1
|
Storz MA. Quantifying the potential renal acid load of edible mushrooms. NPJ Sci Food 2024; 8:17. [PMID: 38472238 DOI: 10.1038/s41538-024-00259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The capability of any food to alter net endogenous acid or base production can be estimated using the potential renal acid load (PRAL) estimation method. The PRAL of edible mushrooms has been rarely examined; thus a quantification study of n = 37 edible mushroom species was performed. Results revealed a heterogeneous picture: although the most commonly consumed mushrooms (e.g., Agaricus bisporus, Lentinula edodes, and Pleurotus ostreatus (white)) have alkalizing properties, several acidifying species (Volvariella volvacea, Pleurotus flabellatus) were identified, which may be attributable to their high phosphorus content.
Collapse
Affiliation(s)
- Maximilian Andreas Storz
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
2
|
Tran TT, Gunathilake M, Lee J, Oh JH, Chang HJ, Sohn DK, Shin A, Kim J. The association of diet-dependent acid load with colorectal cancer risk: a case-control study in Korea. Br J Nutr 2024; 131:333-342. [PMID: 37649268 DOI: 10.1017/s0007114523001691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Acid-base disequilibrium is a contributor to cancer development because it affects molecular activities such as insulin-like growth factor 1 levels and adiponectin production. However, evidence of an association of diet-induced acid-base imbalance with colorectal cancer (CRC) is limited. We examined whether colorectal carcinogenesis is attributable to a diet with a high acid load. We recruited a total of 923 CRC cases and 1846 controls at the National Cancer Center in Korea for inclusion in a case-control study. We collected information on nutrient intake and specific clinical parameters of CRC by using a semiquantitative FFQ and medical records, respectively. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were used to estimate diet-dependent acid load. We used an unconditional logistic regression model to analyse the association. Dietary acid load scores had a positive association with the odds of CRC (OR = 2·31 (95 % CI 1·79, 2·99) and OR = 2·14 (95 % CI 1·66, 2·76) for PRAL and NEAP, respectively, Pfor trend < 0·001). A stronger positive association was observed for females (OR = 3·09, 95 % CI 1·93, 4·94) than for males (OR = 1·71, 95 % CI 1·27, 2·31). Furthermore, acidogenic diets appeared to affect rectal cancer more strongly than colon cancer in females. Our study contributes to reinforcing epidemiological evidence regarding a detrimental effect of acidogenic diets on colorectal carcinogenesis. Thus, it is important to pay attention to the balance of acidogenic (e.g. poultry and red meat) and alkalinogenic foods (e.g. fruits and vegetables) in CRC prevention, especially for females.
Collapse
Affiliation(s)
- Tao Thi Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, Goyang-si, Gyeonggi-do, South Korea
| | - Madhawa Gunathilake
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si, Gyeonggi-do10408, South Korea
| | - Jeonghee Lee
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si, Gyeonggi-do10408, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
| | - Hee Jin Chang
- Center for Colorectal Cancer, National Cancer Center Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, National Cancer Center Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si, Gyeonggi-do10408, South Korea
| |
Collapse
|
3
|
Herter J, Lederer AK, Ronco AL, Hannibal L, Huber R, Storz MA. Dietary Acid Load Correlates with Serum Amino Acid Concentrations after a Four-Week Intervention with Vegan vs. Meat-Rich Diets: A Secondary Data Analysis. Nutrients 2023; 15:2942. [PMID: 37447267 DOI: 10.3390/nu15132942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Chronic low-grade metabolic acidosis is now a common phenomenon in the Western world. The high dietary intake of sulfur-containing amino acids in the form of processed meats results in an excessive release of acid in the form of protons and non-metabolizable acidic anions. The kidneys produce increasing amounts of ammonia to excrete this acid. This process requires the breakdown of the nitrogenous amino acid glutamine, which the body provides by breaking down muscle tissue. Hitherto not examined, we hypothesized that a high dietary acid load (DAL) could alter the serum concentrations of selected amino acids. Using secondary data from a 4-week dietary intervention study conducted in 2017, we examined the associations between various amino acids and DAL in n = 42 individuals who either consumed a meat-rich or vegan diet. Results from this secondary data analysis suggested that DAL (as measured by the potential renal acid load and net endogenous acid production) is positively correlated with higher serum concentrations of lysine and 1-methyl-histidine (r = 0.50 and 0.43, respectively) and negatively correlated with glutamine and glycine (r = -0.43 and -0.47, respectively). The inverse association with glycine and glutamine warrants special attention, as both play an important role in many metabolic disorders and the immune system.
