This is the first article in a two-part series. Part two will look at dietary and lifestyle treatments for hyperacidity and an acidity test you can do at home.
Researchers associate high dietary acidic loads with a myriad of illnesses—even an increased risk of cancer. As a result, acid-base homeostasis has been debated among doctors, dieticians, and health-conscious individuals for decades.
In Germany and other European nations, literature about the subject is plentiful. In the United States, though the subject is somewhat obscure, numerous studies in recent years indicate the importance of a balanced pH level in maintaining good health.
Why Do I Feel Off?
Perhaps you nurture an overall well-balanced lifestyle and consider yourself healthy—conscious about what you eat, how you exercise, and the types of relationships you maintain. Perhaps sometimes, though, you feel off without a clear reason.
You might feel aches and pains that you cannot explain. Your joints feel stiffer than usual, you wake up with headaches that normally are not there, experience a little heartburn after eating certain foods, your muscles feel sore without physical activity, or your immune system seems off-guard.
All these symptoms could be caused by an imbalanced pH level.
Homeostasis–The Body’s Basic Requirement
Human metabolism has three major jobs:
1. Capture energy to ensure proper function of cellular processes
2. Convert food into fundamental building blocks
3. Oversee removal of waste products from the body
One key requirement for the metabolic system to perform these jobs well is acid-base homeostasis—meaning that the pH level in all extracellular fluids (those outside of the cells) stays between 7.35 and 7.45. This pH balance is critical to overall health.
Disturbances of the acid-base homeostasis can lead to a broad spectrum of disorders including but not limited to an increased risk for Type-2 diabetes, insulin resistance, osteoporosis, and a variety of acid stress-related issues, including chronic metabolic acidosis.
pH Balance Critical for Health
Our daily food consumption both produces and consumes acids (ions that can donate a proton). However, the food choices we make determine the quantity of acid production (dietary acid load), which in turn influences the body’s pH balance.
Since human metabolism is programmed to ensure this balance, an imbalanced diet will force many bodily systems to work overtime to return to a state of homeostasis, including the following:
- Digestive system
- Respiratory system
- Eliminatory system
- Muscular/skeletal system
All these systems can be adversely affected if the body is bombarded with too high of a dietary acid load.
Ailments Caused by Acid Imbalance
Disturbances in the acid-base balance can cause many health issues. A 2024 review in Pflugers Archiv of the European Journal of Physiology relates a high dietary acid load among those who live in the West to the high intake of processed food and animal protein.
The researchers recommend an adjustment of people’s diets to lower their dietary acid loads, therefore preventing “a chronic low-grade metabolic acidosis,” which “is associated with increased morbidity and mortality.”
Even if we do not modify our nutrition accordingly, the body always tries to reach homeostasis based on its goal of self-preservation. Toxins usually will not be stored in the heart, the brain, or the lungs, while fat and connective tissue are the easiest disposal sites for them.
Damage to Connective Tissue–A Disposal Site for Surplus Acids
Connective tissue has multiple jobs—one of which is to transport nutrients and waste. Blood and lymph, as well as cartilage and bone, are all considered specialized connective tissues.
To save other organs from harm, connective tissue is the first responder to high dietary acid loads and works tirelessly to reduce toxins in our bodies.
Blood and lymph work to carry the toxins away. If that fails, tissues store the acids. Bone tissue functions as a pivotal buffer and muscle tissue produces glutamine, which is broken down to control acid loads. As a result, the musculoskeletal system can suffer.
If the onslaught of a high dietary acid load continues, other systems, including the lungs and the kidneys, bear the load.
Organ Damage
A large cross-sectional study published in the journal Risk Management and Healthcare Policy enrolled 18,855 participants from the National Health and Nutrition Examination Survey 1999–2018. Researchers concluded that there was a link between dietary acid loads and nonalcoholic fatty liver disease.
Furthermore, high acid loads can lead to chronic metabolic acidosis, which in turn “has been documented to be closely involved in the development of a range of diseases, including CVD [cardiovascular disease], hypertension, diabetes, chronic kidney disease, bone-related disorders, and cancers,” the study stated.
Chronic kidney disease and deterioration of kidney function were found to be directly associated with a high dietary acid load in a 2022 systematic review published in the journal Nutrients. Out of 1,078 investigated articles, only one study found no correlation. The research affirmed that too much acid in our bodies decreases renal function.
The same academic journal featured a study published in 2019 in which researchers were able to show, for the first time, a connection between high dietary acid loads and asthma in overweight and obese children.
The study found a relationship between the body’s pH level and the specific obese-asthma phenotype, which is traditionally harder to treat and includes mechanisms that are poorly known or understood. The researchers highlighted “the importance and the health benefits of a diet rich in base-yielding vegetables and fruits to balance dietary acid load and maintain homeostasis.”
Cancer
A 2021 case-control study published in the journal Cancer Treatment and Research Communications observed the acid-base balance in relation to lung cancer development in men. In the study, 843 lung cancer patients were given a multitopic questionnaire, including questions about their food intake. The research revealed a direct association between dietary acid loads and heightened inflammation and an increased risk of lung cancer.
A 2022 systematic review published in the European Journal of Cancer Prevention showed that people drawn to acid-rich diets were exposed to a higher risk of cancer.
A meta-analysis of observational studies published in 2022 in the journal Frontiers in Nutrition not only confirmed the increased risk of cancer but clarified that the connections between dietary acid loads and various types of cancer are prevalent in both genders, as well as in “high- and low-risk age-groups.”
