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McMullen MK. Many foods are more acid-forming than acid-alkaline formulas indicate. Nutr Health 2024; 30:419-427. [PMID: 37700671 DOI: 10.1177/02601060231200677] [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] [Indexed: 09/14/2023]
Abstract
Foods contain substances impacting the acid-base balance. The Western diet is often viewed as being overly acid due to its high-level of animal-based protein and low-level of vegetable intake. Meanwhile, with ageing the ability to excrete acid compounds is reduced as kidney function declines and so there is a risk of acid retention and subsequent interstitial acidosis. Two systems used for calculating the Dietary Acid Load (DAL): the potential acid load of foods (PRAL) and the net endogenous acid production (NEAP). This report outlines weaknesses in these formulas and concludes that dietitians and nutritionists lack the necessary tools to research the acid-base hypothesis. Additionally, the report emphasizes the importance of food selection in the ageing population. Background: Foods contain substances impacting the acid-base balance. The Western diet is often viewed as being overly acid due to its high-level of animal-based protein and low-level of vegetable intake. There are concerns that the disproportionate acid intake promotes low-grade metabolic acidosis in the interstitial fluid, interstitial acidosis, and may lead to chronic disease. Two formulas are used for calculating the DAL: the PRAL and the NEAP. Both PRAL and NEAP are based on levels of protein and minerals. Aim: To identify additional food constituents that impact DAL. Methods: Review of the literature concerning the acid-forming and alkaline-forming constituents of foods. Results: Five additional food constituents were identified as potentially having a meaningful impact on DAL. The oxidation of taurine and the metabolism of fructose and purines increase acidity, whereas organic acids increase alkalinity. Additionally, polyphenols affect the microbiota which break down uric acid excreted in the intestinal tract. Conclusions: Neither PRAL nor NEAP provides complete assessments of the impact of foods on DAL. These formulas could be improved by the inclusion of dietary amino acids rather than protein, taurine, purines, fructose, organic acids and polyphenols. Currently, dietitians and nutritionists lack the necessary tools both to research the acid-base hypothesis and recommend managed diets. Managed diets are of particular importance for the elderly because of their reduced kidney function which increases the risk of acid retention and subsequent interstitial acidosis.
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Treviño-Alvarez AM, Cabeza de Baca T, Stinson EJ, Gluck ME, Piaggi P, Votruba SB, Krakoff J, Chang DC. Acid accumulation is associated with metabolic alterations; higher energy, fat, and protein intake; and energy expenditure. Obesity (Silver Spring) 2024; 32:1541-1550. [PMID: 38932559 DOI: 10.1002/oby.24086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The objective of this study was to study how acid accumulation (lower plasma bicarbonate and higher anion gap [AG] and corrected anion gap [CAG]) correlates with metabolic parameters, food intake, and 24-h energy expenditure (EE). METHODS Acid accumulation was measured in 286 healthy adults with estimated glomerular filtration rate > 60 mL/min/1.73 m2. Measurements included body composition by dual-energy x-ray absorptiometry scan, ad libitum energy intake by a vending machine paradigm over 3 days, and 24-h EE in a whole-room indirect calorimeter. RESULTS Lower bicarbonate, higher AG, and higher CAG were correlated with higher waist and thigh circumferences, body fat (percentage), fat mass, triglycerides, and lower high-density lipoprotein cholesterol. Acid accumulation markers were correlated with higher total energy (CAG partial r = 0.17; p = 0.02), fat (CAG partial r = 0.17; p = 0.02), protein intake (CAG partial r = 0.20; p = 0.006), and 24-h EE (CAG partial r = 0.24; p = 0.0007). A mediation analysis of CAG and total energy intake found that 24-h EE was a partial mediator (40%), but the association remained significant (β = 0.15; p < 0.0001). CONCLUSIONS In healthy individuals, acid accumulation was associated with an unfavorable metabolic phenotype; higher 24-h EE; and increased total energy, fat, and protein intake. Acid accumulation markers, as putative markers of higher dietary acid load (e.g., from protein), may affect energy balance physiology promoting weight gain.