Collapse
Affiliation(s)
- Julian Herter
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ann-Kathrin Lederer
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany
| | - Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Bvard. Artigas 1590, Montevideo 11600, Uruguay
| | - Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Roman Huber
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| |
Collapse
|
4
|
Ekmeiro-Salvador JE, Storz MA. The Impact of Plant-Based Diets on Dietary Acid Load Metrics in Venezuela: A Cross-Sectional Study. Nutrients 2023; 15:2745. [PMID: 37375649 DOI: 10.3390/nu15122745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Dietary acid load (DAL) is an important determinant of the acid-base balance in humans and has been associated with several chronic non-communicable diseases. Plant-based diets, including vegetarian and vegan diets, decrease DAL-although their alkalizing potential varies substantially. Their net effect on common DAL scores, including potential renal acid load and net endogenous acid production, has been insufficiently quantified and is poorly understood-particularly in populations outside of Europe and North America. We assessed the associations between three plant-based dietary patterns (flexitarian vs. lacto-ovo-vegetarian vs. vegan diet) and DAL scores in a healthy Venezuelan population in the metropolitan area of Puerto La Cruz, Venezuela. Substantial differences in DAL scores were observed, whereby the vegan diet yielded the highest alkalizing potential, followed by the lacto-ovo-vegetarian and the flexitarian diet. DAL scores were substantially lower in comparison to European and North American plant-based populations, probably due to the higher potassium intake (exceeding 4000 mg/d in vegans), the higher magnesium intake (390.31 ± 1.79 mg/d in vegans) and the lower intake of protein in vegans and lacto-ovo-vegetarians. Additional studies in other non-industrialized populations are warranted to allow for a better understanding of the (numeric) impact of plant-based dietary patterns on DAL scores, potentially allowing for an establishment of reference ranges in the near future.
Collapse
Affiliation(s)
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| |
Collapse
|
5
|
Vegan Diet Is Associated with a Lower Risk of Chronic Kidney Disease in Patients with Hyperuricemia. Nutrients 2023; 15:nu15061444. [PMID: 36986174 PMCID: PMC10051587 DOI: 10.3390/nu15061444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Hyperuricemia is a well-known risk factor for chronic kidney disease (CKD). Little is known about whether a vegetarian diet is associated with a lower risk of CKD in patients with hyperuricemia. From 5 September 2005, to 31 December 2016, we retrospectively included clinically stable patients with hyperuricemia who received health check-ups at Taipei Tzu Chi Hospital. All participants completed a dietary habits questionnaire to determine whether they were omnivorous, lacto-ovo vegetarian, or vegan. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 or the presence of proteinuria. A total of 3618 patients with hyperuricemia were recruited for this cross-sectional study, consisting of 225 vegans, 509 lacto-ovo vegetarians, and 2884 omnivores. After adjusting for age and sex, vegans had a significantly lower odds ratio (OR) of CKD than omnivores (OR, 0.62; p = 0.006). The OR of CKD remained significantly lower in vegans after adjusting for additional confounders (OR, 0.69; p = 0.04). Additionally, age (per year OR, 1.06; p < 0.001), diabetes mellitus (OR, 2.12; p < 0.001), hypertension (OR, 1.73; p < 0.001), obesity (OR, 1.24; p = 0.02), smoking (OR, 2.05; p < 0.001), and very high uric acid levels (OR, 2.08; p < 0.001) were independent risk factors for CKD in patients with hyperuricemia. Moreover, structural equation modeling revealed that a vegan diet was associated with a lower OR of CKD (OR, 0.69; p < 0.05). A vegan diet is associated with a 31% lower risk of CKD in patients with hyperuricemia. A vegan diet may be beneficial in reducing the occurrence of CKD in patients with hyperuricemia.
