a good sugar metabolism either by ignorance either from not knowing about his poor sugar metabolism or from not knowing how to improve his sugar metabolism to a tolerable if not optimal state.

That said, Buteyko is helpful if practiced correctly for such people. The increase in acidity in the blood from increasing CO2 in the blood (in the form of carbonic acid) should not be too much that it tips one from acidosis into acidemia which can easily become an ER event. Hence, there is a need to be properly trained in Buteyko.

That said, how Buteyko makes one improve his acid base balance is by causing the temporary increase in acidity from a session of Buteyko to eventually be resolved by the kidneys. The kidneys will excrete the excess acidity in the form of lactic and keto acids. In this way, the carbonic acid in the blood that came about from practicing Buteyko is still retained, while the lactic and keto acid in blood is lessened.

This way, if Buteyko is practiced regularly as in daily, gradually the acidity in blood will be heavily influenced more by the carbonic acid content than by the lactic and keto acid content (also have to consider effect of food intake and of drugs and supplements for sure).

With a large amount of carbonic acid content in blood, it is much easier for the body to lower it's acidity when needed as it's merely a matter of excreting the excess carbonic acid thru the lungs by breathing it out in the form of CO2 as a gas. The lungs is a rapid response system while the kidneys is a slow response way of the body in regulating acid base balance.

There is more to this than a long post like this would cover, but I hope you get the idea.

Really ... Thanks you were very thorough.

To recap: Better to first fix the regular sugar / carbohydrate metabolism and then move on to these techniques 👍 ... personally I find it useful because I combine it with exercises like pushups and squats ... I don't aim for muscle exhaustion but I control my breath with a 1-1-1-1 technique to rise to increase diaphragmatic and thoracic capacity.

An example with pushups: 1 second inhale I go down, 1 second of stop I hold, 1 second I go up I exhale, 1 second I hold and go up with the seconds according to my abilities.

I find it an excellent training system ....
 

FitnessMike

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im not gonna lie, stopping salt make my bladder feel way better... but daaamn i like salt on my potatoes
 

FitnessMike

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Can you expand on that? How does salt affect your urination?
Have you tried salt lite?
Siema!

Chloride is acidic and I have had the same problem with magnesium chloride, chloride seems to be irritating my bladder and makes me feel urgency even with little urine in my bladder, I'm talking about waking up 6 times at night, which was wrecking me. It has been the second day without any salt intake and I sleep longer between awakening and feel no often urges to go to pee.

Before that, I excluded all potential bladder irritants (coffee, cacao powder etc) without any improvements.

Didn't try salt lite, but would like to know if there is salt with less chloride in it.
 

Vanset

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Siema!

Chloride is acidic and I have had the same problem with magnesium chloride, chloride seems to be irritating my bladder and makes me feel urgency even with little urine in my bladder, I'm talking about waking up 6 times at night, which was wrecking me. It has been the second day without any salt intake and I sleep longer between awakening and feel no often urges to go to pee.

Before that, I excluded all potential bladder irritants (coffee, cacao powder etc) without any improvements.

Didn't try salt lite, but would like to know if there is salt with less chloride in it.
Siemka, siemka :alien:
 

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