Review Article The Alkaline Diet: Is There Evidence That an Alkaline pH Diet Benefits Health?

63 Pages·2017·3.64 MB·English

by  Gerry K. Schwalfenberg

HindawiPublishingCorporation
JournalofEnvironmentalandPublicHealth
Volume2012,ArticleID727630,7pages
doi:10.1155/2012/727630
Review Article
The Alkaline Diet: Is There Evidence That an Alkaline pH Diet
Benefits Health?
GerryK.Schwalfenberg
UniversityofAlberta,SuiteNo.301,9509-156Street,Edmonton,AB,CanadaT5P4J5
CorrespondenceshouldbeaddressedtoGerryK.Schwalfenberg,[email protected]
Received3July2011;Accepted8August2011
AcademicEditor:JanetteHope
Copyright©2012GerryK.Schwalfenberg. Thisisanopenaccess articledistributedunder theCreativeCommonsAttribution
License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly
cited.
Thisreviewlooksattheroleofanalkalinedietinhealth.PubmedwassearchedlookingforarticlesonpH,potentialrenalacid
loads,bonehealth,muscle,growthhormone,backpain,vitaminDandchemotherapy.Manybookswritteninthelayliterature
onthealkalinedietwerealsoreviewedandevaluatedinlightofthepublishedmedicalliterature.Theremaybesomevaluein
consideringanalkalinedietinreducingmorbidityandmortalityfromchronicdiseasesandfurtherstudiesarewarrantedinthis
areaofmedicine.
1.Background decrease in potassium (K) compared to sodium (Na) and
an increase in chloride compared to bicarbonate found in
Life on earth depends on appropriate pH levels in and thediet[6].Theratioofpotassiumtosodiumhasreversed,
around living organisms and cells. Human life requires a K/Na pre-viously was 10 to 1 whereas the modern diet has
tightlycontrolledpHlevelintheserumofabout7.4(aslight- a ratio of 1 to 3 [7]. It is generally accepted that agricul-
lyalkalinerangeof7.35to7.45)tosurvive[1]. tural humans today have a diet poor in magnesium and
As a comparison, in the past 100 years with increasing potassium as well as fiber and rich in saturated fat, simple
industrialization, the pH of the ocean has dropped from sugars, sodium, and chloride as compared to the pre-agri-
8.2 to 8.1 because of increasing CO2 deposition. This has a cultural period [6]. This results in a diet that may induce
negative impact on life in the ocean [1, 2] and may lead to metabolic acidosis which is mismatched to the genetically
the collapse of the coral reefs [3]. Even the pH of the soil determined nutritional requirements [8]. With aging, there
in which plants are grown can have considerable influence is a gradual loss of renal acid-base regulatory function
on the mineral content of the food we eat (as minerals are and a resultant increase in diet-induced metabolic acidosis
used as buffers to maintain pH). The ideal pH of soil for while on the modern diet [9]. A low-carbohydrate high-
thebestoverallavailabilityofessentialnutrientsisbetween6 pro-tein diet with its increased acid load results in very
and7.AcidicsoilsbelowpHof6mayhavereducedcalcium little change in blood chemistry, and pH, but results in
and magnesium, and soil above pH 7 may result in chemi- many changes in urinary chemistry. Urinary magnesium
callyunavailableiron,manganese,copperandzinc.Adding levels,urinarycitrateandpHaredecreased,urinarycalcium,
dolomiteandmanurearewaysofraisingpHinanacidsoil undissociated uric acid, and phosphate are in-creased. All
environmentwhenthepHisbelow6[4]. of these result in an increased risk for kidney stones
When it comes to the pH and net acid load in the [10].
human diet, there has been considerable change from the Much has been written in the lay literature as well as
huntergathercivilizationtothepresent[5].Withtheagricul- manyonlinesitesexpoundingonthebenefitsofthealkaline
tural revolution (last 10,000 years) and even more recently diet.Thispaperisanattempttobalancetheevidencethatis
with industrialization (last 200 years), there has been an foundinthescientificliterature.
2 JournalofEnvironmentalandPublicHealth
Table1:Phofselectedfluids,organs,andmembranes.
