Monday, June 15, 2020

Alkalizing Accelerates Fat Loss: Multimineral Supplement Boosts Fat Loss & Performance in Intermittent Fasters

Works, ... whether that's solely due to pH modulation is not clear. So we don't know if simply using bicarbonate as an alkalizer will do the same
Let's get this straight, right away. While the authors ascribe the body weight and performance benefits they observed in their latest study solely to the pH modulating effects of their multimineral supplement, it's by no means clear that the minerals themselves do not at least contribute the effect. But before we get into the nitty-gritty of the discussion, let's first see how the mixed-sex population in the study at hand boosted their weight loss and training efforts ...

The RCT was conducted by German scientists from the Martin-Luther-University of Halle-Wittenberg (Hottenrott 2020). Hottenrott et al. recruited their subjects, a total of 80 healthy (40 females), normal-to-overweight subjects who were aged 20–60 years, and had been physically slightly active before the onset of the trial (1–2 h exercise/week).
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The subjects, 40 men and 40 women were randomly assigned to two groups. One intermittent fasting and one non-fasting group. Within the group a second randomization process yielded another two subgroups of subjects who received either...
  • an alkaline supplement (IF-v, nIF-v) or 
  • a placebo (IF-p, nIF-p)
Said "alkaline mineral supplement" is a standard product from German drugstores: Basica Direkt® (contains and all subjects had to consume one serving (comes in sachets) in the AM and another one in the PM, with the placebo being an equally-looking and -tasting placebo (ingredients: citric acid, sorbitol, lemon flavor, and calcium stearate).

"One stick of Basica Direkt® contains 120 mg calcium, 200 mg magnesium, 2.5 mg zinc, 25 µg molybdenum, 20 µg chromium, 15 µg selenium" (Hottenrott 2020).

All subjects had to participate in an obligatory individualized exercise program for a total of 12 weeks during which the scientists didn't just monitor their subjects' body weight, but also (and more importantly), their body composition, running performance, dietary intake, and acid-base balance.
"All participants performed a personalized endurance training based on heart rate determined by an incremental lactate threshold field-test before the start of the 12-week program (incline in running velocity of 1.5 km/h every 800 m until exhaustion starting at an initial speed of 6 km/h for women and 7 km/h for men) Following the test results, subjects received training plans based on performance status and individual heart rate training zones. The 12-week exercise program consisted of 30–60 min running and 20 min of strength training 3 to 4 times a week. Additionally, all participants completed a walking program up to 2 h every weekend. The training was done individually and training plan adherence was monitored by protocol" (Hottenrott 2020).
Doesn't sound like much of a weight-loss trial, yet? You're right. That's because I still owe you the information about the dietary protocol the 80 subjects were subjected to: 
  • dietary intake of all subjects was monitored with standardized protocols for 7 days
  • at the start of intervention, to adjust to the fasting program, IF-participants started with half-day fasting (800/1200 kcal per day, women/men) three times a week for the first three weeks
  • after the initial adjusting period, the following IF program included 
  • two fasting days weekly with a daily caloric intake of 400 kcal for female and 600 kcal for male participants and 5 days of ‘normal’ caloric consumptions (covering the individual demand)
  • diet plans for fasting (half-)days were provided; both, nIF and IF participants, received advice about a balanced diet in a two-hour seminar and a guidebook.
The diet itself was a classic "sports nutrition" = low fat, high carb diet containing 50–60% carbohydrates, 25–30% fat, and 15–20% protein. All participants received recommendations on their individual daily caloric intake based on their basal metabolic rate and their activity level... 

...and the results were quite impressive - with and without alkaline supplementation

As you can see in Figure 1, the (rather easily) achieved deficit led to a significant reduction in body weight (not shown) and, more importantly, in body fat.
Figure 1: The plot of the body fat loss (kg) tells you two things: (A) Intermittent fasting allows for significantly greater fat loss and (B) combining IF with a multi-mineral alkalizing supplement boosts its effects (Hottenrott 2020).
You will probably already have noticed that "fasting" was generally superior to the non-fasting control regimen and IF led to significantly higher fat mass loss than nIF (IF-p: −3.59 ± 0.45 kg and nIF-p: −2.63 ± 0.30 kg, p = 0.044). Now, that alone is awesome, 'cause it seems to support anecdotal evidence from all over the internet. Anecdotal evidence that's still not been convincingly confirmed in non-obese, physically active subjects, yet. 

To be more precise, the authors found "a significant effect of the supplement on body fat loss in IF only (IF-v: −5.12 ± 0.62 kg and IF-p: −3.59 ± 0.45 kg; p = 0.028)" (Hottenrott 2020). 

The changes in body fat came hand in hand with two other health- and performance-relevant improvements Hottenrott et al. ascribe to the alkalizing multi-mineral supplement - just as the authors had speculated when they planning their trial to check if "[a]lkaline supplementation may circumvent fasting-induced acidosis, leading to enhanced weight loss and improved performance" (Hottenrott 2020).

Wait: That's too good to be true, isn't it?