Collapse
|
6
|
Abstract
Metabolic acidosis is a common complication in patients with chronic kidney disease that occurs when the daily nonvolatile acid load produced in metabolism cannot be excreted fully by the kidney. A reduction in urine net acid excretion coupled with a high nonvolatile acid load may play a role in its pathogenesis. Diet is important in generation of the nonvolatile acid load. Acids are produced from metabolism of dietary protein and from the endogenous production of organic anions from neutral precursors. Acids can be balanced by alkali precursors ingested in the diet in the form of combustible organic anions. These typically are reflected indirectly by the excess of mineral cations to mineral anions in a food or diet. These principles underscore widely used methods to estimate the nonvolatile acid load from dietary intake using formulas such as the net endogenous acid production equation and the potential renal acid load equation. Empiric data largely validate these paradigms with high net endogenous acid production and potential renal acid load contributed by foods such as protein, grains, and dairy, and low net endogenous acid production and potential renal acid load contributed by fruits and vegetables along with corresponding dietary patterns. Although further studies are needed to understand the health benefits of altering nonvolatile acid load via diet, this review provides a detailed assessment on our current understanding of the role of diet in chronic kidney disease-related acidosis, providing an updated resource for researchers and clinicians.
Collapse
Affiliation(s)
- Anita Vincent-Johnson
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Brenda Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Julia J Scialla
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA.
| |
Collapse
|
7
|
Observational and clinical evidence that plant-based nutrition reduces dietary acid load. J Nutr Sci 2022; 11:e93. [PMID: 36405093 PMCID: PMC9641522 DOI: 10.1017/jns.2022.93] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022] Open
Abstract
Contemporary diets in Western countries are largely acid-inducing and deficient in potassium alkali salts, resulting in low-grade metabolic acidosis. The chronic consumption of acidogenic diets abundant in animal-based foods (meats, dairy, cheese and eggs) poses a substantial challenge to the human body's buffering capacities and chronic retention of acid wherein the progressive loss of bicarbonate stores can cause cellular and tissue damage. An elevated dietary acid load (DAL) has been associated with systemic inflammation and other adverse metabolic conditions. In this narrative review, we examine DAL quantification methods and index observational and clinical evidence on the role of plant-based diets, chiefly vegetarian and vegan, in reducing DAL. Quantitation of protein and amino acid composition and of intake of alkalising organic potassium salts and magnesium show that plant-based diets are most effective at reducing DAL. Results from clinical studies and recommendations in the form of expert committee opinions suggest that for a number of common illnesses, wherein metabolic acidosis is a contributing factor, the regular inclusion of plant-based foods offers measurable benefits for disease prevention and management. Based on available evidence, dietary shifts toward plant-based nutrition effectively reduces dietary-induced, low-grade metabolic acidosis.
Collapse
|
8
|
Dietary Acid Load in Gluten-Free Diets: Results from a Cross-Sectional Study. Nutrients 2022; 14:nu14153067. [PMID: 35893918 PMCID: PMC9331248 DOI: 10.3390/nu14153067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
The gluten-free diet (GFD) ensures improvement of clinical symptoms in the vast majority of celiac disease (CD) patients. Despite stable CD rates in many countries, an increasing number of healthy individuals are adopting gluten-free diets, believing that this diet is an inherently healthier choice. The health effects of gluten-free diets are controversial, and a recent study added to the debate by reporting a lower acidogenic potential of this diet. The effects of the GFD on potential renal acid load (PRAL) and net endogenous acid production (NEAP)—two important markers of dietary acid load (DAL)—are poorly understood, and have never been examined in a Western population. Using cross-sectional data from the National Health and Nutrition Examination Surveys, we estimated DAL in U.S. individuals reporting a GFD and contrasted the results to the general U.S. population consuming gluten and denying special diets. The GFD was associated with significantly lower crude DAL scores, and after adjustments for confounders in multivariate regression, the results remain significant. Yet, our study could not confirm the reported alkalizing properties of the GFD. Although overall DAL scores were significantly lower in the GFD group, they were comparable to Western diets producing 50–75 mEq of acid per day.
