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The Alkaline Diet: Is There Evidence That an Alkaline pH Diet Benefits Health?



This review looks at the role of an alkaline diet in health. Pubmed was searched looking for articles on pH, potential renal acid loads, bone health, muscle, growth hormone, back pain, vitamin D and chemotherapy. Many books written in the lay literature on the alkaline diet were also reviewed and evaluated in light of the published medical literature. There may be some value in considering an alkaline diet in reducing morbidity and mortality from chronic diseases and further studies are warranted in this area of medicine.
Hindawi Publishing Corporation
Journal of Environmental and Public Health
Volume 2012, Article ID 727630, 7pages
Review Article
The Alkaline Diet: Is There Evidence That an Alkaline pH Diet
Benefits Health?
Gerry K. Schwalfenberg
University of Alberta, Suite No. 301, 9509-156 Street, Edmonton, AB, Canada T5P 4J5
Correspondence should be addressed to Gerry K. Schwalfenberg,
Received 3 July 2011; Accepted 8 August 2011
Academic Editor: Janette Hope
Copyright © 2012 Gerry K. Schwalfenberg. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
This review looks at the role of an alkaline diet in health. Pubmed was searched looking for articles on pH, potential renal acid
loads, bone health, muscle, growth hormone, back pain, vitamin D and chemotherapy. Many books written in the lay literature
on the alkaline diet were also reviewed and evaluated in light of the published medical literature. There may be some value in
considering an alkaline diet in reducing morbidity and mortality from chronic diseases and further studies are warranted in this
area of medicine.
1. Background
Life on earth depends on appropriate pH levels in and
around living organisms and cells. Human life requires a
tightly controlled pH level in the serum of about 7.4 (a slight-
ly alkaline range of 7.35 to 7.45) to survive [1].
As a comparison, in the past 100 years with increasing
industrialization, the pH of the ocean has dropped from
8.2 to 8.1 because of increasing CO2deposition. This has a
negative impact on life in the ocean [1,2]andmayleadto
the collapse of the coral reefs [3]. Even the pH of the soil
in which plants are grown can have considerable influence
on the mineral content of the food we eat (as minerals are
used as buers to maintain pH). The ideal pH of soil for
the best overall availability of essential nutrients is between 6
and 7. Acidic soils below pH of 6 may have reduced calcium
and magnesium, and soil above pH 7 may result in chemi-
cally unavailable iron, manganese, copper and zinc. Adding
dolomite and manure are ways of raising pH in an acid soil
environment when the pH is below 6 [4].
When it comes to the pH and net acid load in the
human diet, there has been considerable change from the
hunter gather civilization to the present [5]. With the agricul-
tural revolution (last 10,000 years) and even more recently
with industrialization (last 200 years), there has been an
decrease in potassium (K) compared to sodium (Na) and
an increase in chloride compared to bicarbonate found in
the diet [6]. The ratio of potassium to sodium has reversed,
K/Na pre-viously was 10 to 1 whereas the modern diet has
aratioof1to3[7]. It is generally accepted that agricul-
tural humans today have a diet poor in magnesium and
potassium as well as fiber and rich in saturated fat, simple
sugars, sodium, and chloride as compared to the pre-agri-
cultural period [6]. This results in a diet that may induce
metabolic acidosis which is mismatched to the genetically
determined nutritional requirements [8]. With aging, there
is a gradual loss of renal acid-base regulatory function
and a resultant increase in diet-induced metabolic acidosis
while on the modern diet [9]. A low-carbohydrate high-
pro-tein diet with its increased acid load results in very
little change in blood chemistry, and pH, but results in
many changes in urinary chemistry. Urinary magnesium
levels, urinary citrate and pH are decreased, urinary calcium,
undissociated uric acid, and phosphate are in-creased. All
of these result in an increased risk for kidney stones
Much has been written in the lay literature as well as
many online sites expounding on the benefits of the alkaline
diet. This paper is an attempt to balance the evidence that is
found in the scientific literature.
2 Journal of Environmental and Public Health
Tab le 1: Ph of selected fluids, organs, and membranes.
Organ, fluid or membrane pH Function of pH
(1) Skin Natural pH is between 4 and 6.5 [17] Barrier protection from microbes
(2) Urine 4.6 to 8.0 [18] Limit overgrowth of microbes
(3) Gastric 1.35 to 3.5 Break down protein
(4) Bile 7.6 to 8.8 Neutralize stomach acid, aid in digestion
(5) Pancreatic fluid 8.8 Neutralize stomach acid, aid in digestion
(6) Vaginal fluid <4.7 [13] Limit overgrowth of opportunistic microbes
(7) Cerebrospinal fluid 7.3 Bathes the exterior of the brain
(8) Intracellular fluid 6.0–7.2 [19] Due to acid production in cells
(9) Serum venous 7.35 Tightly regulated
(10) Serum arterial 7.4 Tightly regulated
2. The Role of pH in Various Cells, Organs,
and Membranes
another with the highest acidity in the stomach (pH of 1.35
to 3.5) to aid in digestion and protect against opportunistic
microbial organisms. But even in the stomach, the layer just
outside the epithelium is quite basic to prevent mucosal
injury. It has been suggested that decreased gastric lining
secretion of bicarbonates and a decrease in the alkaline/acid
secretion in duodenal ulcer patients may play a significant
role in duodenal ulcers [11]. The skin is quite acidic (pH
4–6.5) to provide an acid mantle as a protective barrier to
the environment against microbial overgrowth. There is a
gradient from the outer horny layer (pH 4) to the basal layer
(pH 6.9) [12]. This is also seen in the vagina where a pH of
less than 4.7 protects against microbial overgrowth [13].
The urine may have a variable pH from acid to alkaline
depending on the need for balancing the internal environ-
ment. Acid excretion in the urine can be estimated by a
formula described by Remer (sulfate + chloride + 1.8x
phosphate + organic acids) minus (sodium + potassium +
2x calcium + 2x magnesium) mEq [14]. Foods can be cate-
gorized by the potential renal acid loads (PRALs) see Table 2.
Fruits, vegetables, fruit juices, potatoes, and alkali-rich and
low phosphorus beverages (red and white wine, mineral soda
waters) having a negative acid load. Whereas, grain products,
meats, dairy products, fish, and alkali poor and low phos-
phorus beverages (e.g., pale beers, cocoa) have relatively high
acid loads [15]. Measurement of pH of the urine (reviewed
in a recent study with two morning specimens done over a
five-year span) did not predict bone fractures or loss of bone
mineral density [16]. However, this may not be reflective of
being on an alkaline or acid diet throughout this time. For
more details, see Table 1.