Organ,fluidormembrane pH FunctionofpH
(1)Skin NaturalpHisbetween4and6.5[17] Barrierprotectionfrommicrobes
(2)Urine 4.6to8.0[18] Limitovergrowthofmicrobes
(3)Gastric 1.35to3.5 Breakdownprotein
(4)Bile 7.6to8.8 Neutralizestomachacid,aidindigestion
(5)Pancreaticfluid 8.8 Neutralizestomachacid,aidindigestion
(6)Vaginalfluid <4.7[13] Limitovergrowthofopportunisticmicrobes
(7)Cerebrospinalfluid 7.3 Bathestheexteriorofthebrain
(8)Intracellularfluid 6.0–7.2[19] Duetoacidproductionincells
(9)Serumvenous 7.35 Tightlyregulated
(10)Serumarterial 7.4 Tightlyregulated
2.TheRoleofpHinVariousCells,Organs, the urine with the modern diet over time could be as high
andMembranes as almost 480gm over 20 years or almost half the skeletal
mass of calcium [21]. However, urinary losses of cal-cium
ThepHinourbodymayvaryconsiderablyfromoneareato are not a direct measure of osteoporosis. There are many
anotherwiththehighestacidityinthestomach(pHof1.35 regulatoryfactorsthatmaycompensatefortheurinarycalci-
to3.5)toaidindigestionandprotectagainstopportunistic um loss. When the arterial pH is in the normal range, a
microbialorganisms.Buteveninthestomach,thelayerjust mild reduction of plasma bicarbonate results in a negative
outside the epithelium is quite basic to prevent mucosal calcium balance which could benefit from supplementing
injury. It has been suggested that decreased gastric lining bicarbonate in the form of potassium bicarbonate [22]. It
secretionofbicarbonatesandadecreaseinthealkaline/acid has been found that bicarbonate, which increases the alkali
secretion in duodenal ulcer patients may play a significant content of a diet, but not potassium may attenuate bone
role in duodenal ulcers [11]. The skin is quite acidic (pH lossinhealthyolderadults[23].Thebonemineralsthatare
4–6.5) to provide an acid mantle as a protective barrier to wasted in the urine may not have complete compensation
the environment against microbial overgrowth. There is a through intestinal absorption, which is thought to result in
gradientfromtheouterhornylayer(pH4)tothebasallayer osteoporosis.However,adequatevitaminDwitha25(OH)D
(pH6.9)[12].ThisisalsoseeninthevaginawhereapHof level of >80nmol/L may allow for appropriate intestinal
lessthan4.7protectsagainstmicrobialovergrowth[13]. absorptionofcalciumandmagnesiumandphosphatewhen
TheurinemayhaveavariablepHfromacidtoalkaline needed[24].Sadly,mostpopulationsaregenerallydeficient
depending on the need for balancing the internal environ- in vitamin D especially in northern climates [25]. In
ment. Acid excretion in the urine can be estimated by a chronic renal failure, correction of metabolic acidosis with
formula described by Remer (sulfate + chloride + 1.8x bicarbonate significantly improves parathyroid levels and
phosphate + organic acids) minus (sodium + potassium + levels of the active form of vitamin D 1,25(OH)2D [26].
