Podcasts about bicarb

In Besenwagen Femmes übernehmen Tanja Erath und Lea Lin Teutenberg ab jetzt das Steuer hinter dem Frauen-Peloton. Das neue Host-Duo sammelt euch und Profis auf, um über das Leben auf und neben dem Rad zu plaudern. Mit Liane Lippert steigt der aktuelle Star des Frauenradsports ein und zeigt dir den Blick direkt von der Zielgeraden. Neben Profi-Ernährung geht es auch um die ersten Frühjahrsklassiker, wo sich diese Besenwagen-Besatzung bald auch im echten Rennen treffen wird.

In dieser Folge gibt es wieder ein paar ganz besondere Kapseln zu schlucken – wir sprechen über Bicarb! Warum Natriumbicarbonat im Wettkampf eine Rolle spielt, für wen es sinnvoll ist, wann und wie viel man davon nimmt, welche Produkte aktuell auf dem Markt sind und worauf man unbedingt achten sollte. Lars erklärt euch das Thema wie gewohnt ganz genau. Spoiler: Mit Bicarb ist er vor ein paar Wochen offenbar direkt zur neuen Bestform geflogen – gebrannt hat's auf der Straße.Außerdem klären wir die vielleicht wichtigste Frage der Woche: Wer ist aktuell das beste Team im Trailrunning? Salomon, Hoka, Adidas, Dynafit, The North Face – wer setzt sich durch, wer fällt im Ranking zurück und wer ist vielleicht der heimliche Verlierer?Und natürlich beantworten wir auch wieder eure Fragen. Zum Beispiel: Hiken auf dem Laufband mit Stöcken – was zur Hölle?! Klingt wild, macht aber vielleicht doch Sinn. Wir haben auf jeden Fall ein paar Tipps und Meinungen dazu parat.Wie immer also: ein bunter Mix aus Wissen, Diskussion und leichtem Wahnsinn.

We loaded up on Vitamin D (and deodorant) before this fresh episode! The main topic was a new sodium bicarbonate study, tracking 40k bike time trial performance at altitude. It's another brick in a really big scientific wall supporting the use of bicarb for performance. We zoom out to let you know why we think it's also effective even in very long distances... and maybe at lower (cheaper) doses.We also talked about Vitamin D supplementation, using a big review study showing that over half of athletes had inadequate levels. Hit the ADEQUATE sign!And this one was full of great topics! Other topics: the power of taking 3 days off, an update on David's health journey, arm band heart rate, our Nomio epiphany, shoe nerd news, a new analysis on running economy changes in different trail shoes, the Hopecore Corner with pieces of art we really like, a quick-hitter CBD study, improving bike power, the theory of doubles, a fun sports bra question, using the stairmill, heart rate zones, and whether to follow logic or the heart with race decisions.We love you all! HUZZAH!-David and MeganClick "Claim Your Sponsorship" for $40 free credit at The Feed here: thefeed.com/swapBuy Janji's amazing gear: https://janji.com (code "SWAP")The Wahoo KICKR Run is the best treadmill on the market: https://www.wahoofitness.com/devices/running/treadmills/kickr-run-buy (code “SWAP”)For training plans, weekly bonus podcasts, articles, and videos: patreon.com/swap

We realized the perils of a hurricane-force tailwind before this amazing holiday episode! To celebrate the season, we opened up the mailbag to answer listener questions on all sorts of topics.Topics this week: what we'd save from a fire, a hot-tub experiment follow-up, Megan's exciting news, whether we'd ever try triathlon, a vest that ejects gels, heat training submersion levels, hemoglobin A1C and REDs, iron supplementation, uphill treadmill effort and timing, scheduling rest days, a supplement hypothetical, Nomio v. sodium bicarbonate, cycling metrics, running power meters, running form changes, tart cherry juice hacks, training on a through-hike, limiting aid station support, and a beautiful listener corner message.Thank you so much for being here in 2025! May your holidays be like the water in our hot tub: ELECTRIC.We love you all! HUZZAH!-David and MeganGet 40% off your first order and $10 credit for every $100 spent at The Feed here: thefeed.com/swapBuy Janji's amazing gear: https://janji.com (code "SWAP")The Wahoo KICKR Run is the best treadmill on the market: https://www.wahoofitness.com/devices/running/treadmills/kickr-run-buy (code “SWAP”)For training plans, weekly bonus podcasts, articles, and videos: patreon.com/swap

Olav joins David again to answer a series of listener questions.  (00:00) Introduction(01:00) What Changes for Olav at UNO-X Now That the Men are a World Tour Team? (07:00) Lactate and Expiring Lactate Strips(09:13) The Impact of Caffeine on Lactate Readings (16:24) The Impact of Altitude and Heat on Lactate Readings (21:24) Periodising Supplements like Bicarb and Plasmaide (24:39) SmO2 and Training Prescription (34:40) Getting Reliable Data when Using SmO2 During Running(38:17) The Biggest Myth Olav Wants to Dispel (41:32) How Does Olav Motivate His Athletes (58:44) What is the Next Big Thing in Triathlon? (1:08:00) What Role Would Olav Add to a High Performance Organisation? Thanks to the sponsors of this podcast series:VO2Master To book your 1 on 1 call head to https://vo2master.com/norwegian-method/Website: https://vo2master.com/ Instagram: @vo2masterYouTube: https://www.youtube.com/c/VO2Master MaurtenTo benefit from the one-time code and get 20% off your next purchase on Maurten.com, simply enter the code “TNMS1” at checkout. The code is applicable once per customer, on all products except the Maurten Bicarb System, valid until 31/12/2025.Maurten WebsiteInstagram: @maurten_officialYouTube: https://www.youtube.com/c/MaurtenOfficialHosted, edited and produced by Dr David LipmanEditing, video and introduction by Roj Ferman

Dietitians Aidan Muir and Torwen Eerkens unpack the role of bicarbonate soda as a supplement for athletic performance. They explore the mechanism, types of exercise which see a benefit, percentage improvement, risks and practical recommendations for incorporating bicarb your regime.     Time stamps (00:53) - Mechanism for Athletes (1:50) - Types of Exercise  (2:52) - Dosage & How to Take (3:53) - What Are the Risks?  (5:25) - Practical Recommendations for Navigating Risks (6:21) - Research on Running and Endurance Events  (8:18) - Research on Strength Performance (8:56) - Bicarb vs Beta Alanine (10:07) - When Do We Recommend This in Practice? WEBSITE:  https://www.idealnutrition.com.au/ PODCAST:  https://www.idealnutrition.com.au/podcast/ INSTAGRAM:  https://www.instagram.com/idealnutrition__/?hl=en Our dietitians

Yohannes Kiflay har tagit ett superkliv 2025 och etablerat sig i det absoluta toppskiktet i löparsverige. Hans historia som löpare är fascinerande, hans livshistoria som ung jordbrukare på den eritrianska landsbygden till att på bara några år prata flytande svenska och vara studerande vid sjuksköterska-programmet är minst lika inspirerande. I veckans avsnitt får vi höra om hur Yohannes kom till Sverige 2019, fastnade för löpningen och på kort tid blev en löpare av toppklass. 2025 har han kammat hem två senior SM-medaljer, vunnit Stockholm Halvmarathon och fortsätter nu sin resa mot att en dag få representera Sverige vid stora internationella mästerskap.  Manne har nästan hamnat i handgemäng under en löptur förbi Slussen men har utöver det kommit in i träningen bra igen! John har varit i Skåne och tävlat vid Kullamannens kortaste distans. Från Kullamannen hör vi också från Jakob Åberg, William Englund, Elov Olsson och Alexandre Bouchioux innan de ger sig ut på den längsta distansen Kullamannen 100 miles.  Den 1-8 December åker vi på löparresa till Playitas. Platserna börjar ta slut och den 7 november är sista chansen att anmäla sig innan platserna släpps till andra resenärer. Är ni sugna, missa inte denna chans för en toppenvecka med löpning som huvudfokus - https://www.apollo.se/resor/traningsresor/traningskalender/loparresan-med-spring-snyggt-podden Veckans Sponsorer:  Lumonite - Med Koden Springsnyggt25 får man 15% rabatt på Lumonites pannlampor hos Valostore.se och Löplabbet  Flowlife - Häng med på gemensamt pass tillsammans med Flowlife och Spring Snyggt - 40% rabatt på hela sortimentet i samband med eventet - info och anmälan - https://www.eventbrite.se/e/flowlife-pop-up-x-spring-snyggt-podden-tickets-1935472653809 Löplabbet - Nu finns BiCarb till salu hos Löplabbet!  Saucony - Nya GTX-serien håller dig torr under höstens blötaste och kallaste löpturer.   

Contributors: Travis Barlock MD, Jeffrey Olson MS4 Feel free to use the cases below for your own practice. All of the scenarios are completely made up and designed to hit several teaching points. Case 1 25 M, presents to the ED with chest pain. Stabbing, started a few hours ago, substernal. Thinks it is GERD. After 2-3 minutes, pain worsens and radiates to the back. VS: BP 125/50 (Right arm 190/110). HR 120. RR of 18. Sat 98% on RA. Additional VS: Temp of 37.2, height of 6'5”, BMI of 18. PMH: None, doesn't see a doctor. Meds: None FH: Weird heart thing (Mitral Valve Prolapse), weird lung thing (spontaneous pneumothorax), tall family members with long fingers and toes Physical Exam: Cards: Diastolic decrescendo at the RUSB, diminished S2. UE pulses are asymmetric, LE pulses are asymmetric, carotid pulses are asymmetric, BP is asymmetric MSK: Knees, elbows, and wrists are hypermobile. Imaging: CXR #1 normal, #2 widened mediastinum (no read yet but shows widened mediastinum), POCUS shows small effusion CTA/MRA doesn't come back until after the case.  ECG: Sinus Tach Labs: NT-proBNP 500 pg/mL D-Dimer: 7000 ng/L CBC: Hemoglobin: 13.5 g/dL, WBC: 20,000/µL, Platelets: 250,000/µL Chem 7: Na 138, K, 5.7, Cl 102, Bicarb 17, BUN 45, Creatinine: 3.5 mg/dL, Glucose: 180 LFTs: Albumin 2.4, Total protein 5.5, ALP: 140, AST: 3500, ALT: 2800, TBili: 3.2, DirectBili: 2.4, Ca: 7.8 LDH: 2200 PT: 20.5, INR: 2.2, Fibrinogen: 170 5th gen High-Sensitivity Troponin:

In Episode 122 of The Eat for Endurance Podcast, I'm catching up with Lauren Thomas, an endurance athlete and the Lead Performance Dietitian for Maurten in the US.Lauren has been a collegiate sports RD, a Tactical Performance Dietitian within US Special Operations, and now works with athletes of all levels at Maurten.This episode is a grab-bag of topics, all focusing on overcoming sports nutrition challenges to improve performance. From sodium bicarbonate and hydration to real-life fueling logistics, Lauren offers a thoughtful perspective based on her unique mix of experiences.Lauren and I discuss:8:32: Why athletes benefit from having the support of a multi-disciplinary team to reach health and fitness goals13:23: Why fueling periodization matters, and how under-fueling on shorter training days can derail progress29:10: Whether sodium bicarb is really worth the hype, and when it may help endurance athletes37:00: When and how to correctly prioritize fluid, carb, and sodium intake, and why US athletes often overdo electrolytes44:00: The role of sport culture and race terrain in shaping fueling strategiesFYI: This episode is NOT sponsored by Maurten. We do talk about Maurten products, as that is part of Lauren's career and story, but as always, I encourage you to try different products and strategies to find what works best for you. 

We conquered the WOOHOO yips before this amazing episode! The main science topic was on a new study that examined the causes of injuries in a 5205-athlete sample. The headline finding was relatively intuitive, but the sub-finding was so shocking that we are still picking our jaws up off the floor. We break it down and discuss how it may clarify training theory!And this one was full of our favorite topics! Other topics: the yips in athletes (and podcasters), Megan's Aspen Mountain breakthrough, the interaction of high carb and bicarb to make endurance sports faster, the best protein supplement we have tried, one of our heroes Kate Courtney wins the Leadville 100 mountain bike, Kilian's next project in the USA, Steph Curry doing weight-vest trail running, and the tricky conversation around bodyweight and health happening in women's cycling. Plus there was a Q+A on the mechanics of podcast recording, nutrition considerations for vegan athletes, the complications of rhabdo in ultra athletes, “purposeful flow” in training plans and how that relates to a new study on overload blocks, overcoming fear in racing, daily carb intake, and high carb in the birth process.It finished with a quote that we'll be living by. Let's feel what there is to feel while we are here.We love you all! HUZZAH!Click "Claim Reward" for free credit at The Feed here: thefeed.com/swap Find TheFeedLab whey protein: https://thefeed.com/products/the-feed-lab-whey-proteinFor weekly bonus podcasts, articles, and videos: patreon.com/swapBuy the Kickr Run treadmill (code "SWAP"): https://www.wahoofitness.com/devices/running/treadmills/kickr-run-buyBuy Janji's amazing gear: https://janji.com/ (code "SWAP")

Alternativer Titel der Folge wäre: "Unten zweilagig" - was gefällt euch besser? Und an die Läuferinnen: was ist euer Take zum Nike sub-4-Event. Schreibt uns gerne hier ein Kommi, oder eine DM auf unserem Instagram Kanal!Hier geht's zum Gel 40 Bicarb von unserem Partner MNSTRY: Klick hier drauf und spare mit dem Code: "BICARB20AL"

Today, we're tackling Acid-Base Balance — yes, that part of nursing school that used to make you want to throw your ABG chart across the room. But I promise — by the end of this episode, you'll be decoding those pH numbers like it's second nature.You can download our 1-page ABG cheat sheet over at DLMNURSING.com to go along with this episode.And if this helped you, tag us @dlmnursing and tell your classmates!Next time, we're diving into Shock States — and I'll give you the real tea on which types you need to know for NCLEX and clinicals.

