Alkalinizing salts in ketogenic diet therapies: a narrative review with clinical recommendations for metabolic health and acid-base balance

The ketogenic diet (KD) is increasingly recognized for its therapeutic benefits in managing metabolic disorders, including obesity, type 2 diabetes, and epilepsy. However, adherence to KD can elevate the body’s acid load through ketone body production, potentially leading to metabolic acidosis. Alkalinizing salts, such as sodium bicarbonate, potassium citrate, magnesium, and calcium, play a crucial role in maintaining acid-base balance and mitigating complications associated with this dietary regimen. Evidence from studies published between 2000 and 2024 highlights that these interventions can reduce acidosis-related complications, including bone demineralization, muscle cramps, and fatigue, while improving mineral balance and metabolic stability. These findings suggest that incorporating alkalinizing strategies may enhance the safety and effectiveness of KDs. Further research is needed to define optimal dosing, assess long-term safety, and develop practical clinical guidelines, particularly for vulnerable populations.