3
2xcalcium+2xmagnesium)mEq[14].Foodscanbecate- Recently, a study has shown the importance of phosphate
gorizedbythepotentialrenalacidloads(PRALs)seeTable2. in Remer’s PRAL formula. According to the formula it
Fruits, vegetables, fruit juices, potatoes, and alkali-rich and would be expected that an increase in phosphate should
lowphosphorusbeverages(redandwhitewine,mineralsoda result in an increase in urinary calcium loss and a negative
waters)havinganegativeacidload.Whereas,grainproducts, calcium balance in bone [27]. It should be noted that
meats, dairy products, fish, and alkali poor and low phos- supplementation with phosphate in patients with bed rest
phorusbeverages(e.g.,palebeers,cocoa)haverelativelyhigh reducedurinarycalciumexcretionbutdidnotpreventbone
acidloads[15].MeasurementofpHoftheurine(reviewed loss [28]. The most recent systematic review and meta-
in a recent study with two morning specimens done over a analysis has shown that calcium balance is maintained and
five-yearspan)didnotpredictbonefracturesorlossofbone improved with phosphate which is quite contrary to the
mineraldensity[16].However,thismaynotbereflectiveof acid-ash hypothesis [29]. As well a recent study looking at
being on an alkaline or acid diet throughout this time. For soda intake (which has a significant amount of phosphate)
moredetails,seeTable1. andosteoporosisinpostmenopausalAmericanfirstnations
women did not find a correlation [30]. It is quite possible
3.ChronicAcidosisandBoneDisease thatthehighacidcontentaccordingtoRemer’sclassification
needs to be looked at again in light of compensatory phos-
Calciumintheformofphosphatesandcarbonatesrepresents phateintake.Thereisonlineinformationpromotinganalka-
alargereservoirofbaseinourbody.Inresponsetoanacid linedietforbonehealthaswellasanumberofbooks.How-
load such as the modern diet these salts are released into ever,arecentsystematicreviewoftheliteraturelookingfor
thesystemiccirculationtobringaboutpHhomeostasis[7]. evidencesupportingthealkalinedietforbonehealthfound
It has been estimated that the quantity of calcium lost in noprotectiveroleofdietaryacidloadinosteoporosis[31].
JournalofEnvironmentalandPublicHealth 3
Table2:Potentialrenalacidloads(PRALs)ofselectedfoods[20].
Foodorfoodgroup PRALmEqof:Cl+P0 +SO −Na−K−Ca−Mg
4 4
Dairy
Parmesancheese 34.2
Processedcheeseplain 28.7
Cheddarreducedfat 26.4
Hardcheese(average) 19.2
Freshcheese(quark) 11.3
Cottagecheeseplain 8.7
Yogurtwholemilk 1.5
IceCream 0.8
Wholemilk 0.7
Buttermilk 0.5
Eggs
Eggsyolk 23.4
Eggswhite 1.1
Eggschickenwhole 8.2
Meats
Cornedbeef 13.2
Luncheonmeatcanned 10.2
Turkey 9.9
Veal 9.0
Leanbeef 7.8
Frankfurters 6.7
Sugars
Sugarwhite −0.1
Honey −0.3
Vegetables
Cucumber −0.8
Broccoli −1.2
Tomato −3.1
Eggplant −3.4
Celery −5.2
Spinach −14.0
FatsandOils
Butter 0.6
Margarine −0.5
Oliveoil 0.0
Fruitsandnutsandfruitjuices
Peanuts 8.3
Walnuts 6.8
Grapejuiceunsweetened −1.0
Orangejuiceunsweetened −2.9
Applesorapplejuiceunsweetened −2.2
Apricots −4.8
Banana −5.5
Blackcurrents −6.5
Raisins −21.0
Grainsandgrainproducts
BrownRice 12.5
RolledOats 10.7
Spaghettiwholemeal 7.3
Spaghettiwhite 6.5
4 JournalofEnvironmentalandPublicHealth
Table2:Continued.
Foodorfoodgroup PRALmEqof:Cl+P0 +SO −Na−K−Ca−Mg
4 4
Cornflakes 6.0
Ricewhite 4.6
Breadryeflower 4.1
Breadwholewheat 1.8
Legumes
Lentilsgreenandbrown 3.5
Greenbeans −3.1
Fish
Troutbrown 10.8
Codfillets 7.1
Beverages
Beerpale 0.9
Coca-Cola 0.4
Beerdraft −0.2
Winewhite −1.2
Coffeeinfusion −1.4
Winered −2.4
Anotherelementofthemoderndietistheexcessofsodi- prior to exhaustive exercise resulted in significantly less
uminthediet.Thereisevidencethatinhealthyhumansthe acidosisinthebloodthanthosethatwerenotsupplemented
increasedsodiuminthedietcanpredictthedegreeofhyper- withsodiumbicarbonate[42].
