Here's why I changed my perspective on the topic of acid-base balance

The popularity of the idea of influencing body pH (acid-base balance) has periodically risen and fallen over many decades, but its popularity (or lack thereof) is no indication of its validity.

Two-sentence executive summary:

The human body is inherently acid-producing via several high-volume metabolic process including the metabolism of 1) carbohydrates (lactic acid), 2) fats (acetoacetate, beta-hydroxybutyrate), 3) protein (sulfuric acid), and 4) chloride. The resulting endogenous metabolic acidosis needs to be counterbalanced by dietary alkalinization.

The popularity of the idea of influencing body pH (acid-base balance) has periodically risen and fallen over many decades, but its popularity (or lack thereof) is no indication of its validity. Nor can one expect popular medical opinion to be of much value on this topic, when 1) medical doctors receive essentially zero training in Nutrition, and when 2) the medical profession as a whole is constantly denigrating and confusing the topic of diet, Nutrition, and nutritional supplementation. If we want clarity, we have to look at the real science—not at popular opinion, not at medical dogma. The real science on this topic has become increasingly clear over the past 20 years. Several landmark publications have guided my line of thought on this topic; these are mentioned in the accompanying videos while the first and one of the most powerful articles (Proudfoot, et al, 2004) is summarized in the paragraph that follows.

In 2004 while I was constructing a lecture for post-graduate continuing medical education, I found the landmark publication by Proudfoot and colleagues, “Position Paper on Urine Alkalinization” printed in Journal of Toxicology: Clinical Toxicology in March of 2004. This was no mere perspective or casual review article—this official position paper was subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT), and the final publication was approved by the boards of the two societies. In sum, the authors review the data on using urinary alkalinization—defined as achieving a urine pH of at least 7.5—and conclude by endorsing its routine use in certain common emergency situations of poisoning in order to increase urinary excretion of toxic substances. As appropriate for their clinical setting of emergency medicine, these experts rely on the use of intravenous sodium bicarbonate, but since the goal (increased excretion of toxic substances) is achieved by the mechanism of urine alkalinization (which increases renal excretion of toxins) the means to achieve urinary alkalinization can vary as needed; the most appropriate means for achieving urinary alkalinization on a long-term outpatient basis is to rely on a diet of fruits and vegetables, with periodic as-needed use of alkalinizing supplements such as potassium citrate, sodium bicarbonate, magnesium carbonate. I think we can reasonably conclude that if urinary alkalinization is sufficiently safe and useful to warrant review and endorsement from the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT), then it is certainly worth our consideration. Supporting the long-term outpatient use of this intervention is the observation that the condition of modest urinary alkalinization (urine pH of 7.5-8.5) is/was the normal human condition among societies of hunter-gatherers who relied on fruits, vegetables, nuts, seeds, berries (base-forming) along with sufficient animal protein and minimal chloride (acid-forming)—see my articles and videos on my 5-part Supplemented PaleoMediterranean Diet for more context. The human body is inherently acid-producing via several high-volume metabolic process including the metabolism of 1) carbohydrates (lactic acid), 2) fats (acetoacetate and beta-hydroxybutyrate), 3) protein (sulfuric acid), and 4) chloride. The resulting endogenous metabolic acidosis needs to be counterbalanced by dietary alkalinization. Please see the following videos for additional information, justification, and citations; note the short recommended reading list toward the bottom of this page.

See my articles and videos on my 5-part Supplemented PaleoMediterranean Diet for more context.

Short reading list:

1. Vasquez A, Supplemented PaleoMediterranean Diet published as an article in 2005 and again in 2011, then updated and expanded for Inflammation Mastery in 2014/2016; now available as PDF/download

2. Proudfoot et al. Position Paper on urine alkalinization. J Toxicol Clin Toxicol 2004

3. Goldberg et al. Urine citrate and renal stone disease. CMAJ. 1989 Aug

4. Della Guardia et al. Diet-induced acidosis and alkali supplementation. Int J Food Sci Nutr. 2016 Nov

5. Pak et al. Successful management of uric acid nephrolithiasis with potassium citrate. Kidney Int. 1986 Sep

6. Adeva MM, Souto G. Diet-induced metabolic acidosis. Clin Nutr 2011

7. Sebastian et al. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr 2002 Dec

Dr Alex Kennerly Vasquez (introduction; brief Bio-CV) writes and teaches for an international audience on various topics ranging from leadership to nutrition to functional inflammology. Major books include Inflammation Mastery, 4th Edition (full-color printing, 1182 pages, equivalent to 25 typical books [averaging 60,000 words each]), which was also published in two separate volumes as Textbook of Clinical Nutrition and Functional Medicine (Volume 1: Chapters 1-4; Volume 2: Chapter 5—Clinical Protocols for Diabetes, Hypertension, Migraine, Fibromyalgia, Rheumatoid Arthritis, Psoriasis, Vasculitis, Dermatomyositis and most other major inflammatory/autoimmune disorders); several sections have been excerpted including Antiviral Strategies and Immune Nutrition (ISBN 1502894890) (aka, Antiviral Nutrition [available as PDF download] and Brain Inflammation in Chronic Pain, Migraine, and Fibromyalgia. Dr Vasquez’s books are available internationally via bookstores such as BookDepository, Amazon.com, Barnes and Noble, ThriftBooks, AbeBooks, BetterWorldBooks, WaterStonesBooks and his new Telegram channel is https://t.me/DrAlexVasquez.

This wonderful information is not personalized health advice.