Het Critérium du Dauphiné is deze week een mooie graadmeter richting de komende Tour de France. Dit weekend vindt de ontknoping plaats en zullen we meer weten over hoe Tadej Pogačar, Jonas Vingegaard en Remco Evenepoel ervoor staan. En laat Mathieu van der Poel in zijn kaarten kijken? Je hoort het in de WielerFlits Podcast! Voordat onze mannen de Franse rittenkoers aansnijden, beginnen ze met opmerkelijk nieuws van de UCI. Daarvoor schuift ook Raymond aan bij Maxim en Youri. De internationale wielerbond heeft - na stemming in de Professional Cycling Council - namelijk het ONE Cycling-project voorlopig afgeschoten. Welke gevolgen dit heeft voor het plan van onder andere Richard Plugge, bespreken onze verslaggevers in het eerste deel van de podcast.Daarna gaan ze snel over naar de Dauphiné. Met de bergetappes van dit weekend op komst is er nog niet heel veel te zeggen, maar toch hebben we een aantal voortekenen gezien. Volgens Raymond is de orde tussen ronderenner Vingegaard en alleskunner Pogačar hersteld na de gebrekkige voorbereiding van de Deen vorig jaar. Youri heeft dan weer een erg goede Evenepoel gezien, maar blessures spelen zijn Tour-ploeg vooralsnog parten.Daarna passeert ook Mathieu van der Poel de revue. Het lijkt erop dat hij het puntenklassement in de Dauphiné gaat winnen, maar die groene trui lonkt ook naar hem in de Tour. Youri analyseert waarom de kans aannemelijk is dat MVDP een grote kanshebber voor het groen is. Maxim haalt daarna de start van de Ronde van Zwitserland aan (zondag) en waarom ook die koers de moeite waard is om te gaan volgen. Luister snel naar een nieuwe WielerFlits Podcast!Alles weten over de Tour? Bestel dan nu RIDE Magazine en je bent thuis, op het werk of op vakantie helemaal op de hoogte! Vette korting bij onze partner MNSRTYDeze podcast wordt mede mogelijk gemaakt door ⁠MNSTRY⁠, producent van hoogwaardige sportvoeding. Zij verkopen nu ook ‘s werelds eerste ⁠Bicarb Gel 40⁠. Bicarbonaat en koolhydraten in één kant-en-klare gel voor tijdens jouw race of training. Gebruik in de ⁠webshop van MNSTRY⁠ de code ‘BICARB20WF' en krijg tot en met 15 juni 20% korting op deze nieuwe Bicarb-gel.

Robert Gorgos ist das Brain hinter den MNSTRY Produkten. Er kümmert sich darum dass ihr auch wirklich nur gute Sachen zuführt und die Produkte so gut funktionieren wie sie es tun. Doch was ist Roberts Philosophie und wie sieht der Prozess aus von der ersten Idee zum fertig entwickelten Gel? Viel hilft viel? Stimmt das eigentlich so wirklich? Was hats mit Bicarb auf sich? Robert bringt Licht ins Dunkle! Danke an https://mnstry.com fürs zusammenbringen mit Robert Spart 15% mit "mnbuddy15" auf das 10in1 und 3in1 Training Bundle -> https://mnstry.com/products/training-bundle?variant=47230208409945

De bizarre ontknoping van de Giro d'Italia ligt pas net achter ons, maar de gedachtes van het peloton zijn alweer bij de volgende grote ronde. Niet gek, want over vier weken begint al de Tour de France 2025. De aanloop daar naartoe is begonnen en daar staan we in de WielerFlits Podcast uitgebreid bij stil!Deze podcast wordt mede mogelijk gemaakt door MNSTRY, producent van hoogwaardige sportvoeding. Zij verkopen nu ook ‘s werelds eerste Bicarb Gel 40. Bicarbonaat en koolhydraten in één kant-en-klare gel voor tijdens jouw race of training. Gebruik in de webshop van MNSTRY de code ‘BICARB20WF' en krijg tot en met 15 juni 20% korting op deze nieuwe Bicarb-gel.Wat zit er in de show?Maxim en Youri stellen vast dat dit Critérium du Dauphiné een volgende stap is in het plan van de topteams naar de Ronde van Frankrijk. De topfavorieten voor die wedstrijd - Tadej Pogačar, Jonas Vingegaard en Remco Evenepoel - staan vanaf komende zondag allemaal aan het vertrek in de Dauphiné en met hen ook al bijna hun gehele Tour-selecties. Dat maakt het een heel interessante wedstrijd. Volgens Youri ligt de druk vol op Vingegaard, die dit seizoen het minst van alle drie heeft laten zien. Maar veel conclusies vastbinden aan deze voorbereidingskoers doen ze niet.Wel vinden beide heren het een beetje jammer dat de Ronde van Zwitserland een week later valt. Voor de wielerfans thuis op de bank biedt het twee weken lang dagelijks kijkplezier, maar de klimtijdrit op de slotdag in Zwitserland had - met het oog op de klimtijdrit in de Tour - toch een boel klassementsrenners kunnen trekken. Nu blokkeert ‘de vierde grote ronde ‘ (zoals men de Tour de Suisse ook wel noemt) een tweede hoogtestage richting de Tour. Het toptrio in het Critérium du Dauphiné kiest allemaal voor die weg. Mogelijk ook zonder kampioenschappen.Dat geldt tevens voor Mathieu van der Poel, die ondanks een breukje in zijn pols acte de présence geeft in de Dauphiné. De organisatie van het WK Gravel hoopt dat later dit jaar ook. Zuid-Limburg is op 11 en 12 oktober gastheer voor dat wereldkampioenschap; MVDP is titelverdediger in die discipline. Parcoursbouwer Bram Tankink ziet het alvast graag gebeuren. Woensdag werden de omlopen door Beek, Beekdaelen en Maastricht voorgesteld. WielerFlits is de exclusieve media-partner van het WK Gravel en zal de komende maanden genoeg aandacht aan dit WK schenken.

We gulped down some pungent juice before recording this amazing episode! The main topics were the two big pieces of news: Jim Walsmley won't be racing Western States, and Kilian Jornet is making training videos now. Jim is the GOAT and we gave him an 85% chance of winning just last week. He's the supermassive black hole at the center of the Western States galaxy. Without Jim at the start line, how does it change the race? Kilian is the GOAT too (yes, we have a GOAT herd), and he just released a training video! He abides by the "no secrets" approach, and we analyzed every frame of that video to try to find clues about whether he might be beatable. Answer: no. Bonus answer: Kilian is the best and it's fascinating that he started his own video series by talking about his heat training.And this one was full of great topics! Other topics: our magical coaching day at the US Mountain Championships, thoughts on training for mountain races, Unbreakable 2 cancellation, the wild triumph of Simon Yates, a new bicarb gel that could upend the bicarb market, the wild science of broccoli sprouts and a new juice supplement from Nomio, anti-histamines and athletic performance, why we're eating dark chocolate (it tastes good), lung training via breathing devices, the relationship between speed work and form in ultras, a hypothetical about Conner Mantz racing Leadville or Western States, an article in the New York Times on unethical mountaineering, training with a newborn, dealing with life transitions, fitting the Naked Belt, the cost of running, cheaper suphershoes, and an incredible poem on failing and flying.Everyone forgets that Icarus also flew. Also, if Icarus had broccoli sprouts and Kilian's training video, maybe he would have flown a bit longer.We love you all! HUZZAH! Click "Claim Reward" for free credit at The Feed here: thefeed.com/swap Order a Core 2 Sensor here before they sell out: https://thefeed.com/products/core-2-temperature-monitorBuy Janji's amazing gear: https://janji.com/ (code "SWAP")For weekly bonus podcasts, articles, and videos: patreon.com/swap

In this episode of Find Your Edge, Coach Chris Newport breaks down popular supplements for endurance athletes—backed by science, tested in real-world training. Learn which ones are worth your attention, and which ones may depend on your unique physiology and genetics.

Study: A handful of almonds before meals promotes weight loss, reduces belly fat, improves blood sugar, lipids, may reverse diabetesA better alternative to bicarb for GERD symptomsPlease critique the Wapo article on probiotics impact on gut healthIs the Atkins Diet a healthy way to eat low carb?

If you enjoyed this episode, please leave a 5 star review! We appreciate the support ❤️ON LABS BOSTON MARATHON GIVEAWAY RSVP: https://forms.gle/1TegBqtcqaynVP7i9 PENN RELAYS LIVE SHOW RSVP: https://forms.gle/WYpsWrm7Q3zK3M5n7Hey everyone, on this episode we dive deep into the running performance revolution with our amazing guests, coaches David Roche and Megan Roche from the SWAP podcast! We were blown away exploring the science behind extreme high-carb fueling (David takes 150g/hour?!), heat training adaptation, bicarb use, and the truth about ketones for recovery. David and Megan share their coaching philosophy, help us debunk some common training myths about VO2 max and zone 2, and give incredible insight into the ultra running world, including David's Leadville record and his prep for Western States. Enjoy and make sure to check out their podcast (below)!Special Guest: SWAP Podcast: https://swaprunning.com/podcast Dr. Megan Roche MD PhD: https://www.instagram.com/drmeganroche/ David Roche: https://www.instagram.com/mountainroche/ Latest YT Video: https://www.youtube.com/watch?v=hTg6cORz6no Follow us here:Instagram: https://www.instagram.com/coffeeclub.pod/George Beamish: https://www.instagram.com/georgebeamish/Morgan McDonald: https://www.instagram.com/morganmcdonald__/Olli Hoare: https://www.instagram.com/ollihoare/Coffee Club Merch: https://coffeeclubpod.comMorgan's discord: https://discord.gg/uaCSeHDpgsMorgan's YouTube: https://www.youtube.com/@MorganMcDonaldisaloserIntro Artwork by The Orange Runner: https://www.instagram.com/theorangerunner/Intro Music by Nick Harris: https://open.spotify.com/artist/3Zab8WxvAPsDlhlBTcbuPi

In this week's episode, Katie and Rachel take the mic to talk about what's new in their lives and the trail world. Rachel shares what's ahead for both her and Tyler as they gear up for their trip to Japan and the Ultra-Trail Mt. Fuji—where she'll be racing the 40k. They dive into how having a big adventure on the calendar can shift your mindset, and how race day conditions play a big role in conversations around course records. Katie gives a training update and reflects on the confidence and joy she's found lately, and how she's learning to balance focus with fun. The two also dig into performance strategies, including nutrition, hydration, and the science behind sodium bicarbonate. It's a thoughtful, fun, and refreshingly honest conversation about racing, training, and finding meaning in the process.This episode is edited and produced by the Sandyboy Productions Podcast Network.A special thank you to Osprey for supporting this episode. Visit Osprey.com to explore their incredible products!And a big thanks to our newest sponsor, ⁠Janji with the code TRAILNETWORK for a 10% discount on your Janji order.