3. Chronic Acidosis and Bone Disease
Calcium in the form of phosphates and carbonates represents
a large reservoir of base in our body. In response to an acid
load such as the modern diet these salts are released into
the systemic circulation to bring about pH homeostasis [7].
It has been estimated that the quantity of calcium lost in
the urine with the modern diet over time could be as high
as almost 480 gm over 20 years or almost half the skeletal
mass of calcium [21]. However, urinary losses of cal-cium
are not a direct measure of osteoporosis. There are many
regulatory factors that may compensate for the urinary calci-
um loss. When the arterial pH is in the normal range, a
mild reduction of plasma bicarbonate results in a negative
calcium balance which could benefit from supplementing
bicarbonate in the form of potassium bicarbonate [22]. It
has been found that bicarbonate, which increases the alkali
content of a diet, but not potassium may attenuate bone
loss in healthy older adults [23]. The bone minerals that are
wasted in the urine may not have complete compensation
through intestinal absorption, which is thought to result in
osteoporosis. However, adequate vitamin D with a 25(OH)D
level of >80 nmol/L may allow for appropriate intestinal
absorption of calcium and magnesium and phosphate when
needed [24]. Sadly, most populations are generally deficient
in vitamin D especially in northern climates [25]. In
chronic renal failure, correction of metabolic acidosis with
bicarbonate significantly improves parathyroid levels and
levels of the active form of vitamin D 1,25(OH)2D3[26].
Recently, a study has shown the importance of phosphate
in Remer’s PRAL formula. According to the formula it
would be expected that an increase in phosphate should
result in an increase in urinary calcium loss and a negative
calcium balance in bone [27]. It should be noted that
supplementation with phosphate in patients with bed rest
reduced urinary calcium excretion but did not prevent bone
loss [28]. The most recent systematic review and meta-
analysis has shown that calcium balance is maintained and
improved with phosphate which is quite contrary to the
acid-ash hypothesis [29]. As well a recent study looking at
soda intake (which has a significant amount of phosphate)
and osteoporosis in postmenopausal American first nations
women did not find a correlation [30]. It is quite possible
that the high acid content according to Remer’s classification
needs to be looked at again in light of compensatory phos-
phate intake. There is online information promoting an alka-
line diet for bone health as well as a number of books. How-
ever, a recent systematic review of the literature looking for
evidence supporting the alkaline diet for bone health found
no protective role of dietary acid load in osteoporosis [31].
Journal of Environmental and Public Health 3
Tab le 2: Potential renal acid loads (PRALs) of selected foods [20].
Food or food group PRAL mEq of: Cl + P04+SO
4Na KCa Mg
Parmesan cheese 34.2
Processed cheese plain 28.7
Cheddar reduced fat 26.4
Hard cheese (average) 19.2
Fresh cheese (quark) 11.3
Cottage cheese plain 8.7
Yogurt whole milk 1.5
Ice Cream 0.8
Whole milk 0.7
Buttermilk 0.5
Eggs yolk 23.4
Eggs white 1.1
Eggs chicken whole 8.2
Corned beef 13.2
Luncheon meat canned 10.2
Turkey 9.9
Veal 9.0
Lean beef 7.8
Frankfurters 6.7
Sugar white 0.1
Honey 0.3
Vege t ab l es
Cucumber 0.8
Broccoli 1.2
Toma t o 3.1
Eggplant 3.4
Celery 5.2
Spinach 14.0
Fats and Oils
Butter 0.6
Margarine 0.5
Olive oil 0.0
Fruits and nuts and fruit juices
Peanuts 8.3
Walnut s 6.8
Grape juice unsweetened 1.0
Orange juice unsweetened 2.9
Apples or apple juice unsweetened 2.2
Apricots 4.8
Banana 5.5
Black currents 6.5
Raisins 21.0
Grains and grain products
Brown Rice 12.5
Rolled Oats 10.7
Spaghetti whole meal 7.3
Spaghetti white 6.5
4 Journal of Environmental and Public Health
Tab le 2: Continued.
Food or food group PRAL mEq of: Cl + P04+SO
4Na KCa Mg
Cornflakes 6.0
Rice white 4.6
Bread rye flower 4.1
Bread whole wheat 1.8
Lentils green and brown 3.5
Green beans 3.1
Trou t br ow n 10.8
Cod fillets 7.1
Beer pale 0.9
Coca-Cola 0.4
Beer draft 0.2
Wine white 1.2
Coee infusion 1.4
Wine red 2.4
Another element of the modern diet is the excess of sodi-
um in the diet. There is evidence that in healthy humans the
increased sodium in the diet can predict the degree of hyper-
chloremic metabolic acidosis when consuming a net acid
producing diet [32]. As well, there is evidence that there are
adverse eects of sodium chloride in the aging population.
A high sodium diet will exacerbate disuse-induced bone
and muscle loss during immobilization by increasing bone
resorption and protein wasting [33]. Excess dietary sodium
has been shown to result in hypertension and osteoporosis in
women [34,35]. As well, dietary potassium which is lacking
in the modern diet would modulate pressor and hyper-
calciuric eects of excess of sodium chloride [36].
Excess dietary protein with high acid renal load may
decrease bone density if not buered by ingestion of supple-
ments or foods that are alkali rich [37]. However, adequate
protein is necessary for prevention of osteoporosis and
sarcopenia; therefore, increasing the amount of fruit and veg-
etables may be necessary rather than reducing protein [38].
4. Alkaline Diets and Muscle
As we age, there is a loss of muscle mass, which may predis-
pose to falls and fractures. A three-year study looking at a
diet rich in potassium, such as fruits and vegetables, as well
as a reduced acid load, resulted in preservation of muscle
mass in older men and women [39]. Conditions such as
chronic renal failure that result in chronic metabolic acidosis
result in accelerated breakdown in skeletal muscle [40].
Correction of acidosis may preserve muscle mass in condi-
tions where muscle wasting is common such as diabetic
ketosis, trauma, sepsis, chronic obstructive lung disease, and
renal failure [41]. In situations that result in acute acidosis,
supplementing younger patients with sodium bicarbonate
prior to exhaustive exercise resulted in significantly less
acidosis in the blood than those that were not supplemented
with sodium bicarbonate [42].
5. Alkaline Supplementation and
Growth Hormone
It has long been known that severe forms of metabolic
acidosis in children, such as renal tubular acidosis, are as-
sociated with low levels of growth hormone with resultant
short stature. Correction of the acidosis with bicarbonate
[7] or potassium citrate [43] increases growth hormone sig-
nificantly and improved growth. The use of enough pota-
ssium bicarbonate in the diet to neutralize the daily net
acid load in postmenopausal women resulted in a significant
increase in growth hormone and resultant osteocalcin [44].
life, reduce cardiovascular risk factors, improve body com-
position, and even improve memory and cognition [45]. As
well this results in a reduction of urinary calcium loss equi-
valent to 5% of bone calcium content over a period of 3 years
6. Alkaline Diet and Back Pain
There is some evidence that chronic low back pain improves
with the supplementation of alkaline minerals [47]. With
supplementation there was a slight but significant increase in
blood pH and intracellular magnesium. Ensuring that there
is enough intracellular magnesium allows for the proper
function of enzyme systems and also allows for activation of
vitamin D [48]. This in turn has been shown to improve back
pain [49].
