Diet Induced Acidosis: Is It Real and Clinically Relevant?

The topic of acidosis has long been controversial, and has not yet gained acceptance by mainstream medicine. Some of the reasons for this may be because of the challenges in thoroughly understanding the complexity of the topic, the obstacles in testing serum acidity accurately, and then the challenges of proving it in research. Nonetheless, acidosis has been shown clinically to have a significant effect on health.

In an article with the same title, published in the British Journal of Nutrition, Joseph Pizzorno, ND reviews relevant published research on the topic of physiological pH and its potential clinical significance.

For the purposes of this article, acidosis refers to the net acid load of the diet, since pH is most significantly influenced by food. Acid excretion can be measured in the urine or calculated based on food intake. The Standard American Diet (SAD) is very acid-producing due to high levels of sodium chloride (salt) and low intake of base producing plant based foods. The conventional American diet is a shock to the human body, as compared to the diet of our ancestors which was mainly plant based and richer in base-producing potassium.

The Effect of Consuming a High Acid Diet

The body requires a very tightly regulated pH of about 7.4 to maintain health. Numerous mechanisms are in place to correct deviation. The lungs and kidneys work together to excrete excessive acid (also excess base, a less likely scenario). pH can fluctuate momentarily, but the real problems come when the pH trends towards acid on a chronic basis, such as in the case of a consistent SAD diet.

The Clinical Consequence of Acidosis

Beyond lungs and kidney, the bones act as reservoir of calcium which can be released to alkalize the system. Osteoclasts break down bone to release calcium and neutralize excess serum acid.

An important question is this: Is chronic acidity a major cause for bone degradation and osteoporosis? Several studies do implicate acid promoting diets as a cause for increased calcium excretion, measured as bone matrix protein. Some clinical trials show that a diet higher in meat than other protein is related to more bone fractures. Some studies show that adding potassium bicarbonate base can reverse bone loss.

Chronic acidity also encourages the formation of kidney stones. As bones release calcium to excessive serum levels, the mineral is more likely to be deposited where it isn’t wanted.

Sarcopenia, the natural progression of muscle loss in older adults, may also be deterred by improving alkalinity. One study showed that eating a diet high in fruits and vegetables was linked to better muscle mass in that age group. Although research isn’t definitive, it seems that acidosis triggers pathways that encourage muscle breakdown.

Identifying Acidosis

Calculating pH is a complex task which isn’t always accurate due to many variables. In his article, Pizzorno suggests the urinary NAE (net acid excretion) test which measures elements such as ammonia, bicarbonate, and acids is more accurate as compared to the popularized and oversimplified pH strips.

Treating Acidosis

The treatment protocol to normalize chronic acidosis isn’t complicated, but it can be challenging for patients to implement. Diet is the primary cause of acidosis, so converting to a whole foods, plant-based diet, with less meat and lower sodium can improve alkaline status. Dietary supplements, such as potassium or sodium bicarbonate, can also help neutralize excess acid.

To learn more about diagnosing and treating acidosis, join Dr. Pizzorno at the Toronto Restorative Medicine Regional Conference, being held February 10-12, 2017. He will be presenting a review of the latest research and cutting-edge information to help you better treat your patients for this prevalent condition.



Pizzorno, J. et al. Diet induced acidosis: is it real and clinically relevant? British Journal of Nutrition (2010), 103, 1185–1194

Peter Melamed, PhD, and Felix Melamed, MS. Acidity Kills the Pancreas. Townsend Letter, August/September 2015 issue.

Yancy WS Jr, Olsen MK, Dudley T, et al. (2007) Acid–base analysis of individuals following two weight loss diets. Eur J Clin Nutr 61, 1416–1422

Sebastian A, Harris ST, Ottaway JH, et al. (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330, 1776–1781.

Dawson-Hughes B, Harris SS & Ceglia L (2008) Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr 87, 662–665.