Tripotassium citrate – the next generation

nutrient for bone health?

Dr. Gerhard Gerstner

Business Development Director

Jungbunzlauer Ladenburg GmbH, Germany

gerhard.gerstner@jungbunzlauer.com

© G. Gerstner, Food Matters Live 2017

• Family owned Swiss company with 1060 employees worldwide

• Globally leading manufacturer of organic acids, xanthan gum and

erythritol

• Fermentation as core technology

• Producer of organic Ca, Mg, Zn, Na and K salts

2

Quick facts about Jungbunzlauer

© G. Gerstner, Food Matters Live 2017

100 000 generations: Hunters and gatherers

500 generations: Introduction of agriculture

10 generations: Industrial age

2 generations: Consumption of highly processed foods

• Our genes are identical to those of our ancestors

• Our body‘s physiology and biochemistry is

optimized to the diet of hunters and gatherers

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Diet and evolution

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• Negative shifts of nutrient uptake mainly with vitamins and minerals

• The highest reduction by weight concerns potassium, minus 8g per day!

Eaton et al.: Eur. J. Clin. Nutr. 51, 207-216, 1997

0 100 200 300 400 500

Folic acid (x10 µg)

Vitamin A (µg)

Vitamin E (mg)

Zinc (mg)

Vitamin C (x10 mg)

Calcium (x10 mg)

Potassium (x10 mg)

Daily Uptake of Nutrient

Paleolithic diet

Current diet

-53%

-59%

-76%

-77%

-87%

-63%

-76%

1000

4

Diet and evolution: Impact on nutrients

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Each vertical bar represents a different diet, shown in ascending order of NEAP.

Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC Jr. Estimation of the net acid load of the diet

of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr. 76:1308-16, 2002

Palaeolithic diets were alkaline

Effect of 159 different ancestral pre-agricultural diets

on Net Endogenous Acid Production (NEAP)

Mean NEAP = -88 ± 82 mEq/day

5 © G. Gerstner, Food Matters Live 2017

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Acid-Base Balance?

Current food intake may lead to latent acidosis

Animal protein

Cereal flour

Phosphates

Vegetables

Fruits

Typical western diet: H+ excess of +50-100 mEq/day

Alkaline diet

High in K

Acidic diet

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Possible consequences of acidosis A

cid

lo

ad

Release of minerals

from the skeleton

Osteoporosis

Lemann et al.:J Clin Invest 10,1608-1614, 1966

Wachmann et al.: Lancet 958-959, 1968

Buffer capacity of the blood

7 © G. Gerstner, Food Matters Live 2017

Potassium 91%

Sodium 1%

Magnesium 4% Calcium

4%

What is the main alkalizing agent in vegetables

such as tomato?

Minerals Organic Acids

(Total 260mg/100g) (Total 390mg/100g)

Compiled from: Food Composition and Nutrition Tables (2008) and Hernándes and Rodríguez, Eur Food Res Technol (2008) 226:423–435

Citrate 74%

Malate 16%

Oxalate 6% Ascorbate

3% Others

1%

Main combination is (tri-)potassium citrate

1kg tomato equals 31 mEq base equivalent

8 © G. Gerstner, Nutrevent 2015

• Most populations around the world consume less than the

recommended levels of potassium and consume a ratio of sodium

to potassium of two to one or more

• An increased potassium intake may reduce blood pressure,

decrease risk of cardiovascular disease, have beneficial effects

on bone-mineral density, and mitigate the negative

consequences of high sodium consumption”

http://www.who.int/mediacentre/news/notes/2013/salt_potassium_20130131/en/index.html

http://www.who.int/nutrition/publications/guidelines/potassium_intake_printversion.pdf

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Recent WHO guidelines on K and Na (2013)

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• Study with 160 postmenopausal women with osteopenia, age 58 ± 4.8 years

• Supplementation with 30 mEq/d K citrate or KCl for 12 months (58% EU RDA)

• Additionally, 500 mg Ca and 400 IU vitamin D daily for all women

• Detection of bone mineral density (DEXA) and various bone markers

RCT study on potassium supplementation

and bone density (2006)

Objective: Neutralization of the acidogenic western diet with K citrate vs.