Journal of Environmental and Public Health 5
7. Alkalinity and Chemotherapy
The eectiveness of chemotherapeutic agents is markedly
influenced by pH. Numerous agents such as epirubicin and
adriamycin require an alkaline media to be more eective.
Others, such as cisplatin, mitomycin C, and thiotepa, are
more cytotoxic in an acid media [50]. Cell death correlates
with acidosis and intracellular pH shifts higher (more alka-
line) after chemotherapy may reflect response to chemother-
apy [51]. It has been suggested that inducing metabolic alka-
losis may be useful in enhancing some treatment regimes by
using sodium bicarbonate, carbicab, and furosemide [52].
Extracellular alkalinization by using bicarbonate may result
in improvements in therapeutic eectiveness [53]. There is
no scientific literature establishing the benefit of an alkaline
diet for the prevention of cancer at this time.
8. Discussion
The human body has an amazing ability to maintain a steady
pH in the blood with the main compensatory mechanisms
being renal and respiratory. Many of the membranes in our
body require an acid pH to protect us and to help us digest
food. It has been suggested that an alkaline diet may prevent
a number of diseases and result in significant health benefits.
Looking at the above discussion on bone health alone, certain
aspects have doubtful benefit. There does not seem to be
enough evidence that milk or cheese may be as detrimental as
Remer’s formula suggests since phosphate does benefit bone
health and result in a positive calcium balance. However,
another mechanism for the alkaline diet to benefit bone
health may be the increase in growth hormone and resultant
increase in osteocalcin. There is some evidence that the K/Na
ratio does matter and that the significant amount of salt in
our diet is detrimental. Even some governments are demand-
ing that the food industry reduce the salt load in our diet.
High-protein diets may also aect bone health but some pro-
tein is also needed for good bone health. Muscle wasting
however seems to be reduced with an alkaline diet and back
pain may benefit from this as well. An alkaline environment
may improve the ecacy of some chemotherapy agents but
not others.
9. Conclusion
Alkaline diets result in a more alkaline urine pH and may
result in reduced calcium in the urine, however, as seen
in some recent reports, this may not reflect total calcium
balance because of other buers such as phosphate. There
is no substantial evidence that this improves bone health or
protects from osteoporosis. However, alkaline diets may re-
sult in a number of health benefits as outlined below
(1) Increased fruits and vegetables in an alkaline diet
would improve the K/Na ratio and may benefit bone
health, reduce muscle wasting, as well as mitigate
other chronic diseases such as hypertension and
(2) The resultant increase in growth hormone with an
alkaline diet may improve many outcomes from car-
diovascular health to memory and cognition.
(3) An increase in intracellular magnesium, which is re-
quired for the function of many enzyme systems, is
another added benefit of the alkaline diet. Available
magnesium, which is required to activate vitamin
D, would result in numerous added benefits in the
vitamin D apocrine/exocrine systems.
(4) Alkalinity may result in added benefit for some
chemotherapeutic agents that require a higher pH.
From the evidence outlined above, it would be prudent to
consider an alkaline diet to reduce morbidity and mortality
of chronic disease that are plaguing our aging population.
One of the first considerations in an alkaline diet, which in-
cludes more fruits and vegetables, is to know what type of
soil they were grown in since this may significantly influence
the mineral content. At this time, there are limited scientific
studies in this area, and many more studies are indicated in
regards to muscle eects, growth hormone, and interaction
with vitamin D.
[1] A. Waugh and A. Grant, Anatomy and Physiology in Healthand
Illness, Churchill Livingstone Elsevier, Philadelphia, Pa, USA,
10th edition, 2007.
[2] University, Birmingham oAa, “Oceans reveal further impacts
of climate change,” ScienceDaily, 2010.
[3] O. Hoegh-Guldberg, P. J. Mumby, A. J. Hooten et al., “Coral
reefs under rapid climate change and ocean acidification,
Science, vol. 318, no. 5857, pp. 1737–1742, 2007.
[4] J. Dam-ampai SO and C. Nilnond, “Eect of cattle manure
and dolomite on soil properties and plant growth in acid up-
land soils,Songklanakarin Journal of Science and Technologh,
vol. 27, supplement 3, pp. 727–737, 2005.
[5] A. Str¨
ohle, A. Hahn, and A. Sebastian, “Estimation of the
diet-dependent net acid load in 229 worldwide historically
studied hunter-gatherer societies,American Journal of Clinical
Nutrition, vol. 91, no. 2, pp. 406–412, 2010.
[6] A. Sebastian, L. A. Frassetto, D. E. Sellmeyer, R. L. Merriam,
and R. C. Morris Jr., “Estimation of the net acid load of the diet
of ancestral preagricultural Homo sapiens and their hominid
ancestors,American Journal of Clinical Nutrition, vol. 76, no.
6, pp. 1308–1316, 2002.
[7] L. Frassetto, R. C. Morris, Jr. R.C. Jr., D. E. Sellmeyer, K.
Todd, and A. Sebastian, “Diet, evolution and aging—the
pathophysiologic eects of the post-agricultural inversion of
the potassium-to-sodium and base-to-chloride ratios in the
human diet,European Journal of Nutrition,vol.40,no.5,pp.
200–213, 2001.
[8] M. Konner and S. Boyd Eaton, “Paleolithic nutrition: twenty-
five years later,Nutrition in Clinical Practice, vol. 25, no. 6, pp.
594–602, 2010.
[9] R. D. Lindeman and R. Goldman, “Anatomic and physiologic
age changes in the kidney,Experimental Gerontology, vol. 21,
no. 4-5, pp. 379–406, 1986.
[10] S. T. Reddy, C. Y. Wang, K. Sakhaee, L. Brinkley, and C. Y. Pak,
“Eect of low-carbohydrate high-protein diets on acid-base
balance, stone-forming propensity, and calcium metabolism,
6 Journal of Environmental and Public Health
American Journal of Kidney Diseases, vol. 40, no. 2, pp. 265–
274, 2002.
[11] Y. S. Malov and A. N. Kulikov, “Bicarbonate deficiency and
duodenal ulcer,Terapevticheskii Arkhiv, vol. 70, no. 2, pp. 28–
32, 1998.