Collapse
|
9
|
Zhao R, Zhou L, Lei G, Wang S, Li Y, Yang X, Xiong G, Hao L. Dietary Acid Load Is Positively Associated With Risk of Gestational Diabetes Mellitus in a Prospective Cohort of Chinese Pregnant Women. Front Nutr 2022; 9:892698. [PMID: 35694169 PMCID: PMC9184257 DOI: 10.3389/fnut.2022.892698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Growing evidence suggests that dietary acid load plays an important role in the development of type 2 diabetes. However, prospective studies on the relationship between dietary acid load and gestational diabetes mellitus (GDM) are limited in the pregnant population. This study aimed to investigate the effect of dietary acid load during early pregnancy on the risk of GDM in Chinese pregnant women. Methods A total of 1,327 pregnant women were enrolled from an ongoing prospective study of the Tongji Birth cohort (TJBC) in Wuhan, China. Dietary intake was assessed before 20 weeks using a 74-item semiquantitative food frequency questionnaire (FFQ). The dietary acid load was estimated using potential renal acid load (PRAL), net endogenous acid production (NEAP), and animal protein to potassium ratio (A:P ratio). A 75g 2-h oral glucose tolerance test (OGTT) was performed at 24-28 gestational weeks to diagnose GDM. Results The mean (standard deviation) values for PRAL score, NEAP score, and A:P ratio were 0.8 ± 11.3 mEq/day, 45.3 ± 16.5 mEq/day, and 9.8 ± 6.0, respectively. There was a significant positive correlation of dietary acid load with the intake of red meat, poultry, fish, and eggs, and a negative correlation with the intake of vegetables, fruits, nuts, and legumes (all P < 0.05). Compared to the lowest tertile, the highest tertile of dietary acid load, including PRAL score (odds ratio [OR]: 2.26, 95% confidence interval [CI] = 1.38–3.71, P-trend = 0.002), NEAP score (OR: 2.02, 95% CI = 1.25–3.27, P-trend = 0.009), and A:P ratio (2.08, 95% CI = 1.30–3.31, P-trend = 0.005), significantly increased the risk of GDM. In addition, the dietary acid load was also significantly associated with an increase in 1-h and 2-h post-load blood glucose concentrations (all P-trend < 0.05). Conclusion We found a significant positive association between dietary acid load during early pregnancy and the risk of GDM in a Chinese population, suggesting that the reduction of food sources of dietary acid load may be an effective strategy for preventing the risk of GDM.