KCl in osteopene women

Jehle et al., J Am Soc Nephrol (2006)

10 © G. Gerstner, Food Matters Live 2017

H+

OH-

Decrease of BMD with potassium

in chloride form

Jehle et al., J Am Soc Nephrol (2006)

11 © G. Gerstner, Food Matters Live 2017

Significant increase in BMD via

potassium citrate

12 © G. Gerstner, Food Matters Live 2017

Jehle et al., J Am Soc Nephrol (2006)

Follow-up study with potassium citrate only

(2013)

Main hypothesis

• Neutralization of acidogenic Western diet with oral administration of K citrate increases bone mineral density and bone mass in elderly people (>65y) with normal baseline BMD (201 individuals)

Study design

• Interventional, randomized, double-blind placebo controlled

• All participants received 500mg calcium and 400 IU VitD3

• Potassium citrate tablets with 60meq were ingested vs. placebo over 24 months (equals 6.5g/d K citrate or 117% EU RDA)

Primary endpoints

• Change in areal bone mineral density (aBMD) by dual-energy x-ray (DEXA)

Secondary endpoints

• Changes in volumetric density and microarchitectural parameters by high-resolution peripheral quantitative computed tomography (HR-pQCT)

• Fracture risk assessment by WHO’s FRAX® tool

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Jehle et al., J Clin Endocrinol Metab, 2013

p<0.05 vs. BL&PB

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Significant Increase of Areal BMD (%) at

Total Body

Jehle et al., J Clin Endocrinol Metab, 2013

† and †† = P 0.05 and 0.001 for comparison with baseline (intragroup)

x and xx = P 0.05 and 0.001 for comparison K-citrate vs. placebo (intergroup)

14 © G. Gerstner, Food Matters Live 2017

Significant increase of trabecular bone density

(%) at radius and tibia

Jehle et al., J Clin Endocrinol Metab, 2013

15 © G. Gerstner, Food Matters Live 2017

Review of 14 studies with potassium salts

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Effect n p KHCO3 n p Kcitrate

Urinary calcium excretion ↓ 7 0.04 7 0.01

Net acid excretion ↓ 4 0.002 3 0.0008

Bone resorption marker NTX ↓ 3 0.04 4 <0.00001

Calcium excretion ↓ 3 <0.00001 6 <0.00001

Combined formation markers ↔ 3 0.70 6 0.57

n = number of studies

p = significance level better performance

© G. Gerstner, Food Matters Live 2017

Osteoporos Int 2015

Baby & Toddlers; 33%

Sports Nutrition; 24%

Soft Drinks; 15%

Supplements; 8%

Dairy; 6%

Other Market Category; 14%

(Emerging) science around potassium citrate

Pharma: Risk reduction

• Potassium deficiency

• Latent and chronic acidosis, acid-base balance

• Urinary tract infection

• Kidney and urinary tract stones

• (Osteoporosis, blood pressure, diabetes)

Food: Technological and health benefits

• pH regulation, stabilization, taste improvement

• Sodium reduction

• Potassium fortification

• Electrolyte source

• EU health claims: – Maintenance of normal blood pressure

– Normal muscle function

– Normal functioning of the nervous system

• (Bone health)

17

Food launches

count: 6033

2015-17

© G. Gerstner, Food Matters Live 2017

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Potassium up, sodium down!

Promote alkaline diet for healthier

bones

Chose citrates to mimic health

effects from veggies and

fruits

Consider K citrate as

facilitator for Ca absorption &

retention

Tripotassium citrate – the next

generation nutrient for bone health! Conclusion

© G. Gerstner, Food Matters Live 2017

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