chloremic metabolic acidosis when consuming a net acid
producingdiet[32].Aswell,thereisevidencethatthereare
adverse effects of sodium chloride in the aging population. 5.AlkalineSupplementationand
A high sodium diet will exacerbate disuse-induced bone GrowthHormone
and muscle loss during immobilization by increasing bone
resorption and protein wasting [33]. Excess dietary sodium It has long been known that severe forms of metabolic
hasbeenshowntoresultinhypertensionandosteoporosisin acidosis in children, such as renal tubular acidosis, are as-
women[34,35].Aswell,dietarypotassiumwhichislacking sociated with low levels of growth hormone with resultant
in the modern diet would modulate pressor and hyper- short stature. Correction of the acidosis with bicarbonate
calciuriceffectsofexcessofsodiumchloride[36]. [7]orpotassiumcitrate[43]increasesgrowthhormonesig-
Excess dietary protein with high acid renal load may nificantly and improved growth. The use of enough pota-
decreasebonedensityifnotbufferedbyingestionofsupple- ssium bicarbonate in the diet to neutralize the daily net
ments or foods that are alkali rich [37]. However, adequate acidloadinpostmenopausalwomenresultedinasignificant
protein is necessary for prevention of osteoporosis and increaseingrowthhormoneandresultantosteocalcin[44].
sarcopenia;therefore,increasingtheamountoffruitandveg- Improving growth hormone levels may improve quality of
etablesmaybenecessaryratherthanreducingprotein[38]. life, reduce cardiovascular risk factors, improve body com-
position,andevenimprovememoryandcognition[45].As
wellthisresultsinareductionofurinarycalciumlossequi-
4.AlkalineDietsandMuscle valentto5%ofbonecalciumcontentoveraperiodof3years
[46].
Asweage,thereisalossofmusclemass,whichmaypredis-
pose to falls and fractures. A three-year study looking at a
dietrichinpotassium,suchasfruitsandvegetables,aswell 6.AlkalineDietandBackPain
as a reduced acid load, resulted in preservation of muscle
mass in older men and women [39]. Conditions such as Thereissomeevidencethatchroniclowbackpainimproves
chronicrenalfailurethatresultinchronicmetabolicacidosis with the supplementation of alkaline minerals [47]. With
result in accelerated breakdown in skeletal muscle [40]. supplementationtherewasaslightbutsignificantincreasein
Correction of acidosis may preserve muscle mass in condi- bloodpHandintracellularmagnesium.Ensuringthatthere
tions where muscle wasting is common such as diabetic is enough intracellular magnesium allows for the proper
ketosis,trauma,sepsis,chronicobstructivelungdisease,and functionofenzymesystemsandalsoallowsforactivationof
renal failure [41]. In situations that result in acuteacidosis, vitaminD[48].Thisinturnhasbeenshowntoimproveback
supplementing younger patients with sodium bicarbonate pain[49].
JournalofEnvironmentalandPublicHealth 5
7.AlkalinityandChemotherapy (2)The resultant increase in growth hormone with an
alkalinedietmayimprovemanyoutcomesfromcar-
The effectiveness of chemotherapeutic agents is markedly diovascularhealthtomemoryandcognition.
influencedbypH.Numerousagentssuchasepirubicinand
adriamycin require an alkaline media to be more effective. (3)Anincreaseinintracellularmagnesium,whichisre-
quired for the function of many enzyme systems, is
Others, such as cisplatin, mitomycin C, and thiotepa, are
another added benefit of the alkaline diet. Available
more cytotoxic in an acid media [50]. Cell death correlates
magnesium, which is required to activate vitamin
withacidosisandintracellularpHshiftshigher(morealka-
D, would result in numerous added benefits in the
line)afterchemotherapymayreflectresponsetochemother-
vitaminDapocrine/exocrinesystems.
apy[51].Ithasbeensuggestedthatinducingmetabolicalka-
losismaybeusefulinenhancingsometreatmentregimesby (4)Alkalinity may result in added benefit for some
using sodium bicarbonate, carbicab, and furosemide [52]. chemotherapeuticagentsthatrequireahigherpH.
Extracellular alkalinization by using bicarbonate may result
in improvements in therapeutic effectiveness [53]. There is Fromtheevidenceoutlinedabove,itwouldbeprudentto
noscientificliteratureestablishingthebenefitofanalkaline consideranalkalinediettoreducemorbidityandmortality
dietforthepreventionofcanceratthistime. of chronic disease that are plaguing our aging population.