Collapse
Affiliation(s)
- Rui Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Leilei Zhou
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Lei
- The Central Hospital of Wuhan, Wuhan, China
| | - Shanshan Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoping Xiong
- The Central Hospital of Wuhan, Wuhan, China
- *Correspondence: Guoping Xiong,
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Liping Hao,
| |
Collapse
|
10
|
Nutrient Intake and Dietary Acid Load of Special Diets in the NHANES: A Descriptive Analysis (2009-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095748. [PMID: 35565143 PMCID: PMC9102013 DOI: 10.3390/ijerph19095748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 12/14/2022]
Abstract
Western diets are characterized by a high dietary acid load (DAL), which has been associated with adverse clinical outcomes, including type-2-diabetes and metabolic syndrome. Effective dietary strategies to lower DAL are urgently warranted. Plant-based diets (PBD), including vegetarian and vegan diets, are an effective measure to reduce DAL. Notably, not every individual wishes to adopt a PBD. Instead, many people rely on special diets promising comparable health benefits. The effects of those diets on DAL have rarely been investigated. Using data from the National Health and Nutrition Examination Surveys, we aimed to quantify DAL and nutrient intake in the most popular special diets in the United States, including weight-loss, low fat, low salt, low sugar, and diabetic diets. Our analysis included 3552 individuals on a special diet. The most popular diets were the weight-loss diet (n = 1886 individuals) and the diabetic diet (n = 728). Energy intake was below 2000 kcal/d for all diets; however, there were no statistically significant intergroup differences. DAL scores were positive for all special diets (>9 mEq/d), suggesting acidifying properties. Acid load scores of special diets did not differ significantly and were comparable to a standard Western diet. None of the examined diets was associated with alkaline properties.
Collapse
|
11
|
Storz MA, Ronco AL. Quantifying dietary acid load in U.S. cancer survivors: an exploratory study using NHANES data. BMC Nutr 2022; 8:43. [PMID: 35505426 PMCID: PMC9063047 DOI: 10.1186/s40795-022-00537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diet is an important determinant of systemic pH and acid–base regulation. A frequent consumption of acid-inducing foods (including processed meats and cheese) combined with a low intake of base-inducing foods (such as fruits, legumes and vegetables) increases Dietary Acid Load (DAL), which has been associated with an increased risk for certain cancers. DAL also appears to be of paramount importance in cancer survivors, in whom it was associated with increased mortality and poor overall physical health. Literature on DAL in cancer survivors, however, is scarce and limited to a few studies. Methods Using cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES), we sought to quantify DAL in U.S. cancer survivors and contrasted the results to the general population. DAL was estimated using established formulas (Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP)). Results Our study comprised 19,413 participants, of which 1444 were self-reported cancer survivors. Almost 63% of cancer survivors were female (weighted proportion) with a mean age of 61.75 (0.51) years. DAL scores were consistently higher in cancer survivors (as compared to the general population) after adjustment for confounders in multivariate regression models. These differences, however, were not statistically significant (p = 0.506 for NEAPF, 0.768 for PRALR and 0.468 for NEAPR, respectively). Notably, DAL scores were positive throughout (> 0 mEq/d) in cancer survivors, suggesting an acidifying diet. Specific examples include mean PRALR scores > 11 mEq/d in cancer survivors aged 55 years and mean NEAPF scores > 50 mEq/d in cancer survivors aged 40–60 years). Conclusions The acidifying diet in this sample of cancer survivors warrants caution and requires further investigation. Comparably high DAL scores have been associated with adverse health outcomes and an increased mortality in previous studies in breast cancer survivors. Thus, increased awareness as well as additional clinical trials in this field are urgently warranted.
Collapse
Affiliation(s)
- Maximilian Andreas Storz
- Department of Internal Medicine II, Center for Complementary Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Bvard. Artigas 1590, 11600, Montevideo, Uruguay.,School of Medicine, CLAEH University, Prado and Salt Lake, 20100, Maldonado, Uruguay.,Biomedical Sciences Center, University of Montevideo, Puntas de Santiago 1604, 11500, Montevideo, Uruguay
| |
Collapse
|
12
|
Abstract
Diet affects the body's acid-base balance by providing acid or alkali precursors in the metabolism. The importance of the acid-base balance of the diet for cardiovascular diseases, which have become the most important cause of morbidity on the global scale, has started to take its place in the literature. The prediction of endogenous acid production in dietary acid-base balance is expressed as dietary acid load. Although the available information about the effect of dietary acid load on cardiovascular diseases is limited, possible mechanisms are indicated as excessive calcium and magnesium excretion from the kidneys, reduced urinary citrate excretion, and excessive cortisol production. Metabolic acidosis has an important role in the development of cardiometabolic abnormalities, especially insulin resistance. Studies examining the relationship between dietary acid load and cardiovascular disease are limited and there is an inconsistency between studies. Practices for determining risk factors for cardiovascular diseases and preventing their effects are very important for the protection and improvement of health. Considering dietary acid load when planning a diet for individuals with cardiovascular diseases can help increase the effectiveness of the diet. The purpose of this review is to examine the effect of dietary acid load on cardiovascular diseases.