[12] H. Ohman and A. Vahlquist, “In vivo studies concerning a pH
gradient in human stratum corneum and upper epidermis,
Acta Dermato-Venereologica, vol. 74, no. 5, pp. 375–379, 1994.
[13] D. G. Ferris, S. L. Francis, E. D. Dickman, K. Miler-Miles, J. L.
Waller, and N. McClendon, “Variability of vaginal pH deter-
mination by patients and clinicians,Journal of the American
Board of Family Medicine, vol. 19, no. 4, pp. 368–373, 2006.
[14] T. Remer and F. Manz, “Estimation of the renal net acid
excretion by adults consuming diets containing variable
amounts of protein,American Journal of Clinical Nutrition,
vol. 59, no. 6, pp. 1356–1361, 1994.
[15] T. Remer, “Influence of diet on acid-base balance,Seminars in
Dialysis, vol. 13, no. 4, pp. 221–226, 2000.
[16] T. R. Fenton, M. Eliasziw, S. C. Tough, A. W. Lyon, J. P. Brown,
and D. A. Hanley, “Low urine pH and acid excretion do not
predict bone fractures or the loss of bone mineral density: a
prospective cohort study,BMC Musculoskeletal Disorders, vol.
11, article 88, 2010.
[17] E. Boelsma, L. P. L. van de Vijver, R. A. Goldbohm, I. A.
A. Kl¨
opping-Ketelaars, H. F. J. Hendriks, and L. Roza, “Hu-
man skin condition and its associations with nutrient concen-
trations in serum and diet,American Journal of Clinical Nutri-
tion, vol. 77, no. 2, pp. 348–355, 2003.
[18] B. A. Ince, E. J. Anderson, and R. M. Neer, “Lowering dietary
protein to U.S. recommended dietary allowance levels reduces
urinary calcium excretion and bone resorption in young
women,Journal of Clinical Endocrinology and Metabolism,
vol. 89, no. 8, pp. 3801–3807, 2004.
[19] W. F. Boron, “Regulation of intracellular pH,Advances in
Physiology Education, vol. 28, pp. 160–179, 2004.
[20] T. Remer and F. Manz, “Potential renal acid load of foods and
its influence on urine pH,Journal of the American Dietetic
Association, vol. 95, no. 7, pp. 791–797, 1995.
A. Hanley, “Meta-analysis of the quantity of calcium excretion
associated with the net acid excretion of the modern diet
under the acid-ash diet hypothesis, American Journal of
Clinical Nutrition, vol. 88, no. 4, pp. 1159–1166, 2008.
[22] A. Sebastian and R. C. Morris Jr., “Improved mineral
balance and skeletal metabolism in postmenopausal women
treated with potassium bicarbonate,New England Journal of
Medicine, vol. 331, no. 4, p. 279, 1994.
[23] B. Dawson-Hughes, S. S. Harris, N. J. Palermo, C. Castaneda-
potassium bicarbonate lowers calcium excretion and bone
resorption in older men and women,Journal of Clinical
Endocrinology and Metabolism, vol. 94, no. 1, pp. 96–102, 2009.
[24] R. P. Heaney, M. S. Dowell, C. A. Hale, and A. Bendich,
“Calcium absorption varies within the reference range for
serum 25-hydroxyvitamin D,” Journal of the American College
of Nutrition, vol. 22, no. 2, pp. 142–146, 2003.
[25] G. K. Schwalfenberg, S. J. Genuis, and M. N. Hiltz, “Addressing
vitamin D deficiency in Canada: a public health innovation
whosetimehascome,Public Health, vol. 124, no. 6, pp. 350–
359, 2010.
[26] K. C. Lu, S. H. Lin, F. C. Yu, S. H. Chyr, and S. D. Shieh, “Influ-
ence of metabolic acidosis on serum 1,25(OH)2D3 levels in
chronic renal failure,Mineral and Electrolyte Metabolism, vol.
21, no. 6, pp. 398–402, 1995.
[27] T. R. Fenton, A. W. Lyon, M. Eliasziw, S. C. Tough, and D.
A. Hanley, “Phosphate decreases urine calcium and increases
calcium balance: a meta-analysis of the osteoporosis acid-ash
diet hypothesis,Nutrition Journal, vol. 8, article 41, 2009.
[28] S.B.Hulley,J.M.Vogel,C.L.Donaldson,J.H.Bayers,R.J.
Friedman, and S. N. Rosen, “The eect of supplemental oral
phosphate on the bone mineral changes during prolonged bed
rest,” Journal of Clinical Investigation, vol. 50, no. 12, pp. 2506–
2518, 1971.
[29] T. R. Fenton, A. W. Lyon, M. Eliasziw, S. C. Tough, and D. A.
Hanley, “Meta-analysis of the eect of the acid-ash hypothesis
of osteoporosis on calcium balance,Journal of Bone and
Mineral Research, vol. 24, no. 11, pp. 1835–1840, 2009.
[30] J. D. Supplee, G. E. Duncan, B. Bruemmer, J. Goldberg, Y.
Wen, and J. A. Henderson, “Soda intake and osteoporosis risk
in postmenopausal American-Indian women,Public Health
Nutrition, pp. 1–7, 2011.
A. Hanley, “Causal assessment of dietary acid load and bone
disease: a systematic review & meta-analysis applying Hill’s
epidemiologic criteria for causality,Nutrition Journal, vol. 10,
no. 1, article 41, 2011.
[32] L. A. Frassetto, R. C. Morris Jr., and A. Sebastian, “Dietary
sodium chloride intake independently predicts the degree of
hyperchloremic metabolic acidosis in healthy humans con-
suming a net acid-producing diet,American Journal of Physi-
ology—Renal Physiology, vol. 293, no. 2, pp. F521–F525, 2007.
[33] P. Frings-Meuthen, J. Buehlmeier, N. Baecker et al., “High sod-
ium chloride intake exacerbates immobilization-induced bone
resorption and protein losses,Journal of Applied Physiology,
vol. 111, no. 2, pp. 537–542, 2011.
[34] F. P. Cappuccio, E. Meilahn, J. M. Zmuda, and J. A. Cauley,
“High blood pressure and bone-mineral loss in elderly white
women: a prospective study,” Lancet, vol. 354, no. 9183, pp.
971–975, 1999.
[35] A. Devine, R. A. Criddle, I. M. Dick, D. A. Kerr, and R. L.
Prince, “A longitudinal study of the eect of sodium and cal-
cium intakes on regional bone density in postmenopausal
women,American Journal of Clinical Nutrition, vol. 62, no.
4, pp. 740–745, 1995.
[36] R. C. Morris Jr., O. Schmidlin, L. A. Frassetto, and A. Seba-
stian, “Relationship and interaction between sodium and
potassium,Journal of the American College of Nutrition, vol.
25, no. 3, pp. 262S–270S, 2006.