Ketones, bicarb, creatine, and more - there are more supplements for runners on the market now more than ever. We discuss some of the most popular supplements for runners, including the research, potential benefits, risks, and more. In this episode, you'll learn about:Branched chain amino acids (BCAAs)Ketone monoester supplementationSodium bicarbonate (“bicarb”) supplementsBlack currant supplementsCreatine for runnersThis episode is general guidance. Please consult a medical profession for individual guidance when selecting supplements. This episode is sponsored by Previnex! Previnex creates clinically effective supplements made with high-quality ingredients. Their Muscle Health Plus contains third-party tested creatine monohydrate, BCAAs, and other ingredients to reduce muscle soreness and improve muscle mass and strength. Use the code treadlightly for 15% off your first order at previnex.com.References: PMID: 28638350PMID: 20386134PMID: 38625669PMID: 16365087PMID: 37185454PMID: 31730565PMID: 32269653PMID: 31699159PMID: 31039280PMID: 37565450PMID: 38612966PMID: 39068627PMID: 34756350PMID: 34503527PMID: 33487131PMID: 34470913PMID: 29619595PMID: 32460873PMID: 37096381Jeukendrup & Gleeson. (2016) Sport Nutrition, 3rd edition. Human Kinetics. https://examine.com/research-feed/study/dxqRN1/?srsltid=AfmBOooIOe4LpwUVPkqXLZSANqWymBfJWWTWZ2GG9owMPcFNMr_QLpRe

Train with Matt: https://sweatelitecoaching.com/matt-fox/ Tune into the Private Podcast Feed and Join Our Discord Discussions:  https://www.sweatelite.co/shareholders/ Contact: matt@sweatelite.co Matt Instagram: https://www.instagram.com/mattinglisfox/ Matt Training Log - Strava: https://www.strava.com/athletes/6248359 In this 25th episode of the IMO on the Sweat Elite podcast, Matt shares updates about his recent experiences, including fascinating and challenging stories related to U.S. immigration and USCIS regulations. The episode covers various topics such as the journey towards obtaining a green card, dealing with unexpected delays and secondary screenings, and the decision to temporarily relocate to Japan and Europe due to visa issues. Plans for participating in the Osaka Marathon are also discussed, alongside a deep dive into the importance of running workouts, recovery strategies, and the potential benefits of substances like bicarb, creatine, and Ozempic. Additional segments include addressing listener questions, discussing the controversial Nick Bester situation, and speculating on the future performance of runner Shelby Houlihan post-doping ban. The host also makes a heartfelt appeal for support via their private podcast feed and community Discord channel. Topics: 00:00 Welcome to the Sweat Elite Podcast00:45 The Wild Immigration Story - Osaka Marathon18:58 Listener Comment: THC, CBD, and Pain Management22:15 Listener Question: Nick Bester Banned?31:01 Listener Question: BiCarb31:50 Listener Question: Training/Work Balance36:25 Listener Question: Recovery Supplements/Ratios41:49 Workouts Of The Week47:32 Controversial Topics: Ozempic and Shelby Houlihan59:07 Conclusion and Upcoming Plans WORKOUTS OF THE WEEK 5-10k: 5 or 6 x (1k @ 10km effort (1min) 500m @ 5k effort), R: 30sec/90sec. HM: 10k at HME, 2min rest, 2k @ goal pace M: 20k @ Marathon effort + 5k @ GMP inspired by Jake Barraclough      

Grant Fisher and Yared Nuguse are world record holders in the 3000 and mile respectively as Cole Hocker and Hobbs Kessler ran faster than anyone else previously in the event. Josh Hoey's amazing 2025 continued with his 2nd American record. Shelby Houlihan ran the 2nd fastest indoor mile by an American in Boston and 16-year-old high school sophomore Cooper Lutkenhaus ran 1:46 at Millrose. We try and tell you what it all means? Want a 2nd podcast every week? And savings on running shoes? Join the LetsRun.com Supporters Club today for exclusive content, a bonus weekly podcast, shoe savings, and more. Cancel anytime .https://www.letsrun.com/subscribe Show notes: 00:00 letsrun.com/subscribe 00:56 Intro 06:46 LetsRun Millrose Watch Party 10:19 Millrose was Amazing 12:53 3000: Grant Fisher world record over Cole Hawker 21:23 Have Fisher and Hocker leveled up? 26:01 Bad news for Jakob? 31:22 Discussion on Track Times and Performances 32:31 Wanamaker Mile: Yared Nuguse world record over Hobbs Kessler 39:30 The other fast Americans 43:38 Text Message of the Week: How fast could Jim Ryun have gone? 47:44 Cam Myers vs Niels Laros vs Jakob Ingebrigtsen 49:51 What about Hobbs Kessler? 51:38 Cole Hawker's the favorite in 1500 for Worlds? 58:19 Grand Slam Track will have 3 of the 4 in 1500, how should they do tv? 01:02:36 Bicarb? 01:05:32 Josh Hoey American record 800 01:13:55 Shelby Houlihan 2nd fastest mile ever by an American indoors 01:18:34 High School Phenom Cooper Lutkenhaus 1:46.86 as 16-year-old 01:20:52 Rapid Fire Rest of Millrose 01:21:01 NIa Akins bombs 01:23:14 Will Sumner and crew impress in 600 01:25:28 Women's 3K: Whitney Morgan's Win & Katelyn Tuohy struggles 01:28:54 Georgia Bell FTW 01:30:09 Another WR for Fisher this weekend in 5000? Contact us: Email podcast@letsrun.com or call/text 1-844-LETSRUN podcast voicemail/text line. Want a 2nd podcast every week? And savings on running shoes? Join the LetsRun.com Supporters Club today for exclusive content, a bonus weekly podcast, shoe savings, and more. Cancel anytime .https://www.letsrun.com/subscribe Check out the LetsRun.com store. https://shop.letsrun.com/ We've got the softest running shirts in the business. Thanks for listening. Please rate us on your podcast app and spread the word to friend. Send us your feedback online: https://pinecast.com/feedback/letsrun/35ed91b1-1232-488b-9fe9-07593cbd3678

Even Brøndbo Dahl (30) en av landets raskeste 1500 m-løpere gjennom tidene, med NM-gull i 2022 på distansen og en pers på svimlende 3:37.89.Med sin utdanning som idrettsfysiolog liker han å gå vitenskapelig til verks i treningen, og har det siste året gått hardt til verks på varmetrening for å øke kapasiteten. Det er neppe tilfeldig at han for bare noen dager siden sprengte VO2 max-apparatet og målte høyere verdier enn noen gang.Er varmetrening noe for deg som sti/terreng/fjell/ultraløper? Hvordan går man til verks? Hvilken protokoll bør man bruke?På tampen tar vi selvfølgelig en del sidespor og havner innpå tema som f.eks sodium bikarbonat (aka bicarb) og høydetrening i kombinasjon med varmetrening.Lenker:EBD-bloggen: Varmetrening; erfaringer og effektEBD-bloggen: Varme + høyde = sant (86,3 ml/kg/min)NEDA-hjørnet på Fjellsport.noFøkk Asfalt PatreonSupport the show

Matt Fox - Marathon Weight Loss Protocol: https://docs.google.com/document/d/18jcXkyboLbvVvU0eSkVUVCNz3x3lmVnsNh99wTTskko/edit?usp=sharing Boulder Experience (April 2025):  https://www.thegloberunners.com/boulder-running-experience-april2025/ Check out Globe Runners on Instagram: https://www.instagram.com/thegloberunners/ Train with Matt: https://sweatelitecoaching.com/matt-fox/ Tune into the Private Podcast Feed and Join Our Discord Discussions:  https://www.sweatelite.co/shareholders/ Contact: matt@sweatelite.co Matt Instagram: https://www.instagram.com/mattinglisfox/ Matt Training Log - Strava: https://www.strava.com/athletes/6248359 In this episode of the Sweat Elite podcast, the host discusses his recent travel and health experiences, including fasting and enduring a calorie deficit. The episode delves into the benefits and potential drawbacks of resting periods for elite marathon runners, using specific examples from his decades-long running career. The host also explores the controversial comeback of Shelby Houlihan in competitive running, touching on broader themes of doping, rehabilitation, and the ethics of lifetime bans. Listener questions are addressed on topics like utilizing effort-based training in hilly terrain, introducing fatigue miles for 5k and 10k training, and optimizing sodium bicarbonate usage for performance enhancement. The host further discusses the merits of using treadmills for training and finds alternatives to maintain fitness while taking breaks from running. The episode concludes with cautionary advice about political repercussions for public stances and a preview of upcoming plans and episodes. Topics: 00:00 Introduction and Personal Update01:00 Training Insights and Rest Periods01:42 Voluntary Recovery and Injury Prevention02:48 Bicarb Experiment and Listener Feedback06:26 Shelby Houlihan Doping Controversy19:36 Cancel Culture and Public Figures23:00 Listener Questions and Running Advice30:28 Understanding Sodium Bicarbonate for Performance30:55 Sodium Bicarbonate Protocols and Personal Experiences32:21 Workouts of the Week: Effective Training Sessions34:39 Half Marathon and Marathon Training Insights38:11 The Role of Treadmills in Elite Running43:01 Political Climate and Its Impact on Athletes49:57 Alternative Training and Recovery Strategies59:51 Concluding Thoughts and Upcoming Events  

Boulder Experience (April 2025):  https://www.thegloberunners.com/boulder-running-experience-april2025/ Check out Globe Runners on Instagram: https://www.instagram.com/thegloberunners/ Train with Matt: https://sweatelitecoaching.com/matt-fox/ Tune into the Private Podcast Feed and Join Our Discord Discussions:  https://www.sweatelite.co/shareholders/ Contact: matt@sweatelite.co Matt Instagram: https://www.instagram.com/mattinglisfox/ Matt Training Log - Strava: https://www.strava.com/athletes/6248359 In this episode of the Sweat Elite Podcast, Matt shares his latest experiences while temporarily based in Tucson, Arizona. He discusses training sessions, his recent Houston Marathon, and preparation for the upcoming Osaka Marathon. Matt also dives deep into trying bicarb supplements for the first time and answers numerous listener questions about their effects, along with other training-related inquiries. Additionally, he provides innovative workout suggestions for 5K, 10K, half marathon, and marathon runners. Listener emails cover a range of topics, such as heavy weight training for cramp prevention, the impact of weight loss on marathon performance, advanced warm-up routines, and balancing training for both trail running and road marathons. Topics: 00:00 Welcome to the Sweat Elite Podcast00:49 Training Updates and Marathon Insights01:15 Bicarb Experiment and Workout Reflections04:08 Listener Questions and Globe Runners Experience08:26 More Listener Questions and Nutrition Insights22:46 The Importance of Rest and Recovery28:58 The Importance of Maintaining Weight During Breaks29:29 Hiking Adventures in Boulder30:24 Returning to Running After a Break31:30 Training Insights and Future Plans34:20 Workouts of the Week44:35 Listener Questions and Advice59:48 Concluding Thoughts and Upcoming Events WORKOUTS OF THE WEEK: 5/10k: 4 x 2k - 2k Threshold, 2k 100m/100m on/float, 2km threshold, 2km 100m/100m on/float HM: 14.4k (9mi): 1600m/1600m, 1400m/1400m, 1200m/1200m, 1k on / 1k float, 800m on/800m float, etc down to 200m. M: 8 miles/13k steady - 3 x Mile @ 5k (3min rest)  

What happens when 5 ultra runners try Bi-carb? Listen to find out. Have you tried it yet? What was your experience? **we have no affiliation and are not sponsored by Maurten bicarb. All thoughts and opinions are our own.

We brought so much gratitude to this amazing episode! The main topic was the news announced this weekend: David's Leadville 100 performance won the International Trail Performance of the Year. Yes, tears were shed. To everyone who listens, THANK YOU. In ways that go deeper than words...thank you. We reflect on the training, the journey, how our lives have changed, and what's ahead. Shooters shoot. Next it was a "No Secrets" Q+A! Topics: why hydration recommendations of "drinking to thirst" are often wrong in races and training, fitness apps, early AM training, when training volume hits a saturation point, what weekly volumes might lead to breakthroughs, how love evolves (or doesn't), recovery runs, AI and energy use, gel flavors, adaptations to long-term heat training, the number of workouts we suggest per week, our frustrations with running media, and Listener Corner. This community kept us going with love and belief through some dark forests this year. This is OUR award. It would not have been possible if it was just us chasing history. But when we have this team lifting us up? Well, we might just F around and make history. We love you all! Huzzah! FAFOing forever, -David and Megan Watch the new video "Let's Shock The World" on David's Western States build: https://www.youtube.com/watch?v=7vpHk6Qoh_g Click "Claim Reward" for $80 at The Feed here: thefeed.com/swap Support Freetrail: https://freetrail.com/pro/ Subscribe to Semi-Rad: https://semi-rad.com/subscribe/ Buy Janji's amazing gear: https://janji.com/ (code "SWAP") For weekly bonus podcasts, articles, and videos (plus hat purchases): patreon.com/swap

Oh gosh guys, I am here swallowing my own advice and not waiting til I can do things 'perfectly' to put out a very (very!) overdue episode on our beloved Waflle Podcast! 15min pow wow on all things Bicarb today to get me (re)started, a supplement that is like the old/new kid on the performance block! So should you consider taking this humble baking cupboard supplement? Listen to find out - and don't forget to like and subscribe so you continue to snag little updates in the world of nutrition and performance :)