Collapse
Affiliation(s)
- Nursel Sahın
- Department of Nutrition and Dietetic, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Ugur Gunsen
- Department of Nutrition and Dietetic, Bandirma Onyedi Eylul University, Balikesir, Turkey
| |
Collapse
|
13
|
Sheele JM, Libertin CR, Fink I, Jensen T, Dasalla N, Lyon TD. Alkaline Urine in the Emergency Department Predicts Nitrofurantoin Resistance. J Emerg Med 2022; 62:368-377. [PMID: 35000812 DOI: 10.1016/j.jemermed.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/09/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH. OBJECTIVE Our aim was to determine whether higher urine pH in the emergency department is associated with nitrofurantoin resistance. METHODS A single health system database of emergency department patients aged 18 years and older who received urinalysis between April 18, 2014, and March 7, 2017, was examined using χ2 test and multivariable regression analysis. RESULTS Of 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p < 0.001). The Proteeae species represented 4.4% of urine samples at pH 5-7, 24.4% at pH 8-9, and 40.0% at pH 9. At urine pH 5-7, 80.4% of urine samples were sensitive to nitrofurantoin; however, this percentage decreased to 66.1% for urine pH 8-9 and 54.6% for urine pH 9. Nitrofurantoin had the highest OR (2.10, 95% CI 1.85-2.39) among cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole for bacteriuria sensitive to those antibiotics at urine pH 5-7. At urine pH 8-9 and 9, nitrofurantoin had the lowest OR among the antibiotics: 0.48 (95% CI 0.42-0.54) and 0.31 (95% CI 0.24-0.40), respectively (p < 0.001 for both). CONCLUSIONS Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance.
Collapse
Affiliation(s)
| | | | - Isaac Fink
- Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida
| | - Taylor Jensen
- Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida
| | - Nicole Dasalla
- Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
14
|
Fan E, Chavez JA, Chavez JM, Christie AL, Zimmern PE. Does urinary pH and diet influence the rate of urinary tract infection recurrence after electrofulguration in women with antibiotic-recalcitrant recurrent urinary tract infections? Urology 2022; 164:94-99. [DOI: 10.1016/j.urology.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
|
15
|
Müller A, Zimmermann-Klemd AM, Lederer AK, Hannibal L, Kowarschik S, Huber R, Storz MA. A Vegan Diet Is Associated with a Significant Reduction in Dietary Acid Load: Post Hoc Analysis of a Randomized Controlled Trial in Healthy Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199998. [PMID: 34639299 PMCID: PMC8507786 DOI: 10.3390/ijerph18199998] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022]
Abstract
The composition of diet strongly affects acid–base homeostasis. Western diets abundant in acidogenic foods (meat and cheese) and deficient in alkalizing foods (fruits and vegetables) increase dietary acid load (DAL). A high DAL has been associated with numerous health repercussions, including cardiovascular disease and type-2-diabetes. Plant-based diets have been associated with a lower DAL; however, the number of trials exploring this association is limited. This randomized-controlled trial sought to examine whether an isocaloric vegan diet lowers DAL as compared to a meat-rich diet. Forty-five omnivorous individuals were randomly assigned to a vegan diet (n = 23) or a meat-rich diet (n = 22) for 4 weeks. DAL was determined using potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores at baseline and after 3 and 4 weeks, respectively. After 3 weeks, median PRAL (−23.57 (23.87)) and mean NEAPR (12.85 ± 19.71) scores were significantly lower in the vegan group than in the meat-rich group (PRAL: 18.78 (21.04) and NEAPR: 60.93 ± 15.51, respectively). Effects were mediated by a lower phosphorus and protein intake in the vegan group. Our study suggests that a vegan diet is a potential means to reduce DAL, whereas a meat-rich diet substantially increases the DAL burden.