[37] U. S. Barzel and L. K. Massey, “Excess dietary protein may can
adversely aect bone,Journal of Nutrition, vol. 128, no. 6, pp.
1051–1053, 1998.
[38] R. P. Heaney and D. K. Layman, “Amount and type of pro-tein
influences bone health,American Journal of Clinical Nutri-
tion, vol. 87, no. 5, pp. 156S–157S, 2008.
[39] B. Dawson-Hughes, S. S. Harris, and L. Ceglia, “Alkaline diets
favor lean tissue mass in older adults,American Journal of Cli-
nical Nutrition, vol. 87, no. 3, pp. 662–665, 2008.
[40] G. Garibotto, R. Russo, A. Sofia et al., “Muscle protein turn-
over in chronic renal failure patients with metabolic acidosis
or normal acid-base balance,Mineral and Electrolyte Meta-
bolism, vol. 22, no. 1–3, pp. 58–61, 1996.
[41] G. Caso and P. J. Garlick, “Control of muscle protein kinetics
by acid-base balance,Current Opinion in Clinical Nutrition
and Metabolic Care, vol. 8, no. 1, pp. 73–76, 2005.
[42] M. J. Webster, M. N. Webster, R. E. Crawford, and L. B. Glad-
den, “Eect of sodium bicarbonate ingestion on exhaustive re-
sistance exercise performance,Medicine and Science in Sports
and Exercise, vol. 25, no. 8, pp. 960–965, 1993.
Journal of Environmental and Public Health 7
[43] E. McSherry and R. C. Morris Jr., “Attainment and mainte-
nance of normal stature with alkali therapy in infants and
children with classic renal tubular acidosis,Journal of Clinical
Investigation, vol. 61, no. 2, pp. 509–527, 1978.
[44] L. Frassetto, R. C. Morris Jr., and A. Sebastian, “Potassium
bicarbonate reduces urinary nitrogen excretion in post-
menopausal women,Journal of Clinical Endocrinology and
Metabolism, vol. 82, no. 1, pp. 254–259, 1997.
[45] J. A. H. Wass and R. Reddy, “Growth hormone and memory,
Journal of Endocrinology, vol. 207, no. 2, pp. 125–126, 2010.
[46] L. Frassetto, R. C. Morris Jr., and A. Sebastian, “Long-term
persistence of the urine calcium-lowering eect of potassium
bicarbonate in postmenopausal women,Journal of Clinical
Endocrinology and Metabolism, vol. 90, no. 2, pp. 831–834,
[47] J. Vormann, M. Worlitschek, T. Goedecke, and B. Silver, “Sup-
plementation with alkaline minerals reduces symptoms in
patients with chronic low back pain,Journal of Trace Elements
in Medicine and Biology, vol. 15, no. 2-3, pp. 179–183, 2001.
[48] I. Zofkov´
a and R. L. Kancheva, “The relationship between
magnesium and calciotropic hormones,Magnesium Research,
vol. 8, no. 1, pp. 77–84, 1995.
[49] G. Schwalfenberg, “Improvement of chronic back pain or
failed back surgery with vitamin D repletion: a case series,”
Journal of the American Board of Family Medicine, vol. 22, no.
1, pp. 69–74, 2009.
[50] E. Groos, L. Walker, and J. R. Masters, “Intravesical chemo-
therapy. Studies on the relationship between pH and cytotox-
icity,Cancer, vol. 58, no. 6, pp. 1199–1203, 1986.
[51] S. R. Smith, P. A. Martin, and R. H. T. Edwards, “Tumour pH
and response to chemotherapy: an in vivo 31P magnetic reson-
ance spectroscopy study in non-Hodgkin’s lymphoma,” British
Journal of Radiology, vol. 64, no. 766, pp. 923–928, 1991.
[52] N. Raghunand and R. J. Gillies, “pH and chemotherapy,
Novartis Foundation Symposium, vol. 240, pp. 199–211, 2001.
[53] N. Raghunand, X. He, R. Van Sluis et al., “Enhancement of
chemotherapy by manipulation of tumour pH,British Jour-
nal of Cancer, vol. 80, no. 7, pp. 1005–1011, 1999.
... The body balance for normal functioning of the human body is solely dependent on the maintenance of continuous pH levels. [4,5] The pH levels are found to be different in various areas of the human body. The consequent alteration of pH levels promotes the activity of opportunistic microbial organisms. ...
... Considering the stomach (normal pH of stomach is 1.35 to 3.5), with the alteration of pH, decreases gastric lining section of bicarbonate and decrease in acid/alkaline secretions promoting the formation of ulcers. [4,6] ...
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One of the most prevalent diseases found in the oral cavity is dental caries. Dental caries, also commonly known as tooth decay is a bacterial process that spreads from the enamel of the tooth towards pulp leading to various periodontal problems causing pain. pH is one of the major factors influencing the formation and progression of dental caries. There is evidence which states that alteration of pH of the interstitial fluid present in the body can significantly affect the tooth mineralization from inside to outside approach, which further accumulates various groups of bacteria causing caries. The early detection of pH interstitial fluid through a device would significantly diagnose the probability of caries progression and the necessary treatment procedure to be applied to prevent internal damage which makes the tooth weak.
... can easily lodge in joint spaces too and create inflammation and joint disorders [19,4]. 5. Infections-Our body is surrounded by many microbes on the body surfaces and in the environment. Healthy and live body is a bit immune to the infections but the unhealthy and dead body is prone to microbial attack [4,20]. ...
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There are many oral lesions which run a chronic course and always recur despite being treated multiple times by experts. They cause tremendous damage to multiple tissues. Many oral diseases have orofacial manifestations only, while others are associated with multiple serious systemic manifestations. Various researchers across the globe have been struggling to find out permanent solutions through various therapeutic approaches like, ayurveda and holistic etc but internal root causes should be found out which might give us breakthrough quick therapies in near future. We need to explore evidence based various hidden internal /systemic causes to achieve permanent cure of such chronic long-standing diseases. All systems of the body are interconnected and always works in harmony. Oral diseases can never be restricted to orofacial tissues. They are strongly connected to gastro intestinal, ectodermal tissues and all the systems. This article is an attempt to find out same through few hypotheses and connecting oral lesions with other disorders.
... soil mineral health) and increasing carbon dioxide emissions may also have affected nutrient content of some foods (Rosanoff, 2013). Such factors must be taken into account when estimating PRAL from foods (Schwalfenberg, 2012). Whether the PRAL values in their existent form still constitute adequate estimates of the acid-base impact of certain foods is thus at least debatable. ...