Oneofthefirstconsiderationsinanalkalinediet,whichin-
cludes more fruits and vegetables, is to know what type of
8.Discussion
soiltheyweregrowninsincethismaysignificantlyinfluence
themineralcontent.Atthistime,therearelimitedscientific
Thehumanbodyhasanamazingabilitytomaintainasteady
studiesinthisarea,andmanymorestudiesareindicatedin
pH in the blood with the main compensatory mechanisms regardstomuscleeffects,growthhormone,and interaction
beingrenalandrespiratory.Manyofthemembranesinour
withvitaminD.
bodyrequireanacidpHtoprotectusandtohelpusdigest
food.Ithasbeensuggestedthatanalkalinedietmayprevent
anumberofdiseasesandresultinsignificanthealthbenefits. References
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8/30/2017 Biological significance of essential fatty acids. - PubMed - NCBI
PubMed
Format: Abstract
J Assoc Physicians India. 2006 Apr;54:309­19.
Biological significance of essential fatty acids.
1
Das UN .
Author information
Abstract
Essential fatty acids (EFAs)­­linoleic acid (LA) and alpha­linolenic acid (ALA) are critical for human
survival. EFAs are readily available in the diet. But, to derive their full benefit, EFAs need to be
metabolized to their respective long­chain metabolites. EFAs not only form precursors to respective
prostaglandins (PGs), thromboxanes (TXs), and leukotrienes (LTs), but also give rise to lipoxins
(LXs), resolvins, isoprostanes, and hydroxy­ and hydroperoxyeicosatetraenoates. Certain PGs, TXs,
and LTs have pro­inflammatory actions whereas LXs and resolvins are anti­inflammatory in nature.
Furthermore, EFAs and their long­chain metabolites modulate the activities of angiotensin converting
and HMG­CoA reductase enzymes, enhance acetylcholine levels in the brain, increase the synthesis
of endothelial nitric oxide, augment diuresis, and enhance insulin action. Thus, EFAs and their
metabolites may function as endogenous ACE and HMG­CoA reductase inhibitors, nitric oxide
enhancers, beta­blockers, diuretics, anti­hypertensive, and anti­atherosclerotic molecules. In
addition, EFAs and their long­chain metabolites react with nitric oxide (NO) to yield respective
nitroalkene derivatives that exert cell­signaling actions via ligation and activation of peroxisome
proliferator­activated receptors (PPARs). Thus, EFAs and their derivatives have varied biological
actions that may have relevance to their involvement in several physiological and pathological
processes.
PMID: 16944615
[Indexed for MEDLINE]
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https://www.ncbi.nlm.nih.gov/pubmed/16944615 1/2
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Linus Pauling Institute » Micronutrient Information Center
Other Nutrients » Essential Fatty Acids
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Essential Fatty Acids
Summary
Contents
Linoleic acid (LA), an omega-6 fatty acid, and α-
Summary
linolenic acid (ALA), an omega-3 fatty acid, are
Introduction considered essential fatty acids (EFA) because
they cannot be synthesized by humans. (More
Metabolism and Bioavailability
information)
Biological Activities
The long-chain omega-3 fatty acids,
Membrane structure and function eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA), can be synthesized
Vision
from ALA, but due to low conversion e�ciency, it
Nervous system
is recommended to obtain EPA and DHA from
Synthesis of lipid mediators additional sources. (More information)
Regulation of gene expression LA, arachidonic acid (AA), and DHA are the most
common polyunsaturated fatty acids (PUFA)
De�ciency
accumulating in tissues. (More information)
Essential fatty acids
Both omega-6 and omega-3 fatty acids are
Omega-3 de�ciency important structural components of cell
membranes, serve as precursors to bioactive
Omega-3 index
lipid mediators, and provide a source of energy.
Disease Prevention
Long-chain omega-3 PUFA in particular exert
Visual and neurological development anti-in�ammatory e�ects and it is
recommended to increase their presence in the
Gestation and pregnancy
diet. (More information)
Cardiovascular disease
Both dietary intake and endogenous metabolism
Alzheimer's disease in�uence whole-body status of EFA. Genetic