Collapse
Affiliation(s)
- Alexander Müller
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Amy Marisa Zimmermann-Klemd
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Ann-Kathrin Lederer
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Luciana Hannibal
- Medical Center, Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Stefanie Kowarschik
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Roman Huber
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
| | - Maximilian Andreas Storz
- Centre for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.M.); (A.M.Z.-K.); (A.-K.L.); (S.K.); (R.H.)
- Correspondence:
| |
Collapse
|
16
|
Prospective Evaluation of Daily and Weekly Urine pH Variations Along With Diet Intake in Postmenopausal Women With Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg 2021; 27:e352-e359. [PMID: 33009261 DOI: 10.1097/spv.0000000000000931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Acidic urine pH may be protective against recurrent urinary tract infections (RUTIs). After reviewing the literature, we primarily analyzed urine pH fluctuations and secondarily compared them with diet in older women with RUTIs. METHODS After IRB approval, postmenopausal women with documented RUTIs were enrolled. Participants were given preformatted charts to record urinalysis reagent strips (Medimpex) findings 4 times per day and concomitant food/beverage intake (food diary). Urine cultures at baseline ensured no infection during measurement period. Nutrient content reported in food diaries was analyzed by an experienced registered dietitian and compared with parallel fluctuations in urine pH. RESULTS Of 26 women with median age of 72 years (55-86 years), the first 3 days of diet and urine pH recordings found that 17 (65%) of 26 exhibited urine pH variation greater than 1 unit, with an overall median of 6 (5-9). Comparing dietary analysis and urine pH changes, beta-carotene (P = 0.017) and total dietary sugar intake (P = 0.036) were associated with a decrease in urine pH, whereas monounsaturated fatty acids (MFA, 22:1, P = 0.023) and protein (P = 0.028) were associated with an increase in urine pH. CONCLUSIONS In this real-life, observational study, 65% of older women with RUTIs exhibited notable changes in urine pH, with decreased urine pH associated with nutrients found in orange and yellow vegetables and several major food groups. A longitudinal study is needed to determine if changing an individual's diet and/or adding supplements could decrease the urine pH, thus affecting the rate of RUTIs.
Collapse
|
17
|
Reply to "Limitations of the Digestible Indispensable Amino Acid Score (DIAAS) and Choice of Statistical Reporting. Comment on "A Comparison of Dietary Protein Digestibility, Based on DIAAS Scoring, in Vegetarian and Non-Vegetarian Athletes." Nutrients 2019, 11, 3106". Nutrients 2020; 12:nu12041184. [PMID: 32340169 PMCID: PMC7230256 DOI: 10.3390/nu12041184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
We appreciate the critique of our paper (Ciuris et al [...].
Collapse
|
18
|
Ameliorating Chronic Kidney Disease Using a Whole Food Plant-Based Diet. Nutrients 2020; 12:nu12041007. [PMID: 32268544 PMCID: PMC7230354 DOI: 10.3390/nu12041007] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 12/18/2022] Open
Abstract
Novel approaches to ameliorating chronic kidney disease (CKD) are warranted as most patients are undiagnosed until they begin displaying symptoms of kidney failure. There is increasing evidence that a whole food plant-based (WFPB) diet may offer benefits that slow the progression of CKD, decrease the incidence cardiovascular disease, decrease rates of diabetes and obesity, and reduce inflammation and cholesterol, which in turn can delay kidney failure and the initiation of dialysis. While animal-based protein ingestion promotes an acidic environment, inflammation and renal hyperfiltration, study authors report plant-based protein can be alkaline-producing and anti-inflammatory and can contain renoprotective properties. Although there may be benefits to adopting a WFPB diet, macronutrient and micronutrient content should be carefully considered and adjusted to avoid malnutrition in CKD patients. Further research needs to be done in order to establish the biological plausibility and feasibility of a WFPB in individuals with diagnosed CKD.