Background: In 1995, Remer and Manz reported potential renal acid load (PRAL) values of various foods, quantifying their estimated impact on acid-base balance. Their estimation considered ionic dissociation, sulphur metabolism and intestinal absorption rates for several micronutrients and proteins. Notably, PRAL values are based on food content data from the early 1990s and may nowadays no longer adequately reflect accurate estimates. Some foods' macronutrient and mineral content has declined over the past three decades due to changes in soil mineral health. Aim: We hypothesize that the 1995 PRAL values no longer adequately reflect reliable estimates of the current acid-base impact of some foods. Methods: Based on specific examples, we argue that these values overestimate the alkalizing effects of various fruits and vegetables. Conclusion: Discussing evidence in favour of (and against) our hypothesis, we conclude that the 1995 PRAL estimates should nowadays rather be used as a relative guidance and reviewed carefully.
... Lungs and kidneys have the most important role in sustaining the acid-base balance [10]. A persistent and severe acid-base imbalance cannot be controlled via diet [11,12]. The alkaline salts and chlorophyll contents, though their effect on the human body has not been proven by scientific evidence [13]. ...
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The stomach of animals plays a significant role throughout life. After taking food, the nutrients of those foods maintain all biological processes. The stomach is a reservoir for storing food for several hours. If digestion within the stomach hampers, the entire body will undergo many ailments. Evolutionary changes in the stomach of various animals (herbivores, carnivores, and omnivores) to understand the quality or nature of the stomach based on their food. Based on some articles, oral communication, and an effective questionnaire proved that in a northern region of Bangladesh (Saidpur town under Nilphamari District), out of 60 families, 85% of family members were affected by acidity problems where 37% of college students (17-19 years) due to their excess taking of oily and spicy foods. On the other hand, their regular food intake showed 80% acidic, 7.5% neutral, and 12.5% alkaline food.
... Mathematically, pH is referred to as pH = -log [H+]. In this case, the normal pH range of human life requires a pH level of about 6.0-8.5, which is the acceptable value for consumption [4], [22]. In this study, the pH sensor was calibrated with a pH meter (Mettler Toledo S210). ...
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Water quality is one of the most important variables impacting human life. Generally, water quality measurements must be conducted onsite. If the region to be investigated is large, several test locations will be required. Repeated evaluations of water quality will be complicated and time-consuming. Therefore, a real-time water quality monitoring system is required to protect and monitor the water in order to take proactive measures for contamination. This project focuses on the aforementioned concerns and uses LoRa technology and the Node-RED application to develop environmental sensors that monitor and display water quality. It is the measurement and collection of data on water quality parameters, including temperature, electric conductivity, pH, air quality, and turbidity, according to the region requiring analysis. The microcontroller processes the sensor data before transmitting it via the wireless network to the database, where it is displayed on the Node-RED dashboard. The experimental results demonstrated that a range of 2.0 km can be used to transmit information in areas where LoRa technology encounters obstacles. Furthermore, the IoT-based monitoring system is able to monitor water quality in real time and display a Node-RED dashboard. It was determined that usability assessments were more efficient and convenient.
... Plants rich in magnesium and potassium can neutralize acid because they increase and maintain the alkalinity in the gastric lumen [36,37], which protects the mucosal layer of the stomach lining. Malaysian plants are rich in phenolic compounds that regulate H + -K + -ATPase and proton pump enzymes [38,39]. ...
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Medicinal plants have been widely studied to identify plant-based anti-gastric ulcer medicines. The mechanism of gastroprotective action is important to discover the potential lead compounds for drug development. All relevant articles between 2011 and 2021 focusing on Malaysian plants were collected and analyzed to understand the underlying pathways. Keywords include peptic ulcer, gastric ulcer, NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), Helicobacterpylori, medicinal plant, gastroprotection, antiulcer, acid secretion, cytoprotective, and digestion processes were applied in the search engines. Twenty-two of the plants had been reported based on the collected data. The review concludes that Malaysian plants could protect the gastric wall against necrotizing agents like ethanol and NSAIDs. This is mainly due to four critical defensive mechanisms: cytoprotective barriers, regulation of heat-shock protein 70 (HSP70) and pro-apoptotic protein (BAX), gastric acid secretion, and antioxidant capability. The mechanisms have been illustrated in the schematic diagrams for better understanding.
... A balanced pH keeps our systems operating the way they should [167]. Human life requires tightly controlled pH level to survive [168]. ...
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Medical science often uses reference ranges of various parameters to decide whether the levels in a person are derailed and need an intervention to put them back on track. Not many efforts are made to find the parameters and their optimal levels that protect our health and prevent the occurrence of various ailments – thus helping us remain healthy even under adverse conditions. This is generally termed positive health. We present a preliminary framework for its objective assessment through medical parameters that can operationalize this concept for personalized care. The positive health of a person can be defined as the ability to live long in good health with no activity limitation. No method is yet available for its objective assessment of individuals. We do not consider distal factors such as diet and lifestyle for its assessment because they are subjective and, instead, concentrate on the objectively measurable proximal parameters such as immunity level, balanced hormones, physiological functions, and the level of biochemical parameters. The focus is on the major parameters that are assets for maintaining health and protection from diseases, and on those that can be assessed by the available non-invasive methods. An optimal combination of such parameters may signify positive health that helps in living longer in good health and in warding off ailments if they strike. For this conceptual framework, we extensively reviewed the literature for the physiological role of hundreds of measurable parameters and identify a total of nearly 50 major items that largely work as a protective shield and could determine the status of positive health at the individual level. We divide them into five domains for easy assessment. This preliminary exercise shows that it is feasible to assess the positive health of a person at any point in time. A scale based on these and other relevant parameters can be developed later that could quantitatively measure the exact level of positive health of a person. Because of epistemic gaps regarding the protective parameters, a framework such as this may initiate a discussion on biomarkers of positive health and characterize the parameters for intervention that could increase the healthy life.
... Similarly, the pH value of body fluid is closely related to homeostasis [17,18]. The pH in sweat is also a key factor for exercise monitoring that is closely related to electrolyte concentration. ...
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Traditional exercise training monitoring is based on invasive blood testing methods. As sweat can reveal abundant blood-related physiological information about health, wearable sweat sensors have received significant research attention and become increasingly popular in the field of exercise training monitoring. However, most of these sensors are used to measure physical indicators such as heart rate, blood pressure, respiration, etc., demanding a versatile sensor that can detect relevant biochemical indicators in body fluids. In this work, we proposed a wearable microfluidic sweat chip combined with smartphone image processing to realize non-invasive in situ analysis of epidermal sweat for sports practitioners. The polydimethylsiloxane (PDMS) based chip was modified with nonionic surfactants to ensure good hydrophilicity for the automatic collection of sweat. Besides, a simple, reliable, and low-cost paper-based sensor was prepared for high-performance sensing of glucose concentration and pH in sweat. Under optimized conditions, this proposed chip can detect glucose with low concentrations from 0.05 mM to 0.40 mM, with a pH range of 4.0 to 6.5 for human sweat. The ability of this microfluidic chip for human sweat analysis was demonstrated by dynamically tracking the changes in glucose concentration and pH in long-distance running subjects.