This is gonna be a salty podcast. That's right, I want to touch on the benefits of staying salty and the crucial role of electrolytes. The vast majority of my clientele I am finding has an electrolytes imbalance, and are chronically dehydrated. Drinking water is important. but without the minerals to help it get into the cell, you will spending more time in the bathroom than out living your best life with vitality and energy. The vast majority of my clientele are chronically fatigued too, and one of the first things I address with them is minerals and electrolytes. So to help you understand the crucial role of electrolytes, staying salty and other ways to optimize your health, because that's what this podcast is all about, I've brought on Charles Barber.....Charles is a nutrition educator and researcher, plant geneticist and soil scientist after struggling for years with chronic fatigue, weakened immunity and depression and found that when it comes to nutrition our world is missing 4 crucial things.... I”ll let him enlighten you as to what those are. To purchase any of the products mentioned here today, visit: Crucial Four Islandic Sea Salt: https://crucialfour.com/JODELLE Promo code: JODELLE for 15% off Find more of Charles highly educational free videos here:    / crucialfour   Would you like help navigating your health journey and achieving your pro-metabolic goals? I offer coaching worldwide for one flat rate initial consult of $199. Email me at getfitwithjodelle@gmail.com to get get started! Thanks to our show sponsors: Buffalo Gal Hair and Skin Products from High Quality Natural Sources Use Promo code: JODELLE for 15% off https://tallowskincare.idevaffiliate.... GlideSUP Paddleboards https://www.glidesup.comsca_ref=3347725.6bJYhtLqEp   use “JODELLE10” for 10 percent off C60 Purple Power https://c60purplepower.com/get-fit/ Promo code: JODELLE saves 10% SaunaSpace Red Light Sauna https://sauna.space/getfitwithjodelle for 5% off any purchase! Grounding Earthing Mat anyone will love and everyone can use from Ultimate Longevity! https://www.ultimatelongevity.com/ear... Swanwick Sleep https://www.bn10strk.com/FITFOR10/ Promo code: FITFOR10 or JODELLE10 Purity coffee - my favorite coffee: https://puritycoffee.com/?rfsn=640373... or https://bit.ly/3oK8woT JODELLE10 to save 10% LIFEBLUD METHYLENE BLUE & Mag+ https://lifeblud.co/?ref=cGFWJ1 PROMO CODE: JODELLE Flo's Daughter Etsy Store - my favorite natural skin care: https://www.etsy.com/shop/FlosDaughte... Promo code: JODELLE10 InfoPathy Infoceuticals...simply drink water to get any supplement you need......: https://www.infopathy.com/?invite=653... Promo Code: JODELLEFIT saves you 10%   Time Stamps:   Too much rigidity in health: 6:20 How to choose the best quality salt: 10:35 Salt and the other minerals crucial role in the body for many reasons: 20:00 EMF and why we need more electrolytes more than ever: 38:00 Magnesium Bicarbonate: 48:20 Ozone Therapy 1:10:30

In this episode, Dennis discusses the role of sodium bicarbonate in medical protocols, particularly in the context of rhabdomyolysis and hyperkalemia. He emphasizes the importance of fluid management and the potential over-hyping of bicarbonate as a treatment. The conversation explores the risks associated with rhabdomyolysis, the mechanisms of potassium management, and the clinical considerations for bicarbonate use in critical care settings. Takeaways Sodium bicarbonate is often over-hyped in medical treatments. Rhabdomyolysis can lead to serious kidney damage. Immediate fluid administration is crucial in suspected rhabdo cases. Bicarbonate has not shown clinical benefits in trials. Managing potassium levels is essential in rhabdomyolysis treatment. Insulin can help drive potassium back into cells. Urine output is a key indicator in treatment effectiveness. Alkalizing urine may not significantly prevent kidney injury. Correcting pH can be important in severe shock situations. Bicarbonate should be used judiciously in critical care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

We considered buying our very own pommel horse before this amazing episode! The main topic was a new study that may show a big reason for performance leaps across sports. In the study, just a few weeks of heat training caused 3% improvements in hemoglobin mass, associated with jumps in fitness. However, the adaptations reversed to baseline rapidly. What does it mean? Heat may be the next frontier of health and performance. Professor Nelly said we should take off all of our clothes, but the study authors beg to differ. We also talked about the Tecton 3, the new trail supershoe from HOKA. It's a total remake, with similar responsive softness as road supershoes. We are big fans, with some small gripes. All of these shoe companies are now on the clock to take a similar evolutionary leap. Adapt or die, trail shoe edition. And this one was packed full of the best topics! Other topics: putting the finishing touches on Leadville 100 training, saying big goals out loud, bad hot takes on gymnastics, medium hot takes on politics, built-in gaiters, another study showing performance improvements from sodium bicarbonate, the uncertain future of bicarb supplementation, our favorite stories from the Olympics, Pommel Horse Guy, Simone Biles and the power of FAAFO, our admiration for Noah Lyles, Grant Fisher's 10k bronze, Kristen Faulkner winning gold after quitting her VC job, Olli Hoare and critics, Snoop Dogg, the wild marathon course, and hot takes. What do Garfield and Clifford listen to when they want to get freaky? Tune in and find out. We love you all! HUZZAH! Click "Claim Reward" for $80 at The Feed here: thefeed.com/swap Support the podcast: patreon.com/swap Buy Janji's amazing gear: https://janji.com/ (code "SWAP")

The draft order:Sophia AmbrusoNayan AroraSwapnil HiremathAC GomezJoel TopfEditor Nayan AroraShow NotesPrevious drafts:2021 KDIGO Hypertension —Joel, Sophia, Swap, Nayan, Josh2021 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, Jennie2022 The ISPD Peritonitis Guideline— Joel, Sophia, Swap, Nayan2022 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan2023 ASN Kidney Week Draft—Joel, Sophia, Swap, Nayan, AC, Josh2024 KDIGO CKD Clinical Practice Guideline —Joel, Sophia, Swap, Nayan, Josh, ACThe guidelineThe NephJC discussion Part 1 | Part 2First RoundSophia's Pick 3.7.1 We recommend treating patients with type 2 diabetes (T2D), CKD, and an eGFR ≥20 ml/min per 1.73 m2 with an SGLT2i (1A).Not Nayan's Pick 3.7.3: We suggest treating adults with eGFR 20 to 45 ml/min per 1.73 m2 with urine ACR

We thought long and hard about alien physiology before recording this great episode! The main topic was a wildly cool wrinkle in training science. Across all different types of events, the most predictive variable for performance is often how fast an athlete can go at VO2 max effort. That could have massive implications for how we think about training and what we consider "specificity" for long events! We discussed why we think that is, along with workout designs, the use of hills, and how much we want to get aliens on a treadmill. ET can phone home after ET does a VO2 max test. And this one was full of our favorite topics! Other topics: Addie dog going strong at nearly 12 years old, the upcoming Olympic Trials on the track, our wild travel schedule between the Trials and Western States, stroller running and our worrisome experience, sodium bicarbonate hacks, workout design, the power of using set-based structures, running economy and other predictors in ultras, a new study on fatigue resistance/durability and its relation to training status, Alex Honnold running the Lavaredo 50k, Roger Federer's wonderful speech on perseverance, messages about ferritin increases from liposomal iron, Joey Chestnut's ban from the hot dog eating contest and what it says about sponsorships, the increasing cost of shoes, Keely Hodgkinson's low-volume approach with lots of cross training, and hot takes. When the aliens arrive, we should give them a cup of chocolate Nesquik so they can experience our finest delicacies. Then it's straight onto the treadmill for some podcast content. We love you all! HUZZAH! Aliens! Click "Claim Reward" for $80 at The Feed here: thefeed.com/swap Support the podcast: patreon.com/swap Buy Janji's amazing gear: https://janji.com/ (code "SWAP")

Lemon juice, tea tree oil, baking soda & vinegar. All items you'd likely find in your pantry, but they are also being used in a lot of homes as natural cleaning products.  We're constantly told that the chemicals in household cleaning products are harmful to us and our families, so a lot of us are seeking natural alternatives that can be found around the home, but do they work? In this episode of The Quicky we dish the dirt on which products really will help keep your home clean and fresh and which are just bad science experiments.  Click here to take the latest Mamamia survey and you'll go in the running to win one of five $100 gift vouchers Want to try our new exercise app? Click here to start a seven day free trial of MOVE by Mamamia. Subscribe to Mamamia GET IN TOUCH Feedback? We're listening! Call the pod phone on 02 8999 9386 or email us at podcast@mamamia.com.au CONTACT US Got a topic you'd like us to cover? Send us an email at thequicky@mamamia.com.au CREDITS Host: Grace Rouvray With thanks to: Nathan Kilah - Lecturer in Synthetic Chemistry at the University of Tasmania  Producers: Grace Rouvray & Claire Murphy Executive Producer: Kally BorgAudio Producer: Tegan SadlerBecome a Mamamia subscriber: https://www.mamamia.com.au/subscribeSee omnystudio.com/listener for privacy information.

Episode 92 - Scott's Back With Vengeance, Cape Epic Upset, and The DJ v Dizzle Saga Continues  What's up party people. Happy Friday y'all and boy is it a good day to be alive. Scott's back from his underground Euro campaign, which of course we get into right at the onset of the show. DJ and Dizzle also brought the inter-squad competition to the lab and wind tunnel this week so we get a little scoop on the latest drama there, and we also touch on some Cape Epic news that might have some heads turning before the start of the Life Time Grand Prix kickoff next month. All that and more coming in hot.  If you have any questions or feedback for the show you can drop us a note at bonkbrospodcast@gmail.com or head over to the Bonk Bros insta and holla at your boys there (@bonkbros @dylanjawnson @adamsaban6 @tylerclouti @raddaddizzle @scottmcgilljr). Alright let's get this thing started.   Patreon: http://patreon.com/patreon_bonkbros   For more Dylan Johnson content: https://www.youtube.com/channel/UCIf1xvRN8pzyd_VfLgj_dow Intro/ Outro music by AlexGrohl on Pixabay.com: https://pixabay.com/music/id-111445/  Listener Question Form: https://docs.google.com/forms/d/1T37wGRLk6iYTCF6X_DQ9yfcaYtfAQceKpBJYR5W7DVA/edit?ts=642eb6d6   The Following Was Generated Using AI And Should Not Be Held To The Higher Standards Of Sentient Beings - Riverside.fm Summary The conversation covers topics such as arriving for the Bonk Roast, Scott's race victory, flying vs. driving to bike races, VO2 max testing, comparing fitness levels, aero testing and Lauf forks, and testing variables and real-world performance. The conversation covers topics such as comparing power files and drafting, factors affecting performance, talent and racing history, VO2 max and genetic potential, natural talent and training, late bloomers, VO2 max and performance, VO2 max testing, unique handlebars and aero positioning, Howard Grotz's performance, and weight and performance. The conversation covers topics such as collegiate road racing, Cape Epic, choosing a partner for Cape Epic, sponsorships, Dremel tools, Matteo Jorgensen and American talent, tire selection, and Training Peaks and coaching. In this episode, the hosts review a training plan, discuss race schedules and travel plans, and share their experiences with bicarb and ketones. They also talk about Adam's interest in archery and his upcoming bow setup. The conversation concludes with some closing remarks.   Takeaways Collegiate road racing can be unpredictable, and even riders from lower categories can win races. Choosing the right partner for Cape Epic is important, considering compatibility and skill level. Sponsorships can lead to unexpected benefits, such as receiving free products. Matteo Jorgensen's recent success in races like Perry Nice and Flanders is impressive. When selecting gravel tires, it's important to consider a balance between rolling resistance and puncture resistance. Training Peaks can be a useful tool for self-coaching, but working with a coach can provide more personalized guidance. Reviewing and following a structured training plan is important for consistent progress. Considerations for race tune-up include the proximity of the race to the main event and the specific demands of the race. Heart rate spikes during exercise may be a cause for concern and should be evaluated by a medical professional. Bicarb and ketones are popular supplements in the endurance sports community, but their effectiveness and safety should be carefully considered. Archery can be a fun and challenging sport to explore outside of cycling.   Chapters 00:00 Arriving for the Bonk Roast 02:21 Scott's Race Victory 03:38 Flying vs. Driving to Bike Races 06:02 VO2 Max Testing 09:18 Comparing Fitness Levels 12:15 Aero Testing and Lauf Forks 16:34 Testing Variables and Real-World Performance 18:04 Factors Affecting Performance 19:26 Talent and Racing History 20:35 VO2 Max and Genetic Potential 22:11 Natural Talent and Training 23:55 Late Bloomers 25:22 VO2 Max and Performance 29:36 VO2 Max Testing 32:27 Testing at VQ Labs 34:39 Unique Handlebars and Aero Positioning 36:13 Howard Grotz's Performance 37:06 Weight and Performance 37:22 Collegiate Road Racing and Cape Epic 40:41 Choosing a Cape Epic Partner 43:18 Sponsorships and Dremel Tools 52:29 Discussion on Tire Selection 56:35 Pathfinder Tires and Gravel Tire Recommendations 57:26 Training Peaks and Coaching 57:47 Training Plan Review 58:29 Discussion on Training Intensity 59:29 Race Schedule and Training Plan 01:00:34 Upcoming Races and Travel Plans 01:02:16 Considerations for Race Tune-up 01:03:11 Concerns about Heart Rate Spikes 01:04:18 Discussion on Bicarb and Ketones 01:05:00 Preferred Method of Ingesting Bicarb 01:06:06 Review of Dylan's Protein Powder 01:07:41 Adam's Interest in Archery 01:09:04 Adam's Bow Setup 01:11:00 Discussion on Surprise Release in Archery 01:14:49 Closing Remarks

The JournalFeed podcast for the week of Jan 1-5, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.MondayThe best articles of 2023!!Friday Spoon Feed:A prospective, observational study demonstrated that giving sodium bicarbonate to patients undergoing mechanical ventilation or CPR resulted in an increase in end-tidal CO2 values in as quickly as 17 seconds and lasted for 7 minutes

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Get ready to dive into the most shocking Talking Pools Podcast episode yet! Hosts Rudy and Andrea reveal jaw-dropping secrets about the International Code Council's sinister plot to make swimming pools less safe, with the shady backing of the PHTA, power cover manufacturers, and portable spa moguls. But that's not all! Rudy goes full science nerd, unraveling the mind-blowing mysteries of Bicarb's hidden reactions, where elements and compounds collide in an explosive twist. And don't miss the spine-tingling sneak peek of a chilling new pool horror movie that will leave you on the edge of your inflatable raft. Plus, we have a special guest, Kelli Clancy, shedding light on the Autism spectrum's connection to residential swimming pools. Buckle up, it's a splash of controversy, chemistry, and captivating conversations you won't want to miss!