Cardio-Metabolic Diseases
Cardio-metabolic diseases, such as hypertension, atherosclerosis, and Type-2 diabetes, are also present on the long list of negative health effects caused by high acidity in the body.
Diabetes and Hypertension
A 2022 study published in the journal Current Aging Science examined the relationship between metabolic acidosis and the development of insulin resistance, hypertension, and other cardiometabolic disorders.
The researchers analyzed the potential renal acid load (PRAL) and “net endogenous acid production” of 114 elderly participants over three days, including a breakdown of their 24-hour dietary records.
The research found that dietary choices significantly affected cardiometabolic diseases. Participants already suffering from hypertension and diabetes showed a much greater acid-forming potential, which in turn is a risk factor for these illnesses.
Another study published in 2023 in the journal European Review for Medical and Pharmacological Sciences examined the connection between dietary acid load (DAL) and Type 2 diabetes risk factors. The case-control study concluded, “It is possible that limiting dietary acid load could lower type 2 diabetes risk in vulnerable individuals.”
A 2019 systematic review and meta-analysis published in the journal Nutrition, Metabolism and Cardiovascular Diseases investigated 14 studies, which included 306,183 individual participants. Researchers found a significant positive connection between hypertension and dietary acid loads.
An American prospective study published in the journal Hypertension followed 87,293 women for 14 years. It also reached the conclusion that a high dietary net acid load led to an increased risk of hypertension. Animal protein and potassium were the largest factors for a rise in people’s diet-dependent acid loads.
International studies from Germany, Japan, and Vietnam also show a rise in hypertension prevalence associated with high dietary net acid loads.
Insulin Resistance
A link between insulin resistance and dietary acid load was identified in a 2022 Latin American population-based study published in the journal Clinical Nutrition. Samples of 545 individuals between the ages of 25 to 64 were examined. The study determined that high levels of dietary acid were consistently associated with higher insulin resistance.
A 2020 Korean genome and epidemiology study published in Nutrition Journal found the same positive association. One goal of this research was to investigate this link in the Asian population, for which research on the topic has been limited.
Obesity
According to the American Heart Association, the incidence of cardiometabolic diseases rooted in poor lifestyle choices has been increasing over the past decades. Currently, they are among the leading causes of morbidity.
Frequently, these diseases are accompanied not only by insulin resistance but also by obesity. However, these conditions seem to go hand-in-hand—meaning that obesity can be a causal factor in metabolic acidosis as well. This was the finding of a team of scientists that examined U.S. adults, in a study published in 2022 in the journal Kidney 360.
Researchers of an updated 2019 systematic review and meta-analysis featured in PLOS ONE found that “high dietary acid load content was associated with higher serum triglyceride concentrations and higher obesity prevalence.” They saw nutritional changes with a low-acid load as a possibly “useful preventive strategy against obesity and metabolic disorders.”
Mental Health
A German study published in 2018 in the journal Nutrients explored, for possibly the first time, a potential correlation between high dietary acid loads and mental/emotional problems, including hyperactivity and peer problems in children.
Researchers measured the potential renal acid load for participants and assessed a strengths and difficulties questionnaire after 10 and 15 years. Data at the 10-year mark found that children consuming a diet high in acids showed more emotional problems and displayed increased hyperactivity. “These findings reveal first evidence for potential relationships between PRAL and mental health in childhood,” the researchers stated.
Acid-Associated Health or Illness
Another 2018 article in the Mexican journal Nefrologia confirmed in detail the connection between a high acid load, an imbalanced pH homeostasis, and chronic diseases. Researchers concluded that nutritional intervention and the reduction of dietary acid load may improve one’s health.
In addition, the 2024 Pflugers Archiv review explains the dietary acid load and its extensive implications. It also provides a valuable graphic to visualize the topic’s far-reaching interrelations.
Summary of the consequences of a high dietary acid load (DAL). Pflugers Arch. 2024; 476(4): 427–443. CC by 4.0
According to the review, it’s hard to measure dietary acid load precisely. A complex evaluation of stool and urine samples, as well as the concurrent food consumption, is needed. However, the assessment of urinary pH and ammonium is another method that is being used to gauge the DAL.
Beside the dietary acid load, scientists developed the PRAL-index almost three decades ago. The PRAL score indicates the potential renal acid load of each food item and is assigned based on its level of acidity.
Australian integrative naturopath and health coach, Catherine McCoy, features a helpful PRAL table on her website, as a tool for both patients and practitioners.
Where Do Acids Come From?
Acids come from dietary chlorides, phosphates, sulfates, sulfurous amino acids from dietary proteins, and biological acids (breathable and non-breathable).
Often, they are vital to our bodies and play key roles. Chlorides, for example, channel water and other nutrients into and out of our cells and help balance bodily fluids, which regulate blood pressure and pH. They assist the muscles to contract and support nerve cells in carrying messages. The mineral also exchanges oxygen and carbon dioxide and aids in the digestion process.
However, it is the quantity of acids that matters.
According to the European Food Information Council, the daily reference value for chloride is 3 grams in healthy adults. This approximately equals 5 grams of table salt. 100 grams of shrimp, for instance, carry 189 percent of the daily value. As a comparison, 180 grams of carrots only make up 7 percent.
Reducing Your Dietary Acid Load
The evidence shows that high acidity causes illness.
If you are interested in discovering more about various dietary and lifestyle ways to treat hyperacidity and the toxification that comes with it, watch for an upcoming article on the topic, which will include how to home-test for acidity and other helpful dietary information.