The above is a valid question. In fact, as a healthy skeptic, you should be asking questions such as: Did the authors work for the supplement producer? Was the study sponsored by Protina Pharmazeutische GmbH, Ismaning, Germany? And, most importantly: Wheres' my sodium bicarbonate? The answers are simple: No, no, and... I don't know. So, what I know is that...
 "[...]he authors declare there are no conflict of interests that would influence the quality or outcome of our research. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results" (Hottenrott 2020).
That doesn't change that there was a funder and that this funder happened to be, you guessed it, the Protina Pharmazeutische GmbH that produces the BASICA powder. 
Figure *: In Margolis 2018 the alkalizing effects of potassium bicarbonate KHCO3 (filled circles) saved the dieting guys net protein balance from declining into the negative as it did in the placebo condition (open boxes).
No quackery, bro! People way too often discard studies that even mention the word "alkalization" as quackery. The evidence that even the mild (but chronic) changes in pH management our bodies experience in response to certain dietary compounds and/or behavior (bed-rest, exercise, etc.) is yet very real: The alkalizing effects of potassium bicarbonate, for example, have been observed to significantly increase the total glutathione concentrations of young, male volunteers who were investigated at the end of two 21-day bed rest periods, one with, and the other without, daily potassium bicarbonate supplementation (90 mmol × d−1)...

oh, and did I mention that "[a]fter alkalinization, net protein balance in the postabsorptive state improved significantly by 17 ± 5% (p < 0.05)" (Biolo 2019) ... oh, and I should add that the alkalization also increased the sum of n-3 PUFA and the n-3-to-n-6 PUFA ratio in erythrocyte membranes, no?

If you've been following the SuppVersity news for some time, this may not come as a total surprise. After all, alkalization regimens have already been shown to be particularly useful in phases with increased (tissue) protein breakdown, such as the previously cited bed-rest study or a much older study, in which scientists conserved much more of the deficiency level of protein they fed ten healthy obese females during a VERY low energy weight loss intervention (412 kcal, all protein! | Gougeon-Reyburn 1989). Needless to say that lean mass conservation is a good thing for anyone trying to lose fat... not muscle or bone, and it seems to work even in those at greatest risk - older people: In Margolis 2018 study those happened to be men, but it can be expected that similar effects of alkalizing potassium bicarbonate as you see them in Figure * could be observed in women at a 28-day 30% energy deficit, too.
So, while we know that the sponsors of the study, who allegedly didn't influence design and/or results + interpretation, had a vested financial interest in proving the efficacy of their product, it is not clear why they mixed 120 mg calcium, 200 mg magnesium, 2.5 mg zinc, 25 µg molybdenum, 20 µg chromium, 15 µg selenium to "supply more alkaline minerals", counter the metabolic impairments and reduced lipolysis when your pH level declines to the low(er) part of the 'normal range' where a suboptimal pH poses a bottleneck to ketosis and fatty acid oxidation (Miller 2013Hood 1998). 
Figure 2: Alkaline supplementation group (verum) significantly differed in urinary pH from the start to the end of the intervention in nIF only. * p < 0.05. In other words: It mostly compensated fasting-induced pH reduction.
Now, with the scientists having measured serum HCO3 and urine pH, their data unquestionably supports this 'ph bottleneck'-hypothesis (Figure 2) - at least for those who were fasting on three (later only two) days a week. What's as of now unproven, though is the scientists' conclusion that the "lack of differences in serum concentrations of Mg2+, Ca2+, K+ and Na+ [would indicate that] the effect of the supplement is due to its alkalinity" and not a result of an increase in vital minerals whose serum content will stay within their tightly controlled normal range in response to supplementation, anyway. So, even if the tissue levels of one or all of the minerals improved that wouldn't necessarily have shown on the authors' radar.
From the @SuppVersity archives: "Alkaline Diet - 4-9 Days Suffice to Boost Urinary pH, Boost Time to Exhaustion (21%) + Fat Oxid. During Exercise (10%)" | learn more!
We don't know if its "just pH", "also pH", or "unrelated to pH"! The product "Basica Direkt®" contained sorbitol, as well as the minerals calcium-citrate, potassium-tartrate as an acid regulator, magnesium-citrate, magnesium-oxide, the obligatory calcium salts of dietary fatty acids that are supposed to stop the powder/perls from clumping, and the trace amounts of natrium-molybdate, chromium-chloride, and natrium-selenite (that's the more precise ingredient profile from the producer's website).

Any of these supplement ingredients and or their specific combination could have mediated the increase in fat loss magic. By pH modulation?

Possibly, but it cannot be excluded that downstream effects on diet or physical activity confounded the results. After all, the subjects' diet and exercise regimen were monitored for only three out of eight weeks, which left plenty of room for dietary modification (e.g. increased protein) that could well explain the difference - irrespective of the Basica Direkt® pearls | Comment!
References:
  • Biolo, Gianni, et al. "Alkalinization with potassium bicarbonate improves glutathione status and protein kinetics in young volunteers during 21-day bed rest." Clinical nutrition 38.2 (2019): 652-659.
  • Hietavala, E. M., et al. "Effect of diet composition on acid–base balance in adolescents, young adults and elderly at rest and during exercise." European journal of clinical nutrition 69.3 (2015): 399-404.
  • Hood, Virginia L., and Richard L. Tannen. "Protection of acid–base balance by pH regulation of acid production." New England Journal of Medicine 339.12 (1998): 819-826.
  • Hottenrott, Kuno, et al. "Exercise Training, Intermittent Fasting and Alkaline Supplementation as an Effective Strategy for Body Weight Loss: A 12-Week Placebo-Controlled Double-Blind Intervention with Overweight Subjects." Life 10.5 (2020): 74.
  • Miller, Clint T., et al. "The effects of exercise training in addition to energy restriction on functional capacities and body composition in obese adults during weight loss: a systematic review." PloS one 8.11 (2013).