Diet-Induced Low-Grade Metabolic Acidosis and Clinical Outcomes: A Review

Abstract

Low-grade metabolic acidosis is a condition characterized by a slight decrease in blood pH, within the range considered normal, and feeding is one of the main factors that may influence the occurrence of such a condition. The excessive consumption of acid precursor foods (sources of phosphorus and proteins), to the detriment of those precursors of bases (sources of potassium, calcium, and magnesium), leads to acid-base balance volubility. If this condition occurs in a prolonged, chronic way, low-grade metabolic acidosis can become significant and predispose to metabolic imbalances such as kidney stone formation, increased bone resorption, reduced bone mineral density, and the loss of muscle mass, as well as the increased risk of chronic diseases such as type 2 diabetes mellitus, hypertension, and non-alcoholic hepatic steatosis. Considering the increase in the number of studies investigating the influence of diet-induced metabolic acidosis on clinical outcomes, this review gathers the available evidence evaluating the association of this disturbance and metabolic imbalances, as well as related mechanisms. It is necessary to look at the western dietary pattern of most countries and the increasing incidence of non-comunicable diseases for the balance between fruit and vegetable intake and the appropriate supply of protein, mainly from animal sources, so that it does not exceed the daily recommendations.

Potassium citrate and metabolic acidosis in children with epilepsy on the ketogenic diet: a prospective controlled study

“…22 It is known from studies on acidosis-producing diets, with a high amount of animalic protein and sodium chloride, that even low-grade reduction of pH and bicarbonate within the normal range over time predisposes to kidney stone formation, increased bone resorption, reduced bone mineral density, loss of muscle mass, and other side effects. 4 In this study we have no long-term follow up measurements of serum pH or bicarbonate concentration. In one study by McNally et al, 11 there was no difference in serum bicarbonate concentrations between participants who received and who did not receive citrate 3 months after starting the ketogenic diet.…”

“…An increased rate of kidney stone formation and loss of bone mineral content with fractures are described side effects of the ketogenic diet that might be related to chronic acidosis . It is known from studies on acidosis‐producing diets, with a high amount of animalic protein and sodium chloride, that even low‐grade reduction of pH and bicarbonate within the normal range over time predisposes to kidney stone formation, increased bone resorption, reduced bone mineral density, loss of muscle mass, and other side effects …”

“…The initial uncompensated acidosis might lead to dehydration and excessive weight loss if left untreated. Chronic metabolic acidosis is also accompanied by side‐effects such as kidney stone formation and loss of bone mineral content . Given the disadvantages and risk of non‐compliance, practical implementation of the ketogenic diet is considered more complicated than treatment with conventional AEDs, therefore, it is rarely used as first line treatment of epilepsy.…”

Intracellular protons accelerate aging and switch on aging hallmarks in mice

“…29 The serum bicarbonate level is an independent predictor of chronic kidney disease progression. Chronic low-grade metabolic acidosis predisposes to metabolic imbalances such as kidney stone formation, increased bone resorption, reduced bone mineral density, and the loss of muscle mass, as well as the increased risk of chronic diseases such as type 2 diabetes, hypertension, and nonalcoholic hepatic steatosis.…”

Can Avicenna Help Manage the Diabetes Epidemic in Central Asia?

“…Higher acidic dietary acid-base load, defined by higher the potential renal acid load and net endogenous acid production scores, may be an independent risk factor for the development of IR and related metabolic disorders [127,128]. Mild metabolic acidosis, measured by plasma lactate, aligns with insulin resistance independent of obesity and is induced by short-term increases in energy and dietary acid load in healthy humans [129].…”