High PaCO2, Low PaO2, Bicarb up, down...what does this all suggest? In this episode, join me as we introduce the principles of arterial blood gas tests and the interpretation of the results. This was a challenging subject to grasp in medical school, so hopefully this episode will help you have an idea about what to expect when the perfusionist or respiratory therapist hands you the reading.

Bicarbonate did not slow the loss of GFR in this well done Swiss, single-blind study of transplant patients.The Filtrate:Joel TopfNayan AroraSwapnil HiremathPirya YenebereWith Special Guest:Nav Tangri nephrologist and epidemiology at the University of ManitobaEditor:Nayan AroraShow Notes:Arsenal FCThe London study that kicked it all off!de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084.The multi center (but unblinded) UBI Study with mortality benefit!Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001.The BiCARB Study: Double blinded and negativeBiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91.The initial Veverimer StudyWesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). doi.org/10.1016/s0140-6736(19)31388-1The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscriptThe study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trialNephJC | PubMed | LancetAlkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93.Metforminator!The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174.Tubular SecretionsSwap The Three-Body Problem (novel) | NetflixNayan Women's World CupTangri English Premier Soccer and InflationPriya Silo on Apple TVJoel Live Podcast recording at ASN Kidney

The Filtrate:Joel TopfNayan AroraSwapnil HiremathPirya YenebereWith Special Guest:Nav Tangri nephrologist and epidemiology at the University of ManitobaEditor:Nayan AroraShow Notes:Arsenal FCThe London study that kicked it all off!de Brito-Ashurst, I., Varagunam, M., Raftery, M. J., & Yaqoob, M. M. (2009). Bicarbonate supplementation slows progression of CKD and improves nutritional status. Journal of the American Society of Nephrology: JASN, 20(9), 2075–2084.The multi center (but unblinded) UBI Study with mortality benefit!Di Iorio, B. R., Bellasi, A., Raphael, K. L., Santoro, D., Aucella, F., Garofano, L., Ceccarelli, M., Di Lullo, L., Capolongo, G., Di Iorio, M., Guastaferro, P., Capasso, G., & UBI Study Group. (2019). Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI Study. Journal of Nephrology, 32(6), 989–1001.The BiCARB Study: Double blinded and negativeBiCARB study group. (2020). Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial. BMC Medicine, 18(1), 91.The initial Veverimer StudyWesson, D. E., Mathur, V., Tangri, N., Stasiv, Y., Parsell, D., Li, E., Klaerner, G., & Bushinsky, D. A. (2019). Long-term safety and efficacy of veverimer in patients with metabolic acidosis in chronic kidney disease: a multicentre, randomised, blinded, placebo-controlled, 40-week extension. In The Lancet (Vol. 394, Issue 10196, pp. 396–406). https://doi.org/10.1016/s0140-6736(19)31388-1The Valor CKD trial is still unpublished. But here is the press release. VALOR-CKD design manuscript The study of the night: Sodium bicarbonate for kidney transplant recipients with metabolic acidosis in Switzerland: a multicentre, randomized, single-blind, placebo-controlled, phase 3 trialNephJC | PubMed | Lancet Alkali with normal bicarb? Sure, take a look at: Goraya, N., Simoni, J., Jo, C., & Wesson, D. E. (2012). Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney International, 81(1), 86–93.Metforminator!The BASE Trial: Raphael, K. L., Isakova, T., Ix, J. H., Raj, D. S., Wolf, M., Fried, L. F., Gassman, J. J., Kendrick, C., Larive, B., Flessner, M. F., Mendley, S. R., Hostetter, T. H., Block, G. A., Li, P., Middleton, J. P., Sprague, S. M., Wesson, D. E., & Cheung, A. K. (2020). A Randomized Trial Comparing the Safety, Adherence, and Pharmacodynamics Profiles of Two Doses of Sodium Bicarbonate in CKD: the BASE Pilot Trial. Journal of the American Society of Nephrology: JASN, 31(1), 161–174.Tubular SecretionsSwap The Three-Body Problem (novel) | Netflix Nayan Women's World CupTangri English Premier Soccer and InflationPriya Silo on Apple TVJoel Live Podcast recording at ASN Kidney