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Affiliation(s)
- Andrés M Treviño-Alvarez
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Tomás Cabeza de Baca
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Emma J Stinson
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Marci E Gluck
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Paolo Piaggi
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Susanne B Votruba
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Jonathan Krakoff
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Douglas C Chang
- Department of Health and Human Services, Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
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Álvarez-Herms J. Summatory Effects of Anaerobic Exercise and a 'Westernized Athletic Diet' on Gut Dysbiosis and Chronic Low-Grade Metabolic Acidosis. Microorganisms 2024; 12:1138. [PMID: 38930520 PMCID: PMC11205432 DOI: 10.3390/microorganisms12061138] [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: 04/14/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Anaerobic exercise decreases systemic pH and increases metabolic acidosis in athletes, altering the acid-base homeostasis. In addition, nutritional recommendations advising athletes to intake higher amounts of proteins and simple carbohydrates (including from sport functional supplements) could be detrimental to restoring acid-base balance. Here, this specific nutrition could be classified as an acidic diet and defined as 'Westernized athletic nutrition'. The maintenance of a chronic physiological state of low-grade metabolic acidosis produces detrimental effects on systemic health, physical performance, and inflammation. Therefore, nutrition must be capable of compensating for systemic acidosis from anaerobic exercise. The healthy gut microbiota can contribute to improving health and physical performance in athletes and, specifically, decrease the systemic acidic load through the conversion of lactate from systemic circulation to short-chain fatty acids in the proximal colon. On the contrary, microbial dysbiosis results in negative consequences for host health and physical performance because it results in a greater accumulation of systemic lactate, hydrogen ions, carbon dioxide, bacterial endotoxins, bioamines, and immunogenic compounds that are transported through the epithelia into the blood circulation. In conclusion, the systemic metabolic acidosis resulting from anaerobic exercise can be aggravated through an acidic diet, promoting chronic, low-grade metabolic acidosis in athletes. The individuality of athletic training and nutrition must take into consideration the acid-base homeostasis to modulate microbiota and adaptive physiological responses.
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Affiliation(s)
- Jesús Álvarez-Herms
- Phymolab, Physiology and Molecular Laboratory, 40170 Collado Hermoso, Segovia, Spain
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Wieërs MLAJ, Beynon-Cobb B, Visser WJ, Attaye I. Dietary acid load in health and disease. Pflugers Arch 2024; 476:427-443. [PMID: 38282081 PMCID: PMC11006742 DOI: 10.1007/s00424-024-02910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Maintaining an appropriate acid-base equilibrium is crucial for human health. A primary influencer of this equilibrium is diet, as foods are metabolized into non-volatile acids or bases. Dietary acid load (DAL) is a measure of the acid load derived from diet, taking into account both the potential renal acid load (PRAL) from food components like protein, potassium, phosphorus, calcium, and magnesium, and the organic acids from foods, which are metabolized to bicarbonate and thus have an alkalinizing effect. Current Western diets are characterized by a high DAL, due to large amounts of animal protein and processed foods. A chronic low-grade metabolic acidosis can occur following a Western diet and is associated with increased morbidity and mortality. Nutritional advice focusing on DAL, rather than macronutrients, is gaining rapid attention as it provides a more holistic approach to managing health. However, current evidence for the role of DAL is mainly associative, and underlying mechanisms are poorly understood. This review focusses on the role of DAL in multiple conditions such as obesity, cardiovascular health, impaired kidney function, and cancer.