The most recent COVID-19 pandemic challenged the world in many respects. Having started as a global health crisis, the pandemic soon threatened the economy and societies, leading to many unpleasant side effects and even affecting democracies and human rights standards. Against this backdrop, global governance by the WHO will be examined, as well as leadership at European and national levels. The Austrian case is analyzed in more detail, also in relation to Switzerland and the Nordic countries. Critical studies from OECD and others reveal huge shortcomings at WHO level with respect to strategic pandemic prevention and preparedness. The European Union falls short of seizing the opportunity to show leadership in global health guidance with a focus on effective prevention strategies and the protection of democracy and human rights. In Austria, the most recent report of the Court of Auditors detected major failures in the government’s strategic prevention and crisis management. Public health standards are investigated as well as consequences of pandemic management on human rights, respect for democracy and debate, freedom of citizens, and inclusiveness in decision-making processes. It seems as if the pandemic has relegated us backward toward growth of disparities and loss of democratic governance. More and more studies question the worldwide vaccination exercise to combat the COVID-19 pandemic, claiming that mass vaccination especially with mRNA vaccines could even impair human immune systems and thus the survival of the human race. In this respect, recommendations suggest an enhanced WHO global health governance system with a stronger focus on prevention, more cautious future policy decisions applying the precautionary principle, increased focus on the proportionality of measures, upgrading public health and nutrition standards, amongst others with alkaline or organic nutrition and healthier lifestyles, as well as exploring less controversial or harmful medical alternatives such as ozone therapy.
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We examined, in immobilization, the effect of a diet high in sodium chloride (NaCl) on bone markers, nitrogen balance, and acid-base status. Eight healthy male test subjects participated in a 14-day head-down-tilt bed rest (HDBR) study. During the bed rest period they received, in a randomized crossover design, a high (7.7 meq Na(+)/kg body wt per day) and a low (0.7 meq Na(+)/kg body wt per day) NaCl diet. As expected, 24-h excretion of urinary calcium was significantly greater in the high-NaCl-intake HDBR phase than in the low-NaCl-intake HDBR phase (P < 0.001). High NaCl intake caused a 43-50% greater excretion of the bone resorption markers COOH- (CTX) and NH(2)- (NTX) terminal telopeptide of type I collagen in HDBR than low NaCl in HDBR (CTX/NTX: P < 0.001). Serum concentrations of the bone formation markers bone-specific alkaline phosphatase (bAP) and NH(2)-terminal propeptide of type I procollagen (PINP) were identical in both NaCl intake phases. High NaCl intake led to a more negative nitrogen balance in HDBR (P < 0.001). Changes were accompanied by increased serum chloride concentration (P = 0.008), reduced blood bicarbonate (P = 0.017), and base excess (P = 0.009) whereas net acid excretion was lower during high than during low NaCl intake in immobilization (P < 0.001). High NaCl intake during immobilization exacerbates disuse-induced bone and muscle loss by causing further protein wasting and an increase in bone resorption. Changes in the acid-base status, mainly caused by disturbances in electrolyte metabolism, seem to determine NaCl-induced degradation processes.
Diets that restrict carbohydrate intake but allow unlimited fat and protein, such as the Atkins' diet, are much in vogue today. Whether a low-carbohydrate, high-protein (LCHP) diet increases the risk of bone loss or kidney stone formation was the question asked in this study of 10 healthy individuals ranging in age from 21 to 52 years. Initially they took their usual diet for 2 weeks and then an Atkins'-type induction diet (with severely restricted carbohydrate) for 2 weeks. An Atkins' maintenance diet then was consumed for 4 weeks in the maintenance phase. In the last week, the participants ate constant metabolic meals. Both the induction and maintenance LCHP diets contained nearly twice as much protein and fat as the subjects' usual diets but significantly less carbohydrate. Intakes of calcium, potassium, magnesium, sodium, and chloride did not differ significantly. Both weight loss and increased blood urea nitrogen levels attested to compliance with the diet. None of the 10 dieters developed clinically apparent metabolic acidosis. Serum sodium levels dropped slightly, but there were no changes in levels of potassium, chloride, calcium, or phosphorus. Urinary pH and citrate fell significantly with the induction and maintenance diets. Urinary ammonium, titratable acidity, and net acid excretion rose nearly 2-fold, as did urinary sulfate levels. Urinary calcium and phosphorus levels increased by about 2.25 mmol and 12.5 mmol/day, respectively, during the LCHP diet periods. Urinary magnesium decreased, but uric acid, oxalate, sodium, and potassium excretion did not change measurably levels measured during the baseline diet. The urinary content of undissociated uric acid doubled. Calcium balance decreased during both LCHP diets. Serum alkaline phosphatase decreased, but the bone-specific fraction did not change. Serum osteocalcin was significantly lower when subjects were on the LCHP diets. Urinary levels of deoxypyridinoline and N-telopeptide tended to increase, but not to a significant degree, and serum levels of calcitriol and parathyroid hormone did not change significantly. Endogenous creatinine clearance rose significantly during both LCH diets. This short-term study suggests that intake of a LCHP weight reduction diet, through delivering an exaggerated acid load, may heighten the risk of both kidney stone formation and bone loss. This possibility should be evaluated in a long-term prospective trial.
In vivo pH measurements by magnetic resonance spectroscopy reveal the presence of large regions of acidic extracellular pH in tumours, with the intracellular pH being maintained in the neutral-to-alkaline range. This acid-outside plasmalemmal pH gradient acts to exclude weak base drugs such as the anthracyclines and vinca alkaloids, a behaviour that is predicted by the decrease in octanol-water partition coefficients of mitoxantrone and doxorubicin with decreasing solution pH. This pH gradient can be reduced or eliminated in mouse models of breast cancer by systemic treatment with sodium bicarbonate. We have demonstrated tumour alkalinization following chronic ad libitum administration of NaHCO3 and acute intraperitoneal administration of NaHCO3 to tumour-bearing mice. Chronic treatment of tumour-bearing SCID mice with NaHCO3 results in an enhancement in MCF-7 tumour xenograft response to doxorubicin. Intraperitoneal administration of NaHCO3 to tumour-bearing C3H/Hen mice prior to treatment with mitoxantrone results in a greater-than 4.5-fold increase in cell-kill in the syngeneic C3H mammary tumour model. Most combination chemotherapy regimens include at least one weak base drug. Our results suggest that agents such as sodium bicarbonate, Carbicarb® and the diuretic furosemide—which are known to induce metabolic alkalosis in humans—may be useful in enhancing the efficacy of these treatment regimens in humans.