Collapse
|
19
|
Osuna-Padilla IA, Leal-Escobar G, Garza-García CA, Rodríguez-Castellanos FE. Dietary Acid Load: mechanisms and evidence of its health repercussions. Nefrologia 2019; 39:343-354. [PMID: 30737117 DOI: 10.1016/j.nefro.2018.10.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022] Open
Abstract
Diet composition has long been known to influence acid-base balance by providing acid or base precursors. In general, foods rich in protein, such as meat, cheese, eggs, and others, increase the production of acid in the body, whereas fruit and vegetables increase alkalis. The capacity of acid or base production of any food is called potential renal acid load (PRAL). Diets high in PRAL induce a low-grade metabolic acidosis state, which is associated with the development of metabolic alterations such as insulin resistance, diabetes, hypertension, chronic kidney disease, bone disorders, low muscle mass and other complications. The aim of this paper is to review the available evidence which evaluates the association of the PRAL of the diet with the incidence of chronic diseases and metabolic disorders, as well as related mechanisms involved in their development.
Collapse
Affiliation(s)
- I A Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, CDMX, México
| | - G Leal-Escobar
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, CDMX, México.
| | - C A Garza-García
- Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | | |
Collapse
|
20
|
Gæde J, Nielsen T, Madsen ML, Toft U, Jørgensen T, Overvad K, Tjønneland A, Hansen T, Allin KH, Pedersen O. Population-based studies of relationships between dietary acidity load, insulin resistance and incident diabetes in Danes. Nutr J 2018; 17:91. [PMID: 30292239 PMCID: PMC6173920 DOI: 10.1186/s12937-018-0395-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/14/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It has been suggested that the acidity of the diet may be related to increased risk of type 2 diabetes. To investigate this hypothesis, we tested if the acidity of the diet, measured as the Potential Renal Acid Load (PRAL) score, was associated with incident diabetes and diabetes-related intermediary traits. METHODS A total of 54,651 individuals from the Danish Diet, Cancer and Health (DCH) cohort were included in the prospective cox regression analyses of incident diabetes over a 15 years follow-up period. Moreover, 5724 Danish individuals with baseline data from the Inter99 cohort were included in the cross sectional, multivariate and logistic regression analyses of measures of insulin sensitivity, insulin release and glucose tolerance status derived from an oral glucose tolerance test (OGTT). RESULTS In the DCH cohort a trend analysis showed that quintiles of PRAL score were, after multifactorial adjustment, associated with a higher incidence of diabetes (ptrend = 6 × 10- 7). HR for incident diabetes was 1.24 (1.14; 1.35) (p = 7 × 10- 7) between first and fifth PRAL score quintile. In Inter99 higher PRAL score associated with insulin resistance as estimated by lower BIGTT-Si (an OGTT-derived index of insulin sensitivity) (p = 4 × 10- 7) and Matsuda index of insulin sensitivity (p = 2 × 10- 5) as well as higher HOMA-IR (p = 0.001). No association was observed for measures of insulin release, but higher PRAL score was associated with lower OGTT-based disposition index. CONCLUSIONS A high dietary acidity load is associated with a higher risk of diabetes among middle-aged Danes. Although adjustment for BMI attenuated the effect sizes the association remained significant. The increased risk of diabetes may be related to our finding that a high dietary acidity load associates with impaired insulin sensitivity.
Collapse
Affiliation(s)
- Joachim Gæde
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
| | - Trine Nielsen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
| | - Mia L Madsen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Copenhagen, the Capital Region of Denmark, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Copenhagen, the Capital Region of Denmark, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kim Overvad
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
| | - Kristine H Allin
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark.,Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, the Capital Region of Denmark, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark.
| |
Collapse
|