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Affiliation(s)
- Michiel L A J Wieërs
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Beverley Beynon-Cobb
- Department of Nutrition & Dietetics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Wesley J Visser
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ilias Attaye
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
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5
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Jonsson K, Pikwer A, Olsson EMG, Peterson M. Hypocapnia in women with fibromyalgia. Scand J Pain 2024; 24:sjpain-2024-0003. [PMID: 38907689 DOI: 10.1515/sjpain-2024-0003] [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: 01/12/2024] [Accepted: 05/27/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES The purpose of this study was to investigate whether people with fibromyalgia (FM) have dysfunctional breathing by examining acid-base balance and comparing it with healthy controls. METHODS Thirty-six women diagnosed with FM and 36 healthy controls matched for age and gender participated in this cross-sectional study. To evaluate acid-base balance, arterial blood was sampled from the radial artery. Carbon dioxide, oxygen, bicarbonate, base excess, pH and lactate were analysed for between-group differences. Blood gas analyses were performed stepwise on each individual to detect acid-base disturbance, which was categorized as primary respiratory and possible compensation indicating chronicity. A three-step approach was employed to evaluate pH, carbon dioxide and bicarbonate in this order. RESULTS Women with FM had significantly lower carbon dioxide pressure (p = 0.013) and higher lactate (p = 0.038) compared to healthy controls at the group level. There were no significant differences in oxygen pressure, bicarbonate, pH and base excess. Employing a three-step acid-base analysis, 11 individuals in the FM group had a possible renally compensated mild chronic hyperventilation, compared to only 4 among the healthy controls (p = 0.042). CONCLUSIONS In this study, we could identify a subgroup of individuals with FM who may be characterized as mild chronic hyperventilators. The results might point to a plausible dysfunctional breathing in some women with FM.
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Affiliation(s)
- Kent Jonsson
- Department of Rehabilitation Medicine, Nykoping Hospital, Nykoping, Sweden
- Department of Public Health and Caring Sciences, Section of Family Medicine, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Andreas Pikwer
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Anesthesia, Eskilstuna County Hospital, Eskilstuna, Sweden
| | - Erik M G Olsson
- Department of Women's and Children's Health, Healthcare Science and e-health, Uppsala University, Uppsala, Sweden
| | - Magnus Peterson
- Department of Public Health and Caring Sciences, Section of Family Medicine, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
- Academic Primary Health Care, Region Uppsala, Uppsala, Sweden
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Lin F, Zhang M, Wang R, Sun M, Zhang Z, Qiao Y, Zhang Z. Association between Dietary Acid Load and Hypertension in Chinese Adults: Analysis of the China Health and Nutrition Survey (2009). Nutrients 2023; 15:4664. [PMID: 37960317 PMCID: PMC10647800 DOI: 10.3390/nu15214664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Current studies show conflicting results regarding the relationship between dietary acid load (DAL) and blood pressure. (2) Methods: The study used data from the Chinese Health and Nutrition Survey (CHNS) 2009. DAL was assessed on the basis of potential renal acid load (PRAL) and net endogenous acid production (NEAP). To examine the link between DAL and the risk of hypertension, a multivariate logistic regression model was utilized. (3) Results: A total of 7912 subjects were enrolled in the study, of whom 2133 participants had hypertension, a prevalence of 27.0%. After accounting for potential covariates, higher PRAL and NEAP scores were associated with a greater likelihood of developing hypertension, with ORs of 1.34 (95% CI, 1.10-1.62) and 1.29 (95% CI, 1.09-1.53) for PRAL and NEAP scores in Q4, respectively, compared with Q1. In the male group, PRAL and NEAP scores were positively linked to hypertension risk, with ORs of 1.33 (95% CI, 1.06-1.67) and 1.46 (95% CI, 1.14-1.85) for PRAL and NEAP scores in Q4, respectively, compared with Q1, while no significant associations were observed in the female group. Correlations between PRAL scores and hypertension risk lacked significance in the subgroup analyses for participants aged <60 years. There was a significant nonlinear connection observed in the dose-response relationship between DAL (based on PRAL) and hypertension; (4) Conclusions: In Chinese adults, higher PRAL and NEAP scores were positively linked to hypertension risk. This implies that a diet with a low DAL may be a favorable dietary pattern for lowering blood pressure.
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Affiliation(s)
- Feng Lin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China;
| | - Min Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (M.Z.); (R.W.); (M.S.); (Z.Z.)
| | - Ruoyu Wang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (M.Z.); (R.W.); (M.S.); (Z.Z.)
| | - Meng Sun
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (M.Z.); (R.W.); (M.S.); (Z.Z.)
| | - Zongfeng Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (M.Z.); (R.W.); (M.S.); (Z.Z.)
| | - Yanjiang Qiao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China;
| | - Zhaofeng Zhang
- Department of Nutrition & Food Hygiene, School of Public Health, Peking University Health Science Center, Haidian District, Beijing 100191, China; (M.Z.); (R.W.); (M.S.); (Z.Z.)