Background. High blood pressure is associated with abnormalities in calcium metabolism. Sustained calcium loss may lead to increased bone-mineral loss in people with high blood pressure. We investigated the prospective association between blood pressure and bone-mineral loss over time in eldery white women. Methods. We studied 3676 women who were initially assessed in 1988-90 (mean age 73 years [SD 4, range 66-91 years]; mean bodyweight 65.3 kg [11.5]; blood pressure 137/75 mm Hg [17/9]) who were not on thiazide diuretics. Mean follow-up was 3.5 years. Anthropometry blood pressure, and bone-mineral density at the femoral neck were measured at baseline and bone densitometry was repeated after 3.5 years by dual-energy X-ray absorptiometry. Findings. After adjustment for age, initial bone-mineral density, weight and weight change, smoking, and regular use of hormone-replacement therapy, the rate of bone loss at the femoral neck increased with blood pressure at baseline. In the quartiles of systolic blood pressure, yearly bone losses increased from 2.26 mg/cm2 (95% CI 1.48-3.04) in the first quartile to 3.79 mg/cm2 in the fourth quartile (3.13-4.45; test for heterogeneity, p = 0.03; test for linear trend, p = 0.01), equivalent to yearly changes of 0.34% (0.20-0.46) and 0.59% (0.49-0.69; test for heterogeneity, p = 0.02; test for linear trend, p = 0.005). There was no significant interaction with age. The exclusion of women on antihypertensive drugs did not alter the results. For diastolic blood pressure, there was an association with bone loss in women younger than 75 years. Interpretation. Higher blood pressure in elderly white women is associated with increased bone loss at the femoral neck. This association may reflect greater calcium losses associated with high blood pressure, which may contribute to the risk of hip fractures.
It is well established that diet and certain food components have a clear impact on acid-base balance. For adults, the following factors are involved: 1) the chemical composition of foods (i.e., their content of protein, chloride, phosphorus, sodium, potassium, calcium, and magnesium), 2) the different intestinal absorption rates of the relevant nutrients, 3) the metabolic generation of sulfate from sulfur-containing amino acids, 4) the grade of dissociation of phosphorus at the physiologic pH of 7.4, and 5) the ionic valence of calcium and magnesium. All these factors allow us to estimate the potential renal acid load (PRAL) of any given food or diet. The PRAL (calculated for a 24-hour period), together with a relatively constant daily amount of urinary excreted organic acids (in healthy subjects proportional to body surface area or body weight), yields the daily net acid excretion. This article provides an overview of the current concepts of diet influences on acid-base balance and also focuses on the underlying physiologic and biochemical basis as well as on relevant clinical implications.
Theoretically, we humans should be better adapted physiologically to the diet our ancestors were exposed to during millions of years of hominid evolution than to the diet we have been eating since the agricultural revolution a mere 10,000 years ago, and since industrialization only 200 years ago. Among the many health problems resulting from this mismatch between our genetically determined nutritional requirements and our current diet, some might be a consequence in part of the deficiency of potassium alkali salts (K-base), which are amply present in the plant foods that our ancestors ate in abundance, and the exchange of those salts for sodium chloride (NaCl), which has been incorporated copiously into the contemporary diet, which at the same time is meager in K-base-rich plant foods. Deficiency of K-base in the diet increases the net systemic acid load imposed by the diet. We know that clinically-recognized chronic metabolic acidosis has deleterious effects on the body, including growth retardation in children, decreased muscle and bone mass in adults, and kidney stone formation, and that correction of acidosis can ameliorate those conditions. Is it possible that a lifetime of eating diets that deliver evolutionarily superphysiologic loads of acid to the body contribute to the decrease in bone and muscle mass, and growth hormone secretion, which occur normally with age? That is, are contemporary humans suffering from the consequences of chronic, diet-induced low-grade systemic metabolic acidosis? Our group has shown that contemporary net acid-producing diets do indeed characteristically produce a low-grade systemic metabolic acidosis in otherwise healthy adult subjects, and that the degree of acidosis increases with age, in relation to the normally occurring age-related decline in renal functional capacity. We also found that neutralization of the diet net acid load with dietary supplements of potassium bicarbonate (KHCO3) improved calcium and phosphorus balances, reduced bone resorption rates, improved nitrogen balance, and mitigated the normally occurring age-related decline in growth hormone secretion – all without restricting dietary NaCl. Moreover, we found that co-administration of an alkalinizing salt of potassium (potassium citrate) with NaCl prevented NaCl from increasing urinary calcium excretion and bone resorption, as occurred with NaCl administration alone. Earlier studies estimated dietary acid load from the amount of animal protein in the diet, inasmuch as protein metabolism yields sulfuric acid as an end-product. In cross-cultural epidemiologic studies, Abelow [1] found that hip fracture incidence in older women correlated with animal protein intake, and they suggested a causal relation to the acid load from protein. Those studies did not consider the effect of potential sources of base in the diet. We considered that estimating the net acid load of the diet (i. e., acid minus base) would require considering also the intake of plant foods, many of which are rich sources of K-base, or more precisely base precursors, substances like organic anions that the body metabolizes to bicarbonate. In following up the findings of Abelow et al., we found that plant food intake tended to be protective against hip fracture, and that hip fracture incidence among countries correlated inversely with the ratio of plant-to-animal food intake. These findings were confirmed in a more homogeneous population of white elderly women residents of the U. S. These findings support affirmative answers to the questions we asked above. Can we provide dietary guidelines for controlling dietary net acid loads to minimize or eliminate diet-induced and age-amplified chronic low-grade metabolic acidosis and its pathophysiological sequelae. We discuss the use of algorithms to predict the diet net acid and provide nutritionists and clinicians with relatively simple and reliable methods for determining and controlling the net acid load of the diet. A more difficult question is what level of acidosis is acceptable. We argue that any level of acidosis may be unacceptable from an evolutionarily perspective, and indeed, that a low-grade metabolic alkalosis may be the optimal acid-base state for humans.
The study of alkaline gastric secretion in health and disease and its changes in response to blockers of H2-histamine receptors. The trial enrolled 74 patients with duodenal ulcer (DU), 28 patients with chronic gastric (CG) and 16 healthy controls. The secretion was studied initially, in administration of ranitidine, in stimulation with hydrochloric acid. DU patients demonstrated a significant reduction of gastric secretion of bicarbonates in the basal and stimulated phases and a 3-fold decrease in the proportion alkaline/acid secretion. There was also a trend to acidosis. Administration of H2-histamine receptors provided recovery of acid-alkaline balance. Bicarbonate deficiency is an important element of duodenal ulcer pathogenesis.