ReferencesWe considered the complexity of the machinery to excrete ammonium in the context of research on dietary protein and how high protein intake may increase glomerular pressure and contribute to progressive renal disease (many refer to this as the “Brenner hypothesis”). Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal diseaseA trial that studied low protein and progression of CKD The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease(and famously provided data for the MDRD eGFR equation A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study GroupWe wondered about dietary recommendations in CKD. of note, this is best done in the DKD guidelines from KDIGO Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment.Joel mentioned this study on red meat and risk of ESKD. Red Meat Intake and Risk of ESRDWe referenced the notion of a plant-based diet. This is an excellent review by Deborah Clegg and Kathleen Hill Gallant. Plant-Based Diets in CKD : Clinical Journal of the American Society of NephrologyHere's the review that Josh mentioned on how the kidney appears to sense pH Molecular mechanisms of acid-base sensing by the kidneyRemarkably, Dr. Dale Dubin put a prize in his ECG book Free Car Prize Hidden in Textbook Read the fine print: Student wins T-birdA review of the role of the kidney in DKA: Diabetic ketoacidosis: Role of the kidney in the acid-base homeostasis re-evaluatedJosh mentioned the effects of infusing large amounts of bicarbonate The effect of prolonged administration of large doses of sodium bicarbonate in man and this study on the respiratory response to a bicarbonate infusion: The Acute Effects In Man Of A Rapid Intravenous Infusion Of Hypertonic Sodium Bicarbonate Solution. Ii. Changes In Respiration And Output Of Carbon DioxideThis is the study of acute respiratory alkalosis in dogs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC293311/?page=1And this is the study of medical students who went to the High Alpine Research Station on the Jungfraujoch in the Swiss Alps https://www.nejm.org/doi/full/10.1056/nejm199105163242003Self explanatory! A group favorite! It Is Chloride Depletion Alkalosis, Not Contraction AlkalosisEffects of chloride and extracellular fluid volume on bicarbonate reabsorption along the nephron in metabolic alkalosis in the rat. Reassessment of the classical hypothesis of the pathogenesis of metabolic alkalosisA review of pendrin's role in volume homeostasis: The role of pendrin in blood pressure regulation | American Journal of Physiology-Renal PhysiologyInfusion of bicarbonate may lead to a decrease in respiratory stimulation but the shift of bicarbonate to the CSF may lag. Check out this review Neural Control of Breathing and CO2 Homeostasis and this classic paper Spinal-Fluid pH and Neurologic Symptoms in Systemic Acidosis.OutlineOutline: Chapter 11- Regulation of Acid-Base Balance- Introduction - Bicarb plus a proton in equilibrium with CO2 and water - Can be rearranged to HH - Importance of regulating pCO2 and HCO3 outside of this equation - Metabolism of carbs and fats results in the production of 15,000 mmol of CO2 per day - Metabolism of protein and other “substances” generates non-carbonic acids and bases - Mostly from sulfur containing methionine and cysteine - And cationic arginine and lysine - Hydrolysis of dietary phosphate that exists and H2PO4– - Source of base/alkali - Metabolism of an ionic amino acids - Glutamate and asparatate - Organic anions going through gluconeogenesis - Glutamate, Citrate and lactate - Net effect on a normal western diet 50-100 mEq of H+ per day - Homeostatic response to these acid-base loads has three stages: - Chemical buffering - Changes in ventilation - Changes in H+ excretion - Example of H2SO4 from oxidation of sulfur containing AA - Drop in bicarb will stimulate renal acid secretion - Nice table of normal cid-base values, arterial and venous- Great 6 bullet points of acid-base on page 328 - Kidneys must excrete 50-100 of non-carbonic acid daily - This occurs by H secretion, but mechanisms change by area of nephron - Not excreted as free H+ due to minimal urine pH being equivalent to 0.05 mmol/L - No H+ can be excreted until virtually all of th filtered bicarb is reabsorbed - Secreted H+ must bind buffers (phosphate, NH3, cr) - PH is main stimulus for H secretion, though K, aldo and volume can affect this.- Renal Hydrogen excretion - Critical to understand that loss of bicarb is like addition of hydrogen to the body - So all bicarb must be reabsorbed before dietary H load can be secreted - GFR of 125 and bicarb of 24 results in 4300 mEq of bicarb to be reabsorbed daily - Reabsorption of bicarb and secretion of H involve H secretion from tubular cells into the lumen. - Thee initial points need to be emphasized - Secreted H+ ion are generated from dissociation of H2O - Also creates OH ion - Which combine with CO2 to form HCO3 with the help of zinc containing intracellular carbonic anhydrase. - This is how the secretion of H+ which creates an OH ultimately produces HCO3 - Different mechanisms for proximal and distal acidification - NET ACID EXCRETION - Free H+ is negligible - So net H+ is TA + NH4 – HCO3 loss - Unusually equal to net H+ load, 50-100 mEq/day - Can bump up to 300 mEq/day if acid production is increased - Net acid excretion can go negative following a bicarb or citrate load - Proximal Acidification - Na-H antiporter (or exchanger) in luminal membrane - Basolateral membrane has a 3 HCO3 Na cotransporter - This is electrogenic with 3 anions going out and only one cation - The Na-H antiporter also works in the thick ascending limb of LOH - How about this, there is also a H-ATPase just like found in the intercalated cells in the proximal tubule and is responsible for about a third of H secretion - And similarly there is also. HCO3 Cl exchanger (pendrin-like) in the proximal tubule - Footnote says the Na- 3HCO3 cotransporter (which moves sodium against chemical gradient NS uses negative charge inside cell to power it) is important for sensing acid-base changes in the cell. - Distal acidification - Occurs in intercalated cells of of cortical and medullary collecting tubule - Three main characteristics - H secretion via active secretory pumps in the luminal membrane - Both H-ATPase and H-K ATPase - H- K ATPase is an exchange pump, k reabsorption - H-K exchange may be more important in hypokalemia rather than in acid-base balance - Whole paragraph on how a Na-H exchanger couldn't work because the gradient that H has to be pumped up is too big. - H-ATPase work like vasopressin with premise H-ATPase sitting on endocarditis vesicles a=which are then inserted into the membrane. Alkalosis causes them to be recycled out of the membrane. - H secretory cells do not transport Na since they have few luminal Na channels, but are assisted by the lumen negative tubule from eNaC. - Minimizes back diffusion of H+ and promotes bicarb resorption - Bicarbonate leaves the cell through HCO3-Cl exchanger which uses the low intracellular Cl concentration to power this process. - Same molecule is found on RBC where it is called band 3 protein - Figure 11-5 is interesting - Bicarbonate resorption - 90% in the first 1-22 mm of the proximal tubule (how long is the proximal tubule?) - Lots of Na-H exchangers and I handed permeability to HCO3 (permeability where?) - Last 10% happens distally mostly TAL LOH via Na-H exchange - And the last little bit int he outer medullary collecting duct. - Carbonic anhydrase and disequilibrium pH - CA plays central role in HCO3 reabsorption - After H is secreted in the proximal tubule it combines with HCO# to form carbonic acid. CA then dehydrates it to CO2 and H2O. (Step 2) - Constantly moving carbonic acid to CO2 and H2O keeps hydrogen combining with HCO3 since the product is rapidly consumed. - This can be demonstrated by the minimal fall in luminal pH - That is important so there is not a luminal gradient for H to overcome in the Na-H exchanger (this is why we need a H-ATPase later) - CA inhibitors that are limited tot he extracellular compartment can impair HCO3 reabsorption by 80%. - CA is found in S1, S2 but not S3 segment. See consequence in figure 11-6. - The disequilibrium comes from areas where there is no CA, the HH formula falls down because one of the assumptions of that formula is that H2CO3 (carbonic acid) is a transient actor, but without CA it is not and can accumulate, so the pKa is not 6.1. - Bicarbonate secretion - Type B intercalated cells - H-ATPase polarity reversed - HCO3 Cl exchanger faces the apical rather than basolateral membrane- Titratable acidity - Weak acids are filtered at the glom and act as buffers in the urine. - HPO4 has PKA of 6.8 making it ideal - Creatinine (pKa 4.97) and uric acid (pKa 5.75) also contribute - Under normal cinditions TA buffers 10-40 mEa of H per day - Does an example of HPO4(2-):H2PO4 (1-) which exists 4:1 at pH of 7.4 (glomerular filtrate) - So for 50 mEq of Phos 40 is HPO4 and 10 is H2PO4 - When pH drops to 6.8 then the ratio is 1:1 so for 50 - So the 50 mEq is 25 and 25, so this buffered an additional 15 mEq of H while the free H+ concentration increased from 40 to 160 nanomol/L so over 99.99% of secreted H was buffered - When pH drops to 4.8 ratio is 1:100 so almost all 50 mEq of phos is H2PO4 and 39.5 mEq of H are buffered. - Acid loading decreases phosphate reabsorption so more is there to act as TA. - Decreases activity of Na-phosphate cotransporter - DKA provides a novel weak acid/buffer beta-hydroxybutyrate (pKa 4.8) which buffers significant amount of acid (50 mEq/d).- Ammonium Excretion - Ability to excrete H+ as ammonium ions adds an important amount of flexibility to renal acid-base regulation - NH3 and NH4 production and excretion can be varied according to physiologic need. - Starts with NH3 production in tubular cells - NH3, since it is neutral then diffuses into the tubule where it is acidified by the low pH to NH4+ - NH4+ is ionized and cannot cross back into the tubule cells(it is trapped in the tubular fluid) - This is important for it acting as an important buffer eve though the pKa is 9.0 - At pH of 6.0 the ratio of NH3 to NH4 is 1:1000 - As the neutral NH3 is converted to NH4 more NH3 from theintracellular compartment flows into the tubular fluid replacing the lost NH3. Rinse wash repeat. - This is an over simplification and that there are threemajor steps - NH4 is produced in early proximal tubular cells - Luminal NH4 is partially reabsorbed in the TAL and theNH3 is then recycled within the renal medulla - The medullary interstitial NH3 reaches highconcentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4 by secreted H+ - NH4 production from Glutamine which converts to NH4 and glutamate - Glutamate is converted to alpha-ketoglutarate - Alpha ketoglutarate is converted to 2 HCO3 ions - HCO3 sent to systemic circulation by Na-3 HCO3 transporter - NH4 then secreted via Na-H exchanger into the lumen - NH4 is then reabsorbed by NaK2Cl transporter in TAL - NH4 substitutes for K - Once reabsorbed the higher intracellular pH causes NH4 to convert to NH3 and the H that is removed is secreted through Na-H exchanger to scavenge the last of the filtered bicarb. - NH3 diffuses out of the tubular cells into the interstitium - NH4 reabsorption in the TAL is suppressed by hyperkalemia and stimulated by chronic metabolic acidosis - NH4 recycling promotes acid clearance - The collecting tubule has a very low NH3 concentration - This promotes diffusion of NH3 into the collecting duct - NH3 that goes there is rapidly converted to NH4 allowing more NH3 to diffuse in. - Response to changes in pH - Increased ammonium excretion with two processes - Increased proximal NH4 production - This is delayed 24 hours to 2-3 days depending on which enzyme you look at - Decreased urine pH increases diffusion of ammonia into the MCD - Occurs with in hours of an acid load - Peak ammonium excretion takes 5-6 days! (Fig 11-10) - Glutamine is picked up from tubular fluid but with acidosis get Na dependent peritublar capillary glutamine scavenging too - Glutamine metabolism is pH dependent with increase with academia and decrease with alkalemia - NH4 excretion can go from 30-40 mEq/day to > 300 with severe metabolic acidosis (38 NaBicarb tabs) - Says each NH4 produces equimolar generation of HCO3 but I thought it was two bicarb for every alpha ketoglutarate?- The importance of urine pH - Though the total amount of hydrogren cleared by urine pH is insignificant, an acidic urine pH is essential for driving the reactions of TA and NH4 forward.- Regulation of renal hydrogen excretion - Net acid excretion vary inverse with extracellular pH - Academia triggers proximal and distal acidification - Proximally this: - Increased Na-H exchange - Increased luminal H-ATPase activity - Increased Na:3HCO3 cotransporter on the basolateral membrane - Increased NH4 production from glutamine - In the collecting tubules - Increased H-ATPase - Reduction of tubular pH promotes diffusion of NH3 which gets converted to NH4…ION TRAPPING - Extracellular pH affects net acid excretion through its affect on intracellular pH - This happens directly with respiratory disorders due to movement of CO2 through the lipid bilayer - In metabolic disorders a low extracellular bicarb with cause bicarb to diffuse out of the cell passively, this lowers intracellular pH - If you manipulate both low pCO2 and low Bicarb to keep pH stable there will be no change in the intracellular pH and there is no change in renal handling of acid. It is intracellular pH dependent - Metabolic acidosis - Ramps up net acid secretion - Starts within 24 hours and peaks after 5-6 days - Increase net secretion comes from NH4 - Phosphate is generally limited by diet - in DKA titratable acid can be ramped up - Metabolic alkalosis - Alkaline extracellular pH - Increased bicarb excretion - Decrease reabsorption - HCO3 secretion (pendrin) in cortical collecting tubule - Occurs in cortical intercalated cells able to insert H-ATPase in basolateral cells (rather than luminal membrane) - Normal subjects are able to secrete 1000 mmol/day of bicarb - Maintenance of metabolic alkalosis requires a defect which forces the renal resorption of bicarb - This can be chloride/volume deficiency - Hypokalemia - Hyperaldosteronism - Respiratory acidosis and alkalosis - PCO2 via its effect on intracellular pH is an important determinant of renal acid handling - Ratios he uses: - 3.5 per 10 for respiratory acidosis - 5 per 10 for respiratory alkalosis - Interesting paragraph contrasting the response to chronic metabolic acidosis vs chronic respiratory acidosis - Less urinary ammonium in respiratory acidosis - Major differences in proximal tubule cell pH - In metabolic acidosis there is decreased bicarb load so less to be reabsorbed proximally - In respiratory acidosis the increased serum bicarb increases the amount of bicarb that must be reabsorbed proximally - The increased activity of Na-H antiporter returns tubular cell pH to normal and prevents it from creating increased urinary ammonium - Mentions that weirdly more mRNA for H-Na antiporter in metabolic acidosis than in respiratory acidosis - Net hydrogen excretion varies with effective circulating volume - Starts with bicarb infusions - Normally Tm at 26 - But if you volume deplete the patient with diuretics first this increases to 35+ - Four factors explain this increased Tm for bicarb with volume deficiency - Reduced GFR - Activation of RAAS - Ang2 stim H-Na antiporter proximally - Ang2 also stimulates Na-3HCO3 cotransporter on basolateral membrane - Aldosterone stimulates H-ATPase in distal nephron - ALdo stimulates Cl HCO3 exchanger on basolateral membrane - Aldo stimulates eNaC producing tubular lumen negative charge to allow H secretion to occur and prevents back diffusion - Hypochloremia - Increases H secretion by both Na-dependent and Na-independent methods - If Na is 140 and Cl is 115, only 115 of Na can be reabsorbed as NaCl, the remainder must be reabsorbed with HCO3 or associated with secretion of K or H to maintained electro neutrality - This is enhanced with hypochloridemia - Concurrent hypokalemia - Changes in K lead to trans cellular shifts that affect inctracellular pH - Hypokalemia causes K out, H in and in the tubular cell the cell acts if there is systemic acidosis and increases H secretion (and bicarbonate resorption) - PTH - Decreases proximal HCO3 resorption - Primary HyperCard as cause of type 2 RTA - Does acidosis stim PTH or does PTH stim net acid excretion

Episode Notes In this episode, PGY3 and rising chief resident, Terra Swanson teaches us about when to use bicarbonate in different scenarios in the hospital. Get ready for a wild ride on the Bicarb Train! This podcast is powered by Pinecast.

In this episode of The Knowledge Podcast by Wahoo, hosts Jinger Gottschall and Mac Cassin explore the age-old question of whether to load or not to load on carbs, water, and bicarb before exercise. They discuss the benefits and limitations of carbohydrate-loading, including how it can increase both muscle and liver glycogen, essential fuel stores for sustained high-intensity exercise. Jinger and Mac also examine the role of water in preventing dehydration and how pre-exercise hyperhydration can improve endurance capacity. Additionally, they discuss the use of sodium citrate and sodium bicarbonate in increasing plasma volume and delaying exhaustion during high-intensity exercise. Tune in to discover the latest research on these strategies and decide for yourself whether loading up is the way to go!

Over the past few years English schools have begun to introduce non-competitive sport in an effort to be more inclusive. But is that the right strategy when it comes to producing future champions and developing a 'winning' mentality? The team take an in-depth look into the evidence surrounding the debate and examples of countries that have already rolled out similar plans.> Jump to 45:17 for the main topic.PLUS RED-S in male athletes / Bicarb in endurance sport / shinty drug testing / Remembering Dick Fosbury, the inventor of modern high jumping.SHOW NOTES:Caught My Eye SegmentJake Smith's Instagram post about his RED-SThe 1984 study on bicarbonate as a performance enhancerA 1993 meta-analysis on bicarbonateA 2022 systematic review on bicarb and performanceA recent article that contains some of Maurten's promises and promotionsPrimoz Roglic's glowing endorsement of bicarb. “With 600W it always hurts, huh?"The BBC piece on Shinty's drug testing plansDavid Epstein's article on Dick FosburyMain SegmentArticle on how early specialisation and training rather than fun increases injury risk Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