- Beijing’s Key Laboratory of Food Safety Toxicology Research and Evaluation, Haidian District, Beijing 100191, China
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Zarantonello D, Brunori G. The Role of Plant-Based Diets in Preventing and Mitigating Chronic Kidney Disease: More Light than Shadows. J Clin Med 2023; 12:6137. [PMID: 37834781 PMCID: PMC10573653 DOI: 10.3390/jcm12196137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 10/15/2023] Open
Abstract
Chronic kidney disease (CKD) is a non-communicable disease that affects >10% of the general population worldwide; the number of patients affected by CKD is increasing due in part to the rise in risk factors such as obesity, hypertension, and diabetes mellitus. As many studies show, diet can be an important tool for preventing and mitigating the onset of non-communicable diseases. Plant-based diets (PBDs) are those that emphasize the consumption of plant foods and may or may not include small or moderate amounts of animal foods. Recently, these diets have received increasing interest because they have been associated with favourable effects on health and also appear to protect against the development and progression of CKD. PBDs, which are associated with protein restrictions, seem to offer adjunctive advantages in patients with chronic kidney disease, as compared to conventional low-protein diets that include animal proteins. The principal aims of this review are to provide a comprehensive overview of the existing literature regarding the role of plant-based diets and low-protein, plant-based diets in the context of chronic kidney disease. Moreover, we try to clarify the definition of plant-based diets, and then we analyse possible concerns about the use of PBDs in patients with chronic kidney disease (nutritional deficiency and hyperkalaemia risk). Finally, we offer some strategies to increase the nutritional value of plant-based low-protein diets. In the Materials and Methods section, many studies about plant-based diets and low-protein plant-based diets (e.g., the very-low-protein diet and vegan low-protein diet, LPD) in chronic kidney disease were considered. In the Results and Conclusion section, current data, most from observational studies, agree upon the protective effect of plant-based diets on kidney function. Moreover, in patients with advanced CKD, low-protein plant-based options, especially a very-low-protein diet supplemented with heteroanalogues (VLPDs), compared to a conventional LPD appear to offer adjunctive advances in terms of delaying dialysis and mitigating metabolic disturbances. However, further studies are necessary to better investigate the possible metabolic and cardiovascular advantages of plant-based LPDs versus conventional LPDs.
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Affiliation(s)
- Diana Zarantonello
- Department of Nephrology, Santa Chiara Hospital, APSS, 38122 Trento, Italy;
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8
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Storz MA, Ronco AL. Dietary Acid Load Is Not Associated with Serum Testosterone in Men: Insights from the NHANES. Nutrients 2023; 15:3075. [PMID: 37447401 DOI: 10.3390/nu15133075] [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: 06/07/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
The dietary acid load (DAL) is a novel marker of overall diet quality, which has been associated with overweight, type 2 diabetes and altered glucocorticoid secretion. A potential association with sex hormones is thus not inconceivable. We investigated whether DAL was associated with serum total testosterone concentrations of men in the National Health and Nutrition Examination Survey. The DAL scores, including the potential renal acid load (PRAL) and net endogenous acid production (NEAP), were estimated and compared between participants with low and normal testosterone levels. The investigated sample encompassed n = 377 males with a mean age of 49.50 years. Approximately 73% of the sample were of Non-Hispanic White origin. None of the examined DAL scores showed significant associations with serum testosterone levels. We observed no significant differences in the crude DAL scores between individuals with low testosterone levels and individuals with normal testosterone levels. Multivariate regression models adjusting for covariates confirmed the lack of associations between the PRAL and serum testosterone. Our results are of particular importance for those individuals who wish to lower their DAL in light of the presumable health effects of a more alkaline diet. Our data suggest that diet modifications toward a lower intake of animal protein and refined grains (which consecutively translates into a lower DAL) may not negatively affect men's testosterone levels.