ReferencesWe considered the effect of a high protein diet and potential metabolic acidosis on kidney function. This review is of interest by Donald Wesson, a champion for addressing this issue and limiting animal protein: Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney DiseaseHostetter explored the effect of a high protein diet in the remnant kidney model with 1 ¾ nephrectomy. Rats with reduced dietary acid load (by bicarbonate supplementation) had less tubular damage. Chronic effects of dietary protein in the rat with intact and reduced renal massWesson explored treatment of metabolic acidosis in humans with stage 3 CKD in this study. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rateIn addition to the effect of metabolic acidosis from a diet high in animal protein, this diet also leads to hyperfiltration. This was demonstrated in normal subjects; ingesting a protein diet had a significantly higher creatinine clearance than a comparable group of normal subjects ingesting a vegetarian diet. Renal functional reserve in humans: Effect of protein intake on glomerular filtration rate.This finding has been implicated in Brenner's theory regarding hyperfiltration: The hyperfiltration theory: a paradigm shift in nephrologyOne of multiple publications from Dr. Nimrat Goraya whom Joel mentioned in the voice over: Dietary Protein as Kidney Protection: Quality or Quantity?We wondered about the time course in buffering a high protein meal (and its subsequent acid load on ventilation) and Amy found this report:Effect of Protein Intake on Ventilatory Drive | Anesthesiology | American Society of Anesthesiologists Roger mentioned that the need for acetate to balance the acid from amino acids in parenteral nutrition was identified in pediatrics perhaps because infants may have reduced ability to generate acid. Randomised controlled trial of acetate in preterm neonates receiving parenteral nutrition - PMCHe also recommended an excellent review on the complications of parenteral nutrition by Knochel https://www.kidney-international.org/action/showPdf?pii=S0085-2538%2815%2933384-6 which explained that when the infused amino acids disproportionately include cationic amino acids, metabolism led to H+ production. This is typically mitigated by preparing a solution that is balanced by acetate. Amy mentioned this study that explored the effect of protein intake on ventilation: Effect of Protein Intake on Ventilatory Drive | Anesthesiology | American Society of AnesthesiologistsAnna and Amy reminisced about a Skeleton Key Group Case from the renal fellow network Skeleton Key Group: Electrolyte Case #7JC wondered about isolated defects in the proximal tubule and an example is found here: Mutations in SLC4A4 cause permanent isolated proximal renal tubular acidosis with ocular abnormalitiesAnna's Voiceover re: Gastric neobladder → metabolic alkalosis and yes, dysuria. The physiology of gastrocystoplasty: once a stomach, always a stomach but not as common as you might think Gastrocystoplasty: long-term complications in 22 patientsSjögren's syndrome has been associated with acquired distal RTA and in some cases, an absence of the H+ ATPase, presumably from autoantibodies to this transporter. Here's a case report: Absence of H(+)-ATPase in cortical collecting tubules of a patient with Sjogren's syndrome and distal renal tubular acidosisCan't get enough disequilibrium pH? Check this out- Spontaneous luminal disequilibrium pH in S3 proximal tubules. Role in ammonia and bicarbonate transport.Acetazolamide secretion was studied in this report Concentration-dependent tubular secretion of acetazolamide and its inhibition by salicylic acid in the isolated perfused rat kidney. | Drug Metabolism & DispositionIn this excellent review, David Goldfarb tackles the challenging case of a A Woman with Recurrent Calcium Phosphate Kidney Stones (spoiler alert, many of these patients have incomplete distal RTA and this problem is hard to treat). Molecular mechanisms of renal ammonia transport excellent review from David Winer and Lee Hamm. OutlineOutline: Chapter 11- Regulation of Acid-Base Balance- Introduction - Bicarb plus a proton in equilibrium with CO2 and water - Can be rearranged to HH - Importance of regulating pCO2 and HCO3 outside of this equation - Metabolism of carbs and fats results in the production of 15,000 mmol of CO2 per day - Metabolism of protein and other “substances” generates non-carbonic acids and bases - Mostly from sulfur containing methionine and cysteine - And cationic arginine and lysine - Hydrolysis of dietary phosphate that exists and H2PO4– - Source of base/alkali - Metabolism of an ionic amino acids - Glutamate and asparatate - Organic anions going through gluconeogenesis - Glutamate, Citrate and lactate - Net effect on a normal western diet 50-100 mEq of H+ per day - Homeostatic response to these acid-base loads has three stages: - Chemical buffering - Changes in ventilation - Changes in H+ excretion - Example of H2SO4 from oxidation of sulfur containing AA - Drop in bicarb will stimulate renal acid secretion - Nice table of normal cid-base values, arterial and venous- Great 6 bullet points of acid-base on page 328 - Kidneys must excrete 50-100 of non-carbonic acid daily - This occurs by H secretion, but mechanisms change by area of nephron - Not excreted as free H+ due to minimal urine pH being equivalent to 0.05 mmol/L - No H+ can be excreted until virtually all of th filtered bicarb is reabsorbed - Secreted H+ must bind buffers (phosphate, NH3, cr) - PH is main stimulus for H secretion, though K, aldo and volume can affect this.- Renal Hydrogen excretion - Critical to understand that loss of bicarb is like addition of hydrogen to the body - So all bicarb must be reabsorbed before dietary H load can be secreted - GFR of 125 and bicarb of 24 results in 4300 mEq of bicarb to be reabsorbed daily - Reabsorption of bicarb and secretion of H involve H secretion from tubular cells into the lumen. - Thee initial points need to be emphasized - Secreted H+ ion are generated from dissociation of H2O - Also creates OH ion - Which combine with CO2 to form HCO3 with the help of zinc containing intracellular carbonic anhydrase. - This is how the secretion of H+ which creates an OH ultimately produces HCO3 - Different mechanisms for proximal and distal acidification - NET ACID EXCRETION - Free H+ is negligible - So net H+ is TA + NH4 – HCO3 loss - Unusually equal to net H+ load, 50-100 mEq/day - Can bump up to 300 mEq/day if acid production is increased - Net acid excretion can go negative following a bicarb or citrate load - Proximal Acidification - Na-H antiporter (or exchanger) in luminal membrane - Basolateral membrane has a 3 HCO3 Na cotransporter - This is electrogenic with 3 anions going out and only one cation - The Na-H antiporter also works in the thick ascending limb of LOH - How about this, there is also a H-ATPase just like found in the intercalated cells in the proximal tubule and is responsible for about a third of H secretion - And similarly there is also. HCO3 Cl exchanger (pendrin-like) in the proximal tubule - Footnote says the Na- 3HCO3 cotransporter (which moves sodium against chemical gradient NS uses negative charge inside cell to power it) is important for sensing acid-base changes in the cell. - Distal acidification - Occurs in intercalated cells of of cortical and medullary collecting tubule - Three main characteristics - H secretion via active secretory pumps in the luminal membrane - Both H-ATPase and H-K ATPase - H- K ATPase is an exchange pump, k reabsorption - H-K exchange may be more important in hypokalemia rather than in acid-base balance - Whole paragraph on how a Na-H exchanger couldn't work because the gradient that H has to be pumped up is too big. - H-ATPase work like vasopressin with premise H-ATPase sitting on endocarditis vesicles a=which are then inserted into the membrane. Alkalosis causes them to be recycled out of the membrane. - H secretory cells do not transport Na since they have few luminal Na channels, but are assisted by the lumen negative tubule from eNaC. - Minimizes back diffusion of H+ and promotes bicarb resorption - Bicarbonate leaves the cell through HCO3-Cl exchanger which uses the low intracellular Cl concentration to power this process. - Same molecule is found on RBC where it is called band 3 protein - Figure 11-5 is interesting - Bicarbonate resorption - 90% in the first 1-22 mm of the proximal tubule (how long is the proximal tubule?) - Lots of Na-H exchangers and I handed permeability to HCO3 (permeability where?) - Last 10% happens distally mostly TAL LOH via Na-H exchange - And the last little bit int he outer medullary collecting duct. - Carbonic anhydrase and disequilibrium pH - CA plays central role in HCO3 reabsorption - After H is secreted in the proximal tubule it combines with HCO# to form carbonic acid. CA then dehydrates it to CO2 and H2O. (Step 2) - Constantly moving carbonic acid to CO2 and H2O keeps hydrogen combining with HCO3 since the product is rapidly consumed. - This can be demonstrated by the minimal fall in luminal pH - That is important so there is not a luminal gradient for H to overcome in the Na-H exchanger (this is why we need a H-ATPase later) - CA inhibitors that are limited tot he extracellular compartment can impair HCO3 reabsorption by 80%. - CA is found in S1, S2 but not S3 segment. See consequence in figure 11-6. - The disequilibrium comes from areas where there is no CA, the HH formula falls down because one of the assumptions of that formula is that H2CO3 (carbonic acid) is a transient actor, but without CA it is not and can accumulate, so the pKa is not 6.1. - Bicarbonate secretion - Type B intercalated cells - H-ATPase polarity reversed - HCO3 Cl exchanger faces the apical rather than basolateral membrane- Titratable acidity - Weak acids are filtered at the glom and act as buffers in the urine. - HPO4 has PKA of 6.8 making it ideal - Creatinine (pKa 4.97) and uric acid (pKa 5.75) also contribute - Under normal cinditions TA buffers 10-40 mEa of H per day - Does an example of HPO4(2-):H2PO4 (1-) which exists 4:1 at pH of 7.4 (glomerular filtrate) - So for 50 mEq of Phos 40 is HPO4 and 10 is H2PO4 - When pH drops to 6.8 then the ratio is 1:1 so for 50 - So the 50 mEq is 25 and 25, so this buffered an additional 15 mEq of H while the free H+ concentration increased from 40 to 160 nanomol/L so over 99.99% of secreted H was buffered - When pH drops to 4.8 ratio is 1:100 so almost all 50 mEq of phos is H2PO4 and 39.5 mEq of H are buffered. - Acid loading decreases phosphate reabsorption so more is there to act as TA. - Decreases activity of Na-phosphate cotransporter - DKA provides a novel weak acid/buffer beta-hydroxybutyrate (pKa 4.8) which buffers significant amount of acid (50 mEq/d).- Ammonium Excretion - Ability to excrete H+ as ammonium ions adds an important amount of flexibility to renal acid-base regulation - NH3 and NH4 production and excretion can be varied according to physiologic need. - Starts with NH3 production in tubular cells - NH3, since it is neutral then diffuses into the tubule where it is acidified by the low pH to NH4+ - NH4+ is ionized and cannot cross back into the tubule cells(it is trapped in the tubular fluid) - This is important for it acting as an important buffer eve though the pKa is 9.0 - At pH of 6.0 the ratio of NH3 to NH4 is 1:1000 - As the neutral NH3 is converted to NH4 more NH3 from theintracellular compartment flows into the tubular fluid replacing the lost NH3. Rinse wash repeat. - This is an over simplification and that there are threemajor steps - NH4 is produced in early proximal tubular cells - Luminal NH4 is partially reabsorbed in the TAL and theNH3 is then recycled within the renal medulla - The medullary interstitial NH3 reaches highconcentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4 by secreted H+ - NH4 production from Glutamine which converts to NH4 and glutamate - Glutamate is converted to alpha-ketoglutarate - Alpha ketoglutarate is converted to 2 HCO3 ions - HCO3 sent to systemic circulation by Na-3 HCO3 transporter - NH4 then secreted via Na-H exchanger into the lumen - NH4 is then reabsorbed by NaK2Cl transporter in TAL - NH4 substitutes for K - Once reabsorbed the higher intracellular pH causes NH4 to convert to NH3 and the H that is removed is secreted through Na-H exchanger to scavenge the last of the filtered bicarb. - NH3 diffuses out of the tubular cells into the interstitium - NH4 reabsorption in the TAL is suppressed by hyperkalemia and stimulated by chronic metabolic acidosis - NH4 recycling promotes acid clearance - The collecting tubule has a very low NH3 concentration - This promotes diffusion of NH3 into the collecting duct - NH3 that goes there is rapidly converted to NH4 allowing more NH3 to diffuse in. - Response to changes in pH - Increased ammonium excretion with two processes - Increased proximal NH4 production - This is delayed 24 hours to 2-3 days depending on which enzyme you look at - Decreased urine pH increases diffusion of ammonia into the MCD - Occurs with in hours of an acid load - Peak ammonium excretion takes 5-6 days! (Fig 11-10) - Glutamine is picked up from tubular fluid but with acidosis get Na dependent peritublar capillary glutamine scavenging too - Glutamine metabolism is pH dependent with increase with academia and decrease with alkalemia - NH4 excretion can go from 30-40 mEq/day to > 300 with severe metabolic acidosis (38 NaBicarb tabs) - Says each NH4 produces equimolar generation of HCO3 but I thought it was two bicarb for every alpha ketoglutarate?- The importance of urine pH - Though the total amount of hydrogren cleared by urine pH is insignificant, an acidic urine pH is essential for driving the reactions of TA and NH4 forward.- Regulation of renal hydrogen excretion - Net acid excretion vary inverse with extracellular pH - Academia triggers proximal and distal acidification - Proximally this: - Increased Na-H exchange - Increased luminal H-ATPase activity - Increased Na:3HCO3 cotransporter on the basolateral membrane - Increased NH4 production from glutamine - In the collecting tubules - Increased H-ATPase - Reduction of tubular pH promotes diffusion of NH3 which gets converted to NH4…ION TRAPPING - Extracellular pH affects net acid excretion through its affect on intracellular pH - This happens directly with respiratory disorders due to movement of CO2 through the lipid bilayer - In metabolic disorders a low extracellular bicarb with cause bicarb to diffuse out of the cell passively, this lowers intracellular pH - If you manipulate both low pCO2 and low Bicarb to keep pH stable there will be no change in the intracellular pH and there is no change in renal handling of acid. It is intracellular pH dependent - Metabolic acidosis - Ramps up net acid secretion - Starts within 24 hours and peaks after 5-6 days - Increase net secretion comes from NH4 - Phosphate is generally limited by diet - in DKA titratable acid can be ramped up - Metabolic alkalosis - Alkaline extracellular pH - Increased bicarb excretion - Decrease reabsorption - HCO3 secretion (pendrin) in cortical collecting tubule - Occurs in cortical intercalated cells able to insert H-ATPase in basolateral cells (rather than luminal membrane) - Normal subjects are able to secrete 1000 mmol/day of bicarb - Maintenance of metabolic alkalosis requires a defect which forces the renal resorption of bicarb - This can be chloride/volume deficiency - Hypokalemia - Hyperaldosteronism - Respiratory acidosis and alkalosis - PCO2 via its effect on intracellular pH is an important determinant of renal acid handling - Ratios he uses: - 3.5 per 10 for respiratory acidosis - 5 per 10 for respiratory alkalosis - Interesting paragraph contrasting the response to chronic metabolic acidosis vs chronic respiratory acidosis - Less urinary ammonium in respiratory acidosis - Major differences in proximal tubule cell pH - In metabolic acidosis there is decreased bicarb load so less to be reabsorbed proximally - In respiratory acidosis the increased serum bicarb increases the amount of bicarb that must be reabsorbed proximally - The increased activity of Na-H antiporter returns tubular cell pH to normal and prevents it from creating increased urinary ammonium - Mentions that weirdly more mRNA for H-Na antiporter in metabolic acidosis than in respiratory acidosis - Net hydrogen excretion varies with effective circulating volume - Starts with bicarb infusions - Normally Tm at 26 - But if you volume deplete the patient with diuretics first this increases to 35+ - Four factors explain this increased Tm for bicarb with volume deficiency - Reduced GFR - Activation of RAAS - Ang2 stim H-Na antiporter proximally - Ang2 also stimulates Na-3HCO3 cotransporter on basolateral membrane - Aldosterone stimulates H-ATPase in distal nephron - ALdo stimulates Cl HCO3 exchanger on basolateral membrane - Aldo stimulates eNaC producing tubular lumen negative charge to allow H secretion to occur and prevents back diffusion - Hypochloremia - Increases H secretion by both Na-dependent and Na-independent methods - If Na is 140 and Cl is 115, only 115 of Na can be reabsorbed as NaCl, the remainder must be reabsorbed with HCO3 or associated with secretion of K or H to maintained electro neutrality - This is enhanced with hypochloridemia - Concurrent hypokalemia - Changes in K lead to trans cellular shifts that affect inctracellular pH - Hypokalemia causes K out, H in and in the tubular cell the cell acts if there is systemic acidosis and increases H secretion (and bicarbonate resorption) - PTH - Decreases proximal HCO3 resorption - Primary HyperCard as cause of type 2 RTA - Does acidosis stim PTH or does PTH stim net acid excretion

References for Chapter 10We did not mention many references in our discussion today but our listeners may enjoy some of the references below. Effects of pH on Potassium: New Explanations for Old Observations - PMC although the focus of this article is on potassium, this elegant review by Aronson and Giebisch reviews intracellular shifts as it relates to pH and K+.Josh swooned for Figure 10-1 is this right? Which figure was it? which shows the relationship between [H+] and pH. You can find this figure in the original reference from Halperin ML and others, Figure 1 here. Factors That Control the Effect of pH on Glycolysis in Leukocytes Here's Leticia Rolon's favorite Henderson-Hasselbalch calculator website: ​​Henderson-Hasselbalch Calculator | Buffer Solutions [hint! for this site, use the bicarbonate (or “total CO2”) for A- and PCO2 for the HA] There's also a cooking tab for converting units! Fundamentals of Arterial Blood Gas Interpretation - PMC this review published posthumously from the late but beloved Jerry Yee and his group at Henry Ford Hospital, explores the details and underpinnings of our understandings of arterial blood gas interpretation (and this also addresses how our colleagues in clinical chemistry measure total CO2 - which JC referenced- but JC said “machine” and our colleagues prefer the word “instrument.”)Amy went deep on bicarbonate in respiratory acidosis. Here are her refs:Sodium bicarbonate therapy for acute respiratory acidosisSodium Bicarbonate in Respiratory AcidosisBicarbonate therapy in severe metabolic acidosisEffect of Intravenous Sodium Bicarbonate on Ventilation, Gas Exchange, and Acid-Base Balance in Patients with Chronic Pulmonary InsufficiencyBicarbonate Therapy in Severe Metabolic Acidosis | American Society of Nephrology this review article from Sabatini and Kurtzman addresses the issues regarding bicarbonate therapy including theoretical intracellular acidosis. Bicarbonate in DKA? Don't do it: Bicarbonate in diabetic ketoacidosis - a systematic review Here's a review from Bushinsky and Krieger on the effect acidosis on bone https://www.sciencedirect.com/science/article/abs/pii/S0085253822002174Here is the primary resource that Anna used in here investigation of meat replacements Nutritional Composition of Novel Plant-Based Meat Alternatives and Traditional Animal-Based MeatsWe enjoyed this paper that Dr. Rose references from the Journal of Clinical Investigation 1955 in which investigators infused HCl into nephrectomized dogs and observed changes in extracellular ions. https://www.jci.org/articles/view/103073/pdWe wondered about the amino acids/protein in some available meat alternatives they are explored in this article in the journal Amino Acids: Protein content and amino acid composition of commercially available plant-based protein isolates - PMC and you may enjoy this exploration of the nutritional value of these foods: Full article: Examination of the nutritional composition of alternative beef burgers available in the United StatesOutlineChapter 10: Acid-Base Physiology - H concentration regulated tightly - Normal H+ is 40 nm/L - This one millionth the concentration of Na and K - It needs to be this dilute because H+ fucks shit up - Especially proteins - Cool foot note H+ actually exists as H3O+ - Under normal conditions the H+ concentration varies little from normal due to three steps - Chemical buffering by extracellular and intracellular bufffers - Control of partial pressure of CO2 by alterations of alveolar ventilation - Control of plasma bicarbonate by changes in renal H+ excretion - Acid and bases - Use definition by Bronsted - Acid can donate protons - Base can accept protons - There are two classes of acids** - Carbonic acid H2CO3 - Each day 15000 mmol of CO2 are generated - CO2 not acid but combines with water to form carbonic acid H2CO3 - CO2 cleared by the lungs - Noncarbonic acid - Formed from metabolism of protein. Sulfur containing AA generate H2SO4. Only 50-100 mEq of acid produced from these sources. - Cleared by the kidneys - Law of Mass Action - Velocity of reaction proportional to the product of the concentrations of the reactants - Goes through mass action formula for water - Concludes that water has H of 155 nanoM/L, more than the 40 in plasma - Says you can do the same mass experiment for every acid in the body - Can do it also for bases but he is not going to. - Acids and Bases can be strong or weak - Strong acids completely dissociate - Weak acids not so much - H2PO4 is only 80% dissociated - Weak acids are the principle buffers in the body - Then he goes through how H is measured in the blood and it becomes clear why pH is a logical way to measure. - Then there is a lot of math - HH equation - Derives it - Then uses it to look at phos. Very interesting application - Buffers - Goes tot he phosphate well again. Amazing math describing how powerful buffers can be - Big picture the closer the pKa is to the starting pH the better buffer, i.e. it can absorb lots of OH or H without appreciably changing pH - HCO3 CO2 system - H2CO3 to H + HCO3 has a PKA of 2.72 but then lots of Math and the bicarb buffer system has a pKa of 6.1 - But the real power of the bicarb buffer is that it is not a sealed system. The ability to ventilate and keep CO2 constant increases the buffering efficiency by 11 fold and the ability to lower the CO2 below normal increases 18 fold. - Isohydric principle - There is only one hydrogen ion concentration and since that is a critical part of the buffer equation, all buffer eq are linked and you can understand all of them by understanding one of them. So we just can look at bicarb and understand the totality of acid base. - Bicarb is the most important buffer because - High concentration in plasma - Ability for CO2 to ventilate - Other buffers include - Bone - Bone is more than just inorganic reaction - Live bone releases more calcium in response to an acid load than dead bone - More effect with metabolic acidosis than respiratory acidosis - Hgb - Phosphate - Protein

Welcome back to our weekend Cabral HouseCall shows!   This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track!   Check out today's questions:    Margie: Hi Dr. Cabral! My questions are about Vit A toxicity. In April I started using a retinol cream at night then developed dry lips that eventually became cracked, bleeding, and painful in July! I also experienced general dryness in my mouth, eyes, and bowels. After listening to your podcast about what your lips tell about your health, I realized that it was the retinol cream & stopped using it immediately. My Vit A history includes 3 treatments of Accutane. It makes sense that adding retinol to my night time routine finally “tipped that scale”, overloading my liver. I've done 2 CBO protocols & several detoxes since 2018. Before I realized that the cream was the source of my problems, I did a 7-day detox & noticed that my lips worsened esp. during the 2 days of fasting. I stopped using the DNS powder, all supplements that listed Vit A on the label & stopped eating foods known to have high levels of Vit A. After several weeks, my symptoms improved. I heard you mention in a podcast that you were going to talk about a low Vitamin A diet but haven't been able to find anything on that topic. What would a low Vitamin A diet consist of? Once my lips are completely healed, would it be safe to resume DNS, supplements, & foods with Vit A? Thanks a bunch!   Paula: Hello and thank you for all that you do Dr Cabral! My 77 yr old mother has had intermittent amnesia episodes for over 13 years now, occurring on average 3 to 4 times per year. She has had extensive testing with no definitive outcome. Tests & scans looking at epilepsy, blood supply to the brain & heart were normal. There have been no head traumas that she is aware of in the past. I have recently started looking into it further myself and have come across a condition called Global Transient Amnesia which describes her symptoms almost exactly. When having an "episode" as she calls them, she loses short term memory for about 1/2 an hour and has no idea what she was doing at the time, nor what has happened in her recent past. She is still able to perform normal functions and is alert and very aware that the episode is happening but is just unable to recall anything from days/weeks prior for about 25 minutes or so which is distressing for her. Her memory returns gradually over that time and is then often very tired afterward. I am wondering if there could be an underlying issue that could be causing this and if you recommend any functional testing? She has been taking Ginkgo Biloba and liquid magnesium on and off for years without any notable differences. Thanks so much in advance.   Dani: Hi Dr cabral, grateful for your work and would love to hear your thoughts. A few months ago I had my first eczema and dermatitis flare up since 2019 when I healed my gut and rebalanced my body with my naturopath. The dermatitis is on my face, either seborrheic or perioral. I have used native and no pong deodorants for years but they irritated and inflamed the eczema on my armpits, it was very painful so I didn't apply anything all winter (based in Aus). My first though was gut-skin connection so I've been using a gut powder. Also ran the big 5 (just have one more test to do). Have already received my intolerance test back as it felt urgent to me but everything was fine on it (not one intolerance?!) I finished the 21 day detox last week. Still some dermatitis on my face, and I just tried some Bicarb free no pong Deodorant and a few hours later a rash and itching started. So now I'm wondering what other causes should I be looking at for this skin flare up. I'm sure I'll get some more answers from my big 5 but I was hoping it would have been something as simple as the food intolerance which I've experienced in the past. I do have some hormonal issues which were the main reason for my big 5 but wasn't sure if that could be a link to my eczema. Thanks again, appreciate you!   Luis: Hi Dr. Cabral, I wanted to get your thoughts on the Salt Water Flush. I believe this is also a ayurvedic practice, but I could be wrong. It involves drinking about a pint of warm to hot water, with about 2 table spoons of salt (pink or sea salt). After some time, it will purge the contents of the intestines until the water eventually comes out clear. The only downside I know of is that it may cause electrolyte imbalances, but replenishing those isn't a problem for me. I have done this many times over the past few years, but wanted your opinion on this procedure as well. Thanks for all you do!   Nikki: Hi Dr. Cabral, -I'm 55 yo female, mainly vata with some kapha, exercising 6 days weekly, 5'6” 112 lbs. -I've done the 21 day detox and the 7 day detox 3 times this past year. I've also done the Big 5 Labs and neurotransmitter test. I have candida and yeast overgrowth along with several food sensitivities (probably from leaky gut). I've done the CBO protocol with citricidal drops, noticing digestive improvement only while on the citricidal drops. Each time I introduced new foods I had gas, bloating and loose stools throughout the remainder of the CBO protocol so I didn't keep eating them. -I then did the 3 day stool test (no h-Pylori or parasites), spoke with one of your health coaches and did the Limited Yeast protocol with the citricidal drops but continued to have the bloating, gas and loose stools after introducing new foods so, I'm still not eating anything off the sensitive gut guide except for once or twice a week when I try a new food. I take Healthy Belly 3 x daily and Healthy Gut Support each morning along with digestive enzymes when I try new foods. -I've done the Para Protocol, Intestinal Cleanse and Heavy Metal Detox. -My hormones are still not aligned although I've taken the Equilife estrogen and progesterone supplements-presumable my digestion isn't able to absorb the nutrients from the supplements. I also tried seed cycling but my digestive problems worsened. -I have restless leg which is somewhat helpful with magnesium cream. I take cal/mag at dinner and full spectrum magnesium at bedtime. I drink 2 DNS shakes daily. -I also have the antiphospholipid syndrome and take fish oils which has kept my platelets in range. -My right thumb is constantly swollen and in pain. -My stomach acid was slightly low so I've been taking 3 Betaine HCL daily but haven't noticed any improvement in digestion. -My allergies (of 52 yrs) are better since eliminating dairy in January and I'm not on meds any longer, just Quercitin 3 x daily. -My health coach says to do another round of the CBO protocol and that should help so I'll be doing that again and will just be finishing when you get this. I'm concerned I will still feel the same and won't be able to introduce foods I can actually continue eating without problems. -Please let me know if you have any thoughts you think may help.     Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions!      - - - Show Notes and Resources: StephenCabral.com/2500 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!