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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
| | - Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Bvard. Artigas 1590, Montevideo 11600, Uruguay
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Ing SW, Finkelman RD, He P, Khan AA, Mannstadt M, Rejnmark L, Song I, Takács I, Wu Y. A Phase I Randomized Trial of Once-Daily Versus Twice-Daily Recombinant Human Parathyroid Hormone (1-84) for Hypoparathyroidism. JBMR Plus 2023; 7:e10758. [PMID: 37457880 PMCID: PMC10339078 DOI: 10.1002/jbm4.10758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 07/18/2023] Open
Abstract
Recombinant human parathyroid hormone (1-84), rhPTH(1-84), is an approved adjunctive treatment to oral calcium and active vitamin D for adult patients with hypoparathyroidism; however, there is limited information on the effect of twice daily (BID) dosing of rhPTH(1-84). This was a phase I, open-label, randomized, crossover, multicenter study conducted in adult patients with chronic hypoparathyroidism. The primary objective was to assess the pharmacokinetic profile and pharmacodynamic effects of 1 day of treatment with rhPTH(1-84) administered subcutaneously at 25 μg BID, 50 μg BID, and 100 μg once daily (QD) with or without supplemental oral calcium. Safety and tolerability were evaluated as secondary objectives. In total, 33 patients with chronic hypoparathyroidism completed the study. Treatment with rhPTH(1-84), both BID and QD, over the short-term maintained serum calcium, lowered serum phosphorus, decreased urinary calcium excretion, and increased urinary phosphorus excretion. The decrease in urinary calcium excretion was numerically greater for BID than QD. Generally, baseline-adjusted pharmacokinetic parameters including area under the curve and maximum observed concentration increased with increasing rhPTH(1-84) dose, although this effect was not dose proportional. No new safety findings were observed. Our study revealed no differences thought to be clinically meaningful in pharmacokinetic or pharmacodynamic parameters with BID versus QD rhPTH(1-84) dosing. Future long-term studies are warranted to further elucidate the effects of alternative dosing strategies. © 2023 Takeda Development Center Americas, Inc and The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Steven W. Ing
- Division of Endocrinology, Diabetes, and MetabolismOhio State University Wexner Medical CenterColumbusOHUSA
| | | | - Ping He
- Takeda Pharmaceuticals USA, Inc.LexingtonMAUSA
| | - Aliya A. Khan
- Divisions of Endocrinology and Metabolism and GeriatricsMcMaster UniversityOakvilleONCanada
| | - Michael Mannstadt
- Endocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Lars Rejnmark
- Department of Clinical Medicine – Department of Endocrinology and Internal MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Ivy Song
- Takeda Pharmaceuticals USA, Inc.LexingtonMAUSA
| | - István Takács
- Department of Internal Medicine and OncologySemmelweis UniversityBudapestHungary
| | - Yuna Wu
- Takeda Pharmaceuticals USA, Inc.LexingtonMAUSA
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10
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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.
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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
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11
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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: 19] [Impact Index Per Article: 9.5] [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.
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Tariq H, Ramakrishnan M, Gupta A. Insights into Cognitive Brain Health in Chronic Kidney Disease. GERONTOLOGY & GERIATRICS : RESEARCH 2022; 8:1074. [PMID: 37671071 PMCID: PMC10478617 DOI: 10.26420/gerontolgeriatrres.2022.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Cognitive impairment and Chronic Kidney Disease (CKD) are common in older adults. With advances in medicine, the average lifespan is expected to increase, further increasing the prevalence of both conditions. The mechanisms underlying cognitive impairment in CKD are unclear. While mild-moderately low estimated glomerular filtration rate (eGFR) may not be associated with cognitive impairment, severely decreased eGFR and albuminuria do. Patients on dialysis have a high prevalence of cognitive impairment. Cognitive function improves after kidney transplantation. However, some residual cognitive deficits persist after transplantation, indicating that restoring the kidney function alone may not be enough to restore cognitive function, and other etiological factors may play a role. Albuminuria, another marker of CKD is also associated with cognitive impairment. However, albuminuria is often undiagnosed. Improving early identification and management of patients with albuminuria may be a good population-based dementia prevention strategy. Other factors associated with cognitive impairment in CKD include anemia and other metabolic derangements commonly observed in CKD. In this article, we reviewed the prevalence of cognitive impairment in CKD, the potential mechanisms underlying cognitive impairment in CKD, andthecurrent evidence on the association between cognitive impairment and eGFR and albuminuria.
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Affiliation(s)
- H Tariq
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - M Ramakrishnan
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
| | - A Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, USA
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